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BackgroundPsoriasis is a chronic systemic inflammatory disorder, and studies have revealed its association with a variety of comorbidities. However, the risk of chronic pancreatitis (CP) in psoriasis has not been studied. This study aimed to investigate the risk of CP among patients with psoriasis.MethodsUsing the Taiwan National Health Insurance Research Database, this population-based cohort study enrolled 48430 patients with psoriasis and 193720 subjects without psoriasis. Stratified Cox proportional hazards models were used to compare the risks of CP between the patients with and without psoriasis.ResultsThe incidence of CP was 0.61 per 1000 person-years in patients with psoriasis and 0.34 per 1000 person-years in controls during a mean 6.6-year follow-up period. Before adjustment, patients with psoriasis had a significantly higher risk of CP (crude hazard ratio (HR) = 1.81; 95% confidence interval (CI) = 1.53–2.15), and the risk remained significantly higher after adjustments for gender, age group, medications, and comorbidities (adjusted HR (aHR) = 1.76; 95% CI = 1.47–2.10). All psoriasis patient subgroups other than those with arthritis, including those with mild and severe psoriasis and those without arthritis, had significantly increased aHRs for CP, and the risk increased with increasing psoriasis severity. Psoriasis patients taking nonsteroidal anti-inflammatory drugs (aHR = 0.33; 95% CI = 0.22–0.49) and methotrexate (aHR = 0.28; 95% CI = 0.12–0.64) had a lower risk of developing CP after adjustments.ConclusionsPsoriasis is associated with a significantly increased risk of CP. The results of our study call for more research to provide additional insight into the relationship between psoriasis and CP.

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ObjectiveTo investigate whether there is an increased risk of cardiac events in diabetic patients with a combined therapy of clopidogrel (CLO) and proton pump inhibitors (PPIs) after drug-eluting stent (DES) deployment.MethodsBy using National Health Insurance Research Database, all patients who received CLO with or without PPI therapy within 90 days after undergoing DES (limus-eluting or paclitaxel-eluting stents) deployment were enrolled. Endpoints were acute coronary syndrome (ACS) and readmission for revascularization (percutaneous coronary intervention or coronary artery bypass graft surgery) after 3, 6, and 12 months.ResultsA total of 6,603 diabetic patients received LESs (5,933 in the CLO subgroup and 670 in the CLO plus PPIs subgroup), and 3,202 patients received PESs (2,923 in the CLO subgroup and 279 in the CLO plus PPIs subgroup). The patients who received CLO plus PPIs were at higher risk of ACS than those receiving CLO within 1 year after DES deployment (LESs: 6-month hazard ratio [HR] = 1.63, and 1-year HR = 1.37; PESs: 3-month HR = 1.72). Patients with a history of ACS who received CLO plus PPIs were at higher risk of ACS after LES implantation (HR = 1.55) than those in the CLO group.ConclusionIn “real-world” diabetic patients with LES deployment, the combination of PPIs and CLO is associated with higher rates of ACS after 6 months and 1 year. Even after correction for confounding factors, concomitant PPI use remained an independent predictor of cardiac events, emphasizing the clinical importance of this drug—drug interaction.

Background Carbamazepine has been associated with severe cutaneous adverse drug reactions (ADR). It is important for patients with these ADRs under off-label prescriptions are not eligible for drug injury relief in Taiwan. We conducted a study to depict the demography and possible factors related to the off-label carbamazepine use in Taiwan. We also explored the policy influence of carbamazepine use. Methods We used the dataset of one million randomly-sampled insured persons in the Taiwan National Health Insurance Research Database for 2002 and 2006 to conduct a cross-sectional study. With the use of a computerized clinical information system, carbamazepine prescriptions were categorized into five groups (A, B, C, D and E) according to these indications: Group A, B were defined as on-label use; group C, D and E were defined as various levels of off-label use, depending on the strength of support from the literature. A logistic regression model was conducted to find the factors related to off-label use.Results Based on the one million representative samples, 6305 and 5703 patients received 31 146 and 27 579 carbamazepine prescriptions in 2002 and 2006 respectively. In both years, nearly 43% of total prescriptions were related to on-label uses. Prescriptions from primary clinics and departments of internal medicine and psychiatry, the physician's age, and the patient's age were factors associated with higher risk of off-label carbamazepine use. Conclusions Our study echoes the highly prevalent off-label use of carbamazepine in Taiwan and adds to the rare research on this subject in the East Asian population. The carbamazepine relabelling in 2004 did not change either prescription patterns or factors related to off-label use.