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Weight loss is reported with oral roflumilast, which is approved for chronic obstructive pulmonary disease (COPD). Recently, the drug has shown efficacy in psoriasis, a disease strongly linked to overweight/obesity. To describe the effects of oral roflumilast on body weight and cardio-metabolic parameters in patients with psoriasis. Posthoc analyses from the PSORRO study, where patients with moderate-to-severe plaque psoriasis were randomized 1:1 to oral roflumilast 500 μg once-daily or placebo for 12 weeks, followed by active, open-label treatment through week 24 in both groups. Changes in body weight, blood pressure, gastrointestinal symptoms, and laboratory tests were registered. No lifestyle or dietary interventions were applied. Forty-six patients were randomized. Baseline characteristics across groups were comparable; mean weight was 103.6 kg. In patients receiving roflumilast, median weight change was −2.6% and −4% at week 12 and 24, respectively. Corresponding numbers were 0.0% and 1.3% in patients initially allocated to placebo. Reduced appetite was more frequent with active therapy. No changes in blood pressure or laboratory tests were observed. Posthoc analyses and low numbers. Oral roflumilast induced weight loss and reduced appetite, which support the growing evidence of roflumilast as an attractive treatment alternative for patients with psoriasis. [ABSTRACT FROM AUTHOR]

A multitude of factors may influence fatigue in psoriasis and psoriatic arthritis (PsA); however, their individual fatigue components have not been thoroughly examined. To explore characteristics of fatigue and its potential drivers in a cohort of patients with psoriasis with or without PsA. Adults with psoriasis and a nonpsoriasis control group completed the Multidimensional Fatigue Inventory-20 questionnaire. Patients with psoriasis also reported joint pain intensity, pruritus, skin pain, and sleep problems using a numerical rating scale. Linear regression models were applied to continuous outcomes, and beta coefficients (β) for the slopes were estimated with 95% confidence intervals (CIs). Among 2741 adults with psoriasis (of which 593 also had PsA) and 3788 controls, the impact on total fatigue was greatest for PsA (β = 5.22; 95% CI, 3.55-6.90), followed by psoriasis (β = 2.10; 95% CI, 0.96-3.25), compared with the general population (P trend <.0001). Among patients with psoriasis with or without PsA, increasing joint pain intensity was associated with overall fatigue (β = 2.23 [95% CI, 2.03-2.44] for each 1-point increase in joint pain numerical rating scale score). We lacked information on the effect of pharmacotherapy. These findings highlight the importance of a symptom-based approach when treating psoriasis, rather than focusing on objective severity measures alone. [ABSTRACT FROM AUTHOR]

Orismilast is a novel oral phosphodiesterase-4 (PDE4) B/D inhibitor being investigated as a potential treatment for moderate-to-severe psoriasis. To evaluate efficacy and safety of orismilast modified-release formulation in moderate-to-severe psoriasis. This multicenter, randomized (1:1:1:1 to 20, 30, 40 mg orismilast or placebo, twice daily), double-blinded, placebo-controlled, parallel-group, phase 2b, 16-week, dose-ranging study evaluated orismilast in adults with moderate-to-severe plaque psoriasis (NCT05190419). Efficacy end points were analyzed using multiple imputation. Of 202 randomized patients, baseline characteristics were balanced across arms, except greater severe disease proportions for orismilast vs placebo. Orismilast showed significant improvements in the primary end point, percentage change in Psoriasis Area and Severity Index (PASI), from baseline to week 16 (orismilast –52.6% to –63.7% and placebo, –17.3%; all P <.001). Greater proportions receiving orismilast achieved PASI75 (39.5%-49.0%; P <.05) and PASI90 (22.0%-28.3%; P <.05 for 20 and 40 mg) vs placebo (PASI75, 16.5% and PASI90, 8.3%) at week 16. Safety findings were as expected with PDE4 inhibition; dose-dependent tolerability effects observed. Small sample size, disease severity imbalance between groups, limited duration and diversity in study population. Orismilast demonstrated greater efficacy vs placebo and a safety profile in line with PDE4 inhibition. [ABSTRACT FROM AUTHOR]

