Psoriasis Review

A review of recent news, research, and treatment related to psoriasis.

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Cardiovascular Risk Factors More Prevalent Among Psoriasis Patients  

Cardiovascular risk factors, including metabolic syndrome, were more prevalent among individuals with psoriasis compared with the general population, according to a recent study. 

The observational, cross-sectional study included 398,701 participants in Lleida, Spain. A total of 6868 cases of psoriasis (1.7%) were identified, which included 499 cases (7.3%) of moderate to severe psoriasis. 

Compared with individuals without psoriasis, those with psoriasis had a higher prevalence of traditional cardiovascular risk factors, including type 2 diabetes (7.4% vs 13.9%, respectively; odds ratio [OR], 2.01), dyslipidemia (17.4% vs 28.8%; OR ,1.92), arterial hypertension (19% vs 31.2%; OR, 1.93), obesity (28.1% vs 33.7%; OR, 1.3), altered fasting basal glycemia (21.4% vs 15.1%; OR, 1.54), low cholesterol high density lipoprotein (32.3% vs 38.1%; OR, 1.29), hypertriglyceridemia (35.2% vs 45.7%; OR, 1.55), and high waist circumference (72.3% vs 75.7%; OR, 1.19).

Metabolic syndrome was more prevalent among individuals with psoriasis compared with those without psoriasis (28.3% vs 15.1%; OR, 2.21). Additionally, cardiovascular risk factors were similar across psoriasis severity groups.  

The prevalence of ischemic heart disease was higher among patients with psoriasis (3.3% vs 1.8%; OR, 1.87), as well as vascular-cerebral accidents (1.8% vs 1.2%; OR, 1.55). In addition, a model for metabolic syndrome showed a significant nonlinear relationship between age and sex, as well as significant differences between individuals with and without psoriasis. 

“We found statistically differences in relation to the prevalence of cardiovascular risk factors, metabolic syndrome and major cardiovascular events in psoriatic patients. However, differences were not seen between psoriasis severity groups,” the researchers concluded. “Our work reinforces the need for a multidisciplinary approach and close monitoring of cardiovascular risk factors in these patients to prevent a cardiovascular event.” 

Reference

Fernández-Armenteros JM, Gómez-Arbonés X, Buti-Soler M, et al. Psoriasis, metabolic syndrome and cardiovascular risk factors. A population-based study [published online June 28, 2018]. J Eur Acad Dermatol Venereol. doi:10.1111/jdv.15159

Which Systemic Therapies Are Associated With Better Adherence?

A recent study found that patients with psoriasis are more likely to adhere to biologic treatment regimens compared with nonbiologic options. 

In the retrospective study, researchers analyzed data from a large US health insurance claims database that included 22,742 patients with psoriasis who were new users of acitretin (Soriatane), adalimumab (Humira), etanercept (Enbrel), methotrexate, and ustekinumab (Stelara). They used the proportion of days covered (PDC) to measure adherence (0.80 or greater) and nonadherence (less than 0.80). In addition, odds ratios (ORs) were calculated to compare adherence between therapies and adjusted for potential confounders.

Greater adherence was observed among patients who received adalimumab (OR, 2.24), etanercept (OR, 1.77), and ustekinumab (OR, 2.54) compared with methotrexate. However, lower adherence was observed among those receiving acitretin compared with methotrexate (OR, 0.57). 

“We report greater adherence in new users of biologics when compared to methotrexate,” the authors concluded. “Further research is needed to understand overall low adherence to systemic medications for psoriasis.” 

Reference

Dommasch ED, Lee MP, Joyce CJ, Garry EM, Gagne JJ. Drug utilization patterns and adherence in patients on systemic medications for the treatment of psoriasis: a retrospective comparative cohort study [published online July 4, 2018]. J Am Acad Dermatol. doi:10.1016/j.jaad.2018.06.053

Do Interleukin Inhibitors Affect Bodyweight?

A recent study found that infliximab (Remicade) increased bodyweight among patients with psoriasis.

While treatment with tumor necrosis factor-α inhibitors has been found to cause weight gain among patients with psoriasis, there is little information about the effects of IL-12 and IL-17A inhibitors on weight.

To determine the effects of the biologics on weight gain, the researchers investigated changes in bodyweight and body mass index (BMI) among patients with psoriasis treated with infliximab (n=18), ustekinumab (Stelara) (n=30), and secukinumab (Cosentyx) (n=20). 

After 7 months, the mean bodyweight and BMI of patients treated with infliximab increased significantly, from 71.4 kg to 74.3 kg for bodyweight and from 24.7 to 25.7 for BMI. However, the bodyweight and BMI of those treated with ustekinumab (from 70.3 to 70.1 kg and from 25.4 to 25.3, respectively) or secukinumab (from 69.0 to 68.9 kg and from 25.2 to 25.2, respectively) did not change significantly. The proportion of patients who experienced a 75% or greater improvement on the Psoriasis Area and Severity Index did not differ between groups. 

“These results suggest that infliximab increases bodyweight in patients with psoriasis, whereas ustekinumab and secukinumab do not affect the bodyweight in these patients,” the researchers concluded. 

Reference

Takamura S, Takahashi, A, Teraki Y. Effects of tumor necrosis factor-α, interleukin-23 and interleukin-17A inhibitors on bodyweight and body mass index in patients with psoriasis [published online July 13, 2018]. J Dermatol. doi:10.1111/1346-8138.14526

Do Psoriatic Diseases Increase Death Risk?

