Therapy for psoriasis also quells vascular inflammation
The approved psoriasis therapy ustekinumab also reduces aortic vascular inflammation, along with improved psoriasis severity, compared with placebo in patients with moderate-to-severe psoriasis, according to the VIP-U* study presented at the 2018 American Academy of Dermatology (AAD) Annual Meeting in San Diego, California, US.
“The type of inflammation we see in psoriasis is similar to what we see in atherosclerosis,” said Dr Joel Gelfand from the Perelman School of Medicine at the University of Pennsylvania in Philadelphia, Pennsylvania, US. “Since ustekinumab blocks the specific pathways involved in in both skin and cardiovascular inflammation, we wanted to test whether it can improve aortic vascular inflammation.”
Ustekinumab targets the interleukin (IL)-12/23 cytokines, the common factor that is upregulated in both psoriasis and vascular disease. In fact, moderate-to-severe cases of psoriasis have been associated with an increased risk of heart attack and premature death in a previous study by Gelfand. [JAMA 2006;296:1735-1741]
The primary outcome of aortic inflammation, as measured by 18-FDG-PET/CT** imaging, was reduced by 6.6 percent in the ustekinumab arm compared with a 12.1 percent increase in the placebo arm at 12 weeks (p=0.001). This translates to a 19 percent improvement with ustekinumab vs with placebo. [AAD 2018, abstract 6645]
“The [benefit in aortic inflammation] is similar to what we would expect if we put the patient on a statin,” said Gelfand. “This study represents promise that this treatment may reduce the risk of heart attack and stroke in the future. It’s an encouraging finding.”
As expected, significantly more ustekinumab-treated patients achieved a ≥75 percent improvement in psoriasis activity at week 12 compared with patients on placebo (PASI***75, 77 percent vs 11 percent; p<0.001).
The phase IV, double-blind, cross-over study randomized 43 patients (mean age 42 years) with moderate-to-severe psoriasis (mean PASI 20) in a 1:1 ratio to ustekinumab or placebo for 12 weeks after a washout period for existing psoriasis treatments.
“These findings provide experimental evidence that inhibition of IL-12/23 in psoriasis may lower cardiovascular risk,” said Gelfand and co-authors.
The study is still ongoing, according to the researchers, who said analysis from an extended follow-up will reveal if the improvements are sustainable in the long term.