Background: Patients with psoriasis have an impaired quality of life and higher use of analgesics than the general population. Whether such use is due to skin pain or a consequence of joint pain resulting from psoriatic arthritis (PsA) is not clear.Objectives: To assess symptoms, disease burden, and use of analgesics in patients with psoriasis with and without PsA.Method: Symptoms, general health (EurQol 5-dimension and 5-levels), and use of analgesics were assessed in patients with psoriasis and the general population from the Danish Skin Cohort.Results: We included 4016 patients with psoriasis (847 with concomitant PsA) and 3490 reference individuals. For patients with psoriasis having PsA, itch, skin pain, and/or joint pain was associated with worse general health. Use of opioids within 12 months was observed among 9.0% of the general population, 14.2% of patients with psoriasis without PsA, and 22.7% of patients with concomitant PsA. Of the symptoms, only joint pain was associated with use of analgesics (odds ratio, 3.72 (2.69-5.14); P < .0001).Limitations: Cross-sectional design.Conclusion: Patients with psoriasis (especially concomitant PsA) have a higher use of analgesics compared with the general population, which appears to be a result of increased joint pain. [ABSTRACT FROM AUTHOR]

Background: Conjunctivitis and several other ocular surface diseases (OSDs) have been linked to atopic dermatitis (AD) and its treatment.Objectives: To examine the association between AD, conjunctivitis, and other OSDs.Methods: A systematic review and meta-analysis was performed. Two authors independently searched EMBASE, PubMed, SCOPUS, and Web of Science and performed title/abstract and full-text review and data abstraction. Pooled random-effects prevalence and odds ratios (ORs) with 95% confidence intervals (CIs) were estimated.Results: The search yielded 5719 nonduplicate articles; 134 were included in the quantitative analysis. AD was associated with conjunctivitis compared to reference individuals (OR, 2.78; 95% CI, 2.33-3.32); the prevalences of conjunctivitis in patients with AD and reference individuals were 31.7% (95% CI, 27.7-35.9) and 13.3% (95% CI, 11.0-15.7), respectively. Keratoconus (OR, 3.71; 95% CI, 1.99-6.94) and ocular herpes simplex (OR, 3.65; 95% CI 2.04-6.51) were also associated with AD.Limitations: Disease definitions differed and often relied on self-reports. Few studies provided data concerning AD phenotype or OSDs other than conjunctivitis.Conclusions: Conjunctivitis is the most common ocular comorbidity in AD. Signs and symptoms of conjunctivitis and other OSDs in AD may be underreported, making proactive inquiry and examination by physicians treating patients with AD important. [ABSTRACT FROM AUTHOR]

Background: Patients with psoriatic disease may be more susceptible to methotrexate hepatotoxicity than those with rheumatoid arthritis (RA); however, direct evidence supporting this notion is lacking.Objective: To compare liver disease risk among patients with psoriasis (PsO), psoriatic arthritis (PsA), or RA receiving methotrexate.Methods: In a population-based cohort study, Danish individuals with PsO, PsA, or RA receiving methotrexate between 1997 and 2015 were compared according to 4 disease outcomes: mild liver disease, moderate-to-severe liver disease, cirrhosis, and cirrhosis-related hospitalization.Results: Among 5687, 6520, and 28,030 patients with PsO, PsA, and RA, respectively, the incidence rate of any liver disease was greatest for PsO, followed by PsA, and lowest for RA. Compared with patients with RA, patients with PsO were 1.6-3.4 times more likely to develop at least one of the liver disease outcomes, whereas those with PsA were 1.3-1.6 times more likely to develop mild liver disease and cirrhosis after adjusting for demographics, smoking, alcohol use, comorbidities, and methotrexate dose.Limitations: Confounding due to unmeasured variables, misclassification, and surveillance bias.Conclusion: PsO, PsA, and RA differentially influence liver disease risk in the setting of methotrexate use independent of other major risk factors. More conservative monitoring should be considered in patients receiving methotrexate for psoriatic disease, particularly in PsO patients. [ABSTRACT FROM AUTHOR]