Patients with psoriasis had a higher risk for mortality compared with the general population, according to a recent study. However, this risk was not elevated among patients with psoriatic arthritis (PsA).

The retrospective cohort study included individuals who received a diagnosis of psoriasis or PsA at a hospital in the Danish National Patient Registry and matched controls from the general population. Cause-specific mortality and risk of death were assessed as the main outcomes.

The death rates per 1000 patient-years for individuals with psoriasis were 22.29 compared with 13.89 for controls and 10.83 for individuals with PsA compared with 11.63 for controls. In the analysis that used stratified hazard ratios, survival was found to be significantly lower among individuals with psoriasis compared with controls. PsA was not associated with lower survival.

In addition, individuals with psoriasis had a significantly increased risk of death compared with controls, and this was associated with a number of causes. The highest risk for death was among individuals with diseases of the digestive system, endocrine, nutritional and metabolic diseases, and certain infections and parasitic diseases. Compared with controls, individuals with psoriasis died at younger ages (mean age 70.96 vs 74.51 years).

Among individuals with PsA, only certain infections, parasitic diseases, and diseases of the respiratory system were associated with increased mortality.

“Individuals with severe psoriasis have an increased mortality risk compared with matched controls, due to a number of causes. Evidence to support an increased risk for individuals with PsA was less convincing,” the researchers concluded. 

Reference

Skov L, Thomsen SF, Kristensen LE, Dodge R, Hedegaard MS, Kjellberg J. Cause-specific mortality in patients with psoriasis and psoriatic arthritis [published online June 27, 2018]. Bri J Dermatol. doi:10.1111/bjd.16919

Suicide Risk Among Patients with Psoriasis

Patients with psoriasis did not have an elevated risk for suicide, however psoriasis was associated with a higher prevalence of mental health comorbidities, according to the findings of a recent study.

The researchers identified 56,961 individuals with psoriasis enrolled in the Clinical Practice Research Datalink and linked the data to the Hospital Episode and Statistics and Office for National Statistics Mortality records. They matched individuals with psoriasis to 876,919 people without psoriasis based on age, gender, and general practice. Hazard ratios (HRs) were calculated to determine the risk of suicide and fatal self-harm, which were adjusted for socioeconomic status.

At baseline, individuals with psoriasis had a higher prevalence for histories of alcohol misuse, bipolar disorder, depression, anxiety, self-harm, and psychotropic drug prescription. While individuals with psoriasis had a lower risk for suicide (HR, 0.59; 95% CI, 0.41-0.85), the risk varied according to age. Those aged 40 years and older at diagnosis had a lower suicide risk (HR, 0.38; 95% CI, 0.21-0.66), while there was no difference in suicide risk among individuals diagnosed
before age 40 (HR, 0.92;  95% CI, 0.58-1.46). However, there was a small increase in the risk of self-harm among those with psoriasis (HR, 1.15, 95% CI, 1.04-1.27). 

“Healthcare professionals caring for patients with psoriasis should continue to monitor and tackle effectively the psychological needs of these individuals,” the researchers concluded. 

Reference

Parisi R, Webb RT, Kleyn CE, et al. Psychiatric morbidity and suicidal behaviour in psoriasis: a primary care cohort study [published online July 14, 2018]. Br J Dermatol. doi:10.1111/bjd.17004

Does the Mediterranean Diet Affect Psoriasis Severity?

The Mediterranean diet may help slow the progression of psoriasis, according to the findings of a recent study.

Using data from the NutriNet-Santé program, an ongoing, observational study in France, the researchers examined the effects of the Mediterranean diet on
psoriasis severity. A total of 35,735 participants who replied to the psoriasis questionnaire in the NutriNet-Santé cohort were included in the analysis.

Participants were classified based on disease severity. Dietary intake, including alcohol, was assessed during the first 2 years of participation and adherence was determined using MEDI-LITE scores, which ranged from 0 (no adherence) to 18 (maximum adherence). In addition, confounding variables, including sex, age, physical activity, body mass index, tobacco use, and history of cardiovascular disease, were collected.

Overall, 3357 (10%) participants reported having psoriasis. Severe cases were documented in 878 participants and 299 incident cases were recorded (those arising more than 2 years after participant inclusion in the cohort). 

After the researchers adjusted for confounders, they found a significant inverse relationship between MEDI-LITE scores and psoriasis severity. The odds ratio for a MEDI-LITE score in the second tertile (score of 8 to 9) was 0.71 (95% CI, 0.55-0.92) and was 0.78 (95% CI, 0.59-1.01) for the third tertile (10 to 18).

“Patients with severe psoriasis displayed low levels of adherence to the Mediterranean diet,” the researchers concluded. “This finding supports the hypothesis that the Mediterranean diet may slow the progression of psoriasis. If these findings are confirmed, adherence to a Mediterranean diet should be integrated into the routine management of moderate to severe psoriasis.” 

Reference

Phan C, Touvier M, Kesse-Guyot E, et al. Association between Mediterranean anti-inflammatory dietary profile and severity of psoriasis: results from the NutriNet-Santé cohort [Published online July 25, 2018]. JAMA Dermatol. doi:10.1001/jamadermatol.2018