Because psoriasis is associated with a higher prevalence in metabolic syndrome, researchers evaluated the effects and safety of two insulin sensitizers (metformin and pioglitazone) used by patients with the coexisting conditions and found that the drugs led to improvements in the parameters of metabolic syndrome and disease severity in psoriasis.
The research paper, titled “Randomized placebo control study of insulin sensitizers (Metformin and Pioglitazone) in psoriasis patients with metabolic syndrome (Topical Treatment Cohort),” was published in BMC Dermatology.
The most common comorbidities (coexisting conditions) associated with psoriasis include obesity, metabolic syndrome, diabetes mellitus and increased cardiovascular mortality and morbidity. Metabolic syndrome is a group of risk factors that include abdominal obesity, hypertension and glucose intolerance. It is a strong predictor of cardiovascular disease, diabetes and stroke. Several pro-inflammatory cytokines involved in the development of psoriasis are also known to contribute to the development of metabolic syndrome.
For the study, researchers theorized that the pharmacological benefits observed with metformin and pioglitazone such as improvement of cardiovascular risk factors and anti-inflammatory effects, respectively, could be used for psoriasis patients with metabolic syndrome.
The researchers enrolled 60 adult psoriasis patients with metabolic syndrome who fit eligibility criteria. The subjects were randomized into placebo, pioglitazone, and metformin treatment groups with 23, 16, and 21 patients, respectively. Effectivity assessment was done at 12 weeks by evaluating psoriasis lesions using psoriasis area and severity index (PASI) scores and an erythema, scaling, and induration (ESI) score.
Compared to the placebo group, the pioglitazone and metformin groups had a statistically significant improvement in PASI, ESI and Physician Global Assessment scores. The groups also presented statistically significant difference in percentage of patients achieving 75 percent reduction in PASI and ESI scores.
After 12 weeks of treatment, the metformin group had significant improvement in weight, BMI, waist circumference, fasting plasma glucose (FPG), triglycerides and total cholesterol. The pioglitazone group had significant improvements in FPG, triglyceride levels, systolic blood pressure, diastolic blood pressure, total cholesterol, and LDL cholesterol levels. No differences in adverse drug reactions were reported in all three experimental groups.
Researchers concluded: “Insulin sensitizers have shown improvement in the parameters of (metabolic syndrome) as well as psoriasis disease. With further evaluation in clinical studies, Insulin sensitizers can be used for the management of psoriasis patients with (metabolic syndrome).”