Iskandar, I.Y.K.; orcid: 0000-0002-8030-1908; email: ireny.iskandar@manchester.ac.ukLunt, M.Thorneloe, R.J.; orcid: 0000-0002-7522-221XCordingley, L.Griffiths, C.E.M.; orcid: 0000-0001-5371-4427Ashcroft, D.M.on behalf the British Association of Dermatologists Biologics and Immunomodulators Register and Psoriasis Stratification to Optimise Relevant Therapy Study Groups2021-08-132021-08-132021-08-13British Journal of Dermatologyhttp://hdl.handle.net/10034/625569From Wiley via Jisc Publications RouterHistory: accepted 2021-06-13, pub-electronic 2021-08-13Article version: VoRPublication status: PublishedFunder: AbbVie; Id: http://dx.doi.org/10.13039/100006483Funder: Medical Research Council; Id: http://dx.doi.org/10.13039/501100000265; Grant(s): MR/1011808/1Funder: Pfizer; Id: http://dx.doi.org/10.13039/100004319Funder: Eli Lilly and Company; Id: http://dx.doi.org/10.13039/100004312Funder: Novartis; Id: http://dx.doi.org/10.13039/100004336Funder: Janssen CilagFunder: Samsung BioepisSummary: Background: Factors that might influence response to systemic treatment for moderate‐to‐severe psoriasis are varied, and generally, are poorly understood, aside from high bodyweight, suggesting that other unidentified factors may be relevant in determining response to treatment. The impact of alcohol misuse on treatment response has not been previously investigated. Objectives: To investigate whether alcohol misuse is associated with poor response to treatment for psoriasis. Methods: This was a prospective cohort study in which response to systemic therapies was assessed using the Psoriasis Area and Severity Index (PASI). The CAGE (Cut down, Annoyed, Guilty, Eye opener) questionnaire was used to screen for alcohol misuse. A multivariable factional polynomial linear regression model was used to examine factors associated with change in PASI between baseline and follow‐up. Results: The cohort comprised 266 patients (biologic cohort, n = 134; conventional systemic cohort, n = 132). For the entire cohort, the median (interquartile range) PASI improved from 13 (10·0–18·3) at baseline to 3 (1·0–7·5) during follow‐up. A higher CAGE score [regression coefficient: 1·40, 95% confidence interval (CI) 0·04–2·77]; obesity (1·84, 95% CI 0·48–3·20); and receiving a conventional systemic rather than a biologic therapy (4·39, 95% CI 2·84–5·95) were significantly associated with poor response to treatment; whereas a higher baseline PASI (–0·83, 95% CI –0·92 to –0·74) was associated with a better response to treatment. Conclusions: The poor response to therapy associated with alcohol misuse and obesity found in people with psoriasis calls for lifestyle behaviour change interventions and support as part of routine clinical care. Targeting interventions to prevent, detect and manage alcohol misuse among people with psoriasis is needed to minimize adverse health consequences and improve treatment response.Licence for VoR version of this article: http://creativecommons.org/licenses/by/4.0/EPIDEMIOLOGYarticle2021-08-13