March 20, 2012 (San Diego, California) — Adalimumab, a tumor necrosis factor inhibitor for the treatment of psoriasis, also reduces the vascular inflammation seen on computed tomography in patients with concomitant coronary atherosclerosis, according to a pilot study presented here at the American Academy of Dermatology (AAD) 70th Annual Meeting.
All dermatologists know that "psoriasis is an inflammatory disease," said principal investigator Robert Bissonnette, MD, president and founder of Innovaderm Research, a clinical research organization based in Montreal, Quebec, Canada.
Nowadays, however, "atherosclerosis is seen more and more as an inflammatory condition as well. Our hypothesis was that the treatment of psoriasis with a product effective for skin lesions would also improve vascular inflammation," he explained.
The study randomized 30 patients with moderate to severe psoriasis and either a history of coronary atherosclerosis or at least 3 risk factors to a standard psoriasis dose of adalimumab or to a control group for 16 weeks.
Patients in the control group were allowed to choose their own nonsystemic treatment or elect no treatment, he said.
All subjects underwent baseline and end-of-study positron-emission tomography with injection of 18-fluorodeoxyglucose so that vascular inflammation in the aorta and carotid arteries could be quantified.
The primary end point of the study was change from baseline in the vessel with the highest baseline inflammation; secondary end points included changes in both the ascending aorta and carotid arteries.
By the end of the study, 70% of the patients in the adalimumab group reached a Psoriasis Area and Severity Index (PASI) score of 75, which is consistent with the PASI results seen in phase 3 trials of the drug, said Dr. Bissonnette. In the control group, 20% reached a PASI score of 75.
Imaging results showed that in the adalimumab group, there was a statistically significant decrease of 12% in vascular inflammation from baseline (P = .004), compared with a nonsignificant change in the control group. The difference between the groups did not reach statistical significance.
However, when the arteries were examined separately, vascular inflammation was significantly lower in the adalimumab than in the control group in both the aorta (P = .02) and carotid (P = .05) arteries, he said.
If these findings are reproduced in larger studies, they suggest that one day, in addition to alerting patients with psoriasis about their increased risk for atherosclerosis, dermatologists might be able to modify that risk with targeted psoriasis treatment, Dr. Bissonnette said.
Asked by Medscape Medical News to comment on the findings, Richard L. Gallo, MD, PhD, professor and chief of dermatology at the University of California at San Diego, and moderator of the session at which the study was presented, said that the study "tends to support the hypothesis that inflammation is part of the development of atherosclerotic plaque. We know that comorbidities in psoriasis are real, particularly vascular comorbidities; this suggests to the practitioner...another thing to think about when treating patients."
Although atherosclerotic inflammation and psoriatic inflammation appear to have "very different pathways," he said their origins might be similar. "We don't know enough about either pathway."
"This is an intriguing study that shows a decrease in vascular inflammation in the aorta and carotid arteries according to FDG uptake in patients treated with adalimumab," David Siegel, MD, a preventive cardiologist and chief of medicine at the Veterans Administration Northern California Health Care System, and professor and vice chair of medicine at the University of California at Davis, told Medscape Medical News.
"This is consistent with one proposed mechanism by which statins decrease atherosclerosis (i.e., decreasing inflammation by a variety of mechanisms). While an interesting outcome for adalimumab, I would caution that what was measured is an intermediary outcome. Stronger evidence would be a study that shows a benefit in clinical outcomes of atherosclerosis in psoriatic patients treated with adalimumab," Dr. Siegel added.
The study was funded by Abbott. Dr. Bissonnette reports receiving grant/research funds from DUSA Pharmaceuticals, Galderma, and QLT; receiving consulting fees from Photocure and Galderma; receiving speaking and teaching fees from Quest Pharma and QLT; and receiving honoraria from and being on the board of QLT. Dr. Gallo reports receiving consulting fees from Allergan and Novartis; receiving investigator grants from Colgate-Palmolive, Galderma Laboratories, L.P., Intendis, Johnson & Johnson Consumer Products, and L'Oreal USA; and being a founder and stockholder of Skin Epibiotics.
American Academy of Dermatology (AAD) 70th Annual Meeting: Late-Breaking Abstracts. Presented March 16, 2012.
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Cite this: Psoriasis Treatment Proves Effective Against Atherosclerosis - Medscape - Mar 20, 2012.
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