Original Research Article
Year: 2020 | Month: May | Volume: 10 | Issue: 5 | Pages: 121-130
Evaluation of Role of Add on Anti Hyperglycaemic Drugs Metformin and Pioglitazone in Patients of Psoriasis with Metabolic Syndrome
Mahesh Chander Gupta1, Kamal Aggarwal2, Kartik Nayak1
1Department of Pharmacology, PGIMS, Rohtak, Haryana, India
2Department of Dermatology, PGIMS, Rohtak, Haryana, India
Corresponding Author: Mahesh Chander Gupta
ABSTRACT
Background: Psoriasis is a chronic non communicable autoimmune cutaneous disorder characterised by abnormal patches of skin. Psoriasis in recent times is known to be associated with systemic manifestations. People suffering from this disorder are at an increased risk of developing metabolic syndrome. An additional anti inflammatory and anti proliferative role of anti hyperglycaemic drugs such as metformin and pioglitazone has been explored to improve the symptomatology and quality of life of psoriatic patients with metabolic syndrome.
Material and Methods: 50 psoriatic patients (mild to moderate severity) with metabolic syndrome were randomized into 3 groups to receive topical clobetasone 3% alone as standard therapy (ST) (Group 1), metformin 500 mg once daily in addition to ST (Group 2) and pioglitazone 15 mg once daily as add on therapy to ST (Group 3) for 12 weeks. Primary efficacy assessment was done using change in Psoriasis Assessment Severity Index (PASI) and change in quality of life was assessed using Dermatological Life Quality Index (DLQI). The secondary outcomes were number of patients achieving PASI 50, 75 and improvement in parameters of metabolic syndrome.
Results: All the treatments significantly reduced the PASI score, maximum being at 12 weeks. Standard therapy reduced the PASI score from 9.39 ± 0.65 to 5.90 ± 0.55 (p <0.0001), metformin from 9.46 ± 0.45 to 3.91 ± 0.57 (p <0.0001) and pioglitazone from 9.61 ± 0.57 to 5.83 ± 0.44 (p <0.0001). Add on treatment with metformin and pioglitazone caused an additional reduction in PASI score as compared to ST alone. Metformin was also found to be significantly superior to pioglitazone therapy in reducing this score. 9 patients achieved PASI 50 and 3 patients achieved PASI 75 with metformin, 4 patients achieved PASI 50 with pioglitazone and 2 patients achieved PASI 50 and 1 patient achieved PASI 75 with ST alone. Both metformin and pioglitazone caused a significant improvement in parameters of metabolic syndrome. Add on treatment caused a significant improvement in QoL, metformin being superior to pioglitazone.
Conclusions: Add on therapy with metformin and pioglitazone to ST showed a better clinical improvement in signs and symptoms of the disease (PASI) as well as quality of life (DLQI) with a good safety profile. Metformin was found to be superior to pioglitazone and both the drugs can be a useful add on therapy for better therapeutic outcome.
Key words: Psoriasis Assessment Severity index, Dermatological Life Quality index, Metabolic Syndrome