Coronary-Artery Plaque Characteristics Improve With Biologic Therapy for Psoriasis

By Will Boggs MD

February 16, 2019

NEW YORK (Reuters Health) - Biologic therapy in patients with severe psoriasis is associated with significant improvements in coronary-artery plaque characteristics, according to new research.

"Anti-inflammatory effects of biologic therapies hold promise for treatment of atherosclerosis, but both mechanistic and larger studies are needed," Dr. Nehal N. Mehta from the National Heart, Lung, and Blood Institute, in Bethesda, Maryland, told Reuters Health by email.

Severe psoriasis is associated with an elevated risk of early myocardial infarction and rates of coronary-artery disease similar to those in type 2 diabetes. Whether biologic therapy alters coronary-artery characteristics is unknown.

Dr. Mehta and colleagues characterized coronary-artery plaque before and after biological therapy in 121 individuals with moderate to severe psoriasis who are participating in the ongoing Psoriasis, Atherosclerosis and Cardiometabolic Disease Initiative.

Among these individuals, non-calcified-plaque burden correlated significantly with traditional cardiovascular risk factors and with skin-disease severity as measured by Psoriasis Area and Severity Index (PASI) score.

At one-year follow-up, PASI score and hsCRP level had improved significantly in the 89 biologic-treated patients, but not in the 32 non-biologic-treated patients.

Among patients receiving biologic therapy, there was a 5% reduction in total coronary-plaque burden, primarily driven by a reduction in non-calcified plaque, and a significant reduction in both fibro-fatty burden and necrotic burden.

Patients not receiving biologic therapy showed no significant changes in plaque burden or fibrous burden, but had significant increases in fibro-fatty burden and non-significant increases in necrotic core.

The significant decrease in non-calcified plaque associated with biologic therapy persisted after adjustment for traditional cardiovascular risk factors, the researchers report in Cardiovascular Research, online February 5.

Within the biologic-treated group, there was a 5% reduction in non-calcified plaque burden on anti-TNF therapy, a 2% reduction on anti-IL12/23 therapy, and a 12% reduction on anti-IL17 therapy after one year.

"In addition to reinforcing that psoriasis is associated with accelerated heart disease, treating sources of inflammation in the body (in this case the skin) may be important in reducing cardiovascular risk," Dr. Mehta said. "Larger studies in other disease states are needed to understand the natural history of coronary plaque in systemic inflammatory states."

Dr. Mehta and one of his co-authors report financial ties to companies that manufacture biologics.


Cardiovasc Res 2019.