Psoriasis severity, comorbidity burden, and biologic therapy: a multicenter observational study using the Charlson...

Psoriasis is a chronic inflammatory disease associated with systemic comorbidities. The Charlson Comorbidity Index (CCI) quantifies comorbidity burden and estimates survival, but its relationship with psoriasis severity and biologic therapies remains underexplored.

To evaluate the association between psoriasis severity and comorbidities, assess the impact of biologic disease-modifying antirheumatic drugs (bDMARDs), in particular (adalimumab [ADA], risankizumab [RISA], secukinumab [SECU]) on CCI and estimate 10-year survival in psoriatic patients versus controls.

In this multicenter cross-sectional study, 343 psoriasis patients and 343 matched controls from 13 Italian centers were analyzed. CCI scores and comorbidity profiles were stratified by disease severity PASI score [Psoriasis Area and Severity Index] and treatment groups. Survival probabilities were estimated using a predictive model.

Psoriasis patients had significantly higher age-adjusted CCI compared to controls (p = 0.021), particularly in severe cases (PASI >10; p = 0.003). Peripheral vascular disease, cerebrovascular disease, and myocardial infarction correlated with disease severity. ADA-treated patients showed lower CCI than those on RISA or SECU (p < 0.05). The estimated 10-year survival did not differ significantly between psoriasis and controls.

Psoriasis severity is associated with increased comorbidity burden, highlighting the importance of cardiovascular and metabolic screening. Biologic therapies may differentially affect comorbidity progression, supporting personalized treatment approaches.