Therapy for psoriasis may also cut coronary plaque
Biologic therapy for treating psoriasis, in particular anti-TNF agents, can also help reduce coronary plaque besides suppressing inflammation in the skin, suggests a study presented at the Society for Cardiovascular Angiography and Interventions (SCAI) 2018 Scientific Sessions in San Diego, California, US.
“To see a reduction in coronary plaque after just 1 year of biologic therapy alone is incredible and very assuring. It’s the first time we’re seeing treatment of a skin disease with biologic therapy have an impact specifically on plaque in the coronary,” said study principal investigator Dr Nehal Mehta from the National Heart, Lung, and Blood Institute in Bethesda, Maryland, US.
After 1 year, patients who were treated with biologics (mainly anti-TNF; n=57) saw their plaque volume decrease by 40 percent from baseline (p=0.002) compared with nonbiologic-treated patients (n=27), whose plaque volume almost doubled from baseline (+90 percent; p=0.04). [SCAI 2018, abstract II-02]
Consistent with a change in plaque volume, the levels of interleukin (IL)-1β also changed in the same direction, which is significant from baseline in the group receiving biologics (p=0.03) even after adjusting for cardiovascular risk factors and statin use.
In addition, unstable plaques prone to rupture was significantly reduced from baseline in biologic-treated patients, as indicated by noncalcified coronary plaque burden (p=0.03), but increased among nonbiologic-treated patients at 1 year (p=0.007).
Similar trend of association was observed with maximal stenosis in proximal artery of >2 mm (p=0.01 for decrease and p=0.02 for increase in maximal stenosis in the biologic and nonbiologic groups, respectively).
“Our study results further emphasize the importance of patients maintaining and treating psoriasis to decrease the risks of adverse cardiovascular events occurring. This also opens the door for us to look at other disease states and see how anti-inflammatory therapy options could impact coronary plaque over time,” said Mehta.
Previous studies have indicated that psoriasis was associated with an increased risk of myocardial infarction and atherogenesis. [JAMA 2006;296:1735-1741; Circulation 2017;136:263-276] Also, the recent CANTOS trial has demonstrated that targeting IL-1β, a key cytokine in modulating inflammatory response, with canakinumab significantly reduced recurrent cardiovascular events. [N Engl J Med 2017;377:1119-1131]
“Immunomodulatory therapy may offer means to treat chronic subclinical atherogenesis by reducing vulnerable plaque volume through circulating IL-1β proinflammatory cytokine modulation,” according to Mehta and co-authors.
The observational study included 84 patients (mean age 51 years) with psoriasis and low cardiovascular risk (Framingham risk scores of 3–6) who were assessed by computed coronary tomography angiography. Biologics comprised either IL-17 inhibitors or anti-TNF agents, while nonbiologics involved topical or ultraviolet light therapy.
The investigators will continue following the patients for additional inflammation and cardiovascular outcome data. They also suggested that randomized studies be conducted on larger number of patients to confirm the observational findings.