Real-World Evidence and Systemic Inflammation in Psoriasis

In "Real-World Evidence and Systemic Inflammation in Psoriasis," our experts scrutinize the evidence behind popular claims about disease progression.

Dr. Wright reduces the retrospective claims data to two damning words: retrospective and claims. Retrospective analyses cannot substitute for prospective study. Claims data lack the ICD-10 granularity to tell whether a patient has one small patch or is covered head to toe. She takes such findings with what she calls a 25-pound bag of salt rather than a grain.

Dr. Wright adds confounding by indication. A clinician facing severe disease may reach for a TNF, an IL-23, or an IL-17, which then shapes that patient's trajectory and skews the data. She urges close attention to how data were collected, on whom, and how they are analyzed before drawing conclusions, warning against treating any such finding as definitive.

Dr. Han notes that overreliance produces contradictory studies. Just last year the rheumatology literature reported IL-17 carried a lower incidence of psoriatic arthritis, the opposite of newer claims. Dr. Wright observes the field was not even discussing obesity's impact a year ago and now is, pointing to the inflammatory contribution of adipose tissue and the need to consider the whole person and all modifiable factors, not just skin, joints, gut, and eyes.

Dr. Khattri raises an influx of patients asking about systemic inflammation, often prompted by social media, that usually circles back to obesity and weight-loss medications. Dr. Han says clinicians should get used to hearing about GLP-1s as the pipeline explodes and new agents win approval quickly. He is intrigued by evidence that GLP-1s may act on inflammatory pathways directly, not only through weight loss. Dr. Wright closes by distinguishing what inflammation feels like from what inflammation is, even in a patient with a BMI of 21.

The next episode in this series, "Putting On-Treatment Remission Into Practice: A Patient-Defined Target in Psoriasis," opens the final section as the panel defines what on-treatment remission looks like in daily practice.