Thursday, 17 Oct 2019

You are here

Biologic Therapy Improves Psoriasis and Reduces CV Inflammation

Psoriasis confers a significant risk of comorbidity, but is psoriasis associated with increased coronary inflammation and is this risk attenuated by biologic therapy? 

JAMA Cardiology has published a cohort study of 134 consecutive patients with moderate to severe psoriasis, showing that biologic therapy was associated with a significant decrease in coronary inflammation as assessed by perivascular fat attenuation index, a marker of coronary inflammation associated with cardiovascular outcomes. Patients not receiving biologic therapy had no change in perivascular fat attenuation index at 1 year.

Researchers assessed coronary inflammation using the perivascular fat attenuation index (FAI), an assessment of coronary inflammation coronary computed tomography angiography (CCTA).

Most of the 134 psoriasis patients (mean 51.1 years; 62.5% male) had low cardiovascular (CV) risk with 10-year Framingham Risk Score of 3% (1%-7%) and moderate to severe skin disease.

Biologic agents were used in 82/134 patients and not used in the remaining 52.  Biologic therapies included TNF inhibitors, anti-IL-12/23, or anti–IL-17 agents.

Focal coronary atherosclerotic plaque was seen in 46 patients at baseline.

Biologic therapy was associated with a significant decrease in FAI at 1 year (baseline FAI −71.22 HU vs −76.09 HU at 1 year; P < .001) concurrent with skin disease improvement (median baseline PASI = 7.7 vs  PASI = 3.2 at 1 year; P < .001).

For those not on biologics, there was no change in FAI (baseline FAI, −71.98 vs −72.66 at 1 year; P = .39).

FAI changes were consistent among patients receiving different biologic agents (TNFi, IL-12/23 or IL-17 inhibitors). 

Control of moderate to severe psoriasis with biologic agents was associated with reduced coronary inflammation assessed by perivascular FAI. 

The author has no conflicts of interest to disclose related to this subject

Add new comment

More Like This

Comorbidity Worsens Axial Spondyloarthritis

Comorbidities are common in patients with axial spondyloarthropathy (axSpA), and a recent study has shown that multimorbidity, the coexistence of 2 or more conditions, is associated with more severe disease than those without comorbidities.

One-Third of Psoriatic Arthritis Patients Will Need Joint Surgery

Dannish study has shown that one-third of psoriatic arthritis (PsA) will have joint surgery that that PsA patients have twice the rate of joint surgery when compared with the general population.

The Danish National Patient Registry was used in this cohort study of incident PsA patients and their future risk of joint surgery compared to a general population cohort (GPC) between 1995-2012).

FUTURE 5 - Secukinumab and Less Radiographic Progression in Psoriatic Arthritis

The FUTURE 5 trial studied the effect of secukinumab (SEC) on radiographic progression through 52 weeks in patients with active psoriatic arthritis (PsA) and found that SEC was clinically and radiographically superior to placebo (PBO). Patients received s.c. secukinumab 300 mg load (300 mg), 150 mg load (150 mg), 150 mg no load regimens or placebo at baseline, at weeks 1, 2 and 3 and every 4 weeks starting at week 4. The majority (87%) of patients enrolled at baseline remained in the study for 52 weeks.

Ixekizumab vs. Adalimumab in Psoriatic Arthritis

The Annals of Rheumatic Disease reports a psoriatic arthritis study where in ixekizumab was non-inferior to adalimumab for achievement of ACR50 responses but was superior to adalimumab for achievement of PASI100 by week 24.

NSAID Use Linked With Hypertension in Ankylosing Spondylitis

Continuous use of nonsteroidal anti-inflammatory drugs (NSAIDs) among patients with ankylosing spondylitis (AS) was associated with the development of incident hypertension, a prospective cohort study found.