Related Articles Pharmacologic Immunomodulation and Cutaneous Malignancy in Rheumatoid Arthritis, Psoriasis, and Psoriatic Arthritis (Review). J Rheumatol. 2010 Sep 1; Authors: Krathen MS, Gottlieb AB, Mease PJ OBJECTIVE: It is unclear if skin cancer risk is affected by the use of immunomodulatory medications in rheumatoid arthritis (RA), psoriasis, and psoriatic arthritis (PsA). The purpose of this study is to evaluate and summarize the available data pertinent to this question. METHODS: The English language literature on PubMed was searched with a combination of phrases, including “malignancy,” “skin cancer,” “squamous cell carcinoma,” “basal cell carcinoma,” “melanoma,” “psoriasis,” “psoriatic arthritis,” and “rheumatoid arthritis” in addition to the generic names of a variety of common immunomodulatory drugs. Relevant articles were identified and data were extracted. RESULTS: In total, 2218 potentially relevant articles were identified through the search process. After further screening, 20 articles relevant to RA were included. An additional 19 articles relevant to either psoriasis or PsA were included as well. RA may be a risk factor for the development of cutaneous malignancy. Treatment with tumor necrosis factor inhibitors increases the rates of non-melanoma skin cancer (NMSC) in RAand psoriasis. This risk doubles when combination methotrexate therapy is used in RA. Methotrexate may increase the risk of malignant melanoma in patients with RA and the risk of NMSC in psoriasis. Cyclosporine and prior phototherapy significantly increase the risk of NMSC. CONCLUSION: RA may potentiate the risk of cutaneous malignancy and therefore dermatologic screening in this population should be considered. The use of immunomodulatory therapy in RA, psoriasis, and PsA may further increase the risk of cutaneous malignancy and therefore dermatologic screening examinations are warranted in these groups. More careful recording of skin cancer development during clinical trials and cohort studies is necessary to further delineate the risks of immunomodulatory therapy. PMID: 20810498 [PubMed - as supplied by publisher]
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Pharmacologic Immunomodulation and Cutaneous Malignancy in Rheumatoid…
Related Articles Cardiovascular and Economic Outcomes After Initiation of Lipid-Lowering Therapy With Atorvastatin vs Simvastatin in an Employed Population. Mayo Clin Proc. 2009 Dec;84(12):1065-72 Authors: Simpson RJ, Signorovitch J, Birnbaum H, Ivanova J, Connolly C, Kidolezi Y, Kuznik A OBJECTIVE: To compare the risk of cardiovascular-related hospitalization, statin adherence, and direct (medical and drug) and indirect (disability and medically related absenteeism) costs in US employees in whom atorvastatin or simvastatin was newly prescribed. PATIENTS AND METHODS: Active employees aged 18 to 64 years with a new atorvastatin or simvastatin prescription were identified from a deidentified claims database for 23 privately insured US companies from January 1, 1999, through December 31, 2006. Employees given atorvastatin were matched to those given simvastatin according to propensity scores based on patient characteristics, index statin dose, preindex cardiovascular events, and wage. Outcomes were compared between matched cohorts during the 2-year postindex period, including the risk of cardiovascular-related hospitalization, adherence to the index statin, use of other lipid-lowering drugs, direct medical costs for third-party payers, and indirect costs to employers. Indirect costs were computed as follows: Disability Payments + Daily Wage x Days of Medically Related Absenteeism. Atorvastatin and simvastatin drug costs were imputed using recent pricing to account for the availability of lower-cost generic simvastatin after the study period. RESULTS: Among 13,584 matched pairs, treatment with atorvastatin vs simvastatin was associated with a reduced risk of cardiovascular-related hospitalization, higher adherence, and less use of other lipid-lowering drugs. The increase in statin costs associated with atorvastatin vs simvastatin therapy was almost completely offset by reductions in medical service and indirect costs. CONCLUSION: In this study, treatment with atorvastatin compared with simvastatin was associated with a reduced risk of cardiovascular events, reduced indirect costs, and a minimal difference in total costs to employers. PMID: 19955243 [PubMed - in process]
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Cardiovascular and Economic Outcomes After Initiation of Lipid-Lowering…
