One of the most exciting developments in the treatment of psoriasis over the past decade, has been the advent of a group of drugs known as biologics. These drugs - e.g. secukinumab, adalimumab etc. – suppress those parts of the immune system responsible for the inflammatory response in psoriasis.
One of the concerns about biologic medications has been whether they may cause weight gain. This large population-based study from Korea set out to answer precisely that question. Researchers used a huge database provided by the Korean National Health Insurance Service, based on 620,885 patients with psoriasis. These were divided into three groups according to the type of treatment; biologics; non-biologics and other treatments.
Psoriatics who were prescribed biologic agents had higher rates of diabetes, fatty liver disease, high cholesterol levels, than those in other treatment groups. They also had a higher body mass index (BMI) and waist circumference.
Importantly, the use of biologic agents was found to be a significant independent risk factor for weight gain (after taking into account age, sex, physical activity, smoking and drinking habits etc).
In contrast, the use of non-biologic systemic agents was not a significant independent risk factor for weight change. Interestingly, the use of biologics had no impact on weight gain in women.
Comment
Biologics tend to be used in more severe cases of psoriasis, where there is already a higher prevalence of overweight and associated conditions such as hypertension, diabetes, raised cholesterol levels.
If biologics increase weight even further, this will have a negative effect on cardiovascular health in men – who are already at increased risk compared with women. Quite why biologics do not have a similar effect on weight gain in women, is not clear.
Men taking biologics for psoriasis, should be warned of the possibility of weight gain and to seek professional help if this occurs.
Reference:
Hyunhee K, Jee-Young H et al. Impact of biologic agents on body weight and obesity-related disorders in patients with psoriasis: A nationwide population-based cohort study. Obes Res Clin Pract, 2023; 17: 210-217
Source:
Dr David Ashton MD PhD