Alcohol Use, Smoking Tobacco May Negatively Impact Psoriasis Treatment Efficacy

New research is calling attention to the negative impact of smoking and alcohol consumption, both individually and interactively, on treatment efficacy in patients with psoriasis.¹

Findings from the observational study of more than 500 patients at the Shanghai Skin Diseases Hospital showed patients who reported smoking tobacco, consuming alcohol, or both smoking and drinking had a greater risk of not achieving a ≥ 75% improvement in Psoriasis Area and Severity Index (PASI) from baseline (PASI75) after 8 weeks of psoriasis treatment.¹

“Although the harmful effects of tobacco smoking and alcohol drinking on health have been reported widely, current research focusing on the influence of tobacco smoking and alcohol drinking on the treatment efficacy of psoriasis patients is still relatively limited, especially their interaction effect,” Ruiping Wang, a professor at Shanghai Skin Disease Hospital at Tongji University in China, and colleagues wrote.¹

Worldwide, an estimated 125 million people representing 2%-3% of the global population have psoriasis. Despite its prevalence, there is no cure, but several treatment options are available to help relieve symptoms. Various factors have been shown to influence the efficacy of psoriasis treatment, and a recent growing interest in the role of lifestyle factors has driven attention toward the potential impact of alcohol and tobacco.^1,2

To explore the interactive effects of smoking and drinking on treatment efficacy in patients with psoriasis, investigators conducted an observational study of 560 patients seen at the Shanghai Skin Diseases Hospital from 2021 to 2022. They collected data for the study through physical examinations conducted during patients’ hospital visits at weeks 0, 4, and 8 as well as a questionnaire on demographic characteristics; lifestyle habits; medical history; and therapy and PASI score evaluation. Investigators used PASI to assess the severity of psoriasis lesions and to evaluate treatment efficacy based on changes in the score.¹

For the purpose of analysis, investigators examined smoking behavior based on whether someone had smoked ≥ 100 cigarettes in their lifetime and drinking behavior based on whether someone drank alcohol ≥ 2 times per week for ≥ 6 months. In total, 245 (43.8%) patients reported tobacco smoking, 142 (25.4%) reported drinking alcohol, and 110 (19.6%) reported both.¹

Investigators then divided patients into 4 groups:

• Group A: non-smoker and non-drinker (n = 283)
• Group B: non-smoker but drinker (n = 32)
• Group C: smoker but non-drinker (n = 135)
• Group D: smoker and drinker (n = 110)

Among the entire study cohort, the majority of patients were male (72.9%) and had a mean age of 47 (interquartile range [IQR], 36-61) years. The median PASI score at baseline was 11.1 (IQR, 7.9-16.6) and was not statistically significantly different between the groups.¹

Logistic regression analysis revealed patients with smoking (Odds ratio [OR], 7.78; 95% CI, 5.26-11.49) and drinking (OR, 5.21; 95% CI, 3.29-8.27) behaviors had an increased risk of failing to achieve PASI75 at week 8 compared to patients without these behaviors. Of note, these findings were consistent after adjustment for potential confounding factors.¹

Further analysis of multiplicative and additive models showed tobacco smoking interacted with alcohol drinking to more severely influence treatment efficacy (OR, 12.74; 95% CI, 7.16-22.67). Investigators pointed out the interaction effect between smoking and drinking on treatment efficacy was consistent even with the adjustment of age, gender, education, marital status, monthly income, and other factors.¹

Investigators acknowledged multiple limitations to these findings, including the potential lack of generalizability; possible information bias due to reliance on questionnaires; the assessment of treatment efficacy at week 8 rather than at week 12; the lack of consideration for factors beyond drinking and smoking; and the disproportionate number of male patients in group A compared with groups B, C, and D.¹

“This study indicated that both tobacco smoking and alcohol drinking could increase the risk of experiencing the failure of PASI75 achievement in patients with psoriasis, and the multiplicative model as well as the additive model verified the interaction effect of tobacco smoking and alcohol drinking on the poor treatment response among psoriasis patients,” investigators concluded.¹ “We recommended that dermatologists should educate patients to pay attention to the negative effects of smoking and drinking, encourage them to quit and provide corresponding support and guidance to assist them to change unhealthy lifestyles, thus improving the treatment efficacy.”

References

1. ^{Shen F, Song Y, Qiang Y, et al. Tobacco Smoking Interacted with Alcohol Drinking Could Increase the Failure of PASI75 Achievement at Week 8 Among Patients with Psoriasis: Findings Based on a Psoriasis Cohort. Psoriasis (Auckl). https://doi.org/10.2147/PTT.S484609}
2. ^{National Psoriasis Foundation. Psoriasis Statistics. December 21, 2022. Accessed October 3, 2024. https://www.psoriasis.org/psoriasis-statistics/}