Prevalence of Advanced Liver Fibrosis in Patients With Severe Psoriasis

Catriona M Maybury; Heather F Porter; Ewa Kloczko; Michael Duckworth; Alice Cotton; Kate Thornberry; Tracy Dew; Martin Crook; Sarah Natas; Rosa Miquel; Cathryn M Lewis; Terry Wong; Catherine H Smith; Jonathan N Barker

doi:10.1001/jamadermatol.2019.0721

Prevalence of Advanced Liver Fibrosis in Patients With Severe Psoriasis

Catriona M Maybury, Heather F Porter, Ewa Kloczko, Michael Duckworth, Alice Cotton, Kate Thornberry, Tracy Dew, Martin Crook, Sarah Natas, Rosa Miquel, Cathryn M Lewis, Terry Wong, Catherine H Smith, Jonathan N Barker

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Abstract

Importance: 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. Objectives: 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. Results: Of 400 patients recruited (108 women and 289 men; mean [SD] age, 49.5 [13] 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 (R ² = 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.

Original language	English
Pages (from-to)	1028-1032
Number of pages	5
Journal	JAMA dermatology
Volume	155
Issue number	9
Early online date	5 Jun 2019
DOIs	https://doi.org/10.1001/jamadermatol.2019.0721
Publication status	Published - 1 Sept 2019

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10.1001/jamadermatol.2019.0721

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6552112/

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title = "Prevalence of Advanced Liver Fibrosis in Patients With Severe Psoriasis",

abstract = "Importance: 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. Objectives: 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. Results: Of 400 patients recruited (108 women and 289 men; mean [SD] age, 49.5 [13] 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 (R 2 = 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. ",

author = "Maybury, {Catriona M} and Porter, {Heather F} and Ewa Kloczko and Michael Duckworth and Alice Cotton and Kate Thornberry and Tracy Dew and Martin Crook and Sarah Natas and Rosa Miquel and Lewis, {Cathryn M} and Terry Wong and Smith, {Catherine H} and Barker, {Jonathan N}",

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month = sep,

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doi = "10.1001/jamadermatol.2019.0721",

language = "English",

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T1 - Prevalence of Advanced Liver Fibrosis in Patients With Severe Psoriasis

AU - Maybury, Catriona M

AU - Porter, Heather F

AU - Kloczko, Ewa

AU - Duckworth, Michael

AU - Cotton, Alice

AU - Thornberry, Kate

AU - Dew, Tracy

AU - Crook, Martin

AU - Natas, Sarah

AU - Miquel, Rosa

AU - Lewis, Cathryn M

AU - Wong, Terry

AU - Smith, Catherine H

AU - Barker, Jonathan N

PY - 2019/9/1

Y1 - 2019/9/1

N2 - Importance: 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. Objectives: 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. Results: Of 400 patients recruited (108 women and 289 men; mean [SD] age, 49.5 [13] 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 (R 2 = 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.

AB - Importance: 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. Objectives: 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. Results: Of 400 patients recruited (108 women and 289 men; mean [SD] age, 49.5 [13] 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 (R 2 = 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.

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DO - 10.1001/jamadermatol.2019.0721

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Prevalence of Advanced Liver Fibrosis in Patients With Severe Psoriasis

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