Psoriasis biologics may help reduce coronary plaque

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CARDIOVASCULAR DISEASE

Psoriasis biologics may help reduce coronary plaque

Medical writer: Kirsty LEE | Last updated: 8th October 2020 | In: AutoImmune Disorders, Cardiovascular

Article Keywords

adalimumab, anti-IL-12, anti-IL-23, anti-TNF, CAD, cardiovascular disease, CCTA, coronary artery disease, coronary computed tomography angiography, coronary plaque, CVD, etanercept, Framingham Risk Score, ixekizumab, psoriasis, secukinumab, ustekinumab

Psoriasis is an immune-mediated chronic inflammatory skin disorder that presents with plaques on the skin, and is associated with an increased prevalence of cardiovascular (CV) risk factors and CV disease (CVD).¹ A meta-analysis has found that patients with psoriasis have a higher prevalence of subclinical coronary artery disease (CAD), and more high-risk coronary plaques, compared with control patients without psoriasis.² Psoriasis is often treated with biologic therapy, including anti-TNF, anti-IL/12/23 or anti-IL-17 inhibitors.³ Inflammation is also critical in the progression of CAD.³ Biologic therapies for psoriasis have been associated with an improvement in non-calcified coronary plaque burden.³

A recently published study characterised the lipid-rich necrotic core (LRNC) in psoriasis and how LRNC modulates in response to biologic therapy.³ The study utilised a histopathologically validated imaging application on coronary computed tomography angiography (CCTA) images characterising LRNC in the coronary arteries before and after the initiation of biologic therapy in patients over one year.³

A total of 209 consecutive biologic-naïve psoriasis patients with baseline and 1-year CCTA scans for analysis were included in this study.³ Biologic therapies for psoriasis included adalimumab, etanercept, ustekinumab, ixekizumab, and secukinumab.³ Patients who chose not to receive biologic therapy at the baseline visit were used as a reference group and were treated with topical, UV, and systemic therapies.³

Study participants were middle-aged and predominantly male, with a low cardiovascular risk and mild-to-moderate psoriasis skin disease.³ At 1-year follow-up, patients who had initiated biologic therapy had a decrease in LRNC area (3.12mm² at baseline vs 2.97mm²; p=0.028).³ In contrast, patients who had not received biologic therapy over the one year demonstrated no significant change in LRNC from baseline.³ The LRNC change over once year between the biologic and non-biologic groups were significant, even after adjustment for psoriasis severity, Framingham risk score, body mass index, and statin use.³ LRNC reductions continued to be significant compared to the non-biologic patients when stratifying by class of biologic.³

This study demonstrated the beneficial effects of biologics on LRNC, although the follow-up period was short, and highlight the potential importance of treating in vivo systemic inflammation to reduce CVD risk in psoriasis.³

Reference

Manolis AA et al. Int Rev Immunol. 2019;38(1):33-54.

Kaiser H et al. Dermatol Basel Switz. 2019;235(6):478-487.

Choi Harry et al. Circ Cardiovasc Imaging. 2020;13(9):e011199.

Disclaimer

This article is not medical advice. Patients should seek personal assessment by a licenced specialist. Physicians are recommended to read the full publication(s) as cited in the article before making medical decisions. This article does not supersede nor replace the published article(s).