Greater Work Impairment, Comorbidity Burden Linked With Concomitant Psoriasis, PsA

According to findings presented at the 2021 American College of Rheumatology (ACR) Annual Meeting, concomitant diagnosis of psoriasis and psoriatic arthritis (PsA) may lead to greater comorbidity burden and work impairment than psoriasis alone.

Affecting more than 7.5 million US adults, psoriasis has been linked with incidence of PsA development. Prior research has suggested approximately one-third of patients with psoriasis will develop PsA during the course of their disease, which may pose added health risks and greater health care utilization concerns.

Seeking to evaluate baseline characteristics and comorbidities in patients with psoriasis with and without a PsA diagnosis, researchers conducted a retrospective observational study using data of the British Association of Dermatologists Biologic and Immunomodulators Register (BADBIR).

“As patient cohorts included in randomized clinical trials are not necessarily representative of the real world, registry data can complement information gained on patient characteristics and disease outcomes,” they explained.

In the study, patients were stratified and compared on whether they had psoriasis alone or concomitant psoriasis and PsA, as well as whether they used ustekinumab as their biologic treatment or received conventional systemic antipsoriatic medication:

• Patients with only psoriasis on ustekinumab (n = 2697)
• Patients with psoriasis and PsA on ustekinumab (n = 590)
• Patients with only psoriasis on conventional systemic (n = 5105)
• Patients with psoriasis and PsA on conventional systemic (n = 529)

Participants were evaluated at baseline for several characteristics, including body mass index, smoking, employment status, and comorbidities such as diabetes, hypertension, myocardial infarction, and depression.

Compared with patients with just psoriasis, those with concomitant psoriasis and PsA were found to be 73% less likely to report ability to work when administered ustekinumab treatment (odds ratio [OR], 0.27; 95% CI, 0.21-0.35) and 51% less likely when given conventional systemic (OR, 0.49; 95% CI, 0.37-0.65).

Moreover, patients with concomitant psoriasis and PsA across both treatment types were found to be at significantly greater risk of reporting diabetes (ustekinumab: OR, 1.45; 95% CI, 1.10-1.89; conventional systemic treatment: OR, 1.51; 95% CI, 1.11-2.04), obesity (ustekinumab: OR, 1.34; 95% CI, 1.11-1.62; conventional systemic treatment: OR, 1.21; 95% CI, 1.01-1.46), and hypertension (ustekinumab: OR, 1.54; 95% CI, 1.26-1.87; conventional systemic treatment: OR, 1.30; 95% CI, 1.03-1.62) compared with those with only psoriasis.

Patients with psoriasis and comorbid PsA receiving ustekinumab were also more likely to have a diagnosis of depression than those receiving conventional systemic treatment in comparisons with those with only psoriasis (ustekinumab: OR, 1.54; 95% CI, 1.25-1.88; conventional systemic treatment: OR, 1.14; 95% CI, 0.91-1.42)

“These results potentially indicate a higher inflammatory and quality-of-life burden in patients with psoriasis and comorbid PsA, highlighting the need for adequate patient assessment and follow-up to ensure a best possible holistic patient management approach,” concluded the study authors.

Reference

Tillett W, Ogdie A, Gorecki P, Passey A. Differences in real-world patient characteristics of 8921 patients with psoriasis with and without comorbid psoriatic arthritis using the UK BADBIR database. Presented at: ACR Convergence 2021; Virtual. Abstract 1354. https://bit.ly/3DAnH9P