Study |
Design |
Age |
BMI |
Baseline Disease Activity |
Intervention |
Comparator |
Duration |
Mean %Weight Change |
Outcome |
|
Comment |
Lifestyle (Diet/Physical Activity) Weight Loss Interventions in Psoriasis |
Gisondi et al (27) |
RCT (n=61) |
51.6±12.5 years |
33.7±4.3 kg/m2 |
PASI: 14.6±5.9 |
2.5mg/kg/day ciclosporin and supervised low calorie diet |
2.5mg/kg/day ciclosporin only |
24 weeks |
Intervention: -7.0% Control: -0.2% |
%PASI75 Intervention: 66.7% Control: 29.0% |
p<0.001 |
Weight loss (5–10%) improves response to ciclosporin in moderate/severe psoriasis |
Al-Mutairi et al (28) |
RCT (n=262) |
46.0±6.5 years |
29.4±4.7 kg/m2 |
PASI: 31.9±6.0 |
Supervised low calorie diet |
No specific diet advised |
24 weeks |
Intervention: -13.0% Control: -1.5% |
%PASI75 Intervention: 85.9% Control: 59.3% |
p<0.001 |
Weight loss (>10%) improves moderate/severe psoriasis |
Guida et al (29) |
RCT (n=44) |
52.0±10.9 years |
32.2±3.2 kg/m2 |
PASI: 8.3±3.8 |
Supervised low calorie diet, high n-3 PUFAs and low n-6 PUFAs |
No specific diet advised |
24 weeks |
Intervention: -11.4% Control: +2.1% |
ΔPASI Intervention: -5.1±1.8 Control: -1.1±2.4 |
p=0.021 |
Weight loss (>10%) improves mild psoriasis |
Naldi et al (30) |
RCT (n=303) |
53.0±14.1 years |
30.8±4.6 kg/m2 |
PASI: 4.0±7.9 |
Supervised low calorie diet and personalised exercise plan |
Counselling re: benefits of weight loss in psoriasis |
20 weeks |
Intervention: -3.0% Control: -1.8% |
%PASI75 Intervention: 24.5% Control: 19.1% |
p=0.25 |
Weight loss <5%. No improvement in mild psoriasis. |
Jensen et al (31) |
RCT (n=60) |
50.8±10.3 years |
34.2±5.2 kg/m2 |
PASI: 5.4±2.8 |
Supervised low calorie diet |
Supervised healthy diet |
16 weeks |
Intervention: -14.8% Control: -0.4% |
ΔPASI Intervention: -2.3±3.8 Control: -0.3±3.8 |
p=0.06 |
Trend towards weight loss (>10%) improving mild psoriasis |
Kimball et al (32) |
RCT (n=30) |
47.2±13.8 years |
104.2 kga |
PASI: 15.4±6.1 |
Narrowband UVB therapy and supervised low calorie diet (Ornish or South Beach) |
Narrowband UVB only |
12 weeks |
Ornish diet: -8.0% South Beach diet: -7.0% Control: 0% |
%PASI75 Ornish diet: 83.0% South Beach diet: 56.0% Control: 38.0% |
p=0.3 |
Weight loss (5–10%) does not improve response to narrowband UVB in moderate/severe psoriasis |
Del Giglio et al (33) |
RCT (n=42) |
59.6±9.7 years |
31.4±1.7 kg/m2 |
PASI: 1.0±1.1 |
Methotrexate until PASI75 for 12 weeks, then stopped and supervised low calorie diet started |
Methotrexate therapy until PASI75 for 12 weeks, then stopped and no specific diet advised |
24 weeks |
Intervention: -9.0% Control: 0% |
PASI Intervention: PASI worsened over time Control: PASI worsened over time |
p>0.05 |
Weight loss (5–10%) cannot maintain moderate/severe psoriasis remission after methotrexate is stopped |
Jensen et al (34) |
Cohort study as follow-up to Jensen et al (31) (n=56) |
51.1±9.9 years |
34.4±5.3 kg/m2 |
PASI: 4.8±3.0 |
Supervised low calorie diet (16 weeks), then maintenance diet |
