A new study suggests that PCSK9 inhibitors may improve psoriasis independently of their cardiovascular benefits.

Many people with psoriasis (PwP) show abnormal lipid metabolism. Circulating levels of proprotein convertase subtilisin/kexin type 9 (PCSK9) are also higher in PwP. Both these changes probably contribute to the increased cardiovascular risk among PwP. 

A genetic analysis included 12,116 PwP and 278,303 controls in the UK and Finland. All participants were of European ancestry.

In UK people, inhibiting PCSK9 (the target for alirocumab, evolocumab and inclisiran) reduced the risk of psoriasis by 31 per cent for each standard deviation (SD) reduction in low density lipoprotein (LDL; about 68 per cent of observations are within one SD, approximately 95 per cent are within two SDs and some 99.7 per cent are within three SDs of the mean). 

In patients from Finland, PCSK9 inhibition reduced psoriasis risk by 23 per cent for each SD reduction in LDL. 

PCSK9’s effect seems to be independent of circulating LDL levels. In addition to cardiovascular risk, previous studies suggest that PCSK9 may contribute to inflammation.

“The study results suggest that PCSK9 is implicated in psoriasis pathogenesis and existing PCSK9 inhibitors that are licensed to treat hypercholesterolaemia may be used for preventing psoriasis,” the authors conclude. (JAMA Dermatology doi:10.1001/jamadermatol.2022.6051)