INTRODUCTION: A large body of evidence supports the association between psoriasis and concomitant diseases. However, the study of comedication for these diseases in patients with psoriasis is limited. The current study aimed to investigate the prescription and drug dispensation for comorbidity associated with psoriasis.
METHODS: We conducted a retrospective case-control study from 9 April 2008 until 1 January 2016 using an electronic medical records database covering the entire population of the County of Jönköping and the Swedish Prescribed Drug Register. ICD-10 and Anatomical Therapeutic Chemical codes were used to identify patients with psoriasis and dispensed pharmaceutical prescriptions. Individuals without psoriasis were selected as controls. Patients receiving systemic treatment for psoriasis were considered as having moderate-severe psoriasis. Odds ratios for being dispensed pharmaceutical prescriptions and differences in mean number of dispensed prescriptions were explored.
RESULTS: A total of 4587 patients with psoriasis were identified in the medical records, and 268,949 individuals served as controls. Patients with psoriasis had a significantly higher number of different drug dispensations compared to controls. Only 1.3% of all patients with psoriasis were without any prescription (excluding medication for psoriasis) during the study period while the number in the general population was 9.3%. Sex- and age-adjusted odds ratios for dispensation of drug groups related to comorbid disease were significantly higher among patients with psoriasis including drug groups such as anxiolytics and sedatives as well as drugs targeting COPD, migraine and erectile dysfunction. The most frequently dispensed comedications were oral antibiotics and analgesics including an increased risk for dispensation of opioids. Sex predisposed dispensation frequency for a variety of drug groups. Drugs targeting obesity, osteoporosis, psychiatric disease and anti-mycotics/-fungals were more frequent among women.
CONCLUSION: Patients with psoriasis have significantly increased numbers of different dispensed prescriptions than those without psoriasis. This underlines previous findings on increased comorbidity and health care costs for patients with psoriasis.
Psoriasis is a chronic inflammatory skin disease that is characterized by T-cell mediated immune response, and has been known to increase the risk of developing hypertension. However, the risk of psoriasis in patients with hypertension is not clear. Therefore, we investigated the risk of psoriasis in patients with hypertension. A total of 256,356 adults (42,726 in the hypertension group and 213,630 in the control group) were followed from 2003 to 2013 in a nationwide population-based cohort study. During the follow-up, 9,254 participants (3.6%) were found to have psoriasis (2,152 [5.0%] in the hypertension group and 7,102 [3.3%] in the control group). The hypertension group had a higher risk of psoriasis incidence (hazard ratio [HR] 1.54, 95% confidence interval [CI] 1.47-1.61, P < 0.001), and the association remained significant after adjusting for comorbidities of diabetes and dyslipidemia, antihypertensive medication and nonsteroidal anti-inflammatory drug use, and sociodemographic factors (HR 1.18, 95% CI 1.08-1.28, P < 0.001). In conclusion, hypertension was significantly associated with an increased risk of psoriasis incidence. Further studies are needed to confirm whether hypertension is associated with the incidence of psoriasis.
OBJECTIVE: Androgen deprivation therapy (ADT) use in prostate cancer (PCa) patients has been reported to exacerbate the course of psoriasis. We aimed to assess the impact of ADT on the subsequent risk of psoriasis.
METHODS: We utilized data from the National Health Insurance Research Database of Taiwan between 1996 and 2013. In total, 17,168 patients with PCa were identified; 5,141 ADT patients comprised the study group with 5,141 matched non-ADT controls. We used 1:1 propensity score-matched analysis. The demographic characteristics and comorbidities of the patients were analyzed; Cox proportional hazards regression was used to calculate the HRs for the risk of psoriasis.
RESULTS: Eighty-nine (0.87%) patients with newly diagnosed psoriasis were identified. Compared with non-ADT patients, ADT patients had similar risk of subsequent psoriasis with an HR of 0.95 (95% CI 0.63-1.45; P=0.816). However, a higher risk of psoriasis was observed in angiotensin-converting enzyme inhibitors patients (adjusted HR 2.14, 95% CI 1.09-4.20; P<0.05).
CONCLUSION: ADT use did not increase risk of psoriasis in patients with PCa. Further studies are warranted to assess the clinical significance.
AIM: To analyze psoriasis risk in type 2 diabetes mellitus (T2DM) patients treated in German primary care practices.