Background: Limited data suggest that hydroxychloroquine may affect risk of cardiovascular disease in patients with lupus erythematosus (LE).Objective: To investigate whether hydroxychloroquine treatment is associated with major adverse cardiovascular events (MACE) (myocardial infarction, ischemic stroke, or cardiovascular-associated death) in patients with cutaneous LE (CLE) or systemic LE (SLE).Methods: Based on the Danish nationwide registers, an observational cohort study was conducted including patients with first-time diagnosis of CLE or SLE (between 1997 and 2017). Cox regression models calculating the hazard ratio (HR) analyzing the risk of MACE were performed comparing time on and off hydroxychloroquine (including never users). The models were adjusted for age, sex, socioeconomic status, concomitant treatment, and cardiovascular risk factors.Results: Among 4587 patients with LE, 51% (n = 2343) were treated with hydroxychloroquine during the study period. An inverse association between use of hydroxychloroquine and MACE risk was observed among patients with SLE (adjusted HR, 0.65; 95% confidence interval, 0.46-0.90) and patients with CLE (adjusted HR, 0.71; 95% confidence interval, 0.42-1.19). Consistent results were found in sensitivity analyses including a case-time control design.Limitations: No information on disease activity/severity was available.Conclusion: Our findings indicate an opportunity to reduce the risk of cardiovascular events in patients with LE through use of hydroxychloroquine. [ABSTRACT FROM AUTHOR]

Background: Atopic dermatitis (AD) has been linked to systemic infections in adulthood, but large-scale studies are few, and potential associations are unclear.Objective: To examine whether adults with AD have increased risk of developing systemic infections leading to hospital-based management.Methods: Nationwide register-based cohort study including all Danish adults from 1995 through 2017. Hazard ratios (HRs) with 95% confidence intervals (CIs) were estimated by using Cox models.Results: A total of 10,602 adults with AD (median age, 29.8 y; interquartile range, 22.6-44.8) and 106,020 reference individuals were included. The overall incidence rate per 10,000 person-years of systemic infections was 180.6 (95% CI, 172.6-189.0) among adults with AD compared with 120.4 (95% CI, 118.3-122.5) among reference adults. The association between AD and systemic infections was observed for musculoskeletal (adjusted HR [aHR], 1.81; 95% CI, 1.42-2.31), heart (aHR, 1.75; 95% CI, 1.21-2.53), and upper (aHR, 1.42; 95% CI, 1.15-1.73) and lower respiratory tract infections (aHR, 1.21; 95% CI, 1.10-1.33). The risk of sepsis (aHR, 1.19; 95% CI, 1.01-1.44) and skin infections (aHR, 2.30; 95% CI, 2.01-2.62) was also increased.Limitations: The findings cannot be generalized to adults with milder AD seen outside the hospital system.Conclusion: We found an increased risk of systemic infections among adults with hospital managed AD. [ABSTRACT FROM AUTHOR]

Background: It is well established that asthma is common in patients with atopic dermatitis (AD).Objectives: We performed a systematic review and meta-analysis to determine the prevalence of asthma and respiratory symptoms in individuals with AD as well as the association between AD and asthma.Methods: At least 2 authors independently searched the medical databases PubMed, EMBASE, LILACS, and SCOPUS for all English-language studies with data on asthma prevalence among patients with AD or the association between AD and asthma. Pooled odds ratios with 95% confidence intervals (CIs) and pooled proportions were estimated with random-effects models. The Newcastle-Ottawa scale was used to assess study quality.Results: The search yielded 39,503 articles. Of these, 213 studies were included in a quantitative analysis. The overall pooled prevalence of asthma was 25.7% (95% CI, 23.7-27.7) in patients with AD and 8.1% (95% CI, 7.0-9.4) among reference individuals. There was a significant association between AD and asthma when compared with reference individuals (odds ratio, 3.03; 95% CI, 2.64-3.47).Limitations: The definitions of AD and asthma differed across the included studies and varied from self-report to physician diagnosed.Conclusions: Asthma is a common comorbidity of AD. Physicians should be cognizant of this relationship and address asthma symptoms in their patients. [ABSTRACT FROM AUTHOR]

