Heart Disease in Psoriasis Slowed with Biologics

Biologic therapy may prevent asymptomatic coronary atherosclerosis progression in patients with moderate-to-severe psoriasis, a study shows.

Writing in the July 7 issue of JAMA Dermatology, Kasper Fjellhaugen Hjuler, M.D., of Aarhus University Hospital in Denmark, and colleagues conducted a small prospective, controlled, observer-blinded, interventional clinical study in patients with moderate-to-severe psoriasis with a Psoriasis Area and Severity Index (PASI) of at least 10.

The three-year study included 58 patients, 30 of whom were on biologic therapy and 28 were in the control group. The patients were just beginning treatment with biologic agents for psoriasis:  adalimumab, etanercept, infliximab and ustekinumab.

The treatment worked well in most patients whose psoriasis symptoms were less severe as shown by a mean PASI reduction of 87.6% while 82% of patients achieved at least a 75% PASI reduction.

But researchers were curious to know whether tumor necrosis factor (TNF) inhibitors could also control the inflammatory process associated with coronary artery disease (CAD) in patients with moderate to severe psoriasis. Physicians have long suspected a connection between coronary artery disease (CAD) and the underlying mechanisms that drive the inflammatory process associated with psoriasis, rheumatoid arthritis and inflammatory bowel disease.  [[{"type":"media","view_mode":"media_crop","fid":"50120","attributes":{"alt":"©ChristineLangerPueschel/Shutterstock.com","class":"media-image media-image-right","id":"media_crop_6779904394849","media_crop_h":"0","media_crop_image_style":"-1","media_crop_instance":"6098","media_crop_rotate":"0","media_crop_scale_h":"0","media_crop_scale_w":"0","media_crop_w":"0","media_crop_x":"0","media_crop_y":"0","style":"font-size: 13.008px; line-height: 1.538em; float: right;","title":"©ChristineLangerPueschel/Shutterstock.com","typeof":"foaf:Image"}}]]

“The inflammatory pathways of psoriasis share similarities with the mechanisms identified in atherosclerosis. There is evidence of systemic inflammation in psoriasis, and the association between psoriasis and cardiovascular disease due to accelerated CAD is well established. However, it remains unknown whether modification of the inflammatory activity modifies the progression of the accelerated atherosclerotic process,” the authors wrote.

Patients were evaluated for the progression of asymptomatic coronary atherosclerosis before the start of the trial and one year after starting biologic therapy. These results were compared to a control group who were prescribed topical therapy only.

Patients underwent non-contrast coronary artery calcium (CAC) computed tomography (CT) and contrast-enhanced coronary CT angiography at baseline and after 13 months of follow-up. Changes in CAC score, number of coronary plaques, severity of narrowing, composition and vessel wall volume were measured. The CT scans showed decreased CAD progression for patients receiving biologics and a reduction in acute-phase proteins in the study group.

Atherosclerosis progressed slowly in the control group, but the progression of CAC was significantly slowed in patients starting biological treatment.

“Our study should therefore be considered exploratory and hypothesis generating to justify a randomized study testing the efficacy of biological treatment for attenuating CAD progression in patients with psoriasis stratified by symptomatic or non-symptomatic CAD,” the authors wrote.

Disclosures:

This study was supported by a grant from AbbVie (grant IMM-10-0165).

References:

Hjuler KF, Bøttcher M, et. al.

"Association Between Changes in Coronary Artery Disease Progression and Treatment With Biologic Agents for Severe Psoriasis."

JAMA Dermatol. 2016 Jul 7. doi: 10.1001/jamadermatol.2016.1984.