Revisiting the Association Between Beta-blockers and Psoriasis: Evidence from Real-World Data.

Introduction: Some cases report that beta-blockers may induce or exacerbate psoriasis. However, pharmacoepidemiology studies have yielded conflicting results. This study aims to investigate whether there is a potential association between beta-blockers and psoriasis.

Methods: An observational study was conducted on the U.S. population from the National Health and Nutrition Examination Survey (NHANES) database using propensity score matching and multivariable logistic regression models. Subsequently, a disproportionality analysis was performed based on the FDA Adverse Event Reporting System (FAERS) database, and a two-sample Mendelian randomization (MR) study was conducted to assess the association between beta-blockers and the risk of developing psoriasis.

Results: Based on the NHANES database, logistic regression analysis, adjusted for relevant confounders, showed no significant association between beta-blocker use and the risk of psoriasis (OR: 1.49, 95% CI: 0.76-2.92, p = 0.250). FAERS analysis identified 300 psoriasis-related reports for beta-blockers, but no robust safety signals were detected (ROR: 0.34, 95% CI: 0.30-0.38), even after false-negative analysis. The meta-analysis of MR results demonstrated a statistically significant association between beta-blocker use and reduced risk of psoriasis (OR: 0.9985, 95% CI: 0.9978-0.9991, p < 0.001).

Discussion: The observed epidemiological association likely stems from confounding by cardiovascular indications for beta-blockers, rather than a direct causal effect. Neuroimmune pathways (sympathetic activity, β1/β2 receptor effects on immune cells/keratinocytes) present biologically plausible but complex and potentially opposing mechanisms, requiring further investigation.

Conclusions: We found that beta-blockers did not significantly elevate the risk of psoriasis. In clinical practice, labeling beta-blockers as drug-induced psoriasis may be inappropriate.