Background: Multiple biologics for psoriasis exist, and interleukin (IL) 17 inhibitors are among those with the best efficacy. However, switching treatment is often required at some point, and intraclass switch of IL-17 inhibitors is not well investigated.Objectives: To determine the efficacy of a second IL-17 inhibitor in patients with psoriasis.Methods: Two authors independently searched the databases PubMed and EMBASE for studies reporting on efficacy of IL-17 inhibitors in patients with psoriasis previously exposed to another IL-17 inhibitor. The study was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.Results: In total, 14 publications comprising 655 patients were included. The proportion of patients achieving a reduction of 75%, 90%, and 100% in Psoriasis Area Severity Index were, respectively, 74.6 (95% confidence interval [CI], 63.9-84.0), 69.4% (95% CI, 53.2-83.4), and 46.4 (95% CI, 30.5-62.7) after short-term treatment (weeks 9, 12, and 16 combined).Limitations: Most studies included were on ixekizumab and were retrospective chart reviews with no information on the response to the previous IL-17 inhibitor.Conclusion: Previous treatment with an IL-17 inhibitor does not appear to affect the efficacy of another IL-17 inhibitor in the treatment of psoriasis. However, further prospective studies are needed. [ABSTRACT FROM AUTHOR]

Parental history of atopic disease is a well-established risk factor for the development of atopic dermatitis (AD), but several aspects of this association remain unclear. We sought to determine the association of parental history of atopic disease with AD in offspring. We searched PubMed and EMBASE through June 2018 for relevant records and adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Pooled odds ratios (ORs) with 95% CI were calculated using random-effects models. A total of 163 records covering 149 unique studies were included. Of these, 119 studies were included in the meta-analysis. Individuals with parental history of atopic disease had increased odds of AD (OR, 1.81; 95% CI, 1.65-1.99). Parental asthma (OR, 1.56; 95% CI, 1.18-2.05) and allergic rhinitis (OR, 1.68; 95% CI, 1.34-2.11) had a smaller effect than AD (OR, 3.30; 95% CI, 2.46-4.42). The effect of maternal and paternal history was comparable for all atopic diseases. An increase in odds was observed when comparing the effect of having 1 (OR, 1.30; 95% CI, 1.15-1.47) or 2 atopic parents (OR, 2.08; 95% CI, 1.83-2.36), as well as having a parent with 1 (OR, 1.49; 95% CI, 1.28-1.74) or more atopic diseases (OR, 2.32; 95% CI, 1.92-2.81). This study provides evidence-based risk estimates that may guide physicians who counsel parents with a history of atopic disease about their children's risk of AD. This information is of particular importance for future efforts toward establishing prophylactic interventions for AD on a general population level. [ABSTRACT FROM AUTHOR]

Background: Psoriasis is a common inflammatory skin disease associated with several immune-mediated inflammatory diseases (IMIDs); however, little is known of the chronology of disease development.Objective: To investigate the chronology of IMIDs relative to psoriasis.Methods: We utilized routinely collected data from Danish nationwide administrative registries to examine the occurrence of IMIDs in patients with psoriasis (n = 10,923) and general population controls (n = 109,230).Results: Approximately 20% of patients with psoriasis developed ≥1 IMID, with a 5-fold increased risk compared with the general population. Most IMIDs were diagnosed before psoriasis, except for psoriatic arthritis. Psoriasis was significantly associated with having multiple IMIDs (odds ratio 15.2, 95% confidence interval 11.6-20.0). Human leukocyte antigen B27 positivity was significantly more frequent among psoriasis patients.Limitations: Clinical measurements were unavailable.Conclusion: IMIDs occur frequently in patients with psoriasis and most are diagnosed before psoriasis. The observed chronology might represent important mechanisms of disease development. [ABSTRACT FROM AUTHOR]

