Study: Alcohol Abuse Associated With Poor Therapeutic Response in Psoriasis

Patients who abuse alcohol are more likely to have a poor response to psoriasis therapy, according to a new study. The report suggests that lifestyle intervention may be an important part of treatment for some patients with psoriasis.

Writing in the British Journal of Dermatology, the authors explained that psoriasis causes a number of direct and indirect consequences in patients. In addition to the physical discomfort, patients can suffer psychological and social difficulties, which the authors said can contribute to anxiety and depression, and sometimes alcohol abuse.

Patients who are overweight are known to have a poor response to psoriasis therapy, but the investigators said other potential factors are less well understood. They said before their current study, there were no known studies looking at the role of alcohol abuse in treatment response.

The study cohort of 266 patients was recruited from 35 dermatology center across England. About half of whom were prescribed a biologic (n = 134) and the remainder were taking a conventional systemic therapy (n = 132). They authors used the Psoriasis Area and Severity Index (PASI) to assess baseline psoriasis status and response to therapy, as well as the Cut down, Annoyed, Guilty, and Eye-opener (CAGE) questionnaire to screen patients for alcohol abuse. The results of the 2 assessments were then compared to determine the effect, if any, of alcohol abuse on treatment success.

“Our results demonstrate that alcohol abuse is associated with poor response to treatment,” the authors wrote.

Specifically, the investigators found that a higher CAGE score, a proxy for alcohol abuse, predicted a poor response to treatment (regression coefficient, 1.40; 95% CI, 0.04-2.77). Obesity (regression coefficient, 1.84; 95% CI, 0.48-3.20) and taking a systemic therapy (regression coefficient, 4.39; 95% CI, 2.84-5.95) were also associated with poor response. Having a higher baseline PASI was associated with a better treatment response (regression coefficient, –0.83; 95% CI, –0.92 to –0.74). Overall, the median PASI score fell from 13 to 3 over the course of the study, which had a median follow-up of 7 months.

The investigators said they would like to see if their findings can be replicated independently in a larger study, but that they still offer considerable insights for clinicians.

“The economic, social, and health consequences of alcohol abuse are considerable,” they said. “Excessive alcohol may worsen the disease, has implications for treatment, and increases the risk of dying in people with psoriasis, on average 3 years younger, compared with peers of the same age and sex in the general population.”

Clinicians should discuss alcohol use with their patients, they added, as well as the negative implications of alcohol abuse with regard to psoriasis treatment. Also, physicians should also be on the lookout for medication nonadherence.

“More than 15% of patients in this study were classified as nonadherent,” they wrote, citing concerns about adverse events as a key factor driving nonadherence.

Interventions such as brief messages and reminders can help keep patients on course, they added. The good news, they concluded, is that factors like alcohol abuse and obesity can be modified.

“Routine screening and identification, using simple screening tools, can be used to detect early signs of hazardous, harmful, and dependent alcohol consumption, which could be implemented in health care settings to detect alcohol abuse among people with psoriasis,” they wrote.

Reference

Iskandar IYK, Lunt M, Thorneloe RJ, Cordingley L, Griffiths CEM, Ashcroft DM. Alcohol abuse associated with poor response to systemic therapies for psoriasis: findings from a prospective multicentre cohort study. Br J Dermatol. Published online June 14, 2021. doi:10.1111/bjd.20577