A study in the British Journal of Dermatology appears to show that alcohol misuse can be associated with poor response to systemic therapies in psoriasis patients. In addition to BMI, assessment of a patient’s alcohol use could be relevant in determining response to treatment for moderate-to-severe psoriasis. This report is the first investigation of the impact of alcohol on treatment response in psoriasis.
The study included 266 patients who were either receiving a biologic therapy (134 patients) or conventional systemic therapy (132 patients). Response to all therapies was assessed using the Psoriasis Area and Severity Index (PASI). The authors implemented the CAGE (Cut down, Annoyed, Guilty, Eye opener) questionnaire to screen for alcohol misuse.
For all patients, the authors report that the median PASI improved to 3 (1.0-7.5) during follow-up from 13 (10.0–18.3) at baseline. A higher CAGE score [regression coefficient: 1.40, 95% confidence interval (CI) 0.04–2.77]; obesity (1.84, 95% CI 0.48–3.20); and receiving a conventional systemic rather than a biologic therapy (4.9, 95% CI 2.84–5.95) were significantly associated with poor response to treatment. The researchers note that a higher baseline PASI (–0.83, 95% CI –0.92 to –0.74) was associated with improved response to therapy.
The authors conclude that “psychological and social difficulties in combination with the physical discomfort associated with psoriasis may contribute to psychological distress (anxiety and depression) and alcohol misuse.”
“Poor response to therapy associated with alcohol misuse 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 misuse among people with psoriasis is needed to minimize adverse health consequences and improve treatment response.”