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Original Investigation
May 26, 2021

Incidence of Venous Thromboembolism in Patients With Dermatologist-Diagnosed Chronic Inflammatory Skin Diseases

Author Affiliations
  • 1Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
  • 2Harvard Medical School, Boston, Massachusetts
  • 3Department of Dermatology, Brigham and Women’s Hospital, Boston, Massachusetts
  • 4Division of Rheumatology, Inflammation, and Immunity, Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
  • 5Associate Editor, JAMA Dermatology
  • 6Department of Dermatology, George Washington University School of Medicine and Health Sciences
JAMA Dermatol. 2021;157(7):805-816. doi:10.1001/jamadermatol.2021.1570
Key Points

Question  What is the background rate of venous thromboembolism in patients with vs without a chronic inflammatory skin disease, including psoriasis, atopic dermatitis, alopecia areata, vitiligo, and hidradenitis suppurativa?

Findings  In this cohort study with analysis of claims data on 158 123 patients with a chronic inflammatory skin disease, no indication of an increased incidence of unprovoked clinical venous thromboembolism events was noted in patients with chronic inflammatory skin diseases compared with similar patients without chronic inflammatory skin diseases.

Meaning  In this newer era of advanced systemic medications for treatment of chronic inflammatory skin diseases, having a background rate of venous thromboembolism established may help monitor the safety of newly marketed systemic treatments in dermatology.

Abstract

Importance  Several studies have linked chronic inflammatory skin diseases (CISDs) with venous thromboembolism (VTE) in a range of data sources with mixed conclusions.

Objective  To examine the incidence of VTE in patients with vs without CISD.

Design, Setting, and Participants  A cohort study using commercial insurance claims data from a nationwide US health care database from January 1, 2004, through 2019 was conducted. A total of 158 123 patients with dermatologist-recorded psoriasis, atopic dermatitis, alopecia areata, vitiligo, or hidradenitis suppurativa were included. Risk-set sampling identified patients without a CISD. Patient follow-up lasted until the first of the following occurred: VTE, death, disenrollment, or end of data stream.

Exposures  Patients with vs without CISD.

Main Outcomes and Measures  Venous thromboembolism events were identified with validated algorithms. Incidence rates were computed before and after 1:1 propensity-score matching to account for VTE risk factors. Hazard ratios were estimated to compare the incidence of VTE in the CISD vs non-CISD cohorts.

Results  A total of 158 123 patients were identified with CISD: with psoriasis (n = 96 138), atopic dermatitis (n = 30 418), alopecia areata (n = 17 889), vitiligo (n = 7735), or HS (n = 5934); 9 patients had 2 of these conditions. A total of 1 570 387 patients were without a CISD. The median follow-up time was 1.9 years (interquartile range, 0.8-4.0 years) in patients with CISD. The incidence rate (per 1000 person-years) of outpatient or inpatient VTE was 1.57 in psoriasis, 1.83 in atopic dermatitis, 0.94 in alopecia areata, 0.93 in vitiligo, 1.65 in HS and 1.53 in CISD overall, compared with 1.76 in patients without a CISD. Incidence rates increased in patients aged 50 years or older (2.3 per 1000 person-years) and decreased in those aged 18 to 49 years (0.8 per 1000 person-years). After propensity-score matching to patients without a CISD, the hazard ratio (HR) of VTE was 0.86 (95% CI, 0.75-0.99) in psoriasis, 1.19 (95% CI, 0.95-1.48) in atopic dermatitis, 0.97 (95% CI, 0.65-1.46) in alopecia areata, 0.90 (95% CI, 0.49-1.65) in vitiligo, 1.64 (95% CI, 0.82-3.27) in hidradenitis suppurativa, and 0.94 (95% CI, 0.84-1.05) in CISD overall.

Conclusions and Relevance  In this large-scale cohort study, CISDs were not associated with an increased incidence of VTE after controlling for relevant VTE risk factors in a representative dermatology patient population.

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