Biologics may reduce coronary artery disease progression in patients with psoriasis
Patients with severe psoriasis who were treated with biologic agents had reduced coronary artery disease progression, according to study results recently published in JAMA Dermatology.
Researchers in Denmark conducted a prospective, observer-blinded clinical study at a tertiary dermatology university clinic. They enrolled 58 patients with severe psoriasis from April 11, 2011 to June 30, 2014. Thirty initiated biologic therapy (intervention) and 28 did not receive systemic therapy (controls). The mean follow-up was 13. 4 months.
Patients initiated treatment within 2 weeks after baseline coronary computed tomography (CT), with biologic treatments including Humira (adalimumab, AbbVie), Enbrel (etanercept, Amgen), Remicade (infliximab, Janssen) or Stelara (ustekinumab, Jannsen). Some patients switched treatments during the study.
Noncontrast coronary artery calcium (CAC) coronary CT and contrast-enhanced coronary CT angiography were conducted at baseline and at 13 months follow-up.
Twenty-eight patients in the intervention group (mean age, 49.2 years; 71% men; mean Psoriasis Area Severity Index [PASI], 15.4), and all 28 patients in the control cohort (mean age, 52.8 years; 71% men, mean PASI, 12.4) completed the study.
In the intervention group, the CAC scores remained stable, with a mean yearly CAC change of –16. In the control group the scores progressed, with a mean yearly CAC change of 14 (P = .02, intervention vs. controls).
Although there was no change in the number of segments with luminal abnormalities in either group, the severity of luminal narrowing in the diseased segments increased in the control group (Wilcoxon W = 281, n = 414, P = .02), but not in the intervention group.
The intervention cohort had no change in the automated vessel wall volume index from baseline to follow-up (mean, 7.1, both), while the control group displayed statistically nonsignificant progression (baseline, 8.3, follow-up, 8.9; P = .06).
“In this study of patients with moderate-to-severe psoriasis, clinically effective antipsoriatic treatment with biological agents was associated with reduced coronary atherosclerosis progression in patients without symptomatic [coronary artery disease] during a mean 13-month follow-up period,” the researchers wrote. “Patients with psoriasis have an increased prevalence of premature [coronary artery disease] compared with a matched background population.”
“Our data provide pathophysicological evidence that anti-inflammatory biologic treatment may prevent asymptomatic coronary atherosclerosis progression in patients with moderate-to-severe psoriasis,” the researchers concluded. – by Bruce Thiel
Disclosure: Hjuler reports grants from AbbVie, consulting fees from AbbVie and Pfizer, and a travel grant from Janssen, outside the submitted work. Please see the full study for a list of all other authors’ relevant financial disclosures.