TNF-α Antagonist and Vascular Inflammation in Patients with Psoriasis Vulgaris: A Randomized Placebo-Controlled Study

Abstract

Vascular inflammation is increased in patients with psoriasis. This randomized, double-blind, multicenter study evaluated the effects of tumor necrosis factor-α antagonist adalimumab on vascular inflammation in patients with psoriasis. A total of 107 patients were randomized (1:1) to receive adalimumab for 52 weeks or placebo for 16 weeks followed by adalimumab for 52 weeks. Vascular inflammation was assessed with positron emission tomography-computed tomography. There were no differences in the change from baseline in vessel wall target-to-background ratio (TBR) from the ascending aorta (primary endpoint) (adalimumab: TBR = 0.002, 95% confidence interval [CI] = -0.048 to 0.053; placebo: TBR = -0.002, 95% CI = -0.053 to 0.049; P = 0.916) and the carotids (adalimumab: TBR = 0.031, 95% CI = -0.005 to 0.066; placebo: TBR = 0.018, 95% CI = -0.019 to 0.055; P = 0.629) at week 16 between adalimumab and placebo. After 52 weeks of treatment with adalimumab there was no significant change from start of treatment in TBR from the ascending aorta (TBR = -0.006, 95% CI = -0.049 to 0.038; P = 0.796), but there was an increase in TBR in carotids (TBR = 0.027, 95% CI = 0.000 to 0.054; P = 0.046). This study showed no difference over 16 weeks in vascular inflammation in patients treated with a tumor necrosis factor-α antagonist or placebo and a modest increase in vascular inflammation in carotids after 52 weeks of treatment with adalimumab.

Effects of secukinumab on metabolic and liver parameters in plaque psoriasis patients

“…There are limited data available on the impact of systemic psoriasis treatments on metabolic and cardiovascular parameters. A study of adalimumab in 21 patients demonstrated a decrease at 12 weeks in E‐selectin and IL‐22, but no impact on vascular inflammation was seen with adalimumab in an FDG‐PET imaging study . Ixekizumab, which also targets IL‐17A, showed a neutral impact on metabolic parameters .…”

Psoriasis and cardiovascular disease risk factors: the HUNT Study, Norway

“…The chronic inflammation in psoriasis could thus influence conditions such as atherosclerosis, obesity and diabetes, but the inflammatory molecules produced in these conditions could also vice versa influence the psoriasis pathogenesis. Studies have supported these hypotheses by showing that treatment of psoriasis could reduce cardiovascular events, probably by reducing inflammation, but a recent double‐blind placebo‐controlled trial using a tumour necrosis factor‐α antagonist showed no reduction in cardiovascular inflammation . The temporal relationship between psoriasis and comorbidities is still unclear.…”

The relationship between duration of psoriasis, vascular inflammation, and cardiovascular events

“…Nevertheless, we emphasize that the independent association between psoriasis and CVD remains a topic of ongoing debate, 20 as does the effect of systemic therapy on the vascular inflammation and CV events. 21 …”