The Impact of Ramadan Fasting on the Reduction of PASI Score, in Moderate-To-Severe Psoriatic Patients: A Real-Life Multicenter Study

Giovanni Damiani, Abdulla Watad, Charlie Bridgewood, Paolo Daniele Maria Pigatto, Alessia Pacifico, Piergiorgio Malagoli, Nicola Luigi Bragazzi, Mohammad Adawi, Giovanni Damiani, Abdulla Watad, Charlie Bridgewood, Paolo Daniele Maria Pigatto, Alessia Pacifico, Piergiorgio Malagoli, Nicola Luigi Bragazzi, Mohammad Adawi

Abstract

Fasting during the month of Ramadan consists of alternate abstinence and re-feeding periods (circadian or intermittent fasting). Nothing is currently known on the impact of this kind of fasting on psoriasis. A sample of 108 moderate-to-severe plaque psoriasis patients (aged 42.84 ± 13.61 years, 62 males, 46 females) volunteered to take part in the study. A significant decrease in the "Psoriasis Area and Severity Index" (PASI) score after the Ramadan fasting (mean difference = -0.89 ± 1.21, p < 0.0001) was found. At the multivariate regression, the use of cyclosporine (p = 0.0003), interleukin-17 or IL-17 blockers (p < 0.0001), and tumor necrosis factor or TNF blockers (p = 0.0107) was independently associated with a low PASI score, while the use of apremilast (p = 0.0009), and phototherapy (p = 0.0015) was associated with a high PASI score before the Ramadan fasting. Similarly, the consumption of cyclosporine (p < 0.0001), IL-17 blockers (p < 0.0001), mammalian target of rapamycin or mTOR inhibitors (p = 0.0081), and TNF blockers (p = 0.0017) predicted a low PASI score after the Ramadan fasting. By contrast, narrow band ultraviolet light B or NB-UVB (p = 0.0015) was associated with a high PASI score after Ramadan fasting. Disease duration (p = 0.0078), use of apremilast (p = 0.0005), and of mTOR inhibitors (p = 0.0034) were independent predictors of the reduction in the PASI score after the Ramadan fasting. These findings reflect the influence of dieting strategy, the biological clock, and circadian rhythm on the treatment of plaque psoriasis.

Keywords: PASI score; Ramadan intermittent fasting; biological clock; circadian rhythm; moderate-to-severe psoriatic patients; plaque psoriasis; systemic treatment; topical treatment.

Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
Change in the “Psoriasis Area and Severity Index” (PASI) score before and after the Ramadan fasting.
Figure 2
Figure 2
Change in the Psoriasis Area and Severity Index (PASI) score before and after the Ramadan fasting, broken down according to the received drug. Abbreviations: IL-17 (interleukin-17); mTOR (mammalian target of rapamycin) inhibitors; NB-UVB (narrow band ultraviolet B); PASI (“Psoriasis Area and Severity Index”); TNF (tumor necrosis factor).

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