Insulin resistance in psoriasis: metabolic recalibration and therapeutic prediction; a prospective cohort study at a tertiary referral centre

This large-scale prospective study establishes the baseline homeostasis model assessment of insulin resistance (HOMA-IR) as a superior independent predictor of biologic response compared with triglyceride glucose-body mass index, resolving recent controversies regarding metabolic metrics in psoriasis. We identify an inflammation-associated metabolic phenotype characterized by compensatory hyperinsulinaemia and demonstrate that effective biologic therapy drives metabolic recalibration, supporting HOMA-IR profiling as a pragmatic tool for personalized management.