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Maybury CM, Porter HF, Kloczko E, et al. Prevalence of Advanced Liver Fibrosis in Patients With Severe Psoriasis. JAMA Dermatol. 2019;155(9):1028–1032. doi:https://doi.org/10.1001/jamadermatol.2019.0721
Which clinical factors are associated with advanced liver fibrosis in severe psoriasis?
In a cohort study of 333 patients with severe psoriasis, results of cross-sectional analysis indicated that 14.1% (47 patients) of the cohort had advanced liver fibrosis. Clinical factors significantly associated with advanced fibrosis were increased central obesity, insulin resistance, and severity of psoriasis disease.
This study suggests that people with severe psoriasis should be screened for advanced liver fibrosis irrespective of which systemic medication they are receiving; obesity and insulin resistance should be proactively managed to prevent the potential poor prognosis associated with advanced liver fibrosis in this population.
Advanced liver fibrosis is a precursor to cirrhosis, a leading cause of mortality. People with severe psoriasis are at risk for liver disease, but our understanding of advanced fibrosis in individuals with psoriasis is limited.
To describe the prevalence of and evaluate the clinical factors associated with advanced liver fibrosis in people with severe psoriasis.
Design, Setting, and Participants
The Co-morbidities in Severe Psoriasis study, a prospective observational cohort study in a large center serving London and Southeast England, was conducted from October 18, 2012, to April 2, 2015; 400 adults with severe psoriasis (Psoriasis Area Severity Index score, ≥10) were recruited from outpatient clinics. Statistical analysis was conducted from October 2, 2016, to March 3, 2017.
Main Outcomes and Measures
The primary outcome was a diagnosis of advanced liver fibrosis determined by transient elastography, a noninvasive criterion standard test. Clinical factors evaluated included psoriasis-specific and metabolic indices, alcohol use, and methotrexate exposure.
Of 400 patients recruited (108 women and 289 men; mean [SD] age, 49.5  years), 333 had a successful transient elastography scan and were included in final analysis. Forty-seven patients (14.1%; 95% CI, 10.4%-17.9%) had advanced liver fibrosis as diagnosed by transient elastography. The clinical factors that produced the best-fit model for advanced fibrosis were central obesity (waist circumference), insulin resistance, aspartate aminotransferase level, platelet count, psoriasis disease severity, and reduced alcohol use (R2 = 0.54).
Conclusions and Relevance
Findings from this study suggest that advanced fibrosis is common in severe psoriasis. Abdominal obesity (by waist circumference) and insulin resistance were associated with the presence of advanced fibrosis. Longitudinal work to characterize the hepatic sequelae 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.
ClinicalTrials.gov identifier: NCT02174367
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