GLP-1RA offers protection against mortality, cardiac events for psoriasis patients

Patients with psoriasis who are using glucagon-like peptide-1 receptor agonists (GLP-1RAs) appear to have lower risks of mortality and adverse cardiovascular events, according to a retrospective study.

Analysis of large real-world data from the US TriNetX database showed that among psoriasis patients who were treated for diabetes or obesity, GLP-1RA treatment was associated with a reduction of between 44 percent and 78 percent in the risks of all-cause mortality (hazard ratio [HR], 0.219, 95 percent confidence interval [CI], 0.123–0.391), major adverse cardiac events (MACE) (HR, 0.561, 95 percent CI, 0.442–0.714), heart failure (HR, 0.534, 95 percent CI, 0.408–0.700), and stroke (HR, 0.352, 95 percent CI, 0.228–0.542) as compared with alternative medications. [Olbrich H, et al, EADV 2025]

Marked risk reductions were also noted for psychiatric outcomes such as alcohol abuse (HR, 0.346, 95 percent CI, 0.174–0.685) and substance abuse (HR, 0.510, 95 percent CI, 0.350–0.743).

“GLP-1RA treatment was safe,” with no statistically significant difference in the risk of hypoglycaemia, nausea and vomiting, or constipation relative to alternative medications, noted first author Dr Henning Olbrich from the University of Lübeck in Lübeck, Germany, who presented the study at the annual EADV meeting.

The analysis included 3,048 psoriasis patients treated with GLP-1RA (mean age 56.94 years, 60.37 percent female) and 3,048 psoriasis patients treated with other antidiabetic/weight-loss drugs (mean age 56.42 years, 61.91 percent female). Overall, 66 percent had obesity, and 82 percent had diabetes.

When analysis was repeated using a cohort of individuals without psoriasis, the risk reductions observed with GLP-1RA treatment vs alternative medications were smaller than those observed in the psoriasis cohort: all-cause mortality (HR, 0.413, 95 percent CI, 0.377–0.451), MACE (HR, 0.837, 95 percent CI, 0.783–0.895), heart failure (HR, 0.780, 95 percent CI, 0.723–0.842), stroke (HR, 0.854, 95 percent CI, 0.771–0.947), alcohol abuse (HR, 0.630, 95 percent CI, 0.535–0.741), and substance abuse (HR, 0.815, 95 percent CI, 0.717–0.926).

Taken together, these findings may have important implications, given that “psoriasis imposes a high risk of cardiometabolic and psychiatric complications,” such as metabolic syndrome, myocardial infarction, cerebral stroke, depression, anxiety, and alcohol abuse, Olbrich noted. [J Invest Dermatol 2012;132:556-562; Eur Heart J 2010;31:1000-1006]

“Physicians should consider GLP-1RAs for patients with psoriasis and comorbid obesity or diabetes,” he added.

In a press statement, senior study author Prof Ralf Ludwig from the University of Lübeck pointed out that it is time to rethink how psoriasis is managed.

“Psoriasis management has traditionally focused on controlling skin symptoms, but [our] findings emphasize the need to consider the wider health risks faced by patients. GLP-1RAs may offer a valuable dual benefit, improving both metabolic control and long-term health outcomes, representing an important step forward in holistic care for people living with psoriasis,” Ludwig said.