Methotrexate Reduces the Occurrence of Cerebrovascular Events among Taiwanese Psoriatic Patients: A Nationwide Population-based Study

Abstract

Psoriasis is a chronic inflammatory disease. The aim of this study was to evaluate the effects of methotrexate and retinoid on risks for developing cerebrovascular disease among psoriatic patients. A population-based nested case-control study was conducted using the Taiwanese National Health Insurance database. Cox proportional hazards models were adopted. The hazard ratio (HR) of newly developed cerebrovascular disease was 1.28 (95% confidence interval (CI) = 1.162-1.413; p < 0.0001) for psoriatic vs. non-psoriatic subjects. In terms of the effects of methotrexate or retinoid on the occurrence of cerebrovascular disease, a significant protection effect (HR = 0.50; 95% CI = 0.27-0.92; p = 0.0264) was found for patients with methotrexate prescription. Retinoid prescription showed no protective effect. Further analyses revealed that a low cumulative methotrexate dose is associated with significant protective effect (HR = 0.53; 95% CI = 0.28-1.00; p = 0.0486) while a high cumulative dose was not (HR 0.80; 95% CI = 0.11-5.68; p = 0.8214). These results suggest that psoriatic patients receiving low-dose methotrexate treatment may have reduced risk for developing cerebrovascular disease. Further prospective study should be performed to validate the vasculoprotective effect of this treatment strategy.

Comprehensive Treatment of Psoriatic Arthritis: Managing Comorbidities and Extraarticular Manifestations

“…Randomized controlled trials (RCT) of TNFi in psoriasis and PsA have not shown significant differences in risk of CV events although timespans of these studies have been short 47,48,49,50 . Randomized controlled trials (RCT) of TNFi in psoriasis and PsA have not shown significant differences in risk of CV events although timespans of these studies have been short 47,48,49,50 .…”

Psoriatic patients with diabetes are prone to develop digestive organ cancers: A population-based study in Taiwan

“…As aforementioned, psoriasis is associated with higher occurrences of metabolic syndrome [1]. Of particular interest is the association between psoriasis and diabetes.…”

“…Psoriasis is an inflammatory skin condition affecting approximately 0.2-3% of the world's population with variations among different ethnic groups [1,2]. The etiology of the disease is still not clear, but both genetic and environmental factors are believed to play a role.…”

“…The etiology of the disease is still not clear, but both genetic and environmental factors are believed to play a role. Epidemiology studies from different parts of the world have repeatedly shown that psoriasis is associated with higher occurrences of different components of metabolic syndrome and severe vascular complications [1]. Therefore, psoriasis is currently considered as a systemic inflammatory disorder and that the concept of ''psoriatic march'', with psoriasis serving as the initiator or the amplifier of the systemic inflammatory march, has been proposed to explain the increased occurrences of severe vascular events observed among psoriatic patients [3,4].…”

Psoriasis as initiator or amplifier of the systemic inflammatory march: impact on development of severe vascular events and implications for treatment strategy

“…As psoriasis is recognized as a systemic inflammatory disorder, it is reasonable to hypothesize that certain amount of anti‐inflammation or immune‐suppression may be beneficial for ameliorating disease progression. In fact, methotrexate therapy has been shown to reduce the incidence of vascular disease in patients with psoriasis and rheumatoid arthritis 15,16 . Therefore, the current study also explored if methotrexate treatment modulates the risk of severe vascular events in psoriatic patients when the temporal relationship between onset of psoriasis and metabolic disorder is taken into consideration.…”