Psoriasis: Alcohol Abuse and Obesity Are Risk Factors for Poor Response to Systemic Therapies

Pavankumar Kamat


June 28, 2021


Why this matters

  • Interventions to prevent or address alcohol abuse and weight gain should be an integral part of psoriasis health management.

Study design

  • A prospective cohort study of 266 patients with psoriasis (age, ≥18 years; biologic cohort, n=134; conventional systemic cohort, n=132) who participated in the Investigating Medication Adherence in Psoriasis (iMAP) study

  • Patients’ response to systemic therapies was assessed using the Psoriasis Area and Severity Index (PASI) score.

  • Alcohol abuse was assessed using the Cut down, Annoyed, Guilty, Eye opener (CAGE) score questionnaire.

  • Funding: None.

Key results

  • The median PASI score improved from 13 (interquartile range [IQR], 10-18.3) at baseline to 3 (IQR, 1-7.5) during follow-up.

  • Poor response to systemic therapies was significantly associated with (Β coefficient; 95% CI):

    • higher CAGE score (for every 1 point increase in the CAGE score; 1.40; 0.04-2.77; P=.044);

    • obesity (1.84; 0.48-3.20; P=.008);

    • conventional systemic therapy vs biologic therapy (4.39; 2.84-5.95; P<.0001); and

    • stopping the therapy during follow-up (4.18; 2.38-5.97; P<.0001).

  • Higher baseline PASI score was significantly associated with a better response to treatment (every 1 point increase in the baseline PASI score; Β coefficient, −0.83; 95% CI, −0.92 to −0.74; P<.0001).


  • Lack of randomisation could lead to confounding bias.

  • The effect of increasing the treatment dose on the PASI response was not evaluated.


Iskandar IYK, Lunt M, Thorneloe RJ, Cordingley L, Griffiths CEM, Ashcroft DM. Alcohol abuse associated with poor response to systemic therapies for psoriasis: findings from a prospective multicentre cohort study. Br J Dermatol. 2021 Jun 14 [Epub ahead of print]. doi: 10.1111/bjd.20577. PMID: 34128222.  View abstract 

This clinical summary originally appeared on Univadis, part of the Medscape Professional Network.


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