Association Between Changes in Coronary Artery Disease Progression and Treatment With Biologic Agents for Severe Psoriasis

Abstract

IMPORTANCE Inflammatory pathways of psoriasis share similarities with the mechanisms identified in atherosclerosis, and the association between psoriasis and cardiovascular disease due to accelerated coronary artery disease is well established. The effect of anti-inflammatory drugs on the development of coronary atherosclerosis remains essentially unknown.OBJECTIVE To investigate the association of biological therapy with changes in coronary artery disease progression, measured by repeated coronary computed tomography (CT). DESIGN, SETTING, AND PARTICIPANTSThis single-center prospective, controlled, observer-blinded clinical study at a tertiary dermatology university hospital clinic enrolled patients with severe psoriasis initiating biological therapy and matched controls not receiving systemic therapy from April 11, 2011, through June 30, 2014.INTERVENTIONS Biological therapy approved for psoriasis (adalimumab, etanercept, infliximab, ustekinumab) with the possibility to switch between treatments to ensure tight control of inflammation. MAIN OUTCOMES AND MEASURESPatients underwent noncontrast coronary artery calcium (CAC) CT and contrast-enhanced coronary CT angiography at baseline and after 13 months of follow-up. Changes in CAC score, number of coronary plaques, severity of narrowing, composition, and vessel wall volume were measured. RESULTS There were 28 treated patients (mean [SD] age, 49.2 [10.2] years; 71% men; mean [SD] Psoriasis Area Severity Index [PASI], 15.4 [4.3]) and 28 controls (mean [SD] age, 52.8 [10.6] years; 71% men; mean [SD] PASI, 12.4 [3.9]). The CAC scores remained stable in the intervention group (mean [SD] yearly CAC change, −16 [56]; P = .15) and progressed in the control group (14 [29]; P = .02) (intervention vs controls: P = .02). The number of segments with luminal abnormalities remained unchanged in both groups. The severity of luminal narrowing in the diseased segments was unchanged in the intervention group (Wilcoxon W = 76, n = 483, P = .39) but increased at follow-up in the control group (Wilcoxon W = 281, n = 414, P = .02). Automated vessel wall volume index remained unchanged from baseline to follow-up in the intervention group (mean [SD] baseline, 7.1 [1.5], follow-up, 7.1 [1.7]; P = .91), while controls demonstrated statistically nonsignificant progression (baseline, 8.3 [1.6], follow-up, 8.9 [2.2]; P = .06). CONCLUSIONS AND RELEVANCEClinically effective treatment with biologic agents was associated with reduced coronary artery disease progression in patients with severe psoriasis. These findings support a beneficial effect of biologic anti-inflammatory agents in preventing cardiovascular disease progression in addition to disease control in inflammatory diseases.

Higher Coronary Plaque Burden in Psoriatic Arthritis Is Independent of Metabolic Syndrome and Associated With Underlying Disease Severity

“…Consistent with our results, a recent study evaluating coronary lesions by CCTA in patients with mild to moderate psoriasis who were asymptomatic for CAD showed that fasting blood glucose level was an independent predictor of CAD (48). Another study using CCTA in severe psoriasis suggested a protective effect of biologic DMARDs on CAD; however, our results do not seem to support this observation (49).…”

Coronary Plaque Characterization in Psoriasis Reveals High-Risk Features That Improve After Treatment in a Prospective Observational Study

“…These results echo prior work which has revealed an association between psoriasis skin inflammation and cardiovascular risk, 3 and suggests that anti-inflammatory treatment may mitigate such risk. 34, 35, 36 …”

Psoriasis and risk of myocardial infarction before and during an era with biological therapy: a population‐based follow‐up study

“…However, Patients with psoriasis General population comparison cohort there has always been a delay in the implementation of scientific evidence in clinical practice. 26 A 2017 US study reported a decreased risk of cardiovascular events among patients treated with TNFa inhibitors compared with patients treated with methotrexate. 23 It has been suggested that inflammation underpins the association between psoriasis and cardiovascular disease.…”