METHODS: The study included 87,964 T2DM patients aged 40 years or over who received their initial diabetes diagnosis between 2004 and 2013. Patients were excluded if they had been diagnosed with psoriasis prior to diabetes diagnosis or if the observation period prior to the index date was less than 365 days. After applying these exclusion criteria, 72,148 T2DM patients were included. A total of 72,148 non-diabetic controls were matched (1:1) to T2DM cases based on age, gender, type of health insurance (private or statutory), number of medical visits, and index date. The primary outcome was the diagnosis of psoriasis. Skin infections, dermatitis/eczema, hyperlipidemia, and medications associated with psoriasis (beta blockers, angiotensin-converting enzyme (ACE) inhibitors, lithium, antimalarials, nonsteroidal anti-inflammatory drugs, and benzodiazepines) were included as potential confounders.
RESULTS: The mean age was 68.7 years (SD=12.7 years) and 48.6% of subjects were men. Hyperlipidemia, dermatitis/eczema, and skin infections were more frequent in T2DM patients than in controls. Beta blockers, ACE inhibitors, and nonsteroidal anti-inflammatory drugs were also more commonly used in people with T2DM than in controls. A total of 3.4% of T2DM patients and 2.8% of matched controls developed psoriasis within ten years of follow-up (p-value <0.001). T2DM patients were at a higher risk of developing psoriasis than controls (HR=1.18, 95% CI: 1.08-1.29).
CONCLUSION: T2DM was positively associated with psoriasis in patients treated in German primary care practices.
BACKGROUND: Psoriasis may or may not be associated with a higher risk for myocardial infarction (MI). We sought to assess differences in MI incidence between control, mild psoriasis and severe psoriasis patients.
METHODS: We performed a retrospective cohort study of Kaiser Permanente Southern California members with psoriasis between 1 January 2004 and 30 June 2012, assessing the risk and incidence rates of MI.
RESULTS: There were 50,865 control patients matched to 10,173 patients with mild psoriasis and 19,205 control patients matched to 3841 patients with severe psoriasis. The MI incidence per 1000 person-years for mild psoriasis controls, mild psoriasis, severe psoriasis controls and severe psoriasis were 4.9, 6.7, 3.7 and 5.1, respectively. Upon multivariable analysis, mild psoriasis patients had a significantly higher risk of MI compared to matched control patients {hazard ratio (HR) = 1.31 [95% confidence interval (CI): 1.14, 1.51]} and severe psoriasis patients had a significantly higher risk of MI compared to matched control patients [HR = 1.28 (95% CI: 1.02, 1.60)].
CONCLUSION: Patients with psoriasis are at higher risk for MI compared to control patients.
AIMS: Psoriasis is a common inflammatory disease that is associated with increased risk of cardiovascular disease, including myocardial infarction. Heart failure (HF) is independently associated with several cardiovascular risk factors and is a major cause of cardiovascular morbidity and mortality. The association between psoriasis and HF is unclear and we therefore investigated the risk of new-onset HF in a nationwide cohort of psoriasis patients compared with the background population.
METHODS: The study included the entire Danish population aged ≥18 years followed from 1 January 1997 until HF, death or 31 December 2011. Information on comorbidity and concomitant medication was identified by individual-level linkage of administrative registers. New-onset HF was defined as first hospital admission for HF. Incidence rates of new-onset HF were calculated and adjusted hazard ratios were estimated by multivariable Cox regression models adjusted for age, gender, comorbidity and cardiovascular medications.
RESULTS: A total of 5 485 856 subjects were eligible for analysis. In the study period 66 389 patients with new-onset psoriasis, including 11 242 patients with severe psoriasis, were identified. The overall incidence rates of new-onset HF were 2.82, 4.22 and 4.70 per 1000 person-years for the reference population, mild psoriasis and severe psoriasis, respectively. Compared with the reference population, the fully adjusted hazard ratios for new-onset HF were increased in patients with psoriasis with a hazard ratio 1.22 (95% confidence interval 1.16-1.29) and hazard ratio of 1.53 (95% confidence interval 1.34-1.74) for those with mild and severe disease, respectively.
CONCLUSION: In this nationwide cohort, psoriasis was associated with a disease severity-dependent increased risk of new-onset HF.
IMPORTANCE: Individuals with psoriasis have an elevated risk of hypertension, and antihypertensive medications, especially β-blockers, have been linked to psoriasis development. However, the association of prior existing hypertension and antihypertensive medications with risk of incident psoriasis has not been assessed using prospective data.
OBJECTIVE: To evaluate the association of hypertension and antihypertensive medications with risk of psoriasis.
DESIGN, SETTING, AND PARTICIPANTS: We performed a prospective cohort study (June 1, 1996, to June 1, 2008) of 77 728 US women from the Nurses' Health Study who provided biennially updated data on hypertension and antihypertensive medications.
MAIN OUTCOMES AND MEASURES: Physician-diagnosed psoriasis.
