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Patients with severe psoriasis at risk for advanced liver fibrosis

Patients with central obesity, insulin resistance and active psoriasis are at high risk for liver fibrosis, according to researchers from King’s College London.

Adult patients were recruited from the Comorbidities in Severe Psoriasis (CORE) study during dermatology outpatient visits at Guy’s and St. Thomas’ Hospital. Of the 400 recruited patients with severe psoriasis, 333 patients had usable transient elastography results and were included in the final analysis.

One hundred thirty-five patients (37%) were deemed overweight with a BMI of 25 kg/m² to 30 kg/m², and 135 patients were obese with a BMI higher than 30 kg/m².

Fifty-three percent of patients were insulin resistant, 22% had type 2 diabetes, and 50% had nonalcoholic fatty liver disease (NAFLD).

Out of 377 patients, 251 (66.6%), were being treated with a biologic. Adalimumab (Humira, AbbVie) was used in 107 patients (28%), etanercept (Enbrel, Amgen) in 77 patients (20%), infliximab (Remicade, Janssen) in 14 patients (4%), ustekinumab (Stelara, Janssen) in 52 patients (14%) and secukinumab (Cosentyx, Novartis) in one patient (0.27%). Eighty-five patients (21%) were treated with methotrexate.

The researchers identified advanced fibrosis in 47 of 333 patients (14.1%; 95% CI, 10.4-17.9). A significant association was found between advanced fibrosis and age, severity of psoriasis, psoriatic arthritis, BMI, waist circumference, metabolic syndrome, physical activity score, NAFLD, fasting glucose level, insulin resistance and triglyceride, high-density lipoprotein, cholesterol, alanine aminotransferase, aspartate aminotransferase, alkaline phosphatase and y-glutamyl transferase levels, according to the study.

The strongest thresholds to detect advanced fibrosis were female waist measurement of 109 cm or higher, male waist measurement of 111 cm or higher, Homeostasis Model Assessment of Insulin Resistance (HOMA-IR) score and aspartate aminotransferase level.

Any level of liver fibrosis was detected in 68 participants (20.4%; 95% CI; 16.1-24.8).

The demographics in the cohort were comparable with those of a reference population from the Biomarkers of Systemic Treatment Outcomes in Psoriasis database and with phase 3 trial populations in North America and Europe, meaning the study findings are generalizable.

“It remains uncertain whether methotrexate contributes to advanced liver fibrosis in psoriasis, and if so, to what degree it contributes,” study author Catriona M. Maybury, MRCP(Derm), and colleagues wrote. “Longitudinal work to characterize the hepatic sequalae of central obesity, insulin resistance and inflammation as well as the influence of systemic drugs (methotrexate and biologics) will inform future personalized therapeutic decision-making.” – by Abigail Sutton

Disclosures: Maybury reports receiving grants from the National Institute for Health Research and Siemens during the conduct of the study. Please see the study for all other authors’ relevant financial disclosures.