Baseline Pathological Liver Function Tests in Patients With Psoriasis Support the Indication for Systemic Therapy Rather Than Being a Reason Against It: A Real-World Analysis.

Abstract

Purpose: Modern systemic therapies offer a high probability of significant improvement for psoriasis. However, elevated liver function tests (LFTs) may cause physicians to be reluctant to initiate systemic treatment. Especially considering the already increased risk of liver disease in patients with psoriasis, clinicians are often concerned about potential further liver damage caused by systemic therapies. The aim of this study was to provide real-world evidence to address this issue.

Patients and methods: This study retrospectively analyzed the treatment courses of N = 278 patients with psoriasis who received systemic anti-psoriatic therapy with secukinumab, ixekizumab, adalimumab, or apremilast in clinical routine. The cohort was divided into two subgroups based on normal or elevated LFTs prior to the start of therapy. AST, ALT, and GGT levels as well as Fibrosis-4 score (FIB-4) were measured at baseline, after 3 months, and after 6 months of therapy.

Results: The subgroup of patients with elevated LFTs had a higher mean PASI (Psoriasis Area and Severity Index), were more likely to be male, and had a higher prevalence of metabolic syndrome comorbidities compared to the subgroup with normal LFTs. During the follow-up period, there were no significant changes in LFTs and FIB-4 for the subgroup with normal LFTs at baseline. In the group of patients with initially elevated LFTs, all LFTs decreased significantly over time, whereas FIB-4 scores demonstrated no significant change. Drug survival, discontinuation rates, and PASI-75 response did not significantly differ between subgroups.

Conclusion: This study provides real world evidence that systemic therapy with secukinumab, ixekizumab, adalimumab, or apremilast does not present a general risk, but rather an opportunity for patients with psoriasis with elevated LFTs at baseline.