Metabolic syndrome is a common comorbidity of psoriasis with implications for both the safety and efficacy of psoriasis treatments |
Metabolic syndrome is associated with decreased effectiveness of some psoriasis treatments, but it is unclear whether this effect is independent of body weight |
The exacerbation of metabolic syndrome may affect patients’ body weight, cholesterol, hyperglycemia/insulin resistance, and liver function |
Treatment selection in patients with psoriasis and concomitant metabolic syndrome requires special consideration of both potential treatment failure and cardiovascular concerns |
Biologic therapeutics appear to be safe for patients with both psoriasis and metabolic syndrome and may be preferable to methotrexate and other conventional systemic therapies |
Introduction
Efficacy of Available Biologic Agents for Treatment of Psoriasis in Patients with Metabolic Syndrome
Clinical Efficacy of Biologic Treatment of Psoriasis in Patients With vs Without Metabolic Syndrome
Study | Agent/s | Result |
---|---|---|
Talamonti et al., 2018 [13] | Adalimumab | Absence of MetS, dyslipidemia, hypertension, lower PASI, and lower baseline age were associated with PASI 50, 75, 90, and 100 at 3, 6, and 12 months |
Jacobi et al., 2016 [20] | Adalimumab Efalizumab Etanercept Infliximab Ustekinumab | Patients with MetS displayed loss of adherence to all biologics |
Pinter et al., 2019 [19] | Secukinumab | MetS, hypertension, and diabetes were associated with lower PASI responses |
Lebwohl et al., 2020 [17] | Tildrakizumab | No difference in efficacy between patients with vs without MetS |
Body Weight as a Confounder in Randomized Controlled Trials and Observational Studies
Study | Agent | Result |
---|---|---|
Randomized controlled trials | ||
Gordon et al., 2006 [104] | Etanercept | PASI 75 response rate 41% in patients weighing < 89.36 kg vs 25% in those weighing > 89.36 kg |
Menter et al., 2010 [29] | Adalimumab | “Modestly reduced” PASI 75 response rates in patients weighing 90–140 kg vs < 90 kg and in obese vs nonobese patients |
Gordon et al., 2018 [33] | Adalimumab; guselkumab | Lower IGA response rates in patients weighing > 90 kg vs ≤ 90 kg after 16 weeks; lower IGA response rates in patients weighing > 90 kg vs ≤ 90 kg after 16 weeks, although “more consistent” compared with adalimumab |
Pinter et al., 2019 [19] | Secukinumab | Nonresponders at week 16 are obese relative to responders |
Hsu et al., 2020 [105] | Brodalumab | Comparable efficacy in obese and nonobese patients |
Reich et al., 2017 [106] | Ixekizumab | Comparable efficacy across body weight categories < 80 kg, 80– < 100 kg, and ≥ 100 kg |
Poulin et al., 2020 [34] | Tildrakizumab | Higher PASI 75 response rates in patients weighing ≤ 90 kg vs > 90 kg after 12 weeks |
Leonardi et al., 2019 [35] | Tidrakizumab | Patients in the heavier weight deciles had slightly higher PASI scores than those in the lighter weight deciles; difference between highest and lowest weight deciles diminished by week 28 |
Strober et al., 2020 [36] | Risankizumab | Comparable efficacy in healthy, overweight, and obese patients |
Real-world evidence | ||
de Groot et al., 2006 [107] | Etanercept | No effect of BMI |
Esposito et al., 2009 [28] | Etanercept | No effect of BMI |
Giunta et al., 2016 [27] | Etanercept | Significantly higher PASI score in obese patients vs healthy-weight or overweight patients after 48 weeks |
Vilarrasa et al., 2016 [108] | Adalimumab, etanercept, infliximab, or ustekinumab | Cumulative probability of drug survival significantly lower in obese vs nonobese patients (23.0 [95% CI 17.4–28.6] months vs 37.3 [95% CI 29.4–45.1] months) |
Menter et al., 2016 [109] | Ustekinumab, infliximab, adalimumab, etanercept | No significant effect of obesity on drug survival |
Meta-analyses | ||
Singh et al., 2018 [30] | TNF-α inhibitors | Clinical trial and real-world data; odds ratio for treatment failure in obese vs healthy patients 1.57 (95% CI 1.30–1.89) |
Mourad et al., 2019 [23] | Adalimumab, etanercept, infliximab, ustekinumab | Obesity predicted treatment discontinuation for all biologics combined and for etanercept and ustekinumab |