Debate Surrounds Potential of GLP-1 Drugs in Psoriasis and PsA Treatment

In a thought-provoking session at the Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA) 2025 Annual Meeting held in Bogotá, Colombia, healthcare professionals engaged in extensive discussions regarding the role of GLP-1 receptor agonists (GLP-1 RAs) in treating psoriasis and psoriatic arthritis (PsA). While many dermatologists and rheumatologists recognize these antidiabetic and weight-loss medications—such as liraglutide, semaglutide, and tirzepatide—as potentially transformative for psoriatic conditions, a lack of robust clinical evidence has prompted experts to urge caution in their application.

GLP-1 RAs are primarily known for their efficacy in managing obesity and diabetes, both of which are significant risk factors for psoriasis and PsA. During the conference, Dr. Artie Kavanaugh, a professor of medicine at the University of California, San Diego, described the advent of GLP-1 drugs as a possible "watershed moment" for treatment protocols, comparable to the introduction of biologic therapies in the 1990s. However, the integration of these medications into routine clinical practice remains contentious due to concerns surrounding evidence gaps, accessibility, cost, and the appropriateness of patient selection.

Dr. Daniel J. Drucker, a renowned endocrinologist and professor at the University of Toronto, initiated the discourse by emphasizing GLP-1 RAs’ potential immunomodulatory properties. In a 2023 clinical trial, he observed that semaglutide resulted in a reduction of cardiovascular events independent of weight loss, suggesting an anti-inflammatory effect that could extend beyond obesity-related conditions. However, Drucker also acknowledged that randomized controlled trials specifically examining GLP-1 RAs' effects on psoriasis symptoms are still lacking.

In a retrospective review conducted at the Hospital Italiano de Buenos Aires, Dr. Enrique Soriano, head of rheumatology, reported that among 6,800 psoriasis patients, only 1% were utilizing GLP-1 RAs. He highlighted that, despite the theoretical benefits, no improvements in skin or joint symptoms were noted in patients who had initiated treatment with these drugs, raising further questions about their efficacy in this population. Soriano’s survey of rheumatologists indicated that less than a third had encountered patients they believed would benefit from GLP-1 therapy, with fewer than 10% expressing confidence in prescribing these medications.

Dr. Anthony Fernandez, director of dermatology at the Cleveland Clinic, praised the safety profile of GLP-1 RAs but echoed concerns regarding the current quality of data supporting their use in psoriasis. He cited existing studies as being limited and mostly involving male populations, which may not adequately represent the broader patient demographic. While some patients have reported significant improvements, Fernandez emphasized that many only experienced modest benefits, far from the substantial improvements seen with established treatments like disease-modifying antirheumatic drugs (DMARDs).

Patient perspectives were also highlighted during the conference, with Dr. Suzanne Grieb, a participant and assistant professor at Johns Hopkins University, sharing insights from a survey of fellow patients. She noted that while most participants managed their condition effectively with existing treatments, there was a curiosity about the potential of GLP-1s. However, concerns regarding long-term medication dependency and accessibility remained prevalent among respondents.

The consensus emerging from GRAPPA 2025 indicates that while GLP-1 RAs may offer new avenues for treatment, particularly in patients with comorbid obesity, the clinical community remains divided on their immediate applicability. As ongoing trials, such as those by Eli Lilly exploring the combination of tirzepatide and the interleukin-17A antagonist ixekizumab, promise to shed further light on this subject, the medical community is urged to proceed with a balanced approach. Experts are calling for more comprehensive clinical trials that can validate the safety and efficacy of GLP-1 RAs in the treatment of psoriasis and PsA before widespread adoption. The implications of these discussions could significantly influence future treatment paradigms for these chronic inflammatory diseases.