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PARIS -- Two-thirds of patients with moderate or severe plaque psoriasis had comorbid conditions at baseline, which appeared to blunt the effect of treatment, according to a study reported here.

Overall, 64% of patients had one or more comorbid conditions at the start of treatment, and some of the patients had new comorbid diagnoses during follow-up. The proportion of patients who achieved disease clearance decreased as the number of comorbidities increased, as reported at the congress.

"Patients with no comorbidities at baseline reported almost double the clearance rate of those patients with three or more comorbidities at baseline," said Finn Ziegler, of LEO Pharma in Ballerup, Denmark. "More insights are needed on how different treatments can influence skin clearance in patients with comorbidities."

Numerous studies have documented a high prevalence of comorbid conditions in patients with plaque psoriasis. However, the impact of comorbidities on treatment-induced disease clearance remained unclear, said Ziegler.

In an effort to clarify the relationship between comorbidities and clearance, an international team of investigators performed a 12-month observational study involving 846 patients with newly diagnosed moderate or severe psoriasis in the United States and Europe. All the patients were either initiating treatment with a biologic agent or switching from one biologic to another at the time of enrollment.

Patients self-reported baseline comorbidities by means of a questionnaire. Investigators also reported patients' comorbidities at baseline and during the follow-up period by means of a separate questionnaire. The physician questionnaire had a checklist of selected conditions identified prior to the start of patient enrollment.

The study population had a mean age of 47.4, and men accounted for about two thirds of the population. The patients had a median psoriasis duration of 18.4 years, mean Psoriasis Area and Severity Index (PASI) score of 14.3, and 40% had prior exposure to a biologic agent. The mean body mass index for the study population was 29.4.

Ziegler said 541 patients had one or more comorbidities prior to starting or switching biologic treatment, including 60% of patients enrolled in Europe and 72.4% of patients from the U.S. The most commonly reported comorbid conditions were hypertension (33.5%), psoriatic arthritis (28.1%), hyperlipidemia (20.9%), diabetes (13.9%), and depression (13.7%). During follow-up, 31 patients developed new comorbid conditions, consisting of anxiety in five patients; hypertension in five; psoriatic arthritis in four; and depression, hyperlipidemia, and other rheumatologic conditions in three patients each.

The subgroup of patients with concomitant psoriatic arthritis consisted of 23.4% of patients with no prior biologic therapy and 35.3% of those previously treated with biologic therapy.

Comparison comorbidity burden and response to treatment, investigators found that 31% of patients with no comorbid conditions at baseline had disease clearance (PASI 100) at 6 months, as compared with 16.5% of patients who had three or more comorbid conditions at enrollment. A similar disparity was observed after 12 months of treatment.

Ziegler acknowledged several limitations of the study. The descriptive design precluded the possibility of assessing causality. Various confounding factors could have affected the results. Rates of psoriatic arthritis differed between the patient and investigator questionnaires, suggesting potential underreporting of that condition and the other comorbidities.

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