Biologic Drugs Reduce Coronary Plaque in Patients With Severe Psoriasis

February 6, 2019

Biologic therapy in patients with severe psoriasis was associated with a reduction of non-calcified coronary plaque and improvement in plaque morphology, compared with patients with severe psoriasis not treated with biologic therapy, according to a study published in Cardiovascular Research.

During 1 year of treatment, biologic therapy improved coronary artery plaque, as assessed by coronary computed tomography angiography (CCTA), similar to the effect of a low-dose statin.

“Psoriasis severity is related to the burden of coronary disease,” said Nehal Mehta, MD, National Heart, Lung, and Blood Institute (NHLBI), part of the National Institutes of Health (NIH), Bethesda, Maryland. “Our findings suggest that treating the psoriasis may potentially benefit coronary heart disease.”

The observational study included 121 patients with severe psoriasis who qualified for biologic treatment. Of those, 89 took biological therapy and 32 used topical treatment.

Only participants who were naïve to biologic or systemic therapies at baseline were included and followed for 1 year.

Treatment agents included adalimumab, etanercept, ustekinumab, secukinumab, and ixekizumab.

All patients underwent imaging of their coronary arteries with CCTA at baseline and 1 year later.

Results showed that patients with severe psoriasis who took biologic therapy for 1 year had an 8% reduction in total and non-calcified coronary plaque burden.

The make-up of coronary plaques also improved in those taking biologics; however, coronary plaque burden increased by 2% in patients who did not take a biologic.

“We found that these anti-inflammatory drugs commonly used to treat severe psoriasis also improve plaque in the coronary artery making them more stable and less likely to cause a heart attack,” said Dr. Mehta. “This occurred in the absence of changes in traditional cardiovascular risk factors including blood pressure and blood lipids.”

During the 1-year study, systemic inflammation assessed by blood markers reduced only in the group taking biologic therapy.

Dr. Mehta said it is too early to say whether biologics exert their effects on coronary plaques directly or by reducing systemic inflammation.

“This preliminary study provides the first evidence that biologic therapy is associated with coronary plaque reduction and stabilisation, and provides strong rationale for a randomised trial testing the impact of biologic therapy on the progression of coronary disease in patients with psoriasis.”

Reference: http://dx.doi.org/10.1093/cvr/cvz009

SOURCE: European Society of Cardiology