Hepatic Steatosis in Biologic‐Treated Patients With Psoriasis and Low Current Disease Activity: Prevalence and Metabolic Determinants

ABSTRACT

Metabolic dysfunction‐associated steatotic liver disease (MASLD) is increasingly recognized as an important comorbidity in patients with psoriasis. In contemporary clinical practice, many patients receiving biologic therapy present with low current skin disease activity, yet the burden and determinants of hepatic steatosis in this population remain incompletely characterized. We conducted a single‐center real‐world cross‐sectional study of adult biologic‐treated patients with psoriasis who underwent transient elastography with FibroScan. Hepatic steatosis was defined as a controlled attenuation parameter (CAP) ≥ 248 dB/m, a validated threshold for detecting steatosis (≥ S1). Clinical characteristics, psoriasis severity, anthropometric parameters, metabolic indices, and biologic treatment duration were analyzed using logistic regression, correlation analyses, and receiver operating characteristic analyses. A total of 133 patients were included, of whom 75 (56.4%) had FibroScan‐defined hepatic steatosis. Among these, 71 (94.7%) fulfilled the diagnostic criteria for MASLD according to the 2023 international consensus. Patients with hepatic steatosis had significantly higher body mass index, waist circumference, triglycerides, fasting glucose, fasting insulin, HOMA‐IR, and triglyceride‐glucose (TyG) index than those without hepatic steatosis. Waist circumference showed good discriminative performance for hepatic steatosis (AUC 0.785, 95% CI 0.706–0.856) and demonstrated better multivariable model performance than body mass index. Higher HOMA‐IR and TyG values were associated with hepatic steatosis in univariable analyses. In multivariable models, waist circumference remained independently associated with hepatic steatosis, whereas current PASI and biologic treatment duration were not significantly associated with hepatic steatosis. FibroScan‐defined hepatic steatosis was common in this real‐world cohort of biologic‐treated psoriasis patients with low current disease activity and was primarily associated with central obesity and metabolic dysfunction. Waist circumference and simple metabolic indices may provide clinically useful tools for metabolic liver risk stratification, whereas low current PASI alone may not reliably identify patients who warrant further liver evaluation.