IPC meeting looks beyond skin

This initiative from the IPC is based on information presented at a recent consensus meeting that brought together an international panel of clinicians and scientists with expertise in dermatology, rheumatology, cardiovascular medicine, hepatology, epidemiology, statistics and pharmacology.

Based on a full day of formal presentations and discussions, the consensus group concurred that there was sufficient evidence linking psoriasis with a spectrum of cardiovascular risk factors, cardiovascular diseases and excess cardiovascular mortality to warrant further studies for elucidating the mechanisms underlying those associations and to determine what impact effective treatment of psoriasis may have on those comorbid risks.

"Our understanding of psoriasis has been evolving over the years," Alan Menter tells Dermatology Times.

"There are multiple questions about these associations that will need to be explored through future research. In the meantime, it is critical for healthcare professionals to be aware of these disease relationships, recognize psoriasis as a significant condition with quality of life implications and adopt a more holistic approach in evaluating and managing their patients with this skin disease."

Dr. Menter is president of the IPC and chairman of the division of dermatology, Baylor University Medical Center, Dallas. He says the idea for holding a consensus meeting to examine the comorbidities associated with psoriasis arose, in part, from the observation that, when compared with the general population, psoriasis patients participating in phase 2 and 3 clinical studies of biologic agents were more likely to be overweight and obese.

Heavy implications

"Our analyses showed the participants in the European and U.S. trials had average weights of 83 kg and 93 kg, respectively.

"That is much heavier than the general population, as well as compared with patients affected by other inflammatory diseases, such as rheumatoid arthritis or Crohn's disease," Dr. Menter notes.

Recognizing that obesity is one component of the metabolic syndrome and, considering the metabolic syndrome is a risk factor for diabetes and cardiovascular disease morbidity and mortality, the IPC decided it would be valuable to convene a multidisciplinary group of experts to begin to explore the implications of psoriasis as a systemic inflammatory disease. The program was jointly chaired by Wolfram Sterry, M.D., IPC board member and chairman, department of dermatology, Humboldt University, Berlin, and Dr. Menter.

Presenters at the IPC consensus conference discussed recent studies that have reported increased prevalence of diabetes, hypertension, hyperlipidemia, smoking, obesity, depression, excessive alcohol consumption and nonalcoholic steatohepatitis among psoriasis patients, particularly in the subgroup with moderate-to-severe disease. The hypothesis that psoriasis and metabolic and cardiovascular disorders may arise through a common pathway involving immune dysregulation driven by adipocyte release of inflammatory cytokines and insulin resistance was also explored.

In addition, issues relating to administration of medications on a fixed dose basis in a population in which there is a preponderance of overweight and obese persons were discussed.

Research cause, effect

Dr. Menter, Dr. Sterry and Bruce Strober, M.D., Ph.D., assistant professor of dermatology, New York University School of Medicine, are coauthoring a white paper that will summarize the meeting's proceedings and enumerate topics for future research studies.

Among the questions the experts believe warrant investigation include: