Methotrexate reduces the occurrence of cerebrovascular events among Taiwanese psoriatic patients: a nationwide population-based study

Acta Derm Venereol. 2012 Jul;92(4):349-52. doi: 10.2340/00015555-1283.

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.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Asian Continental Ancestry Group*
  • Case-Control Studies
  • Cerebrovascular Disorders / diagnosis
  • Cerebrovascular Disorders / ethnology
  • Cerebrovascular Disorders / prevention & control*
  • Chi-Square Distribution
  • Comorbidity
  • Dose-Response Relationship, Drug
  • Female
  • Humans
  • Immunosuppressive Agents / administration & dosage
  • Immunosuppressive Agents / therapeutic use*
  • Incidence
  • Male
  • Methotrexate / administration & dosage
  • Methotrexate / therapeutic use*
  • Proportional Hazards Models
  • Psoriasis / diagnosis
  • Psoriasis / drug therapy*
  • Psoriasis / ethnology
  • Retinoids / therapeutic use
  • Risk Assessment
  • Risk Factors
  • Taiwan / epidemiology
  • Time Factors
  • Treatment Outcome

Substances

  • Immunosuppressive Agents
  • Retinoids
  • Methotrexate