Systemic therapies in pediatric psoriasis: Impact on liver function in a high-risk population

Summary: Abstract Body: This study evaluated the impact of systemic psoriasis treatments on liver function in pediatric patients at high risk for non-alcoholic/metabolic dysfunction-associated fatty liver disease (NAFLD/MAFLD). A cohort of 12 patients (58% female, 58% Hispanic/Latino) with moderate-to-severe psoriasis was followed prospectively from 2010 to 2024, with assessments of liver function (serum hepatic panel and MR imaging), psoriasis severity (by body surface area, BSA), and body mass index (BMI). Nearly all patients (92%, n=11) were overweight or obese and 33% (n=4) were eventually diagnosed with NAFLD/MAFLD. Biologic therapies had variable effects on LFTs. Subjects treated with ustekinumab (n=3; 13–62 months) had ALT levels decline by 62% on average, with normalization (<29 U/L) in one case, and simultaneous improvement in psoriasis BSA (mean 58%) despite a stable BMI. In subjects on secukinumab (n=4; 9–21 months), ALT normalized despite stable BMI in 1 of the 3 subjects with baseline elevations. One patient on guselkumab (n=2; 15–19 months) achieved ALT normalization, but this may have been due to reduced BMI. One patient on adalimumab (n=4; 1–12 months) had normalization of ALT but the remaining subjects had ALT and BSA increases, prompting therapy changes. Etanercept (n=4; 3–44 months) reduced BSA by 52% on average, but improvements in ALT were not observed. Methotrexate (n=7; 3–82 months) achieved a 45% mean BSA reduction but transient ALT elevations occurred in one patient, and 6 patients (86%) required therapy changes due to insufficient psoriasis control. Phototherapy (n=7; 5–100 sessions) resulted in partial improvement in psoriasis symptoms for 4 (57%) of patients; however, logistical challenges limited its practicality, and it lacks the potential to independently mitigate fatty liver risks. These findings suggest biologics like ustekinumab and secukinumab may have the potential to improve both psoriasis and liver function in high-risk populations, but larger studies are needed to validate these results. Xochitl Longstaff¹, Claude Sirlin², Tom Wynnis¹ 1. Pediatric Dermatology, University of California San Diego, La Jolla, CA, United States. 2. University of California San Diego, La Jolla, CA, United States. Clinical Research: Epidemiology and Observational Research