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Biologic therapy for psoriasis may also benefit coronary plaque
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SAN DIEGO — In a first-in-human observational study, treatment with common biologic therapies used for psoriasis resulted in regression of coronary plaque burden over 1 year, according to data presented at the Society for Cardiovascular Angiography and Interventions Scientific Sessions.
It is estimated that 2% to 4% of the population has psoriasis, with more than 1 billion immune cells activated within the body during a severe psoriasis flare. There are FDA-approved biologic treatments for psoriasis, including commonly used interleukin (IL)-17 inhibitors and anti-tumor necrosis factor (TNF) agents. There has been increasing interest in looking at psoriasis as “more than just a skin disease,” and increasing attention on the CV effects of psoriasis, Youssef Elnabawi, BS, fourth-year medical student at Tufts University School of Medicine and research fellow with the NHLBI, said here.
The researchers aimed to investigate whether treatment of psoriasis with anti-inflammatory therapies would confer favorable coronary characteristics. They analyzed 84 patients with psoriasis who were being followed under the ongoing, observational Psoriasis, Atherosclerosis and Cardiometabolic Disease Initiative (PACI). The mean age of the patients was 50.5 years, and more than half were men. Mean Framingham risk score was low at baseline. Patients were stratified by treatment: 57 received anti-TNF or IL-17 inhibitors and 27 received topical or ultraviolet light therapies. The researchers then assessed noncalcified burden, plaque volume and maximal artery stenosis in the proximal vessels based on coronary CTA using dedicated software at baseline, the first follow-up visit and 1 year.
At 1 year, there was a small decrease in IL-1B in the biologic-treated group (2.6 to 2.4; P = .03) and a small increase in the non-biologic-treated group (1.9 to 2.5; P = .05). The researchers also observed a “lipid-neutral effect” at 1 year in both groups, Elnabawi said.
Plaque volume in the biologic-treated group decreased by 40%, from 2.5 mm3 at baseline to 1.5 mm3 at 1 year (P = .002); however, the same trend was not observed in the non-biologic-treated group during follow-up (3.3 mm3 to 6.3 mm3; P = .04). Trends in noncalcified plaque index (biologic group: 1.29 mm2 to 1.17 mm2; P = .03; non-biologic group: 1.09 mm2 to 1.29 mm2; P = .007) and maximal stenosis (biologic group: 49.7% to 46.6%; P = .01; non-biologic group: 42.9% to 55.4%; P = .02) were consistent with plaque volume in both treatment groups, according to the researchers. Change in plaque volume was positively associated with a change in IL-1B, even after adjustment for age, sex, BMI, LDL, statin use and psoriasis treatment (beta = 0.56; P = .03).
This study shows that “biologic therapy was associated with regression of coronary plaque burden over 1 year,” Elnabawi said. “Targeting pro-inflammatory cytokines related to CVD may be of potential benefit.”
The promise of anti-inflammatory therapies for CVD has garnered interest lately, due in part to results of the CANTOS trial and the soon-to-be-reported CIRT trial. As previously reported by Cardiology Today, CANTOS evaluated canakinumab (Ilaris, Novartis), a fully human monoclonal antibody that targets IL-1B, and found that it was associated with a lower rate of recurrent CV events compared with placebo in patients with a history of MI and an elevated high-sensitivity C-reactive protein level. The NHLBI-funded CIRT trial is looking at the CV effects of low-dose methotrexate.
Although the current study is limited by its small sample size, observational design and use of coronary CTA only, “it may serve as the basis for larger randomized controlled trials,” Elnabawi said.
The researchers noted that further research is warranted to confirm these observational findings and to better understand how treatment with anti-inflammatory medications modulates coronary plaque volume over time.
“To see a reduction in coronary plaque after just 1 year of biologic therapy alone is incredible and very reassuring. It’s the first time we’re seeing treatment of a skin disease with biologic therapy have an impact specifically on plaque in the artery,” Nehal N. Mehta, MD, MSCE, FAHA, from the NHLBI, said in a press release. “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.” – by Katie Kalvaitis
Reference:
Elnabawi Y, et al. Immunomodulatory therapy reduces atherosclerotic plaque burden by coronary CT angiography in psoriasis at one-year. Presented at: Society for Cardiovascular Angiography and Interventions Scientific Sessions; April 25-28, 2018; San Diego.
Disclosures: Mehta reports he is a full-time government employee and receives research grants to the NHLBI from AbbVie, Celgene, Janssen and Novartis. Elnabawi reports no relevant financial disclosures.