medwireNews: People with psoriatic arthritis (PsA) have an increased risk for venous thromboembolism (VTE) relative to the general population, and this association is likely to be related to underlying comorbidities, research suggests.
This study “is of particular significance given the recent concern raised over increased incidence of VTE events” in rheumatoid arthritis (RA), psoriasis, and PsA patients with pre-existing cardiovascular (CV) risk factors treated with the Janus kinase (JAK) inhibitor tofacitinib, say the authors. They also point to findings from the ORAL Surveillance study, which indicated significantly higher rates of VTE among RA patients treated with tofacitinib 10 mg twice daily versus a tumor necrosis factor inhibitor.
For the current investigation, Tal Gazitt (Carmel Medical Center, Haifa, Israel) and colleagues evaluated data from 5275 patients from an Israeli database who were diagnosed with PsA between 2003 and 2018, and 21,011 controls without PsA who were matched for age, sex, ethnicity, and index date. Both groups were followed up until 2019.
As reported in Arthritis Research & Therapy, 1.2% of the PsA group and 0.8% of the controls were diagnosed with VTE during follow-up, translating into a significantly increased risk for VTE among people with PsA in an unadjusted analysis (hazard ratio [HR]=1.40).
However, this association was no longer statistically significant after adjusting for factors including various comorbidities, demographics, and smoking. In this multivariate analysis, prior VTE was the strongest predictor of VTE risk (adjusted HR=13.00), while older age, obesity, cancer, ischemic heart disease, and vascular disease were also independently associated with VTE risk, with adjusted HRs ranging from 1.08 to 1.67.
These findings suggest “that underlying comorbidities may play a significant role in increasing the risk of VTE among PsA patients,” write Gazitt and team.
They then carried out a multivariate analysis restricted to the PsA group, finding that the only significant predictors of VTE risk were prior VTE (HR=31.63) and older age (HR=1.08). Use of conventional or biologic DMARDs was not significantly associated with VTE risk.
The authors caution that because their study was conducted prior to widespread use of JAK inhibitors for PsA, “these medications were excluded from our analysis,” which they point out is “of significance” given the association between JAK inhibitor use and VTE risk in patients with inflammatory arthritis and CV risk factors.
Taken together, the study results indicate that “screening for the presence of comorbidities, especially cardiovascular risk factors and previous history of VTE, are important in the treatment management and may influence medication choices,” conclude the researchers.
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