Alcohol misuse is associated with poor response to systemic therapies for psoriasis: findings from a prospective multicentre cohort study*

Iskandar, Ireny; Thorneloe, Rachael; Cordingley, Lis; Griffiths, C.E.M.; Ashcroft, Darren M.

doi:10.1111/bjd.20577

Cited by 13 publications

(11 citation statements)

References 36 publications

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“…Previous reviews have identified scant evidence for the impact of alcohol on treatments for psoriasis but recently published registry data clearly associates alcohol misuse with poor response to systemic treatments. Among 266 patients on biologic and systemic treatments, 5.6% reported alcohol misuse with a Cut down, Annoyed, Guilty, Eye-opener (CAGE) score of ≥ 2 [ 9 ]. A higher CAGE score was associated with reduced response to treatment (regression coefficient 1.4).…”

Section: Excess Alcohol Consumption Reduces Treatment Efficacymentioning

confidence: 99%

“…A further study using CAGE identified a 30% prevalence of problem drinking in a psoriasis clinic [ 14 ]. In the most up-to-date publication from the British Association of Dermatologists Biologic Interventions Register (BADBIR) this was lower, with just 5.6% of patients reporting alcohol misuse using CAGE [ 9 ]. There are a number of possible explanations for this lower rate, including reducing alcohol consumption over the last 10–15 years in the United Kingdom (UK) [ 52 ].…”

Section: Screening and Interventions For The Dermatologistmentioning

confidence: 99%

“…There are a number of possible explanations for this lower rate, including reducing alcohol consumption over the last 10–15 years in the United Kingdom (UK) [ 52 ]. Patients enrolled in BADBIR are on a conventional systemic or biologic treatment for their psoriasis, reducing their burden of disease [ 9 ]. The patients in BADBIR also report a lower frequency of depression and anxiety using the Hospital Anxiety and Depression Scale (HADS) when compared with the study from Kirby et al [ 9 , 14 ].…”

Section: Screening and Interventions For The Dermatologistmentioning

confidence: 99%

“…Patients enrolled in BADBIR are on a conventional systemic or biologic treatment for their psoriasis, reducing their burden of disease [ 9 ]. The patients in BADBIR also report a lower frequency of depression and anxiety using the Hospital Anxiety and Depression Scale (HADS) when compared with the study from Kirby et al [ 9 , 14 ].…”

Section: Screening and Interventions For The Dermatologistmentioning

confidence: 99%

“…Alcohol can contribute to excess mortality in psoriasis and the many comorbidities experienced by our patients including psoriatic arthritis, cardiovascular disease, malignancies and liver disease [4][5][6][7][8]. Emerging evidence from long-term registry data suggests the impact of alcohol on treatment efficacy [9]. There are multiple screening questionnaires taking seconds to minutes to complete that are suitable for use in the dermatology clinic, with guidelines on brief intervention or referral to specialist services for patients in whom problem alcohol use is identified [10][11][12][13].…”

Section: Introductionmentioning

confidence: 99%

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Alcohol and Psoriasis for the Dermatologist: Know, Screen, Intervene

Kearney

Kirby

2022

Am J Clin Dermatol

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Psoriasis patients are at increased risk of harmful alcohol use and alcohol dependency with many deleterious effects. Increasing alcohol use is associated with worsening psoriasis severity, is a risk factor for poor response to systemic treatments and may impact on comorbidities such as psoriatic arthritis, cardiovascular disease, cancer and liver disease. Harmful alcohol use and alcohol dependency can be defined by the updated ICD-11 coding system and screening can be completed using many tools including the Cut down, Annoyed, Guilty, Eye-Opener (CAGE), Alcohol Use Disorders Identification Test (AUDIT) and Michigan Alcohol Screening Test (MAST) questionnaires. Dermatologists may be able to complete brief interventions encouraging alcohol reduction in psoriasis patients. Psoriasis patients may respond to messages of gain with reduced psoriasis severity and loss with reduced cardiovascular risk. It is important for dermatologists to discuss alcohol with all psoriasis patients, to be aware of the impact of alcohol in psoriasis and to familiarise themselves with screening tools, brief intervention and local services available to patients who require specialist input for harmful alcohol use or alcohol dependency.