Background: Factors that are associated with patient-reported importance of obtaining complete or almost complete clearance of psoriasis and atopic dermatitis (AD) are unknown.Objectives: To investigate the importance of and factors associated with obtaining complete or almost complete clearance of psoriasis or AD.Methods: A cross-sectional study of 4016 and 3842 adults with psoriasis and AD.Results: Patients with AD reported significantly greater importance of almost complete or complete skin clearance compared with patients with psoriasis. For both patient groups, almost complete was more important that complete skin clearance. Increasing disease severity and itch and skin pain were significantly associated with perceived importance of skin clearance for patients with both diseases. AD and psoriasis located on the face or neck and psoriasis located on the palms, soles, or genitals were significantly associated with patient-perceived importance of almost complete skin clearance. Only 7% and 27% of patients with severe AD and psoriasis, respectively, were currently receiving a systemic therapy.Limitations: Specific reasons for infrequent use of systemic treatments was not examined.Conclusion: Patients with psoriasis or AD expressed a strong request for almost complete or complete skin clearance. Patient education and effective therapies should be used to reduce disease severity. [ABSTRACT FROM AUTHOR]

Background: Biologics targeting interleukin 17 are increasingly being used for treatment of moderate-to-severe psoriasis, but data on drug survival for these therapies remain scarce.Objectives: To investigate the drug survival of secukinumab and ixekizumab in a nationwide cohort of patients with psoriasis in Denmark.Methods: Using DERMBIO, we examined Danish patients receiving treatment with secukinumab or ixekizumab according to the standard in-label dosing. Kaplan-Meier plots were used to present survival curves.Results: In all, 368 and 62 patients received treatment with secukinumab and ixekizumab, respectively. In total, 40.7% and 12.9% of secukinumab- and ixekizumab-treated patients were bionaive. Ixekizumab-treated patients had received significantly more previous treatments. Over 12 months, 23.5% and 0.0% of bionaive secukinumab- and ixekizumab-treated patients discontinued therapy, respectively. Drug survival for bionaive and non-naive patients was lower for secukinumab than for ixekizumab. During the maximum 3 years of follow-up, secukinumab drug survival was lowest for patients who had previously been treated with 2 or more biologics, followed by patients treated with secukinumab as their second-ever biologic.Limitations: The total number of patients and follow-up time were modest.Conclusions: Drug survival was higher for ixekizumab even though secukinumab-treated patients had been treated with significantly fewer biologics before starting this drug. [ABSTRACT FROM AUTHOR]

Background: Adult atopic dermatitis (AD) has been associated with several comorbidities, but cause-specific mortality risk is unknown.Objective: To examine cause-specific death rates and risk in adults with AD.Methods: We performed cross-linkage of nationwide health care and cause of death registers. Adult patients with AD were matched with 10 controls per study subject. We calculated incidence rates per 1000 person-years and hazard ratios (HRs) of cause-specific death with 95% confidence intervals (95% CIs) using Cox proportional hazards models.Results: A total of 8686 patients and 86,860 matched controls were studied. The risk for death due to any cause was significantly increased in patients with AD (HR 1.27, 95%CI 1.11-1.45). Significant causes included cardiovascular (HR 1.45; 95% CI 1.07-1.96), infectious (HR 3.71; 95% CI 1.43-9.60), and urogenital diseases (HR 5.51; 95% CI 1.54-19.80). No increased risk for death due to cancer, endocrine, neurologic, psychiatric, respiratory, or gastroenterologic disease was observed.Limitations: The results might not be generalizable to patients seen exclusively by primary care physicians.Conclusion: Adults with atopic dermatitis had slightly increased risk for death during follow-up. While the risk for death from cardiovascular, urogenital, and infectious diseases was slightly elevated among patients with AD, the absolute risk was very low. [ABSTRACT FROM AUTHOR]

