GLP-1 Therapies: A dermatologist’s Dilemma and Patient Curiosity

The growing popularity of GLP-1 receptor agonists (GLP-1 RAs) for weight management is sparking debate within the medical community, particularly for dermatologists and rheumatologists who manage chronic immune-mediated conditions.While the possibility of safely prescribing these medications exists, the question of whether thay should be a regular part of dermatological practice remains a notable point of contention.

Dr. David Soriano, a prominent voice in the discussion, expressed his reservations. “My opinion is no,” he stated, outlining a scenario where GLP-1 RAs might be considered. “There will be rare patients who are obese and or have type 2 diabetes and either fail or have a contraindication to all the great systemic medicines we already have available to us. And in those patients, a trial of a GLP-1 RA would seem to be reasonable.But personally, I think we need much, much better data for recommendations concerning general use by dermatologists.”

This sentiment was echoed during a question-and-answer session, where physicians highlighted practical hurdles such as insurance approvals and the time commitment required to manage the complex comorbidities often associated with chronic immune-mediated diseases. Despite these concerns,some practitioners shared positive anecdotal evidence of patients experiencing improved disease activity with GLP-1 RA treatment,even in the absence of other systemic therapies.

Patient Interest Peaks, but Caution Prevails

The intrigue surrounding GLP-1 RAs extends to the patient community. suzanne Grieb, PhD, a patient research participant with GRAPPA (Group for Research and Assessment of Psoriasis and Psoriatic Arthritis) and an assistant professor at johns Hopkins University, Baltimore, presented findings from a survey of her fellow GRAPPA patient research participants.

None of the 11 respondents reported being prescribed GLP-1 medications. Grieb noted that “the majority of us described our psoriatic disease as mostly manageable with our current treatment.” However, this didn’t dampen their curiosity. The survey revealed a widespread awareness of the importance of exercise and healthy weight in disease management, with many participants admitting to ongoing struggles in these areas. Few had discussed specific weight-management interventions with their providers.

While three respondents expressed interest in GLP-1s, they voiced uncertainty about accessibility.”Patients are interested in GLP-1s’ impact on our psoriatic disease, but also on other elements of our health, thinking more holistically [about] the benefits that could be achieved through these medications,” grieb explained.

Her personal perspective shed further light on the patient experience. “I don’t meet the requirement for obesity,” Grieb shared, “But I’m overweight, and I could probably benefit from a GLP-1. Without clear weight-related indications, it’s hard, perhaps to be able to justify prescribing it if it’s not going to be available. So it’s a hard conversation [for clinicians] to bring up with their patients.” Patients also conveyed concerns about the potential long-term commitment of taking these medications.

The discussions at this session underscore a critical juncture: while GLP-1 RAs offer promising avenues for broader health benefits, their integration into dermatological and rheumatological care requires further robust data and a clearer understanding of patient access and physician capacity. The conversation is ongoing, with both clinicians and patients navigating the evolving landscape of these powerful new therapies.

Coudl rapid weight loss induced by GLP-1RAs be a primary driver of psoriasis/PsA onset or exacerbation, or is it more likely a contributing factor alongside immune modulation and gut microbiome changes?

GLP-1 Drugs and Psoriasis/PsA: A Contentious Relationship

The Emerging Link Between Diabetes Medications and Skin Conditions

For years, GLP-1 receptor agonists (GLP-1RAs) – initially developed for type 2 diabetes management – have been lauded for their efficacy in blood sugar control and weight loss. Though, a growing body of evidence suggests a complex, and sometimes concerning, relationship between these medications and inflammatory conditions like psoriasis and psoriatic arthritis (PsA). This article delves into the current understanding of this connection, exploring potential mechanisms, reported cases, and what it means for patients. We’ll cover topics like Ozempic and psoriasis, Wegovy side effects, and GLP-1 RA induced psoriasis.

How Do GLP-1 Drugs Work? A Rapid Recap

GLP-1RAs mimic the effects of glucagon-like peptide-1, a naturally occurring hormone. Their primary actions include:

Stimulating Insulin Release: Helping the pancreas release insulin when blood sugar is high.

Suppressing Glucagon Secretion: Reducing the release of glucagon, a hormone that raises blood sugar.

Slowing Gastric Emptying: Leading to a feeling of fullness and reduced appetite. (As per recent research from Zhihu [https://www.zhihu.com/question/503144626])

Potential Immunomodulatory Effects: Emerging research suggests GLP-1 receptors are present on immune cells, hinting at a broader impact beyond glucose regulation. This is a key area in understanding the psoriasis/PsA link.

The Psoriasis/PsA Connection: What’s the Evidence?

Reports of new-onset psoriasis or PsA flares following the initiation of GLP-1RAs are increasing. While a definitive causal link hasn’t been established,the correlation is becoming difficult to ignore.

Case Reports: Numerous case reports detail individuals with no prior history of psoriasis or PsA developing these conditions shortly after starting medications like semaglutide (Ozempic, Wegovy), liraglutide (Victoza), and dulaglutide (Trulicity).

Post-Market surveillance: Pharmacovigilance databases are showing a signal – a statistically notable increase in reports of psoriasis and PsA among GLP-1RA users compared to the general population.

Inflammation & Autoimmunity: Both psoriasis and PsA are autoimmune diseases characterized by chronic inflammation. The potential immunomodulatory effects of GLP-1RAs could, paradoxically, exacerbate these inflammatory processes in susceptible individuals.

Several theories attempt to explain the link between GLP-1 agonists and autoimmune disease:

1. Immune Cell Modulation: GLP-1 receptors are found on immune cells like T cells and dendritic cells. Activation of these receptors could alter immune responses, perhaps triggering or worsening autoimmune reactions.
2. Gut Microbiome Changes: GLP-1RAs can influence the gut microbiome composition. Alterations in gut bacteria have been implicated in the pathogenesis of psoriasis and PsA.
3. Rapid Weight Loss: While weight loss is often a desired effect,rapid weight loss can sometimes trigger inflammatory responses in the body,potentially unmasking or exacerbating underlying autoimmune conditions.
4. IL-17 Pathway: Psoriasis is heavily driven by the IL-17 pathway.Some research suggests GLP-1RAs might indirectly influence this pathway, contributing to disease activity.

While reports exist for various GLP-1RAs, semaglutide (Ozempic, Wegovy) appears to be the most frequently associated with psoriasis/PsA progress or flares. This could be due to its higher potency and wider use. Though, it’s crucial to remember that any* GLP-1RA has the potential to trigger these reactions.

Recognizing the Symptoms: What to Watch For

If you’re taking a GLP