Preventing Cardiovascular Disease Progression in Psoriasis

Oct 25, 2016

Biologic anti-inflammatory agents can lead to a drop in coronary artery disease in psoriasis patients, a study shows.

Patients with moderate-to-severe psoriasis who receive biologic anti-inflammatory agent treatments can experience a drop in coronary artery disease, a study shows.

The connection between psoriasis and cardiovascular disease, due to coronary artery disease, is already well-established. By using treatments already approved for psoriasis, including adalimumab, etanercept, inifliximab, ustekinumab, researchers demonstrated the medications can prevent the progression of asymptomatic coronary artherosclerosis in this patient group.

The July 2016 study was published in the Journal of the American Medical Association and was led by Kasper FjellHaugen Hjuler, M.D., from Denmark’s Aarhus University Hospital. Results support the biologic anti-inflammatory medication’s proactive impact in preventing cardiovascular disease, as well as controlling inflammatory diseases.

“Our findings indicate that biological agents may attenuate coronary artherosclerosis disease progression,” the authors wrote. “The results are strengthened by the simultaneous use of three different, independent cardiac CT modalities that consistently demonstrated decreased coronary artery disease progression among patients treated with biologics.”

The single-center, prospective, controlled, observer-blind study was conducted in a tertiary, university hospital dermatology clinic.

Researchers divided participants into two groups:  28 individuals who received biologic agent treatment, and 28 in a control group. They assessed individuals’ coronary artherosclerosis at baseline and at 13 months via CT and CT angiography. Investigators looked for changes in coronary artery calcium score, number of coronary plaques, severity of narrowing, composition, and vessel wall volume changes.

According to results, coronary artery calcium scores remained stable for the intervention group (mean yearly change, -16 [56]; P=.15) and progressed in the control group (14 [29]; P=.02). Neither group experienced a change in the number of segments with luminal abnormalities. The intervention group saw no change in luminal narrowing severity (Wilcoxon W=76, n-483, P=.39), but the control group had an increase (Wilcoxon W=281, n=414, P=.02). There was no change in the automated vessel wall volume index for the intervention group (mean baseline, 7.1 [1.5], follow-up 7.1 [1.7]; P=.91), and the control group demonstrated a statistically nonsignificant progression (baseline, 8.3 [1.6], follow-up, 8.9 [2.2]; P=.06).

Previous observational study data also suggests a protective effect from anti-tumor necrosis factor and methotrexate treatments, they wrote.

The study was limited, however, as a nonrandomized trial with a small number of patients. There are also several unknown factors, researchers said. It’s unclear whether the results can be extended to individuals with other inflammatory diseases, and the extent to which reduced coronary artery disease progression can be translated to a lowered cardiovascular event risk is also unknown.

Ultimately, investigators said, any generalization of their findings might be limited to moderate-to-severe psoriasis patients who have unknown coronary artery disease.

 

References:

Kasper Fjellhaugen Hjuler, MD; Morten Bottcher,MD, PhD., et al. "Association Between Changes in Coronary Artery Disease Progression and Treatment With Biologic Agents for Severe Psoriasis," JAMA Dermatology. Published online July 7, 2016. 152(10):1114-1121. DOI:10.1001/jamadermatol.2016.1984

 

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