It is unknown whether skin biomarkers collected in infancy can predict the onset of atopic dermatitis (AD) and be used in future prevention trials to identify children at risk. This study sought to examine whether skin biomarkers can predict AD during the first 2 years of life. This study enrolled 300 term and 150 preterm children at birth and followed for AD until the age of 2 years. Skin tape strips were collected at 0 to 3 days and 2 months of age and analyzed for selected immune and barrier biomarkers. Hazard ratio (HR) with 95% confidence interval (CI) using Cox regression was calculated for the risk of AD. The 2-year prevalence of AD was 34.6% (99 of 286) and 21.2% (25 of 118) among term and preterm children, respectively. Skin biomarkers collected at birth did not predict AD. Elevated thymus- and activation-regulated chemokine/C-C motif chemokine ligand 17 -levels collected at 2 months of age increased the overall risk of AD (HR: 2.11; 95% CI: 1.36-3.26; P =.0008) and moderate-to-severe AD (HR: 4.97; 95% CI: 2.09-11.80; P =.0003). IL-8 and IL-18 predicted moderate-to-severe AD. Low filaggrin degradation product levels increased the risk of AD (HR: 2.04; 95% CI: 1.32-3.15; P =.001). Elevated biomarker levels at 2 months predicted AD at other skin sites and many months after collection. This study showed that noninvasively collected skin biomarkers of barrier and immune pathways can precede the onset of AD. [ABSTRACT FROM AUTHOR]

Background: Tofacitinib is an oral Janus kinase (JAK) inhibitor. Immunomodulatory therapies can increase the risk for herpes zoster (HZ) in patients with psoriasis.Objective: To evaluate the relationship between tofacitinib use and HZ risk.Methods: We used phases 2 and 3 and long-term extension (LTE) data from the tofacitinib development program in psoriasis to calculate HZ incidence rates (IR; events per 100 patient-years); potential HZ risk factors were evaluated using Cox-proportional hazard models.Results: One hundred thirty (3.6%) patients on tofacitinib (IR 2.55), no patients on placebo, and 2 using etanercept (IR 2.68) developed HZ. Nine patients (7%) were hospitalized, and 8 (6%) had multidermatomal HZ; no encephalitis, visceral involvement, or deaths occurred. In total, 121 (93%) patients on tofacitinib continued or resumed use after HZ. HZ risk factors included Asian descent (hazard ratio [HR] 2.92), using tofacitinib 10 mg twice daily (vs 5 mg twice daily; HR 1.72), prior use of biologics (HR 1.72), and older age (HR 1.30).Limitations: Generalizability to other psoriasis populations might be limited. The effect of HZ vaccination was not studied.Conclusion: Tofacitinib is associated with increased HZ risk relative to placebo. Asian race, increasing age, higher dose, and prior biologic exposure are associated with heightened risk. [ABSTRACT FROM AUTHOR]

Background: It is unclear whether patients with atopic dermatitis (AD) have an altered prevalence or risk for contact sensitization. Increased exposure to chemicals in topical products together with impaired skin barrier function suggest a higher risk, whereas the immune profile suggests a lower risk.Objective: To perform a systematic review and meta-analysis of the association between AD and contact sensitization.Methods: The PubMed/Medline, Embase, and Cochrane databases were searched for articles that reported on contact sensitization in individuals with and without AD.Results: The literature search yielded 10,083 citations; 417 were selected based on title and abstract screening and 74 met inclusion criteria. In a pooled analysis, no significant difference in contact sensitization between AD and controls was evident (random effects model odds ratio [OR] = 0.891; 95% confidence interval [CI] = 0.771-1.03). There was a positive correlation in studies that compared AD patients with individuals from the general population (OR 1.50, 95% CI 1.23-1.93) but an inverse association when comparing with referred populations (OR 0.753, 95% CI 0.63-0.90).Limitations: Included studies used different tools to diagnose AD and did not always provide information on current or past disease. Patch test allergens varied between studies.Conclusion: No overall relationship between AD and contact sensitization was found. We recommend that clinicians consider patch testing AD patients when allergic contact dermatitis is suspected. [ABSTRACT FROM AUTHOR]

