The pharmacological management of patients with comorbid psoriasis and obesity

ABSTRACT

Introduction: Psoriasis is a chronic inflammatory skin disease that is increasingly being recognized as a complex disorder affecting multiple systems. Systemic inflammation is considered the pathogenic link between psoriasis and its comorbid conditions that include arthritis, metabolic disorders, depression, and cardiovascular diseases. The presence of comorbid conditions modifies both its clinical management and the therapeutic approach in psoriatic patients.

Areas covered: This review describes the clinical, epidemiological, and pathogenic link between psoriasis and obesity. Furthermore, data related to the effects of synthetic antipsoriatic drugs on obesity are collated.

Expert opinion: Obesity is one of the most common comorbid conditions that is relevant both for a patient’s overall health and the clinical outcomes of antipsoriatic therapies. Indeed, some treatments of psoriasis might be impaired by adiposity. Moreover, obesity’s association with dyslipidemia, hypertension, and increased liver enzymes could further be worsened by acitretin, cyclosporine and methotrexate, respectively. Therefore, the identification of therapeutic targets whose blockade could have positive effects on both psoriasis and mechanisms regulating body weight homeostasis may be of great relevance to the treatment of patients with psoriasis.

KEYWORDS:

• Psoriasis
• obesity
• adipokines
• IL-17
• guselkumab
• leptin
• resistin

Article highlights

• Psoriasis is a chronic inflammatory disease associated with several comorbid conditions, including obesity

• The pathogenic mechanism linking psoriasis to obesity likely involves inflammatory cells, as well as adipokines, cytokines, and chemokines

• The contribution of cytokines to obesity and adipokines to psoritasis inflammation needs to be fully understood

• Biologic agents do not improve obesity but, on the other hand, obesity may negatively affect the therapeutic response

• PDE4 inhibition might reduce body weight through (i) the increase energy expenditure, (ii) the improvement of glucose metabolism, (iii) the enhancement of metformin activity, (iv) and the regulation of adipose tissue inflammation

This box summarizes the key points contained in the article.

Declaration of interest

A Chiricozzi has served as consultant/speaker for AbbVie, Eli Lilly and Company, Janssen Pharmaceuticals, Leo Pharma, Novartis, Sanofi Genzyme, and UCB Pharma. G Girolomoni has served as a consultant/speaker for AbbVie, Abiogen, Allmirall, Amgen, Bayer Healthcare, Biogen Idec, Boehringer Ingelheim, Celgene, Eli Lilly and Company, Galderma, Hospira, Janssen Pharmaceuticals, Leo Pharma, Merck and Co, Merck Sharp & Dohme, Mundipharma, Novartis, Otsuka, Pfizer Inc, Pierre Fabre, Regeneron, Sandoz, Sanofi and Sun Pharma. P Gisondi has served as consultant/speaker for AbbVie, Abiogen, Bayer Healthcare, Celgene, Eli Lilly and Company, Janssen Pharmaceuticals, Leo Pharma, Merck & Co, Merck Sharp and Dohme, Novartis, Otsuka, Pfizer Inc, and Pierre Fabre. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This manuscript has not been funded.