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Considering absolute risk in patients with psoriasis may help patient management

Considering absolute risk for comorbidities in patients with psoriasis, using numbers needed to harm, may improve patient management when compared with considering relative risks, according to study results recently published in the Journal of the American Academy of Dermatology.

Researchers at Wake Forest School of Medicine, Winston-Salem, North Carolina, conducted a systematic review of patients with psoriasis, excluding those solely focused on psoriatic arthritis, by using Medline. They identified comorbidities associated with psoriasis, relative risks and information for calculating absolute risks were identified.

There were 33 studies that met initial inclusion data from 490 studies screened. Of the 33 studies, 10 were initially deemed eligible for the study.

Nonmelanoma skin cancer was the comorbidity with the highest relative risk (RR = 7.5; 95% CI, 5.07-11.1), followed by melanoma (RR = 6.12; 95% CI, 1.53-24.47) and lymphoma (RR = 3.61; 95% CI, 1.81-7.22).

“The number of patients required to attribute one of these events to psoriasis were 1,551; 20,135; and 5,823, respectively,” the researchers wrote.

The three conditions had attributable risks of 0.64, 0.05 and 0.17 per 1,000 person-years, respectively.

“As our understanding of the comorbidities of psoriasis grows, we are seeing numerous recommendations for screening for comorbidities of psoriatic patients,” the researchers concluded. “To understand whether screening and intervention should be done requires more than just knowing there is a relative risk and more than knowledge that a treatment can reduce the risk. Costs and benefits need to be fully considered, including how big a problem the comorbidity is on an absolute basis, not just on a relative basis.” – by Bruce Thiel

Disclosure: Saleem reports no relevant financial disclosures. Please see the full study for a list of other researchers’ relevant financial disclosures.