Biologic Therapy Holds Promise to Thwart Adverse CV Events in Psoriasis

MAUI, HAWAII — A novel study that examined the link between psoriasis and CVD was one of several studies summarized at Maui Derm for Dermatologists 2020 that examined psoriasis’ link to several co-morbidities.

“This paper was one of the more exciting papers of the year,” Andrew Blauvelt, MD, MBA, Oregon Medical Research Center and Healio Dermatology Editorial Board Member, told attendees. The novel study appeared in Cardiovascular Research and was reported on by Healio.

“This time, researchers use a different method. They used CT scans and angiography,” Blauvelt explained. “They also injected dye in the coronary arteries, took CT pictures of the dye-filled coronary arteries, measured the lumen size of the patients’ coronary arteries and their plaque burden, and then treated patients with biologics for 1 year.”

“These researchers found that the higher the Psoriasis Area and Severity Index (PASI) score, the higher the amount of atherosclerosis,” he continued. “Excitingly, after 1 year of biologic therapy, the amount of noncalcified plaque decreased, and the amount of calcified plaque showed no change.”

The researchers also found that patients on TNF, IL-17 and IL-23 blockers showed no decrease or increase in major adverse cardiovascular events with short-term use vs. placebo-treated patients, according to Blauvelt. In addition, TNF, IL-17 and IL-23 blockers likely decreased the risk for major adverse cardiovascular events with long-term use.

“Do we have tremendous, clear convincing evidence of these claims? No. But the story is building,” Blauvelt said. “I tell all my patients that current biologic therapy offers the promise of decreasing risk of major adverse cardiovascular events,” he said.

Joel M. Gelfand, MD, MSCE, professor of dermatology and epidemiology, University of Pennsylvania Perelman School of Medicine, and co-author of the paper, shared additional clinical pearls related to cardiology.

“Either institute age-appropriate screening for traditional risk factors like blood pressure and high cholesterol or refer your patients back to their primary care physician for these clinical services.” He also recommended statin use in patients with more severe psoriasis, given statins’ indication for reducing CVD risk in some patients.

Gelfand added that in the past year, research established or affirmed that patients with psoriasis have worse gingival inflammation, more alveolar bone loss, fewer remaining teeth, more missing teeth, worse outcomes in cirrhosis or fatty liver disease and a modest increased risk for cancer.

“You need to encourage your patients to stay up to date on age-appropriate cancer screening,” Gelfand said of that last link.

References:

Blauvelt A. Update on psoriasis pathogenesis.

Gelfand GM. Update on psoriasis co-morbidities. Presented at: Maui Derm for Dermatologists; Jan. 25-29, 2020; Maui, Hawaii.