Impact of Adverse Events Associated With Acitretin Treatment of Moderate-to-Severe Plaque Psoriasis: Based on an Observational, Single-Center Study in Shanghai, China

Abstract

Objective: Acitretin is a widely used systemic retinoid that is to treat psoriasis but has significant variations in efficacy and adverse events (AEs) among individuals. This study aimed to determine the impact of AEs associated with acitretin treatment of moderate-to-severe plaque psoriasis on the Dermatology Life Quality Index (DLQI) and Hospital Anxiety and Depression Scale (HADS) scores. Methods: This prospective, observational, single-center study was conducted from March 2021 to June 2022 and analyzed 116 patients with moderate-to-severe plaque psoriasis treated with acitretin who were followed up for 12 weeks. The primary outcome was the incidence of AEs related to acitretin, and the secondary objective was to investigate the effect of AEs on the DLQI and HADS scores. The generalized linear models were used to assess the association between AEs related to acitretin and DLQI scores or HADS scores, and the association between the involved system/tissue and DLQI scores or HADS scores. Results: A final total of 45 patients were included in the analysis, and a total of 157 treatment-related AEs involving nine organs or systems were reported in 41 patients. The most common AE was skin- or mucosa-related, with 72 cumulative events in 31 patients. AEs also commonly affected the endocrine, digestive, and genitourinary systems. Compared with the group with 0–2 AEs, the group with 3–5 AEs had a significantly increased DLQI score by 5.49 points (95% CI, 1.47–9.51) (P = 0.0089). Compared with AEs involving 0 to 1 system, AEs affecting 2 to 3 systems resulted in a significant increase in the DLQI score by 5.75 points (95% CI, 1.67–9.83) (P = 0.0071). Generalized linear models showed no statistically significant associations between AEs and the HADS scores. Conclusion: Our study demonstrates a high incidence of acitretin-related AEs. These AEs may affect quality of life but rarely cause psychological problems such as anxiety and depression.