Effects of TNF-alpha antagonism in patients with metabolic syndrome and psoriasis

Effects of biological agents on glycogen metabolism in psoriasis patients: A systematic review and meta-analysis

The effectiveness and safety of biological agents for treating psoriasis have been confirmed; however, their effects on glucose metabolism biomarkers in psoriasis patients remain unclear. A systematic review and meta-analysis were performed according to PRISMA guidelines. The final analysis enrolled 12 studies, including eight randomized controlled trial (RCT) (n = 5628 patients) and four observational cohort studies (OBSs) (n = 393 patients). The meta-analysis comprising nine studies (six RCTs and three OBSs) revealed a slight reduction in the levels of HOMA-IR associated with the use of biological therapies in OBS (biological therapies vs. traditional therapies: WMD = -0.2, CI = -0.10 to 0.50, p = 0.02). Although a considerable number of studies were analysed, our review did not show a significant alteration in HOMA-IR levels among patients treated with biological therapies such as IL-17 inhibitors and IL-12/23 inhibitors at weeks 12-16 in RCTs. We also did not observe remarkable alterations in the fasting plasma glucose levels of patients in both OBS and RCT. Additional RCT on a larger scale and duration is required to provide more conclusive evidence regarding the effect of biological agents on glycogen metabolism in psoriasis.

Efficacy and safety of secukinumab in a psoriatic patient affected by comorbid metabolic disorders

Psoriasis is a common, chronic, immune-mediated disease occurring more frequently in association with comorbid metabolic disorders. The management of patients with multiple organ dysfunction is challenging since the use of all conventional systemic agents is limited or contraindicated. In the last two decades, the introduction of biological drugs has revolutionized treatment paradigms of psoriasis and enabled numerous patients to achieve disease control with an acceptable safety profile. We reported for the first time the case of a 66-year-old female psoriatic patient affected by myocardial infarction, hypertension, chronic renal failure, hyperthyroidsm and morbid obesity, who experienced remarkable improvement in skin and joint synthoms and metabolic parameters after 48 weeks of secukinumab monotherapy. In our patient, secukinumab was well tolerated and no side effects have been observed. Our observation suggests that secukinumab could be a safe therapeutic option in patients with organ impairment or failure in which the majority of conventional systemic agents are contraindicated.

Metabolic syndrome and the skin: a more than superficial association. Reviewing the association between skin diseases and metabolic syndrome and a clinical decision algorithm for high risk patients

There is ongoing scientific interest regarding comorbidities associated with the metabolic syndrome (MeTS). MeTS comprises a combination of parameters that predispose individuals to the development of type 2 diabetes and cardiovascular disease (CVD). Three or more of the following criteria are necessary: fasting glucose > 110 mg/dl (5.6 mmol/l), hypertriglyceridemia > 150 mg/dl (1.7 mmol/l), HDL levels < 40 mg/dl (men)/< 50 mg/dl (women), blood pressure > 130/85 mmHg, waist circumference (values for Mediterranean populations > 94 cm (men)/> 89 cm (women). In this review we attempted to summarize relevant data by searching dermatological literature regarding associations between various skin conditions and MeTS. A multitude of studies was retrieved and a further goal of the present article is to present plausible mechanistic connections. The severity of skin conditions like psoriasis has been linked with MeTS. Parameters of MeTS like insulin resistance are present in patients with early onset androgenic alopecia, hidradenitis suppurativa acne and rosacea. Since MeTS can lead to CVD and type 2 diabetes early detection of patients would be very important. Also therapeutic intervention on MeTS could lead to improvement on the severity of skin conditions. This reciprocal relationship between skin diseases and MeTS in our opinion holds great interest for further investigation.