Improved Sleep Quality in Psoriasis Patients Under Biologicals: A Prospective Observational Study

Sleep disorders are an underappreciated component of psoriasis-related morbidity. Biologic therapies targeting IL-17 and IL-23 may improve sleep quality by reducing systemic inflammation and improving signs and symptoms.

To explore the association between moderate-to-severe psoriasis and sleep quality, as well to determine if IL-17 and IL-23 inhibitors may improve sleep disorders over 16 weeks.

This prospective open, single center, observational cohort study enrolled patients with moderate-to-severe psoriasis treated with IL-17 or IL-23 inhibitors. Psoriasis Area and Severity Index (PASI), Dermatology Life Quality Index (DLQI), pruritus, pain (measured using numeric scales for maximum and average intensity), and sleep quality (Pittsburgh Sleep Quality Index, PSQI) were evaluated at baseline, week 4, and week 16.

Seventy patients exhibited moderate sleep impairment at baseline (mean PSQI 7.57). Pruritus and pain correlated significantly with poor sleep quality. Both IL-17 (n=30) and IL-23 inhibitors (n=40) significantly improved PASI, DLQI, pruritus, pain, and PSQI scores by week 16. IL-23 inhibitors demonstrated earlier PSQI improvement at week 4 (P=0.0057), while IL-17 inhibitors showed significant improvement only by week 16 in adjusted models (P=0.03). Regression analyses confirmed improvements in sleep remained significant after adjusting for confounders.

Biologic therapy significantly improves sleep quality primarily through symptom control. IL-23 blockade might offer faster onset of sleep benefits, although both IL-17 and IL-23 therapies effectively improved sleep by week 16. Sleep quality may represent a meaningful therapeutic response measure in psoriasis management.  .