Apremilast may improve cardiometabolic health in patients with psoriasis
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Patients with psoriasis taking apremilast saw a 5% to 6% decrease in subcutaneous and visceral adiposity, indicating that the drug may benefit cardiometabolic health, according to a study.
This reduction in adiposity, which the researchers of this open-label, nonrandomized clinical trial saw after 16 weeks of treatment, persisted through 52 weeks.
“Apremilast impacts visceral adipose tissue after 16 weeks of treatment, suggesting a beneficial impact on cardiometabolic diseases,” Nehal N. Mehta, MD, MSCE, director of inflammatory risk at the Hospital of the University of Pennsylvania, clinical professor of medicine at George Washington University and senior author of the study, told Healio. “This study underscores the importance of treating skin disease in psoriasis as a source of inflammation.”
In their study, Mehta and colleagues assessed the associations of apremilast with aortic vascular inflammation, adiposity and blood-based biomarkers of inflammation, as well as lipid and glucose metabolism, in patients with moderate to severe psoriasis.
The study included 70 patients (mean age, 47.5 years; 77.1% men; 82.9% white), with 60 patients completing the trial through week 16 and 39 completing it through week 52.
Dosage titration for the first 5 days was 10 mg on day 1; 10 mg twice daily on day 2; 10 mg once in the morning and 20 mg in the evening on day 3; 20 mg twice daily on day 4; and 20 mg in the morning and 30 mg in the evening on day 5). Thereafter, apremilast was administered 30 mg twice daily through 52 weeks.
The primary endpoint measured changes in inflammation around the aorta, but also assessed changes in body composition and several important cardiometabolic biomarkers. Patients were evaluated by a blinded investigator at weeks 4, 8, 12, 16, 28, 40 and 52.
Aortic vascular inflammation did not change from baseline at week 16 (target to background ratio, –0.02; 95% CI, –0.08 to 0.05) or at week 52 (target to background ratio, –0.07; –0.15 to 0.01), but there was a 5% to 6% reduction of subcutaneous and visceral adiposity at 16 weeks that was maintained through 52 weeks.
At week 16, compared with baseline, there were potentially beneficial reductions of interleukin-1b (–0.5 pg/mL), fetuin A (–50.7 µg/mL), valine (–0.17 mg/dL), leucine (–0.12 mg/dL) and isoleucine (–0.08 mg/dL). At week 52, compared with baseline, there were potentially beneficial reductions in levels of ferritin (–22.6 ng/mL), beta-hydroxybutyrate (–48.5 µmol/L), acetone (–0.189 mg/dL) and ketone bodies (–79.3 µmol/L), and a potentially beneficial increase in levels of apolipoprotein A-1 (5.8 mg/dL); however, there was also a reduction in cholesterol efflux capacity (–0.16), which may negatively impact the atheroprotective effects associated with high-density lipoprotein cholesterol.
These findings indicate that in addition to treating skin disease, the drug may also have a benefit on cardiometabolic diseases in psoriasis.
“The results of this study along with the evaluation of blood pressure, body mass index, blood glucose and blood cholesterol levels of those with psoriasis should help practitioners consider psoriasis as a risk enhancer for cardiovascular disease,” Mehta said. “Clinicians must remember that all of this research is fuel to show treating the skin disease is important.”