Biologic therapy for severe psoriasis may also reduce coronary artery plaque
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Coronary artery plaque lipid-rich necrotic core was associated with psoriasis severity and may be improved with biologic therapy, researchers reported.
“In our prior studies, we have shown that patients with psoriasis are at higher risk for developing high-risk coronary plaque at earlier ages compared to non-psoriasis,” Nehal N. Mehta, MD, MSCE, FAHA, Lasker senior investigator and chief of the Lab of Inflammation and Cardiometabolic Diseases at the NHLBI/NIH in Bethesda, Maryland, told Healio. “In this study, we asked whether biologic therapy for severe psoriasis is associated with reduction in a particular high-risk plaque feature, the lipid-rich necrotic core, following 1 year of treatment.
“Lipid-rich necrotic core represents a high-risk coronary plaque feature, thought to be driven by inflammation,” Mehta said in an interview. “We found that the degree of skin disease in psoriasis related to the lipid-rich necrotic core. We were most interested to find that following biologic therapy for the skin, systemic inflammation decreased with a reduction in lipid-rich necrotic core.”
For this prospective, observational study, investigators evaluated 209 (mean age, 50 years; 61% men; median Framingham risk score, 1.9) consecutive biologic naive patients with psoriasis and cardiac CT available at baseline and at 1 year. Biologic therapy for systemic inflammation was initiated in 124 patients within 1 month of their initial visit. Outcomes included changes in lipid-rich necrotic core, Psoriasis Area Severity Index, high-sensitivity C-reactive protein and glycoprotein acetylation at 1 year among patients treated or not treated with biologic therapy.
Biologic therapy for 1 year
Investigators observed that lipid-rich necrotic core was more prevalent among men (beta = 0.13; 95% CI, 0.01-0.24) and was associated with hypertension (beta = 0.19; 95% CI, 0.07-0.3), Framingham risk score (beta = 0.12; 95% CI, 0-0.24) and psoriasis severity (beta = 0.13; 95% CI, 0.01-0.26).
At 1 year, patients treated with biologic therapy experienced improvements in Psoriasis Area Severity Index (5.9 vs. 2.5; P < .001), lower hsCRP (1.5 mg/L vs. 1.3 mg/L; P = .017) and lower glycoprotein acetylation (401 mol/L vs. 382 mol/L; P = .007).
Patients not treated with biologic therapy also experienced improvements in Psoriasis Area Severity Index (4.4 vs. 3.9; P = .05) but had no significant reduction in hsCRP (1.9 mg/L vs 1.8 mg/L; P = .74) or glycoprotein acetylation (392 mol/L vs. 382 mol/L; P = .1).
Moreover, biologic-naive patients with psoriasis who initiated biologic therapy at baseline experienced reduction at 1 year in lipid-rich necrotic core area (3.12 mm2 vs. 2.97 mm2; P = .028), whereas those not on biologic therapy had a slight increase in lipid-rich necrotic core area (3.12 mm2 vs. 3.34 mm2; P = .06).
The 1-year change in lipid-rich necrotic core area was greater in those who had biologic therapy compared with those who did not (0.22 mm2 vs. 0.14 mm2; P = .004) and remained significant after adjustment for CV risk factors and psoriasis severity (beta = –0.09; P = .033), according to the researchers.
“There is approximately 6% to 8% reduction in coronary plaque following therapy with statins,” Mehta said in the release. “Similarly, our treatment with biologic therapy reduced coronary plaque by the same amount after 1 year. These findings suggest that biologic therapy to treat psoriasis may be just as beneficial as statin therapy on heart arteries.”
Mehta told Healio: “Two things were surprising. In those with moderate to severe psoriasis who did not treat their skin disease with a biologic, high-risk plaque features including lipid-rich necrotic core worsened after 1 year, supporting the concept that untreated inflammation is dangerous to coronary arteries. Second, it was surprising to see that this high-risk plaque feature is able to be modified since the lipid-rich necrotic core, which is detected as a low-attenuation plaque on CT imaging, is the highest-risk plaque feature for rupture causing MI.”
‘Sampling bias exists’
“It was clear in this observational intention-to-treat study, sampling bias exists as patients with more Psoriasis Area Severity Index were more likely to receive biological therapy,” Mohamed A. Zayed, MD, PhD, FACS, director of the Zayed Lab and Vascular Surgery BioBank at the Washington University School of Medicine in St. Louis, wrote in a related editorial. “Although this raises concerns about the validity of the study findings, it also argues that if Psoriasis Area Severity Index was more evenly distributed, the change in lipid-rich necrotic core could have been potentially even greater in the biological therapy group.”
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