GLP-1 Receptor Agonists Improved Psoriasis Despite Diabetes Mellitus

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Treating psoriasis with glucagon-like peptide 1 receptor agonists (GLP-1 RAs) results in substantial reductions in severity of disease among patients, according to new findings, regardless of the presence of diabetes mellitus.¹

These conclusions on glucagon-like peptide 1 receptor agonists, may be used for the simultaneous management of disease activity and blood glucose level, particularly in patients with psoriasis and comorbid hyperglycemia.

The investigators of this study, led by Su-Chi Ku of the Taipei Medical University Hospital’s department of general medicine, noted that there is a strong link between psoriasis and metabolic syndrome such as diabetes mellitus. Recent findings indicate glucagon-like peptide 1 receptor agonists can reduce severity of psoriasis, though additional evidence was needed.^2,3

“Furthermore, new studies have been conducted after the publication of previous reviews,” Ku and colleagues wrote. “Accordingly, the present systematic review and meta-analysis was performed to elucidate the clinical efficacy of GLP-1 RAs in skin severity of psoriasis.”

Study Background

The research team looked for studies which had evaluated glucagon-like peptide 1 receptor agonists’ clinical efficacy in improving psoriasis skin lesions, specifically without any language restrictions. The team did not look for conference abstracts, case reports, and review articles.

A search of Embase, PubMed, Cochrane Library, and Web of Science was conducted by the investigators for relevant articles which had been released prior to August 2023, with searches implementing terms such as 'glucagon-like peptides', 'glucagon-like peptide-1 receptor agonists', and 'psoriasis', in addition to medical subheadings (MeSH) or abbreviations which were related.

Two reviewers were tasked with extraction of data and risk of bias assessments, done independently and with disagreements fixed through consensus. Assessment of observational research was done utilizing the Newcastle-Ottawa Scale, and the randomized controlled trials done with the Cochrane risk-of-bias tool.

A random-effects model was used by the investigators for their meta-analysis. The mean difference (MD) in subjects’ psoriasis area and severity index (PASI) scores prior to and following treatment was determined to be the main outcome evaluated.

The research team looked into heterogeneity of the studies through the use of χ2 and I2 statistics, calculating their pooled estimates using the Comprehensive Meta-Analysis software.

The incorporation of 4 prospective cohort studies was done for the team’s meta-analysis, as well as 2 randomized controlled trial. This research involved a total of 63 patients with diagnoses of psoriasis.

Outside of a single study with either liraglutide or exenatide, all of the research had used liraglutide. The investigators had a range of 6 - 12 weeks for their follow-up period.

Conclusions

Overall, major reductions in subjects’ PASI scores were seen in the pooled analyses (MD: −5.826; 95% confidence interval [CI]: −9.546 to −2.105) after treatment. Psoriasis patients saw comparable PASI reductions in those with diabetes (MD: −7.448; 95% CI: −12.704 to −2.192), as did those with obesity but no diabetes (MD: −3.227; 95% CI: −5.234 to −1.220).

The investigators’ meta-analysis had not shown significant publication bias, with the team noting that their sensitivity analysis used a leave-1-out method to confirm the reliability of the data. The research team noted that 35% of all included subjects had seen an improvement of 75% in PASI from the point of baseline following their period of treatment.

A larger sample size and more recent research had been included in this analysis compared to prior publications. The investigators commented that this reinforced the information supporting the benefits of glucagon-like peptide 1 receptor agonists for psoriasis therapy, and such effects were noted as extending past individuals with psoriasis and comorbid diabetes mellitus.

“In conclusion, our updated study demonstrated that treatment with GLP-1 RAs results in significant reductions in disease severity among patients with psoriasis, irrespective of whether they have DM,” they wrote. “Thus, GLP-1 RAs may be used for the simultaneous management of disease activity and blood glucose level, particularly in patients with psoriasis and comorbid hyperglycemia.”

References

1. ^{Ku, S.-C. and Chang, H.-C. (2024), Efficacy of glucagon-like peptide-1 receptor agonists for psoriasis: An updated systematic review and meta-analysis. JDDG: Journal der Deutschen Dermatologischen Gesellschaft. https://doi.org/10.1111/ddg.15431.}
2. ^{Chang G, Chen B, Zhang L. Efficacy of GLP-1rA, liraglutide, in plaque psoriasis treatment with type 2 diabetes: A systematic review and meta-analysis of prospective cohort and before-after studies. J Dermatolog Treat. 2022; 33: 1299-1305.}
3. ^{Sun X, Cai X, Liu L, et al. Effect of Different Types of Hypoglycemic Medications on Psoriasis: An Analysis of Current Evidence. Dermatology. 2023; 239: 299-313.}