Background: Rosacea features increased neurovascular reactivity; migraine is a complex neurologic disorder characterized by recurrent episodes of headache associated with nausea and increased sensitivity to light and sound.Objective: We evaluated the prevalence and risk of new-onset migraine in patients with rosacea.Methods: All Danish individuals 18 years of age or older were linked in nationwide registers. Adjusted hazard ratios (HRs) were estimated by Cox regression.Results: In the total cohort (n = 4,361,688), there were 49,475 patients with rosacea. Baseline prevalence of migraine was 7.3% and 12.1% in the reference population and in patients with rosacea, respectively. The fully adjusted HR of migraine was 1.31 (95% confidence interval 1.23-1.39) for patients with rosacea. Patients with phymatous rosacea (n = 594) had no increased risk of migraine (adjusted HR 0.45; 95% confidence interval 0.11-1.80), whereas patients with ocular rosacea (n = 6977) had a 69% increased risk (adjusted HR 1.69; 95% confidence interval 1.43-1.99). Notably, the risk was higher among patients age 50 years or older than in younger individuals, and the risk was only significant among women.Limitations: We were unable to distinguish between migraine subtypes.Conclusion: We found a significantly higher prevalence and risk of incident migraine especially in female patients with rosacea. These data add to the accumulating evidence for a link between rosacea and the central nervous system. [ABSTRACT FROM AUTHOR]

Background: Psoriasis and atopic dermatitis (AD) are chronic inflammatory skin disorders. Mortality is increased in psoriasis, yet no studies on mortality in AD are currently available.Objective: We investigated 10-year mortality after hospitalization for AD compared with psoriasis and the general population.Methods: Between 1996 and 2002 all Danes aged 18 years or older with a first-time hospitalization as a result of AD or psoriasis and AD-matched healthy control subjects were examined in nationwide registers. Multivariable (adjusted for age, sex, socioeconomic status, Charlson Comorbidity Index score, smoking, and medication) hazard ratios were estimated by Cox regression.Results: The study comprised 576 and 951 hospitalized patients with AD and psoriasis, respectively, with a maximum follow-up time of 10 years. During the study period, there were 65 and 286 deaths among patients with AD and psoriasis. Risk of death was decreased in patients with AD versus psoriasis (hazard ratio 0.75; 95% confidence interval 0.57-1.00), but higher than in general population control subjects (n = 5760) (hazard ratio 1.71; 95% confidence interval 1.20-2.44). Patients hospitalized with AD died on average 8.3 years younger than control subjects.Limitations: Lifestyle may have affected the risk.Conclusions: The 10-year mortality was significantly lower after hospitalization for AD compared with psoriasis, but increased when compared with the general population. [ABSTRACT FROM AUTHOR]

Background: Psoriasis is a systemic inflammatory condition that is associated with a higher risk of cardiovascular (CV) disease. Tofacitinib is being investigated as a treatment for psoriasis.Objective: We sought to evaluate the effects of tofacitinib on CV risk factors and major adverse CV events (MACEs) in patients with plaque psoriasis.Methods: Changes in select CV risk factors and the incidence rate (IR) of MACEs were evaluated in patients who were treated with tofacitinib.Results: Tofacitinib treatment was associated with small, dose-dependent increases in total cholesterol, low-density lipoprotein (LDL), and high-density lipoprotein (HDL) cholesterol, while the total/HDL cholesterol ratio was unchanged. There were no changes in blood pressure and glycated hemoglobin levels; C-reactive protein levels decreased. The IRs of a MACE were low and similar for both tofacitinib doses. Among 3623 subjects treated with tofacitinib, the total patient-years of exposure was 5204, with a median follow-up of 527 days, and the IR of MACEs was 0.37 (95% confidence interval, 0.22-0.57) patients with events per 100 patient-years.Limitations: There was relatively short follow-up time for patients who had MACEs.Conclusions: While treatment with tofacitinib is associated with a small increase in cholesterol levels, the total/HDL cholesterol ratio does not change, there are no unfavorable changes in several CV risk factors, and the incidence of MACEs is low. [ABSTRACT FROM AUTHOR]

