Associations of glucose- and lipid-lowering medications with incident or first-recorded psoriasis: a systematic review of real-world observational studies
- 1The Fourth Affiliated Hospital of Heilongjiang University of Chinese Medicine
- 2Heilongjiang University of Chinese Medicine
Abstract
Background: Glucose-lowering and lipid-lowering medications may influence psoriasis development through metabolic, inflammatory, and immune pathways, but real-world evidence remains inconsistent.
Objective: To systematically evaluate associations between these medications and the risk of incident or first-recorded psoriasis, with particular attention to comparator choice, outcome definition, study design, and data-source overlap.
Methods: PubMed, Embase, Web of Science Core Collection, and the Cochrane Library were searched from inception to 1 July 2026, with an updated search conducted on 11 September 2026 during manuscript revision. Longitudinal observational studies evaluating glucose-lowering or lipid-lowering medication use and incident or first-recorded psoriasis were included. Evidence was grouped by medication class, comparator, and outcome type and synthesized narratively. Psoriasis-specific outcomes and broader or composite psoriatic-disease outcomes were treated as distinct evidence categories. Risk of bias was assessed using ROBINS-I. Meta-analysis was not performed because sufficiently comparable and mutually independent estimates were unavailable within most medication–comparator–outcome strata.
Results: Eighteen reports were included. Dipeptidyl peptidase-4 inhibitor estimates were generally below 1; in an active-comparator study using a broader psoriasis-related outcome including psoriatic arthritis codes, the hazard ratio versus sulfonylureas was 0.422 (95% confidence interval, 0.273–0.716). Glucagon-like peptide-1 receptor agonist estimates were notably comparator dependent: estimates were above 1 in comparisons with dipeptidyl peptidase-4 inhibitors, approximately null in comparison with sodium-glucose cotransporter-2 inhibitors, and inconsistent across comparisons with GLP-1RA nonuse. Most sodium-glucose cotransporter-2 inhibitor estimates were near or above the null. Metformin and thiazolidinediones yielded lower estimates in some studies, whereas statins showed no consistent association or exposure-response gradient. Of the 18 report-level ROBINS-I assessment anchors, 13 (72.2%) had a serious overall risk of bias and five (27.8%) had a moderate risk; none had a low risk of bias. Several reports may also have included overlapping populations and were therefore not interpreted as independent replications.
Conclusion: The available observational evidence does not establish causal effects of glucose-lowering or lipid-lowering medications on incident or first-recorded psoriasis. This review does not support choosing or avoiding these medications solely to prevent psoriasis or modifying standard diabetes or cardiovascular treatment on the basis of the reported associations. The findings remain hypothesis-generating because of confounding by indication, other risks of bias, and limited independent evidence.
Systematic Review Registration: https://doi.org/10.37766/inplasy2026.7.0070 , identifier INPLASY202670070.
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BibTeX
@article{li2026associations,
title = {{Associations of glucose- and lipid-lowering medications with incident or first-recorded psoriasis: a systematic review of real-world observational studies}},
author = {Zhihong Li and Jie Yang and Danping Chen},
journal = {Frontiers in Pharmacology},
year = {2026},
month = oct,
doi = {10.3389/fphar.2026.1942307},
url = {https://www.frontiersin.org/articles/10.3389/fphar.2026.1942307/full},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Associations of glucose- and lipid-lowering medications with incident or first-recorded psoriasis: a systematic review of real-world observational studies
AU - Zhihong Li
AU - Jie Yang
AU - Danping Chen
PY - 2026
DA - 2026/10/14
JO - Frontiers in Pharmacology
DO - 10.3389/fphar.2026.1942307
UR - https://www.frontiersin.org/articles/10.3389/fphar.2026.1942307/full
AB - Background: Glucose-lowering and lipid-lowering medications may influence psoriasis development through metabolic, inflammatory, and immune pathways, but real-world evidence remains inconsistent. Objective: To systematically evaluate associations between these medications and the risk of incident or first-recorded psoriasis, with particular attention to comparator choice, outcome definition, study design, and data-source overlap. Methods: PubMed, Embase, Web of Science Core Collection, and the Cochrane Library were searched from inception to 1 July 2026, with an updated search conducted on 11 September 2026 during manuscript revision. Longitudinal observational studies evaluating glucose-lowering or lipid-lowering medication use and incident or first-recorded psoriasis were included. Evidence was grouped by medication class, comparator, and outcome type and synthesized narratively. Psoriasis-specific outcomes and broader or composite psoriatic-disease outcomes were treated as distinct evidence categories. Risk of bias was assessed using ROBINS-I. Meta-analysis was not performed because sufficiently comparable and mutually independent estimates were unavailable within most medication–comparator–outcome strata. Results: Eighteen reports were included. Dipeptidyl peptidase-4 inhibitor estimates were generally below 1; in an active-comparator study using a broader psoriasis-related outcome including psoriatic arthritis codes, the hazard ratio versus sulfonylureas was 0.422 (95% confidence interval, 0.273–0.716). Glucagon-like peptide-1 receptor agonist estimates were notably comparator dependent: estimates were above 1 in comparisons with dipeptidyl peptidase-4 inhibitors, approximately null in comparison with sodium-glucose cotransporter-2 inhibitors, and inconsistent across comparisons with GLP-1RA nonuse. Most sodium-glucose cotransporter-2 inhibitor estimates were near or above the null. Metformin and thiazolidinediones yielded lower estimates in some studies, whereas statins showed no consistent association or exposure-response gradient. Of the 18 report-level ROBINS-I assessment anchors, 13 (72.2%) had a serious overall risk of bias and five (27.8%) had a moderate risk; none had a low risk of bias. Several reports may also have included overlapping populations and were therefore not interpreted as independent replications. Conclusion: The available observational evidence does not establish causal effects of glucose-lowering or lipid-lowering medications on incident or first-recorded psoriasis. This review does not support choosing or avoiding these medications solely to prevent psoriasis or modifying standard diabetes or cardiovascular treatment on the basis of the reported associations. The findings remain hypothesis-generating because of confounding by indication, other risks of bias, and limited independent evidence. Systematic Review Registration: https://doi.org/10.37766/inplasy2026.7.0070 , identifier INPLASY202670070.
SN - 1663-9812
ER -