Women with psoriasis face increased adverse effects with systemic therapy

Long-term conventional systemic therapies lead to higher drug-related adverse events and treatment discontinuation rates compared with biologics.

A 2.2-fold higher adverse event rate

“We investigated the safety of systemic psoriasis therapies, employing sex stratification in assessing drug toxicity to enable the customisation of treatment plans,” described Dr Fabio Verardi (University Hospital Zurich, Switzerland)1.

Dr Verardi and his team conducted a comprehensive analysis using the Swiss psoriasis registry SDNTT, retrieving 10-year data from patients with moderate-to-severe psoriasis receiving conventional systemic therapies and/or biologics. They calculated adverse event rates per 100 patient-years (PY) and used descriptive statistics to assess patient and disease characteristics. They also compared treatment groups and sex-specific differences using binomial and t-test methods to gain valuable safety insights.

The eligible patients for the current study (n=791) had a mean age of 46 years, and 37% (n=290) were women. Moreover, 45% (n=358) received conventional systemic therapies (CST), while 55% (n=433) underwent biologic treatments. The study showed that the patients who received CST had a 2.2-fold higher adverse event rate (40.43/100 PY vs 18.22/100 PY; P<0.0001) and an 8.0-fold higher treatment discontinuation rate (0.16/PY vs 0.02/PY; P<0.0001) than those who were under biologic therapy.

Sex stratification: a much needed component for therapy decisions

Further analysis revealed a higher cumulative adverse event rate for both treatments in women: 1.8-fold for CSTs (57.30/100 PY vs 31.69/100 PY; P<0.0001), and 2.0-fold for biologics (27.36/100 PY vs 13.9/100 PY; P<0.0001). In general, the women receiving CST, except for apremilast and cyclosporine, experienced a higher rate of adverse events and discontinuation rates.

“Patients with psoriasis undergoing CST develop more drug-related adverse events than those receiving biologics. Also, the drug toxicity, especially in CST, is sex associated and higher in women,” Dr Verardi concluded. He further emphasised the importance of integrating sex stratification in therapeutic decision-making when managing patients with psoriasis.

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  1. Verardi F, et al. Sex differences in drug toxicity in systemic psoriasis treatments: A decade of insights from the Swiss psoriasis registry (SDNTT). P2372, EADV Congress 2023, 11–14 October, Berlin, Germany.