Background: Patients with psoriasis may have increased risk of major adverse cardiovascular (CV) events (MACE), and a family history of CV disease (CVD) is an independent risk factor for MACE.Objective: We investigated the risk of first-time MACE in patients with psoriasis with or without a family history of CVD.Methods: Between January 1, 1997, and December 31, 2011, we identified 2,722,375 individuals, including 25,774 and 4504 patients with mild and severe psoriasis, through administrative registers. Incidence rate ratios were estimated by Poisson regression.Results: Mean baseline age was 26.6 (SD 8.6) years. A family history of CVD was found among 16,080 (62.4%) and 3009 (66.8%) patients with mild and severe psoriasis, respectively. In patients with psoriasis and a family history of CVD, the adjusted incidence rate ratios (95% CI) of MACE were 1.28 (1.12-1.46) and 1.62 (1.14-2.30) for mild and severe disease, respectively. In patients with psoriasis but without a family history of CVD, there was no increased risk of MACE.Limitations: Results may not apply to late-onset psoriasis.Conclusions: A family history of CVD predicted the risk of first-time MACE in young adults with psoriasis. The findings call for increased focus on a family history of CVD in CV risk assessment of patients with psoriasis. [ABSTRACT FROM AUTHOR]

Background: Recent studies have shown a higher prevalence of cardiovascular (CV) risk factors in patients with rosacea. However, it remains unknown whether rosacea represents an independent CV risk factor.Objective: We evaluated the risk of myocardial infarction, stroke, CV death, major adverse CV events, and all-cause mortality, respectively.Methods: Between January 1, 1997, and December 31, 2012, a total of 4948 patients with rosacea were identified and matched with 23,823 control subjects. We used Poisson regression to calculate incidence rate ratios.Results: Adjusted incidence rate ratios were 0.75 (95% confidence intervals [CI] 0.57-1.00) for myocardial infarction, 1.08 (95% CI 0.86-1.35) for ischemic stroke, 1.01 (95% CI 0.61-1.67) for hemorrhagic stroke, 0.99 (95% CI 0.80-1.24) for CV death, 0.99 (95% CI 0.86-1.15) for major adverse CV events, and 0.95 (95% CI 0.85-1.06) for all-cause mortality.Limitations: We were unable to distinguish between the different subtypes and severities of rosacea.Conclusions: In this population-based study, rosacea was not associated with increased risk of adverse CV outcomes or death. [ABSTRACT FROM AUTHOR]

Background: Psoriasis and migraine are common conditions with potential overlap of pathophysiological mechanisms. Both these diseases have been associated with increased cardiovascular risk but little is known about their interplay.Objective: We sought to investigate the link between psoriasis, and the risk of new-onset migraine, in a nationwide cohort of the Danish population.Methods: Data on all Danish citizens aged 18 years or older from January 1, 1997, to December 31, 2011, were linked at individual-level in nationwide registers. Incidence rates per 1000 person-years were calculated and crude and adjusted incidence rate ratios were estimated by Poisson regression models.Results: The study comprised a total of 5,379,859 individuals, including 53,006 and 6831 patients with mild and severe psoriasis, respectively, and 6243 patients with psoriatic arthritis. Fully adjusted incidence rate ratios for migraine were 1.37 (95% confidence interval 1.30-1.45), 1.55 (95% confidence interval 1.29-1.86), and 1.92 (95% confidence interval 1.65-2.22) for mild psoriasis, severe psoriasis, and psoriatic arthritis, respectively. Stratification for sex revealed increased risk of migraine in both male and female patients.Limitations: We were unable to distinguish between subtypes of migraine, eg, migraine with and without aura.Conclusions: Psoriasis was associated with a disease severity-dependent increased risk of migraine independent of measured confounders. Further studies are warranted to determine the effects of antipsoriatic treatment on this association, and whether migraine modifies the psoriasis-associated risk of cardiovascular disease. [ABSTRACT FROM AUTHOR]