Damian McNamara

October 02, 2016

VIENNA — Improving control of psoriasis could reduce the risk of future cardiovascular disease, according to the results of an observational cohort study presented here at the 25th European Academy of Dermatology and Venereology Congress.

Patients with psoriasis showed a decrease in aortic vascular inflammation, as measured by fluorodeoxyglucose positron emission tomography/computed tomography (FDG-PET/CT), after 1 year of treatment. Blood pressure, high-sensitivity C-reactive protein levels, and Framingham risk scores also significantly improved at 1 year compared with baseline.

"The main message of this study is that treating psoriatic skin disease may reduce vascular diseases measured by FDG-PET," Nehal N Mehta, MD, from the National Heart, Lung and Blood Institute in Bethesda, Maryland, told Medscape Medical News.

"Psoriasis has been associated with cardiovascular events and increased cardiovascular risks in general — that is pretty well borne out," Dr Mehta explained.

He and his colleagues previously showed that the amount of vascular inflammation is associated with Psoriasis Area Severity Index (PASI) scores (Arterioscler Thromb Vasc Biol 2015;35:2667-2676).

"The next logical question is: If you treat the disease, do you modulate the vascular inflammation?" he said.

To find out, the researchers measured vascular inflammation of the aortic arch at baseline and 1 year on FDG-PET in 90 consecutive patients. They also tracked changes in PASI score and affected body surface area.

Participants were an average of 50 years old, presented with low-risk Framingham scores, and had an average PASI score of 5 at baseline, indicating mild-to-moderate disease.

Study participants treated their psoriasis with topical agents (64%), biologics (60%, mostly anti-tumor necrosis factor agents), and ultraviolet B (UVB, 14%) therapy.

Compared with baseline, PASI scores improved 33% at 1 year in the entire cohort (P < .001).

The change in target-to-background measure of FDG-PET/CT inflammation was less significant when adjusted for Framingham risk score, body mass index, statin use, and use of biologic or other systemic psoriasis therapy (P = .04).

Table 1. Outcomes at 1 Year Associated With PASI Score Improvements

Outcome Improvement P value vs baseline
Mean blood pressure Yes < .05
hsCRP Yes < .05
Framingham risk score Yes < .05
Aortic arch inflammation 6.4% reduction < .001

The 6% decrease in vascular inflammation is similar to what researchers have reported with low-dose statin therapy in coronary artery disease, Dr Mehta noted (J Am Coll Cardiol 2013;62:909-917).

The results also translate to about a 10% reduction in cardiovascular events over 10 years, he added. "A 1% per year reduction in risk does not sound like a lot, but in the decade from 50 to 60, that can be significant."

Even so, Dr Mehta said that the data should be interpreted with caution. "This was an observational cohort study, but it suggests the signal is there," he said. The 1-year results are part of an ongoing cohort study designed to follow 600 psoriasis patients over 4 years.

"It is really impressive," said session chair Christa de Cuyper, MD, of Bruges, Belgium, when asked by Medscape Medical News to comment on the study. "But for me, the selection of patients was not the population who would [normally] get a biologic." She also raised this point to Dr Mehta during the question and answer period.

"Some people come in on biologics," Dr Mehta replied. "What I tell my students is there is a lot of dirtiness in cohort studies."

Including patients with a history of biologic use "could have interfered with the outcome of the study," said Dr de Cuyper, adding that "it is a very good idea to do a randomized controlled trial next."

Which is just what Dr Mehta is planning. The Vascular Inflammation in Psoriasis trial, which just finished enrollment, will randomize 96 patients to adalimumab, UVB, or placebo, and use FDG-PET/CT to measure changes in inflammation. The researchers also want to assess which patients with mild, moderate, or severe disease at baseline achieve a PASI-75, -90 or -100 at follow-up.

Dr Mehta and Dr de Cuyper had no relevant financial relationships.

25th European Academy of Dermatology and Venereology (EADV) Congress: Abstract OP06.09. Presented October 1, 2016.


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