August 31, 2017
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Psoriasis severity may predict mortality

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Individuals with psoriasis on more than 10% of their body surface area were at a significantly increased risk for mortality, according to recent findings.

Data for the prospective, population-based, cohort study were culled from The Health

Improvement Network database in the U.K. The investigators followed 8,760 individuals with psoriasis and 87,600 individuals without psoriasis.

Participating physicians were asked to confirm a diagnosis of psoriasis and to classify the severity of disease. Mortality was the primary outcome measure.

Results showed 125 deaths in the psoriasis group, for a rate of 3.35 fatalities per 1,000 person-years (95% CI, 2.81-3.99). For the nonpsoriasis group, 1,188 deaths were reported, for a mortality rate of 3.24 per 1,000 person-years (95% CI, 3.06-3.43).

There were 58 fatalities among patients with less than 3% body surface area (BSA) of psoriasis, 38 fatalities among these with 3% to 10% BSA psoriasis, and 29 fatalities among patients with more than 10% BSA psoriasis.

Multivariate analysis results indicated that only patients with psoriasis on more than 10% of their BSA had a significant increase in mortality risk (HR = 2.12; 95% CI, 1.46-3.07). This trend persisted in a further analysis that adjusted for Charlson comorbidity index, in which the mortality risk increased among patients with BSA more than 10% (HR = 1.79; 95% CI, 1.23-2.59). The risk remained after adjusting for BMI, alcohol and tobacco use, and treatment with systemic therapy.

The researchers suggested that there is one excess death for every 390 individuals with psoriasis who have annual BSA more than 10%.

Joel M. Gelfand, MD, MSCE, director of the Psoriasis and Phototherapy Treatment Center, vice chair of Clinical Research, medical director of the Dermatology Clinical Studies Unit, professor of dermatology and professor of epidemiology in biostatistics and epidemiology at the University of Pennsylvania, put the findings into context in an interview with Healio Dermatology.

“A simple measure of body surface area affected by psoriasis is a strong predictor of death independent of standard risk factors for mortality,” he said. “Clinicians should routinely assess body surface area affected by psoriasis. Patients with 10% or more BSA affected are at increased risk for death and should be targeted for preventive health intervention.” – by Rob Volansky

Disclosure: Gelfand reports serving as a consultant for Coherus (DSMB), Dermira, Dr Reddy’s labs, Janssen Biologics, Merck (DSMB), Novartis Corp, Pfizer Inc., Regeneron and Sanofi; receiving honoraria; receiving research grants (to the Trustees of the University of Pennsylvania) from Abbvie, Celgene, Janssen, Novartis Corp, Pfizer Inc., Regeneron and Sanofi; receiving payment for continuing medical education work related to psoriasis that was supported indirectly by Abbvie and Lilly; and being a co-patent holder of resiquimod for treatment of cutaneous T cell lymphoma.

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