Metabolic abnormalities associated with initiation of systemic treatment for psoriasis: evidence from the Italian Psocare Registry.
OBJECTIVE
To evaluate variations in laboratory parameters and diagnoses of selected clinical conditions up to 16 weeks after starting a new systemic psoriasis treatment for Psocare Registry enrollees.


METHODS
Prospective cohort study.


METHODS
Italian public referral centres for psoriasis treatment.


METHODS
First-time recipients (n = 10,539) of continuous systemic psoriasis treatment for at least 16 weeks.


METHODS
Mean variations in (weeks 8 and 16) and proportions of patients reaching a clinically meaningful increase in serum levels (week 16) of total and low-density lipoprotein cholesterol, triglycerides, aspartate amino transferase, alanine amino transferase and creatinine, as well as week-16 cumulative incidences of new diagnoses of diabetes mellitus and arterial hypertension.


RESULTS
Mean cholesterol and triglyceride levels significantly increased in patients treated with acitretin or cyclosporine. Mean triglyceride levels also increased in efalizumab- and etanercept-treated patients. Mean transaminase values increased in methotrexate-treated patients, and mean aspartate amino transferase levels increased in infliximab-treated patients. The average serum creatinine value increased in cyclosporine-treated patients. Acitretin and cyclosporine were associated with risk of hypercholesterolaemia (odds ratios 1.51 and 1.34) and acitretin with risk of hypertriglyceridaemia (odds ratio 1.43). Methotrexate and infliximab were associated with risk of more than doubling the upper normal aspartate amino transferase (odds ratios 2.06 and 1.87) and alanine amino transferase (odds ratios 2.38 and 1.74) values. The relative risk of developing arterial hypertension and diabetes was increased for patients receiving cyclosporine (odds ratios 3.31 and 2.88).


CONCLUSIONS
Systemic treatments for psoriasis resulted in heterogeneous effects on the parameters analysed.
Department of Medicine, Section of Dermatology and Venereology, University of Verona, Italy GISED Study Centre, Ospedali Riuniti, Bergamo, Italy.
P
P
Gisondi
S
S
Cazzaniga
S
S
Chimenti
A
A
Giannetti
M
M
Maccarone
M
M
Picardo
G
G
Girolomoni
L
L
Naldi
D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000911:Antibodies, Monoclonal / Q000008:administration & dosage* / Q000009:adverse effects; D000970:Antineoplastic Agents / Q000008:administration & dosage* / Q000009:adverse effects; D015331:Cohort Studies; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D019317:Evidence-Based Medicine; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage* / Q000009:adverse effects; D015994:Incidence; D007558:Italy; D008297:Male; D008659:Metabolic Diseases / Q000139:chemically induced* / Q000453:epidemiology / Q000503:physiopathology; D011446:Prospective Studies; D011565:Psoriasis / Q000175:diagnosis / Q000188:drug therapy*; D012042:Registries; D018570:Risk Assessment; D012720:Severity of Illness Index; D017678:Sex Distribution; D016896:Treatment Outcome; D055815:Young Adult
D000911:Antibodies, Monoclonal; D000970:Antineoplastic Agents; D007166:Immunosuppressive Agents