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Biological therapy for severe psoriasis may also reduce coronary plaque



September 15, 2020

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Disclosure: Mehta reports that he was a US civil servant and consultant for Amgen, Eli Lilly, and Leo Pharma. Investigators at AbbVie, Celgene, Janssen Pharmaceuticals and Novartis. And a senior researcher at NIH. Zayed has not reported disclosure of relevant financial information. See the survey for relevant financial information for all other authors.

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The lipid-rich necrotic core of coronary plaques is associated with the severity of psoriasis and may be ameliorated by biotherapy, researchers report.

Nehal N. Meta

“Our previous study shows that patients with psoriasis are at increased risk of developing high-risk coronary plaques at an early age compared to non-psoriasis.” , MD, MSCE, FAHALasker’s senior investigator at NHLBI / NIH in Bethesda, Maryland, and head of the Institute for Inflammation and Cardiovascular Metabolism, told Healio. “This study asked if biotherapy for severe psoriasis was associated with a reduction in the lipid-rich necrotic core that is characteristic of certain high-risk plaques after one year of treatment.

Arterial plaque
Source: Adobe Stock.

“The lipid-rich necrotic core characterizes high-risk coronary plaques that are thought to be caused by inflammation,” Meta said in an interview. “The degree of skin disease in psoriasis was found to be associated with a lipid-rich necrotic core. After biological treatment of the skin, systemic inflammation decreased and Lipid-rich necrotic core.. “

In this prospective observational study, researchers found a series of psoriasis and cardiac CT in 209 patients (mean age 50 years, 61% male, median flamingham risk score, 1.9) available at baseline and 1 year later. We evaluated patients with biologically naive psoriasis. Biological therapy for systemic inflammation was initiated in 124 patients within a month of their first visit. Results included changes in lipid-rich necrotic core, psoriasis area severity index, sensitive C-reactive protein and glycoprotein acetylation, in patients treated or untreated with biotherapy. The results after one year are shown.

1 year biological therapy

Researchers have observed that lipid-rich necrotic cores were more common among men (beta = 0.13; 95% CI, 0.01-0.24) and Was associated with high blood pressure (Beta = 0.19; 95% CI, 0.07-0.3), flamingham risk score (beta = 0.12; 95% CI, 0-0.24) and psoriasis severity (beta = 0.13; 95% CI, 0.01-0.26).

At 1 year, patients treated with biotherapy experienced an improvement in the psoriasis area severity index (5.9 vs. 2.5; P <.001), lower hsCRP (1.5 mg / L vs 1.3 mg / L; P = .017) and lower glycoprotein acetylation (401 mol / L vs. 382 mol / L; P = .007).

Patients who were not treated with biotherapy also experienced an improvement in the psoriasis area severity index (4.4 vs. 3.9; P = .05), but there was no significant reduction in hsCRP (1.9 mg / L vs. 1.8 mg / L; P = .74) or glycoprotein acetylation (392 mol / L vs. 382 mol / L; P = .1).

In addition, biologically naive patients with psoriasis who started biological treatment at baseline have a lipid-rich necrotic core region (3.12 mm).2 Vs. 2.97 mm2; P = .028), the core region of lipid-rich necrosis (3.12 mm) in those who have not received biological therapy2 Vs. 3.34 mm2; P = .06).

The one-year change in the lipid-rich necrotic core region was greater in patients who received biotherapy than in those who did not (0.22 mm).2 Vs. 0.14 mm2; P = .004), remained significant after adjusting for CV risk factors and psoriasis severity (beta = -0.09; P = .033), according to researchers.

“Coronary plaques after treatment with statins are reduced by about 6% to 8%,” Mehta said in a statement. “Similarly, treatment with our biotherapy reduced coronary plaque by the same amount after one year. These findings indicate that biotherapy for treating psoriasis is a statin for the heart arteries. It suggests that it may be as beneficial as therapy.

Mehta told Healio: The notion that in people with moderate to severe psoriasis who have not treated their skin disease with biological, high-risk plaque function, it worsens after one year and untreated inflammation is dangerous to the coronary arteries. Is backed up. Second, it was surprising to be able to alter this high-risk plaque function, as the lipid-rich necrotic core detected as low-damping plaque on CT imaging is the highest-risk plaque function that causes rupture. MI “

“There is a sampling bias”

“This observational intent and treatment study revealed that there is a sampling bias because patients with higher psoriasis area severity index are more likely to receive biological therapy.” Mohamed A. Zayed, MD, PhD, FACS“This raises concerns about the validity of the findings, but the psoriasis area severity index is more evenly distributed,” said a related editorial director at the Zyed Lab and Vascular Surgery Biobank at Washington University in St. Louis. If so, he argues that changes in the lipid-rich necrotizing core could be even greater in the biotherapy group. “


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