Safety Profile of Systemic Therapy for the Management of Psoriasis in Patients With Diabetes Mellitus: Data From the BIOBADADERM Prospective Cohort

Background and Objective: Patients with psoriasis and concomitant diabetes mellitus (DM) may be vulnerable to diabetes-related adverse events (DM-AEs). This study aimed to evaluate the incidence of DM-AEs associated with systemic treatments used in patients with psoriasis and DM. Methods: We conducted a prospective cohort study using data from the BIOBADADERM registry. We calculated incidence rates (IRs) of DM-AEs for each systemic treatment class, including biologics (tumor necrosis factor [TNF] inhibitors, interleukin [IL]-12/23 inhibitors, IL-17 inhibitors, and IL-23 inhibitors), conventional systemic therapies (methotrexate [MTX], cyclosporine, and acitretin), and apremilast (APR). The primary outcome was the adjusted incidence rate ratio (aIRR) for DM-AEs comparing patients receiving MTX with those receiving other systemic therapies using Poisson regression models adjusted for potential confounders. Results: The study included 732 patients, 1401 treatment cycles, and 2865 person-years (PYs) of follow-up. APR (aIRR, 0.30; 95%CI, 0.10-0.60) was associated with a significantly lower risk of DM-AEs compared with MTX. Cyclosporine (aIRR, 7.50; 95%CI, 3.30-17.30) and acitretin (aIRR, 2.10; 95%CI, 1.20-3.70) were associated with a higher risk compared with MTX. Conclusions: Among patients with psoriasis and DM, APR was associated with a lower incidence of DM-AEs, whereas cyclosporine and acitretin were associated with higher incidences compared with MTX.