The interplay between antidiabetic and lipid-lowering therapies in psoriasis: A narrative review of risks and benefits

Diabetes mellitus, hyperlipidemia, and psoriasis share overlapping immunometabolic pathways driven by chronic systemic inflammation. Key mediators such as tumor necrosis factor alpha and the interleukin-23/Th17 axis promote insulin resistance, endothelial dysfunction, and atherogenic lipid alterations, linking metabolic and dermatologic disease activity through cytokine upregulation, oxidative stress, and dysregulated adipokines. Antidiabetic therapies exert variable effects on psoriasis and cardiometabolic health. Glucagon-like peptide-1 receptor agonists (GLP-1RAs) reduce systemic inflammation and improve insulin sensitivity, lipid metabolism, and weight control. In psoriasis patients with diabetes or obesity, GLP-1RAs have been associated with decreased major adverse cardiovascular events and all-cause mortality, supporting their dual metabolic and anti-inflammatory roles. Thiazolidinediones may also improve psoriasis severity and metabolic indices but require caution due to risks of edema and heart failure. Among lipid-lowering agents, statins remain first-line for psoriatic patients with dyslipidemia, offering cardiovascular protection and modest improvement in disease severity with an excellent safety profile. PCSK9 inhibitors show mechanistic and genetic evidence of benefit, though clinical data in psoriasis are still emerging. Integrated management targeting shared immunometabolic pathways is recommended for patients with psoriasis and cardiometabolic comorbidities, with multidisciplinary collaboration to optimize outcomes.