RESULTS: A total of 843 incident psoriasis cases were documented during 1 066 339 person-years of follow-up. Compared with normotensive women, women with a hypertension duration of 6 years or more were at a higher risk of developing psoriasis (hazard ratio [HR], 1.27; 95% CI, 1.03-1.57). In stratified analysis, the risk of psoriasis was higher among hypertensive women without medication use (HR, 1.49; 95% CI, 1.15-1.92) and among hypertensive women with current medication use (HR, 1.31; 95% CI, 1.10-1.55) when compared with normotensive participants without medication use. Compared with women who never used β-blockers, the multivariate HRs for psoriasis for women who regularly used β-blockers were 1.11 (95% CI, 0.82-1.51) for 1 to 2 years of use, 1.06 (95% CI, 0.79-1.40) for 3 to 5 years of use, and 1.39 (95% CI, 1.11-1.73) for 6 years or more of use (P for trend = .009). No association was found between use of other individual antihypertensive drugs and risk of psoriasis.
CONCLUSIONS AND RELEVANCE: Long-term hypertensive status is associated with an increased risk of psoriasis. Long-term regular use of β-blockers may also increase the risk of psoriasis.
OBJETIVOS: Comparar el riesgo de síndrome coronario agudo (SCA) entre los pacientes con y sin la espondilitis anquilosante (AS).
Método: Este estudio de cohorte retrospectivo identificó a todos los pacientes con AS de edad ≥ 18 años recién diagnosticados desde 2000 hasta 2009, registrada en la Base de Datos Nacional de Investigación de Seguros de Salud (NHIRD) en Taiwán. La cohorte no AS consistió en cuatro veces de control de los pacientes seleccionados al azar libres de la EA, la frecuencia emparejados por edad, sexo y año de diagnóstico. La incidencia de ACS se determinó tanto para AS y cohortes no-AS.
Resultados: Se seleccionaron 6.262 pacientes con EA y 25 048 pacientes sin AS. Los pacientes con AS fueron más frecuentes que los que no, con co-morbilidad de la hipertensión, la diabetes mellitus (DM), hiperlipidemia, derrames cerebrales y enfermedades vasculares periféricas. La tasa de incidencia global de ACS fue mayor en la cohorte de AS que en la cohorte-AS no (4,4 frente a 2,9 por 1.000 personas-año), con una razón de riesgo ajustada (AHR) del intervalo de confianza 1,36 [95% (IC) 1,16 -1,59]. AS pacientes con co-morbilidad de la hipertensión, DM, y el cáncer había una AHR del 7,74 por ACS, en comparación con aquellos sin estas comorbilidades.
Conclusiones: los pacientes con EA tienen un mayor riesgo de ACS en comparación con sujetos no-AS. Gestión de los factores de riesgo CV debe ser tomado en cuenta para el tratamiento de pacientes con AS, especialmente para los pacientes con co-morbilidad de la hipertensión, DM, y el cáncer.
OBJETIVOS: Analizar si las personas con espondilitis anquilosante (AS) tienen un mayor riesgo de infarto agudo de miocardio (IM) o un derrame cerebral en comparación con aquellos sin AS.
MÉTODOS: registros de atención primaria estaban vinculados con todos los ingresos hospitalarios y las muertes causadas por infarto de miocardio o accidente cerebrovascular en Gales para los años 1999-2010. Los datos vinculados fueron estratificados por el diagnóstico y el análisis de supervivencia que se utilizó para obtener la tasa de incidencia de infarto de miocardio y la enfermedad cerebrovascular separado (ECV) / carrera. Regresión de Cox se utilizó para ajustar por sexo y edad. La regresión logística se utilizó para examinar la prevalencia de la diabetes, la hipertensión, la hiperlipidemia o para aquellos con AS en comparación con los que no.
RESULTADOS: Hubo 1.686 pacientes con EA (75,9% hombres, edad promedio 46,1 años) en comparación con los controles (1.206.621 48,9% hombres, edad promedio 35,9 años). Por edad y cocientes de riesgo ajustado por sexo para MI fueron 1,28 (IC del 95%: 0,93 a 1,74) P = 0,12, y por ECV / carrera 1.0 (IC del 95%: 0,73 a 1,39) P = 0,9, en comparación con los controles. La prevalencia de la diabetes y la hipertensión, pero no la hiperlipidemia / hipercolesterolemia, fue mayor en AS.
CONCLUSIONES: No hay un aumento en el infarto de miocardio o tasas de ECV / accidente cerebrovascular en pacientes con EA en comparación con aquellos sin AS, a pesar de las tasas más altas de hipertensión, que pueden estar relacionados con el uso de antiinflamatorios no esteroideos de drogas.
