The therapies have emerged as potential adjunct for psoriasis as evidence builds on metabolic and inflammatory benefits.
New guidance from the US National Psoriasis Foundation suggests glucagon-like peptide-1 receptor agonists could play a broader role in psoriasis management.
Emerging evidence has linked the medicines to improvements in skin severity, systemic inflammation and cardiometabolic comorbidities in selected patients.
Writing in a new review published in JAMA Dermatology, researchers said the rapidly expanding class of GLP-1 RA therapies may offer dermatologists a novel opportunity to address both psoriatic disease and the obesity, diabetes and cardiovascular conditions that commonly accompany it.
The review, developed by the US National Psoriasis Foundation Medical Board, highlighted mounting clinical and translational data supporting a possible immunomodulatory effect beyond weight loss alone.
The researchers noted that psoriasis was a chronic immune-mediated disease closely linked to cardiovascular, metabolic, hepatic, musculoskeletal and psychiatric comorbidities.
GLP-1 RA therapies were already approved for many of these conditions, including type 2 diabetes, obesity, cardiovascular risk reduction, chronic kidney disease and metabolic dysfunction-associated steatohepatitis.
Small, randomised trials and observational cohorts cited in the review reported Psoriasis Area and Severity Index (PASI) reductions ranging from approximately 40% to 80%, particularly among patients with obesity or type 2 diabetes.
One open-label study of semaglutide in patients with obesity, diabetes and psoriasis found PASI scores fell by 52% over 12 weeks, accompanied by reductions in LDL cholesterol, IL-6 and C-reactive protein.
Another liraglutide study in patients with type 2 diabetes reported an 83% PASI reduction over the same period.
The review notes that improvements may not be solely attributable to weight loss. Early translational studies demonstrated reductions in inflammatory cytokines, suggesting a possible direct immunologic effect.
However, the authors cautioned that evidence remained preliminary, with most psoriasis studies involving small patient numbers, short follow-up periods and limited control groups.
The only placebo-controlled randomised trial included in the review did not demonstrate a statistically significant PASI improvement despite meaningful weight loss.
The article also outlined practical considerations for dermatologists increasingly encountering patients prescribed GLP-1 RA therapies through primary care or endocrinology settings.
The researchers said it was important for dermatologists to understand dosing schedules, contraindications, gastrointestinal adverse effects and monitoring requirements, while also recognising uncommon dermatologic reactions such as bullous pemphigoid, eosinophilic panniculitis and injection-site reactions.
The review highlighted that GLP-1 therapies could generally be co-administered safely with methotrexate, cyclosporine and biologic agents, with no clinically meaningful pharmacokinetic interactions identified to date.
Despite enthusiasm around the drug class, the authors stressed that GLP-1 RAs were not currently approved for psoriatic disease itself and therefore costly.
They said the greatest potential value may lie in patients with moderate-to-severe psoriasis and significant metabolic comorbidities, where treatment could simultaneously address multiple disease pathways.
Several larger clinical trials are now underway, including studies evaluating tirzepatide in moderate-to-severe psoriasis and psoriatic arthritis.
Until more definitive data emerged, the National Psoriasis Foundation said GLP-1 RA therapies should be considered a promising adjunctive option.
Related
“GLP-1 RAs, including dual GIP/GLP-1 agents, represent a biologically plausible and clinically intriguing adjunct in selected patients, although their definitive role in psoriasis management remains to be established,” they concluded.
“Clinical evidence demonstrates improvements in skin severity, quality of life, and systemic inflammation, mediated by both weight-dependent and independent mechanisms.
“Safety profiles are generally favourable, with mostly mild gastrointestinal adverse effects.
“While these agents offer a mechanistically and clinically compelling option, further large-scale randomised clinical trials are needed to clarify their role in all patients with psoriasis, including those without metabolic comorbidities.”
