Alcohol abuse associated with poor response to systemic therapies for psoriasis: findings from a prospective multicentre cohort study

Background Factors that might influence response to systemic treatment for moderate-to-severe psoriasis are varied, and generally, are poorly understood, aside from high body weight, suggesting that other unidentified factors may be relevant in determining response to treatment. The impact of alcohol abuse on treatment response has not been previously investigated. Objective To investigate whether alcohol abuse is associated with poor response to treatment for psoriasis. Methods Prospective cohort study in which response to systemic therapies was assessed using the Psoriasis Area and Severity Index (PASI). The CAGE questionnaire was used to screen for alcohol abuse. A multivariable factional polynomial linear regression model was used to examine factors associated with change in PASI between baseline and follow-up. Results The cohort comprised of 266 patients (biologic cohort, n=134; conventional systemic cohort, n=132). For the entire cohort, the median (interquartile range) PASI improved from 13[10-18.3] at baseline to 3[1-7.5] during follow-up. A higher CAGE score (regression co-efficient: 1.40; 95% CIs: 0.04-2.77); obesity (1.84; 0.48-3.20); and receiving a conventional systemic rather than a biologic therapy (4.39; 2.84-5.95) were significantly associated with poor response to treatment; whereas a higher baseline PASI (-0.83; -0.92,-0.74) was associated with better response to treatment. Conclusion The poor response to therapy associated with alcohol abuse 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 abuse among people with psoriasis is needed to minimise adverse health consequences and improve treatment response.