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AAD game-changer of the year: Systemic treatment of psoriasis reduces all-cause mortality


Photo by: James Heilman, MD, via Wikimedia Commons

At the American Academy of Dermatology (AAD) annual meeting in New Orleans, research findings that showed systemic treatment of psoriasis reduced overall mortality risk were recognized by the AAD as the “Game Changer” of the year—work that will have a profound impact on the future of dermatology.


Originally published in the Journal of the American Academy of Dermatology in 2021 (Jan. 2021; 84(1):60-69), the findings came from the Psoriasis Longitudinal Assessment and Registry (PSOLAR) study.


PSOLAR is an international, prospective, longitudinal registry of patients with psoriasis being treated with systemic therapies. The registry evaluates patient and disease characteristics, including patient-reported assessment of psoriatic arthritis (PsA); and clinical and quality of life outcomes.


Launched in 2007, PSOLAR gathered data on roughly 12,000 patients initially, and there are plans to recruit approximately 3,500 more, said Dr. Richard Langley.


Dr. Langley is a dermatologist and professor of medicine in the Division of Clinical Dermatology and Cutaneous Science at Dalhousie University in Halifax.


He co-authored the paper recognized by the AAD with his colleagues Drs. Yves Poulin (Québec), Bhaskar Srivastava (Cambridge, Mass.), Kimberly Parnell Lafferty (Doylestown, Pa.), Steven Fakharzadeh (Philadelphia), Wayne Langholff (Edison, N.J.), and Matthias Augustin (Hamburg).


In the analysis, the investigators found that in patients with moderate to severe psoriasis, short and long-term treatments with biologics were associated with lower risks of all-cause and cardiovascular mortality compared to patients with no exposure to biologics.


This reduced risk was seen both when they looked at pooled data from all biologic therapies and for sub-analyses considering TNF inhibitors and ustekinumab separately.


Apart from biologics, long-term (but not short-term) treatment with methotrexate was associated with a lower risk of mortality compared to no exposure to methotrexate.


“We have shown that long-term treatment can reduce inflammation and can reduce mortality rates. So [physicians treating psoriasis] have not only improved quality of life but have improved quantity of life,” Dr. Langley said.


He said that the findings emphasize “the importance of early treatment of these patients not only to improve their quality of life but to reduce the cumulative life impact that psoriasis can have. Many patients who develop psoriasis and do not get treated may choose not to get married. Psoriasis can impact how patients choose the jobs they have. We have children who are teased in school and will not go swimming in pools.”


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