A comparison of efficacy and safety with add on therapy of pioglitazone in adult patients of psoriasis with and without metabolic syndrome

Abstract

Background: Psoriasis is a chronic disease involving skin with systemic manifestations whose etiology remains unknown. In recent times, an increased occurrence of metabolic syndrome has been seen in psoriatic patients and potential role of antihyperglycemic in such conditions is being evaluated.Methods: This was a prospective, controlled, randomized, open label comparative clinical study conducted on 51 psoriatic patients. The patients were divided into two groups with and without MS and both these groups were further randomised to receive either standard therapy alone (topical 0.05% betamethasone dipropionate applied twice daily) or therapy with pioglitazone 15 mg orally once daily as add on to standard treatment. The study was conducted over a period of 12 weeks and the primary efficacy outcome was assessed by a change in psoriasis area severity index (PASI). The secondary outcomes were achievement PASI 50/75 and change in parameters of metabolic syndrome (MS). Change in quality of life assessed using dermatological life quality index (DLQI). Results: Both the treatments significantly reduced the PASI score in psoriatic patients with and without MS, maximum being at 12 weeks. In patients with and without MS, pioglitazone caused a greater reduction in PASI score and DLQI score though it was found comparable to ST alone. Significant improvement in parameters of metabolic syndrome was observed in pioglitazone treated group.Conclusions: Pioglitazone given as add on therapy caused an additional improvement in clinical severity and QOL in both the group of psoriatic patients with and without metabolic syndrome. Role of pioglitazone needs to be further explored with higher recommended dose range (30 mg and 45 mg) to demonstrate the usefulness of this drug in psoriatic patients.