The Association between Obesity and Efficacy of Psoriasis Therapies: An Expert Consensus Panel

J Am Acad Dermatol. 2024 Dec 19:S0190-9622(24)03390-5. doi: 10.1016/j.jaad.2024.12.016. Online ahead of print.

Abstract

Background: Psoriasis is a chronic inflammatory skin disease often associated with obesity. Psoriasis therapies may be less effective in obese patients. The purpose of this expert consensus panel is to evaluate the relationship between obesity and efficacy of psoriasis therapies, thereby optimizing patient care.

Methods: A comprehensive literature search was completed on July 19, 2024, using the keywords "psoriasis," "obesity," "efficacy," "treatments," and "therapies". A panel of 11 dermatologists with significant expertise in treatment of psoriasis gathered to review the articles and create consensus statements. A modified Delphi process was used to approve each statement and a strength of recommendation was assigned.

Results: The literature search produced 500 articles. A screening of the studies resulted in 22 articles that met criteria. The panel unanimously voted to adopt 10 consensus statements and recommendations, six were given a strength of "A", two were given a strength of "B", and two was given a strength of "C".

Conclusion: Psoriasis and obesity have a strong association. Obesity decreases efficacy of biologics and may decrease efficacy and potentiate side effects of conventional therapies. It also impacts drug survival. Weight control is a vital component of caring for psoriasis patients and the number of therapeutic options available is rising.

Keywords: TNF inhibitors; biologics; efficacy; new therapies; obesity; psoriasis; weight loss.