Text Messaging for Cardiovascular Risk Prevention in Psoriasis: A Randomized Clinical Trial

Abstract

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