Biologic Therapy for Psoriasis Reduced Coronary Inflammation, Study Says

Allison Inserro

Biologic treatment for moderate to severe psoriasis was linked with reduced coronary inflammation as determined by a new imaging biomarker, according to a study published Wednesday in JAMA Cardiology.

The study used the perivascular fat attenuation index (FAI), which assesses coronary inflammation by mapping spatial changes of perivascular fat composition via coronary computed tomography angiography (CCTA).

The authors said they believe their study is the first to discuss FAI as a biomarker of inflammation in coronary arteries and one that can show response to anti-inflammatory treatments. Inflammatory diseases, such as psoriasis, are linked with increased cardiovascular (CV) risk. Other studies have begun to show that CV risk may be reduced when treating the underlying psoriasis.

A previous study, according to the researchers, found that treatment of psoriasis with biologics, including anti-tumor necrosis factor alpha (anti-TNFa), or inhibitors of interleukin (IL) 17 or 12/23, may impact coronary plaque compared with no biologic treatment.

In a statement, the lead author said the findings could have implications for other inflammatory conditions as well, such as lupus and rheumatoid arthritis. The study was funded by the National Heart, Lung, and Blood Institute (NHLBI), part of the National Institutes of Health,

“Coronary inflammation offers important clues about the risk of developing heart artery disease,” said study’s senior author Nehal N. Mehta, MD, a cardiologist and head of the Lab of Inflammation and Cardiometabolic Diseases at NHLBI. “Our findings add to the growing body of research that shows treating underlying inflammatory conditions may reduce the risk of cardiovascular diseases.”

This prospective cohort study recruited 310 patients from an ongoing cohort study to assess the association between psoriasis and cardiometabolic disease under the Psoriasis, Atherosclerosis and Cardiometabolic Disease Initiative from January 1, 2013, through March 31, 2019. Of those, 257 finished 1 year of follow-up, and 134 participants were included in the final analysis. At baseline, no patients were receiving biologics.

Perivascular FAI was measured around the proximal right coronary artery and defined as the weighted mean attenuation of all adipose tissue–containing voxels (−190 to −30 Hounsfield units [HU]) located within a radial distance from the outer vessel wall equal to the diameter of the respective vessel.

Of the 134 patients, most were male (62.4%), with a mean age of 51.1. Most had low CV risk by traditional risk scores (median 10-year Framingham Risk Score, 3%) and moderate to severe skin disease.

Of these patients, 82 received biologic therapy for 1 year; 52 did not receive any biologic therapy and were given topical or light therapy.

At baseline, 46 patients (27 in the treated group and 19 in the untreated group) had a focal coronary atherosclerotic plaque.

Results showed that biologic therapy was associated with a significant decrease in FAI at 1 year (median FAI −71.22 HU at baseline vs −76.09 HU at 1 year; P <.001) as well as improvement in skin disease as measured by the Psoriasis Area and Severity Index (PASI).

Skin disease symptoms improved (median PASI, 7.7 at baseline vs 3.2 at 1 year; P <.001), whereas no change in FAI was noted in those not receiving biologic therapy (median FAI, −71.98 at baseline vs −72.66 at 1 year; P = .39). The associations with FAI were independent of the presence of coronary plaque and were consistent among patients receiving different biologic agents, including anti-TNFa −71.25 at baseline vs −75.49 at 1 year; P < .001) and anti–IL-12/23 or anti–IL-17 therapy (median FAI, −71.18 at baseline vs −76.92 at 1 year; P < .001).

The researchers said the results should be further explored to understand how psoriasis treatments may affect future CV events. 

Elnabawi YA, Oikonomou EK, MD, Dey AK, et al. Association of biologic therapy with coronary inflammation in patients with psoriasis as assessed by perivascular fat attenuation index [published online July 31, 2019]. JAMA Cardiol. doi:10.1001/jamacardio.2019.2589.

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