- |
64 weeks |
After low calorie diet: -14.1% After maintenance diet: -9.5% |
ΔPASI After low calorie diet: -2.3±3.1 After maintenance diet: -2.9±3.8 |
p<0.05 p<0.05 |
Improvement in mild psoriasis from weight loss can be maintained up to 64 weeks |
Lifestyle (Diet/Physical Activity) Weight Loss Interventions in PsA |
Di Minno et al (35) |
RCT (n=126) |
45.2±11.5 years |
31.2±2.3 kg/m2 |
TJC: 14.5±10.5 SJC: 3.1±4.5 |
Biologic agent (anti-TNF) and supervised low calorie diet |
Biologic agent (anti-TNF) and supervised healthy diet |
24 weeks |
5% Weight Loss Intervention: 77.8% Control: 39.7% |
%MDA Intervention: 42.9% Control: 34.9% |
p=0.043 |
Weight loss (>5%) improves probability of achieving MDA in patients with PsA commencing anti-TNF treatment |
Pharmacological Weight Loss Methods in the Treatment of Psoriasis |
Buysschaert et al (36) |
Case series (n=7) |
56.0±8.0 years |
32.0±10.1 kg/m2 |
PASI: 12.0±5.9 |
Exenatide 5g subcutaneously twice daily (n=1) or liraglutide 1.2mg subcutaneously once daily (n=6) |
- |
18 weeks |
After treatment: -4.4%c |
ΔPASI -2.8±2.9 |
p<0.05 |
Exenatide/liraglutide may improve moderate/severe psoriasis in obese patients with diabetes |
Ahern et al (37) |
Case series (n=7) |
49.4±10.9 years |
50.1±14.4 kg/m2 |
PASI: 8.7±9.2 |
Liraglutide 1.2mg subcutaneously once daily |
- |
10 weeks |
After liraglutide: -5%b |
ΔPASI -3.7±5.3 |
|
|
Faurschou et al (38) |
RCT (n=20) |
51.3±13.1 years |
36.1 ±9.6 kg/m2 |
PASI: 13.2±6.5 |
Liraglutide 1.8mg subcutaneously once daily |
Placebo |
8 weeks |
Intervention: -4.1% Control: -1.5% |
ΔPASI Intervention: -2.6±2.1 Control: -1.3±2.4 |
p=0.23 |
Liraglutide does not improve moderate/severe psoriasis in obese patients without diabetes |
Bariatric Surgery in the Prevention of Psoriasis/PsA |
Egeberg et al (39) |
Cohort (n=13435) |
28.2±10.2 years |
- |
- |
Gastric bypass (n=12364) Gastric banding (n=1071) |
No control group (compared pre- and post-surgery) |
Pre-surgery Bypass: 12.8 yearsc Banding: 9.3 yearsc Post-surgery Bypass: 2.7 yearsc Banding: 6.3 yearsc |
- |
Incident Psoriasis Gastric bypass: Adjusted HR 0.52 (95%CI 0.33, 0.81) Gastric banding: Adjusted HR 1.23 (95%CI 0.40, 3.75) Incident PsA Gastric bypass: Adjusted HR 0.29 (95%CI 0.12, 0.71) Gastric banding: Adjusted HR 0.53 (95%CI 0.08, 3.56) |
p=0.004 p=0.72 p=0.01 p=0.52 |
Risks of developing psoriasis and PsA are reduced with gastric bypass, but not gastric banding |
Maglio et al (40) |
Cohort (n=4009) |
48.0±6.1 years |
41.0±5.1 kg/m2 |
- |
Gastric bypass (n=375) Gastric banding (n=262) Vertical banded gastroplasty (n=1354) |
No intervention or supervised low calorie diet and exercise programme |
Intervention: 18.7 yearsd Control: 18.1 yearsd |
Intervention: -17.0%e Control: +1.7%e |
Incident Psoriasis Adjusted HR 0.65 (95%CI, 0.47, 0.89) Incident PsA Adjusted HR 0.71 (95%CI, 0.38, 1.33) |
p=0.008 p=0.287 |
Risk of developing psoriasis, but not PsA, is reduced with bariatric surgery |