Abstract
Importance: Conventional systemic and biologic therapies are used for the management of moderate-to-severe psoriasis; however, many patients do not respond to or lose response to these treatments.
Objectives: To investigate whether current or past alcohol overuse influences response to systemic therapies taking into account medication non-adherence, psychological, demographic, social, and clinical factors.
Design, Setting and Participants: A prospective cohort study of patients with psoriasis aged ≥18 years old, attending 35 dermatology clinics across England and enrolled in the British Association of Dermatologists Biologics and Immunomodulators Register were recruited into the iMAP (Investigating Medication Adherence in Psoriasis) study which collected biomedical and psychological data from patients with psoriasis.
Exposures: Treatment with conventional systemic (acitretin, ciclosporin, fumaric acid esters or methotrexate) or biologic therapies (adalimumab, etanercept, golimumab, infliximab, secukinumab, or ustekinumab).
Main Outcomes and Measures: Response to systemic therapies was assessed using change in Psoriasis Area and Severity Index (PASI). A multivariable factional polynomial linear regression model was developed to identify factors associated with change in PASI between baseline and follow-up.
Results: The cohort comprised of 266 patients with psoriasis (biologic cohort, n=134; conventional systemic cohort, n=132). In total, 16.6% of the study cohort were classified as non-adherent, with a higher proportion of patients using conventional systemic therapies classified as non-adherent (27.6%) compared to those using biologic therapies (5.9%). For the entire cohort, the median (interquartile range) PASI improved from 13 [10-18.3] at baseline to 3 [1-7.5] during follow-up. Obesity (regression co-efficient: 1.84; 95% CIs: 0.48-3.20), a higher alcohol overuse screening score (CAGE: Cut-down, Annoyed, Guilty and Eye-opener; 1.40; 0.04-2.77), and receiving a conventional systemic therapy (4.39; 2.84-5.95) were significantly associated with poor response to treatment as measured by change in PASI; whereas a higher baseline PASI (-0.83; -0.92,-0.74) was associated with good response to treatment.
Conclusions and Relevance: The poor response to therapy associated with alcohol overuse and obesity found in people with psoriasis calls for lifestyle behaviour change interventions and support as part of routine clinical care. Targeting interventions to prevent, detect and manage alcohol consumption and misuse among people with psoriasis is needed to minimise adverse health consequences and improve treatment response without increasing stigma.
Objectives: To investigate whether current or past alcohol overuse influences response to systemic therapies taking into account medication non-adherence, psychological, demographic, social, and clinical factors.
Design, Setting and Participants: A prospective cohort study of patients with psoriasis aged ≥18 years old, attending 35 dermatology clinics across England and enrolled in the British Association of Dermatologists Biologics and Immunomodulators Register were recruited into the iMAP (Investigating Medication Adherence in Psoriasis) study which collected biomedical and psychological data from patients with psoriasis.
Exposures: Treatment with conventional systemic (acitretin, ciclosporin, fumaric acid esters or methotrexate) or biologic therapies (adalimumab, etanercept, golimumab, infliximab, secukinumab, or ustekinumab).
Main Outcomes and Measures: Response to systemic therapies was assessed using change in Psoriasis Area and Severity Index (PASI). A multivariable factional polynomial linear regression model was developed to identify factors associated with change in PASI between baseline and follow-up.
Results: The cohort comprised of 266 patients with psoriasis (biologic cohort, n=134; conventional systemic cohort, n=132). In total, 16.6% of the study cohort were classified as non-adherent, with a higher proportion of patients using conventional systemic therapies classified as non-adherent (27.6%) compared to those using biologic therapies (5.9%). For the entire cohort, the median (interquartile range) PASI improved from 13 [10-18.3] at baseline to 3 [1-7.5] during follow-up. Obesity (regression co-efficient: 1.84; 95% CIs: 0.48-3.20), a higher alcohol overuse screening score (CAGE: Cut-down, Annoyed, Guilty and Eye-opener; 1.40; 0.04-2.77), and receiving a conventional systemic therapy (4.39; 2.84-5.95) were significantly associated with poor response to treatment as measured by change in PASI; whereas a higher baseline PASI (-0.83; -0.92,-0.74) was associated with good response to treatment.
Conclusions and Relevance: The poor response to therapy associated with alcohol overuse and obesity found in people with psoriasis calls for lifestyle behaviour change interventions and support as part of routine clinical care. Targeting interventions to prevent, detect and manage alcohol consumption and misuse among people with psoriasis is needed to minimise adverse health consequences and improve treatment response without increasing stigma.
| Original language | English |
|---|---|
| Journal | JAMA dermatology |
| Publication status | Submitted - Oct 2019 |