Weight loss improves response to psoriasis treatment

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This study builds on the observation that psoriasis is frequently associated with obesity. The question is whether this has any impact on the response to treatment or, conversely, whether losing weight may improve the response to treatment. This study was designed to investigate the possibility that moderate weight-loss would improve the therapeutic response to a drug called cyclosporine? in patients with chronic plaque psoriasis. A total of 61 obese patients were included in this 24-week study were divided into two groups; the first group received the drug combined with a low-calorie diet, whilst the second group received only the drug.

The primary endpoint was an improvement from baseline of >or=75% in the Psoriasis Area and Severity Index (PASI 75 response) at week 24.

At the end of study period those in the first group had lost 7% of their baseline weight compared with 0.2% in the control group. The PASI 75% response was achieved by 20/30 (66.7%) of those treated with cyclosporine plus a low-calorie diet, but only by 9/31 (13.3%) of patients treated with the drug alone.

Comment: This is a well designed study which, for the first time, suggests that losing weight could substantially improve the response to treatment in patients who have psoriasis but who are also obese. It is also important to note that the difference between the groups was large: those who followed a low-calorie diet were five times more likely to achieve a PASI 75% score than those taking only the drug. It would be interesting to see whether the addition of a low-calorie diet to the treatment regime would have a similar beneficial effect if combined with other forms of drug treatment.

Reference:

Gisondi P, Del Giglio M, Di Francesco V et al. Weight loss improves the response of obese patients with moderate-to-severe chronic plaque psoriasis to low-dose cyclosporine therapy: a randomized, controlled, investigator-blinded clinical trial. Am J Clin Nutr 2008;88:1242-7.

Article prepared by:
Dr David Ashton MD PhD
27 April 2009