By Dr. Shravani Dali
Copyright medicaldialogues
A new study published in Dermatology just put to rest the idea that biologics or methotrexate might double as anti-diabetes medications for people with psoriasis. Researchers tracked HbA1c levels in 386 psoriasis patients over the course of a year—those treated with TNF-α inhibitors (like adalimumab and infliximab), IL-17 inhibitors (brodalumab, ixekizumab, secukinumab), IL-12/23 inhibitor (ustekinumab), IL-23 inhibitors (guselkumab, risankizumab), and methotrexate. Across all treatment groups, HbA1c values stayed essentially unchanged. A tiny increase seen with secukinumab was deemed not clinically significant. Even when the analysis focused only on patients with higher initial HbA1c (36–47 mmol/mol), treatment had zero impact. Why does this matter? People with psoriasis generally run a higher risk of developing type-2 diabetes—likely tied to chronic inflammation. It’s tempting to hope that anti-inflammatory biologics or methotrexate could pull double duty by improving glucose metabolism. But this study’s data suggest otherwise: these effective skin-clearing treatments don’t seem to nudge blood sugar. That doesn’t mean biologics aren’t valuable—they still work wonders for managing skin symptoms and overall inflammation. But for diabetics, or psoriasis patients concerned about long-term metabolic risks, it’s important to know these drugs don’t appear to offer glycemic protection. For clinicians, this means continuing to monitor HbA1c routinely, just like in any other patient, and pushing for proven metabolic strategies—diet, exercise, medications when needed—rather than assuming psoriasis treatment alone will move the needle. Reference:Bukhari, M. F., Schwarz, C. W., Zachariae, C. O. C., Loft, N., & Skov, L. (2025). No change in HbA1c levels during treatment with biologics or methotrexate in patients with psoriasis. Dermatology. https://doi.org/10.1159/000547591 [API] Keywords: psoriasis, biologic therapy, methotrexate, HbA1c, glucose metabolism, antidiabetic effect, Dermatology journal
