Text Messaging for Cardiovascular Risk Prevention in Psoriasis

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Importance: Cardiovascular disease (CVD) is the leading cause of mortality in patients with psoriasis, yet structured CVD prevention is not routinely embedded in dermatology care. Objective: To evaluate the effectiveness of a text-messaging intervention in improving patient activation and cardiovascular risk factors among patients with psoriasis. Design, Setting, and Participants: This single-center, parallel-group randomized clinical trial took place at a tertiary hospital dermatology clinic in Australia from February 2024 to February 2025. Adults with dermatologist-confirmed psoriasis were randomized 1:1 during outpatient dermatology visits between April and July 2024. Data were analyzed from February to April 2025. Intervention: A 6-month text-messaging intervention (Tobacco, Exercise, and Diet Messages for Psoriasis [TEXTME PSO]), comprising 4 text messages per week, compared with standard care. Main Outcomes and Measures: The primary outcome was score on the 13-item Patient Activation Measure. Secondary outcomes included Mediterranean Diet Score, physical activity, cardiometabolic measures, psoriasis-CVD knowledge, medication adherence, Psoriasis Area and Severity Index, Dermatology Life Quality Index, and user feedback. Analysis of covariance was used to adjust for baseline values under an intention-to-treat framework with multiple imputation. Results: Among 111 participants (mean [SD] age, 51.8 [13.2] years; 71 [65.1%] male), the intervention showed a statistically significant improved patient activation at 6 months compared with usual care (adjusted mean difference, 10.8 points; 95% CI, 7.0-14.6 points; P < .001). Statistically significant improvements were also observed in Mediterranean diet adherence (adjusted mean difference, 1.7; 95% CI, 1.0-2.4; P < .001), medication adherence (adjusted mean difference, 1.6; 95% CI, 0.8-2.5; P < .001), and psoriasis-CVD knowledge (adjusted mean difference, 6.6; 95% CI, 4.7-8.4; P < .001). Minutes per week of physical activity increased (adjusted mean difference, 127.9; 95% CI, 21.9-234.0; P = .02), and body mass index, calculated as weight in kilograms divided by height in meters squared, decreased (adjusted mean difference, -1.0; 95% CI, -1.4 to -0.7; P < .001). No statistically significant between-group differences were observed for lipid parameters, hemoglobin A1c, smoking behavior, dermatology-specific quality of life, or psoriasis severity. Conclusions and Relevance: In this randomized clinical trial, a text-messaging intervention improved patient activation and cardiovascular risk behaviors in adults with psoriasis. While biomarker changes were modest or not statistically significant, findings support digital tools as an adjunct to cardiovascular risk in dermatology care. Trial Registration: ANZCTR Identifier: ACTRN12624000498594.

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