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Section: Excess Alcohol Consumption Reduces Treatment Efficacymentioning

confidence: 99%

Section: Screening and Interventions For The Dermatologistmentioning

confidence: 99%

Section: Screening and Interventions For The Dermatologistmentioning

confidence: 99%

Section: Screening and Interventions For The Dermatologistmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Alcohol and Psoriasis for the Dermatologist: Know, Screen, Intervene

Kearney

Kirby

2022

Am J Clin Dermatol

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Prevalence of multiple long‐term conditions with psoriasis in England: A cohort study using the Clinical Practice Research Datalink

Payne,

Ciamponi,

Allen

et al. 2023

JEADV Clinical Practice

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BackgroundPeople with psoriasis live with other long‐term conditions (co‐morbidities) that affect their use of healthcare, but the scale of this is not well characterised.ObjectiveEstimate the concurrent prevalence of co‐morbidities known to affect the use of healthcare in people living with psoriasis in England.MethodsA retrospective cohort study using linked data from the UK's Clinical Practice Research Datalink with Hospital Episode Statistics, Office for National Statistics mortality records, and Index of Multiple Deprivation 2010. A cohort of adults (≥18 years) with psoriasis was matched with a comparator cohort of individuals based on age, sex and registered general practice between April 2007 and December 2017. A predefined list of 21 co‐morbidities was selected from a published measure: the Cambridge Multimorbidity Index (CMI). Descriptive analysis describes prevalence with statistical tests (t tests; two‐sample proportions test) of difference for selected variables.ResultsThe study cohort comprised 372,949 individuals (54,817 psoriasis; and 318,132 matched‐comparator). The calculated CMI general score was statistically higher at 0.54 (standard deviation: 0.9) for psoriasis compared with 0.39 (standard deviation: 0.75) for the matched comparator (t test; p < 0.001). A higher percentage (53.2%) of individuals within the psoriasis cohort had at least one co‐morbidity compared with 45.4% of individuals in the matched‐comparator cohort. The prevalence of 20 individual co‐morbidities was statistically significantly (two‐sample proportions test; p < 0.001) higher than in the matched‐comparator cohort.ConclusionsIndividuals living with psoriasis are more likely to live with multiple long‐term conditions that have developed at an earlier age compared with those without psoriasis. Knowing the characteristics for a higher prevalence of co‐morbidities in people living with psoriasis provides clinicians with the motivation to consider more holistic approaches to improve management and treatment, noting the importance of mental health alongside physical health, and enabling a conversation about the importance of making lifestyle changes.

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Efficacy of Brodalumab in Patients with Psoriasis and Risk Factors for Treatment Failure: A Review of Post Hoc Analyses

Lebwohl,

Armstrong,

Alexis

et al. 2024

Dermatol Ther (Heidelb)

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Factors such as obesity, alcohol consumption, and tobacco use are associated with both increased psoriasis severity and inadequate response to systemic and biologic therapies. Obesity is linked to chronic inflammation, which can contribute to psoriasis pathogenesis. Fixed-dose therapies may have reduced efficacy in patients with a higher body mass index, while weight-based dosing can increase the burden of drug-specific side effects. Alcohol and nicotine from tobacco have also been shown to stimulate keratinocyte and immune cell proliferation and production of proinflammatory cytokines. While these risk factors are prevalent among patients with moderate-to-severe psoriasis, their influence on treatment outcomes may be overlooked when evaluating therapeutic options. Brodalumab is a fully human interleukin-17 receptor A antagonist approved for the treatment of moderate-to-severe psoriasis. In this review, we describe the lifestyle-related risk factors associated with decreased response to treatment. We further summarize the post hoc analyses of brodalumab in participant subgroups with moderate-to-severe psoriasis and a history of prior biologic failure, obesity, and alcohol or tobacco use from two phase 3 clinical trials (AMAGINE-2 and AMAGINE-3; ClinicalTrials.gov identifiers: NCT01708603 and NCT01708629, respectively). Our review of clinical trial and real-world data suggests that brodalumab is an efficacious and safe treatment option for patients with lifestyle factors that increase the likelihood of treatment failure, allowing them to achieve skin clearance and improve quality of life.

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Alcohol misuse is associated with poor response to systemic therapies for psoriasis: findings from a prospective multicentre cohort study*

Cited by 13 publications

References 36 publications

Alcohol and Psoriasis for the Dermatologist: Know, Screen, Intervene

Alcohol and Psoriasis for the Dermatologist: Know, Screen, Intervene

Prevalence of multiple long‐term conditions with psoriasis in England: A cohort study using the Clinical Practice Research Datalink

Efficacy of Brodalumab in Patients with Psoriasis and Risk Factors for Treatment Failure: A Review of Post Hoc Analyses

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