Reduced risk of mortality associated with systemic psoriasis treatment in the Psoriasis Longitudinal Assessment and Registry (PSOLAR): A nested case-control analysis

J Am Acad Dermatol. 2021 Jan;84(1):60-69. doi: 10.1016/j.jaad.2020.08.032. Epub 2020 Aug 13.


Background: The effects of systemic therapy on mortality risk among patients with psoriasis are not fully understood.

Objective: To evaluate the impact of systemic treatment on mortality risk in patients enrolled in the Psoriasis Longitudinal Assessment and Registry.

Methods: Nested case-control analyses were performed to estimate mortality risk. Cases were defined as patients who died while participating in the Psoriasis Longitudinal Assessment and Registry. Cases were matched (1:4) with controls by age, race, sex, and geographic region. Evaluated treatments included methotrexate, ustekinumab, and tumor necrosis factor α inhibitors. Exposure was defined as at least 1 dose of treatment within 3 months before death and was stratified by duration of therapy.

Results: Among 12,090 patients, 341 deaths occurred, matched to 1364 controls. Biologic treatment within the preceding 3 months was protective against mortality versus no exposure: odds ratio (OR) for exposure of less than 1 year, 0.08 (95% confidence interval [CI], 0.03-0.23); OR for exposure of 1 year or longer, 0.09 (95% CI, 0.06-0.13). Methotrexate was protective against mortality only with exposure for 1 year or longer (OR, 0.08; 95% CI, 0.02-0.28).

Limitations: Observational studies are subject to unmeasured confounding.

Conclusions: Biologic therapy was associated with reduced mortality risk in patients with moderate to severe psoriasis, regardless of treatment duration; methotrexate reduced risk only with exposure for 1 year or longer.

Keywords: PSOLAR; biologic; methotrexate; mortality; psoriasis; systemic; tumor necrosis factor; ustekinumab.

MeSH terms

  • Aged
  • Case-Control Studies
  • Cause of Death
  • Dermatologic Agents / therapeutic use*
  • Female
  • Follow-Up Studies
  • Humans
  • Male
  • Methotrexate / therapeutic use
  • Middle Aged
  • Psoriasis / complications
  • Psoriasis / drug therapy*
  • Psoriasis / mortality*
  • Registries
  • Tumor Necrosis Factor-alpha / therapeutic use
  • Ustekinumab / therapeutic use


  • Dermatologic Agents
  • Tumor Necrosis Factor-alpha
  • Ustekinumab
  • Methotrexate