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Association between use of thiazolidinediones or other oral antidiabetics and psoriasis: A population based case-control study

https://doi.org/10.1016/j.jaad.2007.11.023Get rights and content

Background

Small clinical trials suggest that thiazolidinediones may exert a beneficial effect on skin lesions of patients with psoriasis. Little is known about other classes of antidiabetic drugs and the psoriasis risk.

Objective

We sought to study the association between use of thiazolidinediones, sulfonylureas, biguanides, or acarbose and the risk of developing a first-time diagnosis of psoriasis.

Methods

We conducted a case-control analysis on the United Kingdom–based General Practice Research Database. We identified patients with an incident psoriasis diagnosis from 1994 to 2005 and matched one control subject to each patient on age, sex, general practice, calendar time, and years of history in the database. Conditional logistic regression was used to estimate the odds ratio with 95% confidence intervals (CI) of developing a first-time psoriasis diagnosis in relation to previous exposure to antidiabetic drugs, stratified by exposure timing and duration of use and adjusted for a variety of potential confounders.

Results

We identified 36,702 patients with a first-time psoriasis diagnosis and the same number of matched control subjects. As compared with no use, the adjusted odds ratio for current use of 1 to 4 prescriptions or greater than or equal to 5 prescriptions for thiazolidinediones were 1.01 (95% CI 0.34-3.01) and 0.33 (95% CI 0.16-0.66), respectively. Current use of greater than or equal to 15 prescriptions for metformin or sulfonylureas yielded adjusted odds ratio of 0.77 (95% CI 0.62-0.96) and 1.07 (95% CI 0.88-1.31), respectively.

Limitations

The findings are based on a small number of patients exposed to thiazolidinediones (100 in total, 48 current users of ≥5 prescriptions).

Conclusions

The findings of this large observational study provide further evidence for a potentially beneficial effect of thiazolidinediones on psoriasis. While current long-term use of metformin was also associated with a suggestion of a reduced psoriasis risk, no such effect was seen for use of other oral antidiabetics.

Section snippets

Methods

We conducted a matched case-control analysis to explore the risk of developing a first-time psoriasis diagnosis in relation to a prevalent diabetes diagnosis and to previous use of thiazolidinediones, the biguanide derivative metformin, sulfonylureas, or acarbose within the GPRD.

Results

We identified 36,702 patients with a first-time diagnosis of psoriasis between January 1, 1994, and December 31, 2005, and the exact same number of matched control subjects. Table I displays the age and sex distribution and the distribution of smoking status, BMI, and various comorbidities of patients and control subjects. The study population encompassed 53.8% women, and 41.7% of patients were younger than 40 years at the time of the diagnosis. Current smoking was associated with a

Discussion

The findings of this large population-based case-control analysis support the hypothesis of a possible beneficial effect of thiazolidinediones in psoriasis in patients with an existing diabetes diagnosis, as previously observed in small clinical trials. We found a statistically significantly decreased risk of developing a first-time psoriasis diagnosis in current users of greater than or equal to 5 thiazolidinedione prescriptions (reflecting a treatment duration of approximately 1 year),

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    Supported by an unrestricted grant from Merck Serono, Switzerland, and by a grant from the Senglet Foundation, Switzerland (Ms Brauchli).

    Conflicts of interest: None declared.

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    Copyright © 2008 American Academy of Dermatology, Inc. Published by Mosby, Inc. All rights reserved.