ANTECEDENTES: enfermedades Certain inmune mediada (IMDS), tales como la artritis reumatoide y el lupus eritematoso sistémico, se han relacionado con trastornos cardiovasculares. Hemos examinado si existe una asociación entre el 32 IMD y el riesgo de la posterior hospitalización por enfermedad coronaria (CHD) en relación con la aterosclerosis coronaria diferentes en un estudio de seguimiento a nivel nacional en Suecia.
MÉTODOS Y RESULTADOS: Todas las personas en Suecia hospitalizadas con un diagnóstico principal de una IMD (n = 336.479) y sin enfermedad coronaria previa o coexistente, entre 1 de enero 1964 y el 31 de diciembre de 2008, fueron seguidos durante primera hospitalización por enfermedad coronaria. La población de referencia es la población total de Suecia. Se calcularon las razones de incidencia estandarizada (SIRS) para CHD. El riesgo general de enfermedad coronaria durante el primer año después de la hospitalización para una IMD fue 2,92 (95% CI 2,84-2,99). Veintisiete de los 32 estudiados IMD se asociaron a un aumento del riesgo de enfermedad coronaria durante el primero año después de la hospitalización. El riesgo general de enfermedad coronaria disminuyó con el tiempo, a partir de 1,75 después de 1-5 años (IC del 95%: 1,73 a 1,78), a 1,43 después de 5 a 10 años (IC 95% 1,41-1,46) y 1,28 después de 10+ años de CI (95% 01.26 a 01.30). Las hembras generalmente tenían SIRs más altos que los hombres. El IMD para el que los SIR de CDH era más alta durante el primer año después de la hospitalización incluida la corea menor (IC del 95%: 1,32 a 20,65) 6,98, lupus eritematoso sistémico 4,94 (IC del 95%: 4,15 a 5,83), la fiebre reumática 4,65 (IC del 95%: 3,53 -6,01), tiroiditis de Hashimoto CI 4,30 (95% 3,87 a 4,75), polimiositis / dermatomiositis 3,81 (IC del 95% 2,62 a 5,35), la poliarteritis nodosa 3,81 (95% CI 2,72 a 5,19), la artritis reumatoide CI 3,72 (95% 3.56- 3.88), esclerosis sistémica 3,44 (IC del 95% 2,86 a 4,09), cirrosis biliar primaria 3,32 (IC del 95% 2,34 a 4,58), y anemia hemolítica autoinmune 3,17 (IC del 95% 2,16 a 4,47).
Conclusiones: La mayoría de IMD se asocian con un mayor riesgo de enfermedad coronaria en el primer año después de la admisión hospitalaria. Nuestros hallazgos sugieren que muchos IMDs hospitalizados están estrechamente vinculados a la aterosclerosis coronaria.
A large body of evidence supports the association between psoriasis and concomitant diseases. However, the study of comedication for these diseases in patients with psoriasis is limited. The current study aimed to investigate the prescription and drug dispensation for comorbidity associated with psoriasis.
METHODS:
We conducted a retrospective case-control study from 9 April 2008 until 1 January 2016 using an electronic medical records database covering the entire population of the County of Jönköping and the Swedish Prescribed Drug Register. ICD-10 and Anatomical Therapeutic Chemical codes were used to identify patients with psoriasis and dispensed pharmaceutical prescriptions. Individuals without psoriasis were selected as controls. Patients receiving systemic treatment for psoriasis were considered as having moderate-severe psoriasis. Odds ratios for being dispensed pharmaceutical prescriptions and differences in mean number of dispensed prescriptions were explored.
RESULTS:
A total of 4587 patients with psoriasis were identified in the medical records, and 268,949 individuals served as controls. Patients with psoriasis had a significantly higher number of different drug dispensations compared to controls. Only 1.3% of all patients with psoriasis were without any prescription (excluding medication for psoriasis) during the study period while the number in the general population was 9.3%. Sex- and age-adjusted odds ratios for dispensation of drug groups related to comorbid disease were significantly higher among patients with psoriasis including drug groups such as anxiolytics and sedatives as well as drugs targeting COPD, migraine and erectile dysfunction. The most frequently dispensed comedications were oral antibiotics and analgesics including an increased risk for dispensation of opioids. Sex predisposed dispensation frequency for a variety of drug groups. Drugs targeting obesity, osteoporosis, psychiatric disease and anti-mycotics/-fungals were more frequent among women.
CONCLUSION:
Patients with psoriasis have significantly increased numbers of different dispensed prescriptions than those without psoriasis. This underlines previous findings on increased comorbidity and health care costs for patients with psoriasis.
