Alpha-Glucosidase Inhibitor Use in Type 2 Diabetes Linked With Increased Psoriatic Disease Risk

Discontinued use and high dosage of alpha-glucosidase inhibitors in combination with metformin was shown to increase risk of psoriasis and psoriatic arthritis in patients with type 2 diabetes compared with those given only metformin.

Alpha-glucosidase inhibitor (AGI) use may increase the risk of psoriatic disease in patients with type 2 diabetes (T2D), according to study findings published this week in The International Journal of Clinical Practice.

As recent studies have shown that diabetes and psoriasis share a common pathogenesis, researchers note that the use of antidiabetic drugs may thus be considered in the treatment of psoriasis.

Investigations on the use of antidiabetic therapies in these patient populations have generated some positive findings, with metformin use shown to be safe and effective for the prevention and treatment of psoriasis in patients with an underlying metabolic disease or diabetes. Conversely, insulin has been found in prior case studies to potentially increase risk of psoriasis in patients with diabetes.

“In an animal model, AGI can alleviate psoriasis-like dermatitis lesions,” said researchers. “The influence of AGIs on psoriatic disease risk has not been investigated in humans with T2D.”

Seeking to evaluate the association between AGI use and psoriatic disease risk, including both psoriasis and psoriatic arthritis, researchers conducted a retrospective, population-based cohort study of patients with T2D registered in the 1999-2013 Taiwanese Longitudinal Cohort of Diabetes Patients Database who initiated hypoglycemic treatment between 2003 and 2012.

Participants without a history of psoriatic disease before T2D diagnosis who received metformin in combination with AGIs (n = 1390) or metformin alone (n = 47,514) were compared via the primary outcome of duration from the index date of diabetes treatment to the first date of psoriatic disease diagnosis.

Both groups were matched at a 1:10 ratio for age, sex, and index date of T2D drug use. The effect of AGI interruption at 30, 90, and 180 days was also assessed.

After matching both cohorts, the overall incidence rates of psoriatic disease were 349.25 in the AGI exposure group and 38.83 in the comparison group (incidence rate ratio, 9.00; 95% CI, 1.82-44.57; P = .007). Notably, ​​patients in the AGI exposure group whose AGI use was discontinued for 30 days were found to be 8.77 times more likely to be diagnosed with psoriatic disease than those given metformin only (HR, 8.77; 95% CI, 1.58-48.58).

Risk of psoriatic disease was substantially increased in patients with higher-than-median AGI use when AGI was discontinued after 30 days (HR, 36.11; 95% CI, 5.60-232.80). Risk was shown to decline after AGI exposure discontinuation.

“These results can aid the clinical application of AGIs in patients with T2D at risk of psoriatic disease,” concluded the study authors. “Further studies on the effects of the alteration of gut microbiota and inflammatory activities on patients with T2D receiving AGIs and different AGI categories.”

Reference

Huang PJ, Wei JCC, Liu YT, Lin CH, Lin CC, Chen HH. Association between α-glucosidase inhibitor use and psoriatic disease risk in patients with type 2 diabetes mellitus: a population-based cohort study. Int J Clin Pract. Published online September 7, 2021. doi:10.1111/ijcp.14819