Background/Purpose: Psoriasis and type 2 diabetes mellitus (T2D) may share common underlying pathophysiology, in which the pathogenesis of psoriasis is mediated by NOD-like receptor family pyrin domain-containing inflammasome (NLRP)-dependent inflammatory pathways that is a target of sodium-glucose co-transporter 2 inhibitors (SGLT2i). The aim of the present study was to investigate whether treating psoriasis patients with concomitant T2D using SGLT2i improves clinical outcomes compared to similar line oral antidiabetic medications.

Methods: This was a population-based cohort study between 2014 and 2023 that included psoriasis patients with concomitant T2D from 92 hospitals across the United States. The risk of psoriasis-related comorbidities and general medical outcomes in patients treated with SGLT2i was compared with that in 1:1 propensity score-matched psoriasis patients with T2D on dipeptidyl peptidase 4 inhibitors (DPP4i). Hazard ratios (HRs) were estimated using Cox proportional hazards regression.

Results: After propensity-score matching, there were 17,085 patients with psoriasis and concomitant T2D on SGLT2i. Compared to those using DPP4i, patients on SGLT2i presented with a significantly lowered risk of incident cardiorenal complications including myocardial infarction (HR: 0.84, 95% CI: 0.74, 0.95), acute kidney failure (HR: 0.68, 95% CI: 0.63, 0.73), and chronic kidney disease (HR: 0.73, 95% CI: 0.69, 0.77), and a significantly lowered risk of incident emergency visits (HR: 0.82, 95% CI: 0.78, 0.85) over a mean follow-up period of six years. The risk of psoriatic arthritis (HR: 1.04, 95% CI: 0.98, 1.10), metabolic syndrome (HR: 1.15, 95% CI: 0.96, 1.39), stroke (HR: 0.93, 95% CI: 0.83, 1.04), amputation of the lower limb (HR: 0.78, 95% CI: 0.42, 1.47), and hospitalization (HR: 0.88, 95% CI: 0.76, 1.02) was not significantly different between SGLT2i and DPP4i users. Diabetic ketoacidosis (HR: 1.602, 95% CI: 1.21, 2.12) was a potential adverse event of SGLT2i.

Conclusion: Among patients with psoriasis and concomitant T2D, SGLT2i use was associated with a significantly decreased risk of incident cardiorenal events and emergency visits and did not trigger psoriasis-related comorbidities including psoriatic arthritis. Further research, including clinical trials are warranted to validate the findings.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/safety-and-efficacy-of-sodium-glucose-co-transporter-2-inhibitors-in-patients-with-psoriasis-and-concomitant-type-2-diabetes-mellitus-a-population-based-cohort-study/