It’s time for dermatology clinicians to rethink their understanding of obesity and their approach in addressing weight with psoriasis patients. That’s according to Dr. Jennifer Soung, associate professor at Harbor-UCLA Medical Center. Next Steps in Derm, in partnership with Skin of Color Update, interviewed Dr. Soung, who shares a comprehensive perspective in addressing psoriatic arthritis and metabolic conditions. Learn Dr. Soung’s strategies in broaching the sensitive topic of weight with patients. Find out how she helps patients manage their weight, including using GLP-1 agonists. Plus hear how excess weight impacts the efficacy of biologics.
Further Reading
If you want to read more about approaches to address psoriasis comorbidities, check out the following articles published in the Journal of Drugs in Dermatology:
Psoriasis and Obesity: Optimizing Pharmacologic Treatment and Lifestyle Interventions
ABSTRACT
Obesity is a metabolic disease that is marked by excessive fat accumulation and is objectively defined as a body mass index (BMI) ≥30 kg/m2. Obesity is associated with several other comorbidities, including psoriasis, which is a chronic autoimmune skin disease. Adipocytes produce pro-inflammatory signaling molecules, namely adipokines and classic cytokines, that drive increased inflammation axnd may contribute to the pro-inflammatory pathways driving psoriasis disease pathogenesis. Optimizing dermatologic management of obese patients with psoriasis may be challenging due to the effect of comorbid obesity on the pharmacokinetics of systemic therapies. Biologic therapy is a mainstay of psoriasis treatment in these patients. The IL-17 and IL-23 inhibitor classes, including those targeting the IL-17 receptor (brodalumab), IL-17 cytokine antagonists (secukinumab, ixekizumab, bimekizumab), and IL-23 cytokine antagonists (guselkumab, risankizumab, tildrakizumab). In general, the most efficacious biologics that work well for generalized plaque psoriasis also tend to work well for most obese psoriasis patients. For example, brodalumab, an IL-17 receptor inhibitor, demonstrated comparable efficacy across BMI categories in both clinical trial and real-world practice data. In addition to psoriasis-specific therapy, interventions targeted at weight loss may help treat obesity and decrease psoriasis disease severity. These interventions include glucagon-like peptide-1 receptor agonist therapy, caloric restriction, and different forms of bariatric surgery. Clinical trials and real-world data evaluating the efficacy of different biologic treatments and weight-loss interventions in the treatment of obese psoriasis patients should be used to support clinical decision-making for treatment options.
GLP-1 Receptor Agonists for the Dermatologist: Uses and Considerations
ABSTRACT
The glucagon-like peptide-1 receptor agonists (GLP1RAs) are a widely popularized drug class due to their notable success in promoting weight loss. The GLP1RAs, dulaglutide, exenatide, semaglutide, liraglutide, tirzepatide, and lixisenatide are FDAapproved for use in the treatment of obesity and type 2 diabetes mellitus (DM), particularly to reduce cardiovascular risk and improve glycemic control.1,2,3 GLP1RAs work by mimicking glucagon-like peptide-1 (GLP-1), an incretin, that functions to subdue appetite, delay gastric emptying, and regulate homeostasis of glucose. GLP1RAs also have anti-inflammatory effects; GLP-1 receptors are expressed in activated regulatory T cells and GLP-1 receptor agonists reduce proinflammatory cytokines through inhibition of tumor necrosis factor alpha (TNF-α), nuclear factor-kappa B (NF-κB), interleukin (IL)-23, IL-17, and IL-22.1
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