Revisiting the Association Between Beta-blockers and Psoriasis: Evidence from Real-World Data

Some cases report that beta-blockers may induce or exacerbate psoriasis. However, pharmacoepidemiology studies have yielded conflicting results. This study aims to investigate whether there is a potential association between beta-blockers and psoriasis. An observational study was conducted on the U.S. population from the National Health and Nutrition Examination Survey (NHANES) database using propensity score matching and multivariable logistic regression models. Subsequently, a disproportionality analysis was performed based on the FDA Adverse Event Reporting System (FAERS) database, and a two-sample Mendelian randomization (MR) study was conducted to assess the association between beta-blockers and the risk of developing psoriasis. Based on the NHANES database, logistic regression analysis, adjusted for relevant confounders, showed no significant association between beta-blocker use and the risk of psoriasis (OR: 1.49, 95% CI: 0.76-2.92, p = 0.250). FAERS analysis identified 300 psoriasis-related reports for beta-blockers, but no robust safety signals were detected (ROR: 0.34, 95% CI: 0.30-0.38), even after false-negative analysis. The meta-analysis of MR results demonstrated a statistically significant association between beta-blocker use and reduced risk of psoriasis (OR: 0.9985, 95% CI: 0.9978-0.9991, p < 0.001). The observed epidemiological association likely stems from confounding by cardiovascular indications for beta-blockers, rather than a direct causal effect. Neuroimmune pathways (sympathetic activity, β1/β2 receptor effects on immune cells/keratinocytes) present biologically plausible but complex and potentially opposing mechanisms, requiring further investigation. We found that beta-blockers did not significantly elevate the risk of psoriasis. In clinical practice, labeling beta-blockers as drug-induced psoriasis may be inappropriate.