• Ching-Chi Chi, Chin-Yu Lee, Chia-Yu Liu, Shu-Hui Wang, Felice Tien O'Donnell, and Tao-Hsin Tung.
• Department of Dermatology, Chang Gung Memorial Hospital, Linkou, Taiwan.
• Eur. J. Clin. Invest. 2021 Feb 1; 51 (2): e13377.

BackgroundPsoriasis, a chronic inflammatory skin disease, poses an elevated risk of developing diabetes mellitus.PurposeTo investigate the effects of antidiabetic medications on psoriasis.Data Sources, Study Selection And Data ExtractionWe conducted a systemic review and meta-analysis and searched MEDLINE, EMBASE and CENTRAL for relevant randomized controlled trials. Our outcomes included 75% improvement in the psoriasis area and severity index from baseline (PASI 75), change in the psoriasis area and severity index (PASI) score, or change in the Dermatology Life Quality Index score under antidiabetic agents. Cochrane Collaboration's tool was used to evaluate the risk of bias of included studies. Subgroup analysis of different dosages of the antidiabetic agents was also performed.Data SynthesisWe included 10 randomized controlled studies examining the effect of antidiabetic agents. Eight studies were rated high risk of bias. Pioglitazone demonstrated significant increase in PASI 75 (risk difference = 0.42; 95% CI: 0.18-0.65) and decrease in mean PASI (mean difference = -3.82; 95% CI: -6.05-1.ㄍ59). In subgroup analysis, 30 mg pioglitazone group demonstrated a significantly higher portion of PASI 75 than 15 mg pioglitazone group (P = .003).LimitationsSome biases are reported high risk in involved articles. The main limitation of the study is in the inclusion of only glitazones. The lack of effect was seen for rosiglitazone and metformin. In the case of metformin, there was only one study available, which is also an important issue.ConclusionsThe current evidence demonstrates therapeutic efficacy of pioglitazone, which may be a treatment option in patients with psoriasis and diabetes mellitus.© 2020 Stichting European Society for Clinical Investigation Journal Foundation. Published by John Wiley & Sons Ltd.

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