[Moderate-severe psoriasis and associated comorbidity in patients on biologic therapy: implications for primary care]

To describe the comorbidity profile in patients with moderate-to-severe psoriasis treated with biologics and their association with clinical phenotype and therapeutic choice.

This was an observational, cross-sectional, single-center study conducted at the Lozano Blesa University Clinical Hospital (Zaragoza, Spain). Consecutive patients with moderate-to-severe psoriasis receiving biologic treatment were included. Data were collected during the Dermatology consultation and reviewed from medical records. The variables analyzed included demographic data, clinical phenotype, previous and current treatments, cardiometabolic comorbidities, neoplasia, infections, and lifestyle habits. Statistical analysis employed means and proportions comparison tests, and logistic regression to explore associations between phenotype, comorbidities, and biologic type.

350 patients were included (median age 54.1years; 57% men; 84% plaque psoriasis). The most prevalent comorbidities were dyslipidemia (55%), hypertension (42%), and obesity (36%). Among patients with liver elastography, 58% met MASLD criteria. Significant associations were observed between clinical phenotype and comorbidities: plaque psoriasis with hypertension and vitaminD deficiency, erythrodermic psoriasis with alcoholism and neoplasia, pustular psoriasis with dyslipidemia and kidney disease, and guttate psoriasis with a lower prevalence of cardiovascular factors. Guselkumab was the most commonly used biologic (15%).

Patients with moderate-to-severe psoriasis have a high burden of comorbidities, with differential profiles according to phenotype. These results reinforce the need for a multidisciplinary approach and the role of primary care in screening and managing comorbidities to improve disease control and overall prognosis.