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Association between traditional systemic antipsoriatic drugs and tuberculosis risk in patients with psoriasis with or without psoriatic arthritis: Results of a nationwide cohort study from Taiwan - 14/06/13

Doi : 10.1016/j.jaad.2012.12.966 
Yi-Ju Chen, MD, PhD a, c, Chun-Ying Wu, MD, PhD b, d, e, Jui-Lung Shen, MD, PhD a, Tzu-Ting Chen, MS d, Yun-Ting Chang, MD, PhD a, f,
a Department of Dermatology, National Yang-Ming University, Taipei, Taiwan 
b Faculty of Medicine, National Yang-Ming University, Taipei, Taiwan 
c Department of Dermatology, Taichung Veterans General Hospital, Taichung, Taiwan 
d Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan 
e Department of Public Health, College of Public Health, China Medical University, Taichung, Taiwan 
f Department of Dermatology, Taipei Veterans General Hospital, Taipei, Taiwan 

Reprint requests: Yun-Ting Chang, MD, PhD, Department of Dermatology, Taipei Veterans General Hospital and National Yang-Ming University, No. 201, Sec 2, Shi-Pai Rd, Taipei 112, Taiwan.

Abstract

Background

Although the link between tuberculosis (TB) and biologics use is well established, the risk of TB among patients with psoriasis exposed to traditional systemic therapies remains elusive.

Objectives

The aim is to investigate the association between traditional systemic therapies and TB among patients with psoriasis.

Methods

We conducted a retrospective cohort study on the risk of active TB among patients with psoriasis and psoriatic arthritis, using the National Health Insurance Research Database of Taiwan, 1996 through 2008. Standardized incidence ratios of TB were analyzed in comparison with age- and gender-matched general population. Logistic regression was used in a nested case-control analysis to estimate the odds ratios of TB related to exposure to traditional systemic agents during the year before TB development.

Results

Among the 81,266 patients in the psoriasis cohort, 497 new active TB cases were identified. The incidence rate of TB was 102 cases per 100,000 person-years among patients with psoriasis (standardized incidence ratio 1.22, 95% confidence interval 1.18-1.33). The risk of TB was higher in patients with severe disease (standardized incidence ratio 1.52, 95% confidence interval 1.46-1.74). To facilitate comparisons with the 497 active TB cases, a total of 1988 matched control subjects were selected for a nested case-control study. Patients taking systemic corticosteroids and nonsteroidal anti-inflammatory drugs were associated with higher incidence of TB, especially frequent users, after adjustment for multiple TB risk factors, drug exposures, hospital visits, and level of urbanization. Stratified analyses of current users and new users of these drugs revealed similar results. Finally, traditional systemic antipsoriatic treatment was not associated with TB on any of the analyses.

Limitation

The National Health Insurance Research Database did not contain information regarding severity of psoriasis, smoking status, alcohol use, diet, laboratory parameters, chest radiograph, or history of recent contact with an individual with TB. Misclassification of disease cannot be ruled out in a registry-based database. The accessibility of health care may be associated with the level of urbanization, which could confound the effect of drugs in multivariate analyses.

Conclusions

Severe psoriasis may be associated with an elevated TB risk. Traditional systemic therapies do not seem to be strongly associated with TB occurrence.

Le texte complet de cet article est disponible en PDF.

Key words : antipsoriatic drugs, association, psoriasis, traditional systemic, tuberculosis

Abbreviations used : CI, COX, EPTB, ICD-9-CM, IFN, LTBI, NHI, NHIRD, NSAID, PTB, SIR, TB, TNF


Plan


 The first 2 authors contributed equally to this article.
 This study is based in part on data from the National Health Insurance Research Database provided by the Bureau of National Health Insurance, Department of Health, and managed by the National Health Research Institute. The interpretations and conclusions contained herein do not represent those of the Bureau of National Health Insurance, Department of Health, or the National Health Research Institute.
 Supported in part by Taichung Veterans General Hospital research grants (TCVGH-1006801B, TCVGH-1006802C).
 Conflicts of interest: None declared.


© 2012  American Academy of Dermatology, Inc.. Publié par Elsevier Masson SAS. Tous droits réservés.
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Vol 69 - N° 1

P. 25-33 - juillet 2013 Retour au numéro
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