Semaglutide in Patients with Obesity and Psoriasis: Insights from an 18-Month Real-World Experience

Psoriasis is often associated with obesity and type 2 diabetes mellitus (T2DM) due to a common low-grade chronic inflammatory mechanism amplified by metabolic dysfunction. Biologics have revolutionized psoriasis treatment, but patients with obesity show reduced responses and higher discontinuation rates. Glucagon-like peptide-1 receptor agonists—such as semaglutide—may enhance the efficacy of psoriasis care; however, data are limited in this context. We presented a retrospective analysis of our single-center real-world experience with 33 obese patients (24 men and 9 women) affected by mild (n = 19, 57.6%) or moderate (n = 14, 42.4%) psoriasis and treated with semaglutide over 18 months. Adherence to the semaglutide prescription was 94% (range 88–99%), with most patients (54.5%) having a last recorded dose of 1.0 mg. A significant mean reduction of 4.25 points in the PASI score (from 9.31 ± 1.54 to 5.05 ± 0.88; p < 0.001) was reported, followed by a mean decrease of 4.15 kg/m2 in BMI (from 32.53 ± 1.92 to 28.38 ± 1.59 kg/m2; p < 0.001) and significant improvements in all metabolic parameters. In addition, there was a significant decrease in inflammatory markers (CRP decreased from 5.47 ± 1.69 to 2.69 ± 0.94 mg/L, and ESR from 17.76 ± 4.22 to 11.64 ± 2.83 mm/h). More than fifty-seven percent (57.6%) of patients experienced mild and transitory gastrointestinal reactions, but no cases of discontinuation or cutaneous reaction occurred. Data provide additional insights into the role of semaglutide in patients with mild-to-moderate psoriasis. Large-scale, multicenter studies are needed to validate long-term results.