Efficacy of Adding Oral Simvastatin to Topical Therapy for Treatment of Psoriasis: The Vietnamese Experience

Abstract

BACKGROUND:Psoriasis, the prevalence of which ranges from 2% to 3% of the general population, has been recently recognised as not only a chronic inflammatory skin disorder but also an immunometabolic systemic disease. Dyslipidemia is one of the most important comorbidities of psoriasis. Statins, frequently used as anti-hyperlipidemic agents, may be beneficial in the treatment of several autoimmune diseases, including psoriasis, due to their anti-inflammatory and immunomodulatory characteristics. Hence, we hypothesised that using this medication was not only beneficial for reducing hyperlipidemia but also improving psoriatic conditions.AIM:We conducted a study to determine the prevalence of dyslipidemia in psoriatic patients as well as whether the addition of statins (simvastatin prescribed forms) to standard topical antipsoriatic treatment can improve skin lesions in psoriatic patients.METHODS:A group of 128 psoriatic patients and 128 healthy controls who were matched with the patients regarding ethnicity, age, and sex were enrolled, and their lipid concentrations were determined. Furthermore, sixty patients were randomly selected from the former group and divided into two treatment subgroups to evaluate the effect of statins on the severity of psoriasis using the PASI score.RESULTS:We found that the rate of dyslipidemia in the patient group was significantly higher than in the healthy group (53.9% versus 21.9%, p < 0.001), particularly the triglyceride concentration (1.86 ± 1.17 versus 1.43 ± 0.79 mg/dL, p < 0.001). Also, the PASI score reduction in the simvastatin-treated subgroup was significantly different from that in the placebo-treated one after eight weeks of therapy (8.63 ± 4.78 versus 5.34 ± 3.59, p < 0.01).CONCLUSION:This study showed that simvastatin might play a role in controlling hyperlipidemia and in turn decrease the PASI score in psoriatic patients.

The effect of statins on psoriasis severity: a meta-analysis of randomized clinical trials

“…In the study by Naseri et al [11], patients from the statin and placebo arms differed substantially in their baseline PASI values (9.51 vs. 5.64, respectively), which may explain the greater improvement in the statin arm. Patients who received either statins or comparators had a similar psoriasis severity in the studies by Trong et al (about 12) and Chua et al (about 6) [26,27].…”

“…[11], Trong et al [27], and Vasiuk et al [12]. After exclusion of either study, the effect of statin therapy on PASI values was no longer significant (Table II).…”

“…This meta-analysis showed that oral statins may decrease the severity of psoriatic lesions after just eight weeks. Both of the studies with simvastatin reported a reduction in the severity of psoriasis [11,27], but two studies that compared atorvastatin with placebo did not show any effect [14,26]. In one study, the addition of atorvastatin to standard therapy improved the severity of psoriasis [12].…”

“…Concomitant therapies used during the included RCTs could have had an effect on treatment outcomes. Vasiuk et al [12], Chua et al [26], and Trong et al [27] did not specify whether their patients received any concomitant treatments, and participants in the studies by Faghihi et al and Naseri et al were allowed to use topical steroids [11,14]. Moreover, in the study by Faghihi et al [14], patients were allowed to use emollients, which could have had an effect on psoriasis severity.…”

Elevated circulating Krüppel-like factor 4 level as a novel independent marker of the proatherogenic risk in patients with psoriasis: a preliminary study

“…The positive effect of such a commonly administered drug as simvastatin has been widely documented to date in psoriatics. Recently, Trong et al has demonstrated that adding oral simvastatin to antipsoriatic therapy might be beneficial in controlling hyperlipidemia and decreasing the severity of the disease [25]. Going further, an improvement in psoriatic lesions has been observed in diabetic patients treated orally with troglitazone and pioglitazone which are PPAR-g agonists [26,27].…”