Secukinumab cardioprotective in patients with plaque psoriasis
Treatment with secukinumab results in improved endothelial function in patients with plaque psoriasis, with the improvements translating to reduced risk of cardiovascular (CV) disease, according to data from the CARIMA trial.
The 52-week, randomized, double-blind, placebo-controlled exploratory trial randomized patients with moderate-to-severe plaque psoriasis without clinical CV disease to receive secukinumab at 300 or 150 mg until week 52, or placebo until week 12 then 300 or 150 mg secukinumab until week 52. The primary outcome of endothelial function was measured using flow-mediated dilation (FMD).
At baseline, FMD was significantly lower in psoriasis patients vs healthy volunteers (4.4 percent vs 6.1 percent; p=0.01). At week 12, FMD increased by 1.2 percent in the 300-mg secukinumab group, by 0.76 percent in the 150-mg group, although these improvements did not reach significance vs the placebo group (p=0.223 and p=0.403 by ANCOVA, respectively).
However, at week 52, FMD further increased across groups. Compared with baseline, week-52 FMD improved significantly in patients receiving the 300-mg secukinumab (increase of 2.1 percent from baseline; 95 percent CI, 0.8–3.3; p=0.0022). Other relevant CV markers showed no change.
Psoriasis is associated with CV diseases and associated risk factors, conferring an approximately 25-percent increase in the risk of CV disease, independent of smoking, obesity and hyperlipidaemia. For optimal patient management and reduction of the overall burden of CVD in psoriasis, dermatologists should be educated about the benefits of appropriate screening and referral for CV risk factors. This is in line with guidelines stating that patients with psoriasis should be screened for traditional, modifiable CV risk factors and managed appropriately to reduce risk. [J Am Acad Dermatol 2018;79:345-352]
IL-17A inhibitors, such as secukinumab, are a new class of anti-inflammatory agents and have been shown to be effective against moderate-to-severe psoriasis. Inflammatory mechanisms, including the IL-17A pathway, are potential links between psoriasis and CVD. The CARIMA trial indicates that secukinumab exerts a beneficial effect on CV risk in plaque psoriasis patients by improving endothelial function.