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Improvement of psoriasis during glucagon‐like peptide‐1 analogue therapy in type 2 diabetes is associated with decreasing dermal γδ T‐cell number: a prospective case‐series study
Author(s) -
Buysschaert M.,
Baeck M.,
Preumont V.,
Marot L.,
Hendrickx E.,
Van Belle A.,
Dumoutier L.
Publication year - 2014
Publication title -
british journal of dermatology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.304
H-Index - 179
eISSN - 1365-2133
pISSN - 0007-0963
DOI - 10.1111/bjd.12886
Subject(s) - medicine , psoriasis , type 2 diabetes , prospective cohort study , glucagon like peptide 1 , diabetes mellitus , endocrinology , oncology , dermatology
Summary Background A few case reports suggest that incretin‐based therapies could improve psoriasis in patients with type 2 diabetes, the mechanism(s) of which remain unclear. Objectives To determine the effects after 16–20 weeks of treatment with a glucagon‐like peptide ( GLP )‐1 analogue on clinical severity and histopathological aspects of psoriasis in patients with type 2 diabetes, and to examine the presence of γδ T cells and the expression of interleukin ( IL )‐17 in psoriasis before and after treatment. Methods Seven patients with type 2 diabetes and psoriasis were followed. Psoriasis Area and Severity Index ( PASI ) was measured at baseline (T0) and after 7 ± 1 (T1) and 18 ± 2 (T2) weeks' treatment with exenatide/liraglutide. The histopathological pattern of psoriasis, and flow cytometry and immunological data (γδ T‐cell percentage and IL ‐17 expression) were obtained from psoriatic and control sites. Results The mean PASI decreased from 12·0 ± 5·9 to 9·2 ± 6·4 ( P = 0·04). Histological analysis showed a reduction in epidermal thickness after treatment. The dermal γδ T‐cell percentage was higher in psoriatic lesions than in control specimens ( P = 0·03), as was IL ‐17 expression ( P = 0·018). A reduction of γδ T cells from 6·7 ± 4·5% to 2·7 ± 3·8% ( P = 0·05) was demonstrated in the six patients with improved/unchanged PASI . A correlation between PASI and γδ T‐cell percentage evolution during therapy (T2−T0) was noted ( r = 0·894, P = 0·007). IL ‐17 was reduced in the four patients with the highest PASI reductions. Conclusions The administration of a GLP ‐1 analogue improved clinical psoriasis severity in patients with type 2 diabetes. This favourable outcome was associated with a decrease of dermal γδ T‐cell number and IL ‐17 expression. Further studies are needed to establish long‐term efficacy in (diabetic) patients with psoriasis.