GLP-1 Agonists Address Metabolic Risk in Psoriatic Disease

Joel Gelfand, MD, MSCE, dermatologist, professor of dermatology and epidemiology, and director of the Center for Clinical Sciences in Dermatology and the Psoriasis and Phototherapy Treatment Center at the University of Pennsylvania Perelman School of Medicine, recently discussed the role of GLP-1 agonists in psoriatic disease during a panel session at Fall Clinical 2026. He described growing enthusiasm among dermatologists for talking with patients about the effects of these agents on psoriatic disease and overall health. Gelfand framed the topic around optimizing the patient’s full medical experience.

Treating Beyond the Skin

Gelfand said the field is recognizing skin treatment alone is not enough for managing psoriatic disease. A patient can reach clearance on a biologic and still have elevated blood pressure, insulin resistance, or prediabetes. He said these patients presumably remain at higher risk of psoriatic arthritis, other metabolic problems, and biologic failure over time.

“We all had this hope if we just cleared the skin, everything would turn to normal,” Gelfand said.

He added that a large percentage of patients still have residual systemic inflammation after skin clearance, much of it obesity related.

Psoriasis as an Inflammatory Metabolic Disease

Gelfand described psoriasis as an inflammatory metabolic disease. Among inflammatory diseases of medicine, he said psoriasis has by far the closest association with obesity. Obesity makes psoriasis more likely, makes it more severe, and raises the risk of psoriatic arthritis.

He also cited genetic causal relationships, with people carrying genes for higher weight developing psoriasis at higher rates. Patients with excess weight are harder to treat and more likely to lose response.

“We’re not just trying to get them clear for 3 months,” Gelfand said.

He said the goal is skin clearance and remission for many years, with the metabolic components of survival addressed as a key part of care.

Metabolic Benefits Seen in Psoriasis and Psoriatic Arthritis Data

Gelfand said data from the TOGETHER-PsO trial of ixekizumab plus tirzepatide in psoriasis showed real improvements in skin and joints, though the differences were not huge. Metabolic benefits were more pronounced. Blood pressure dropped by about 8 to 10 mm Hg.

“The benefits metabolically were dramatic,” Gelfand said.

He said patients who miss this benefit face added risk of stroke, coronary disease, and other adverse health outcomes.

Experience in Clinical Practice

Gelfand said colleagues who prescribe GLP-1s described the experience as gratifying during roundtable discussions. Patients return after their psoriasis has been cleared, and the conversation turns to the relationship between psoriasis and weight.

“Wow, my skin is better. I feel better now. My weight is down. My numbers look better,” Gelfand said, describing patient responses after starting a GLP-1.

Gelfand said a more holistic approach can clear the skin further and improve joint outcomes while delivering profound benefits in overall health.