Abstract
Abstract The treatment landscape for psoriasis vulgaris has been transformed by the introduction of targeted biologic therapies, but these treatments show limited efficacy in palmoplantar pustulosis (PPP). Janus kinase (JAK) inhibitors have emerged as a promising therapeutic option in PPP, but have an evolving side-effect profile, particularly relating to cardiovascular disease and malignancy. PPP is closely associated with smoking, but the wider comorbidity burden is poorly described. The objective of this study was to quantify the prevalence of comorbidities, including cardiovascular risk factors and malignancy, in individuals with PPP (PROSPERO: CRD42024508151). A systematic search of six databases (Embase, Ovid, Pubmed, Web of Science, Cochrane, and Cinahl) was conducted on 29 July 2024. For the systematic review, studies reporting the prevalence of the relevant comorbidities in adults (≥18 years) with PPP were included. No publication date or language restrictions were applied. Conference abstracts, review articles, and case reports were excluded. Records were screened and data extracted by at least two reviewers independently. The quality of included studies was assessed using the Joanna Briggs Institute Critical Appraisal Checklist for Studies Reporting Prevalence Data. To determine the prevalence of comorbidities in our at-risk PPP population, following quality assessment, we meta-analysed studies conducted in a specialist setting. Population-based studies based on coding and claims databases were excluded. This approach aimed to ensure the inclusion of comparable, tightly-phenotyped populations likely to be considered for JAK inhibitor treatment. Prevalence estimates for comorbidities were pooled using a random-effects model and presented with 95% confidence intervals (95% CI). Of 23 727 references identified, 86 studies met the inclusion criteria for the systematic review, comprising 72 studies conducted in a specialist setting and 14 population-based database studies. Quality assessment identified that only 33/86 (38.4%) studies specified the diagnostic criteria for comorbidities. Following quality assessment, 57 studies were included the meta-analysis. Psoriasis vulgaris [prevalence, 24.4% (95% CI: 18.1–30.6%)] and psoriatic arthritis [19.7% (95% CI: 15.5–24.0)] were common. The most prevalent cardiovascular risk factors were smoking [78.2% (95% CI: 73.6–82.6%)], hypertension [28.6% (95% CI: 24.4–32.8%)], hyperlipidaemia [28.3% (95% CI: 22.3–34.3%)], and obesity [25.2% (95% CI: 17.7–32.7%)]. The prevalence of major adverse cardiovascular events (myocardial infarction/stroke/transient ischaemic attack) and malignancy were 6.9% (95% CI: 3.8–9.9%) and 6.9% (95% CI: 2.6–11.2%), respectively. High heterogeneity was apparent between studies, a common finding in meta-analyses of prevalence. This systematic review and meta-analysis of people with PPP highlights a high prevalence of smoking and cardiovascular risk factors. Our findings underscore the importance of screening for comorbidities to guide treatment decision-making with novel therapeutic agents, such as JAK inhibitors.
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