The effects of systemic therapy on mortality risk among patients with psoriasis are not fully understood.
To evaluate the impact of systemic treatment on mortality risk in patients enrolled in the Psoriasis Longitudinal Assessment and Registry.
Nested case-control analyses were performed to estimate mortality risk. Cases were defined as patients who died while participating in the Psoriasis Longitudinal Assessment and Registry. Cases were matched (1:4) with controls by age, race, sex, and geographic region. Evaluated treatments included methotrexate, ustekinumab, and tumor necrosis factor α inhibitors. Exposure was defined as at least 1 dose of treatment within 3 months before death and was stratified by duration of therapy.
Among 12,090 patients, 341 deaths occurred, matched to 1364 controls. Biologic treatment within the preceding 3 months was protective against mortality versus no exposure: odds ratio (OR) for exposure of less than 1 year, 0.08 (95% confidence interval [CI], 0.03-0.23); OR for exposure of 1 year or longer, 0.09 (95% CI, 0.06-0.13). Methotrexate was protective against mortality only with exposure for 1 year or longer (OR, 0.08; 95% CI, 0.02-0.28).
Observational studies are subject to unmeasured confounding.
Biologic therapy was associated with reduced mortality risk in patients with moderate to severe psoriasis, regardless of treatment duration; methotrexate reduced risk only with exposure for 1 year or longer.Le texte complet de cet article est disponible en PDF.
Key words : biologic, methotrexate, mortality, PSOLAR, psoriasis, systemic, tumor necrosis factor, ustekinumab
Abbreviations used : BMI, BSA, CAD, CI, COPD, HR, OR, PAD, PGA, PSOLAR, PUVA, TNFi
| Funding sources: Supported by Janssen Scientific Affairs, LLC, Horsham, Pennsylvania.
| Disclosure: Dr Langley has served and has received compensation in the form of grant funding and/or honoraria as principal investigator for and is on the scientific advisory board or has served as a speaker for AbbVie, Amgen, Boehringer Ingelheim, Celgene, Janssen, LEO Pharma, Eli Lilly, Merck, Novartis, Pfizer, Sun Pharma, and UCB. Dr Poulin has received grant funding and honoraria for services as an investigator, speaker, and member of advisory boards from AbbVie, Amgen, Bausch, Centocor/Janssen-Ortho, and UCB and has received grant funding as an investigator from Baxter, Boehringer Ingelheim, Bristol Myers Squibb, Celgene, Galderma, Genentech, GlaxoSmithKline, Eli Lilly, Incyte, LEO Pharma, MedImmune, Merck, Novartis, Pfizer, Regeneron, Serono, and Takeda. Dr Srivastava is employed by Janssen Research & Development, LLC and owns stock in Johnson & Johnson, of which Janssen is a subsidiary. Dr Lafferty is employed by Janssen Scientific Affairs, LLC, and owns stock in Johnson & Johnson, of which Janssen is a subsidiary. Dr Fakharzadeh is employed by Janssen Global Services, LLC, and owns stock in Johnson & Johnson, of which Janssen is a subsidiary. Dr Langholff is employed by Janssen Research & Development, LLC, and owns stock in Johnson & Johnson, of which Janssen is a subsidiary. Dr Augustin has served as a consultant to or paid speaker for clinical trials sponsored by companies that manufacture drugs used for the treatment of psoriasis, including AbbVie, Almirall, Amgen, Biogen, Boehringer Ingelheim, Celgene, Centocor, Eli Lilly, Fresenius, Galderma, GlaxoSmithKline, Janssen-Cilag, LEO Pharma, Medac, Merck, MSD, Novartis, Pfizer, UCB, and XenoPort.
| IRB approval status: Reviewed and approved by Goodwyn IRB, Cincinnati, OH, USA (C0168Z03).
| Reprints not available from the authors.