Addressing Cardiometabolic Disease in Patients with Psoriasis

New phase 4 data on apremilast in patients with psoriasis found that treatment resulted in a decrease in subcutaneous and visceral adiposity as well as a notable decrease in interleukin (IL)-1β.

The findings were presented at the American Academy of Dermatology (AAD) 2022 Annual Meeting in Boston, MA.

Previous research of apremilast found the oral therapy was associated with weight loss in patients. However, it was uncertain as to why patients experienced weight loss and if it benefitted their overall health.

“We know people with psoriatic disease are more prone to being obese, having cardiovascular risk factors, having cardiovascular events that lead to premature mortality,” said Joel Gelfand, James L. Leydon, MD, Endowed Professor at the Perelman School of Medicine at the University of Pennsylvania. “And so, there's a real need to understand what are treatments for psoriatic disease due to key pathways of cardiovascular risk.”

Gelfand and colleagues set out to determine the effect that apremilast had on aortic vascular inflammation, several cardiometabolic biomarkers and body composition in patients with moderate to severe psoriasis.

The team enrolled 70 patients, all of whom were imaged at week 16 and week 52 of the study to evaluate aortic vascular inflammation. Both subcutaneous and visceral fat were examined in patients following apremilast treatment, the latter of which has been known to lead to adverse health effects.

Overall, the team observed a neutral effect of aortic vascular inflammation.

However, elevations in inflammation at baseline were observed in a subset of patients, with patients improving at 52 weeks. Overall, patients lost roughly 5-6% of subcutaneous and visceral adiposity during the study, which Gelfand felt warranted further exploration.

These changes occurred by week 16, but did not remain into week 52.

“We know it's very hard for people to lose weight, they often lose weight and then it gains back,” Gelfand said. “This shows that these effects on visceral fat - which is metabolically active- causes disease over time, and are persistent over time. So, the question is, will that result in clinically meaningful benefits to patients over time?”

Gelfand and colleagues also observed a decrease in IL-1 beta, which is known to be causally related to heart disease, and a decrease in ketones. The data suggested that apremilast could potentially be used to lower heart event rates, which he considered a striking and unanticipated finding, and that the overall metabolic benefits could include enhancements to glucose metabolism.

Gelfand added that an increased awareness of the associations between the psoriatic disease and cardiovascular risk could help improve upon the life expectancy of patients affected by the skin disease.

“Cardiometabolic disease is a major problem for people with psoriasis, and so as clinicians to take care of these patients, the guidelines are clear: we need to educate them about the risk of cardiovascular and diabetic diseases,” Gelfand said. “We should be encouraging patients get screened for additional cardiovascular risk factors, check their blood pressure, check their lipids, check their hemoglobin-A1C, and then make sure these things are adequately treated when patients have traditional cardiovascular risk factors.”