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Psoriasis drugs reduces heart disease risk

Psoriasis drugs reduces heart disease risk

Publication date: Monday, 08 April 2019

Recent research shows that anti-inflammatory biological drugs* used to treat severe psoriasis have the potential to prevent heart disease in patients with the condition. Over one year of treatment, biological therapy improved coronary artery plaques in a manner similar to a low-dose statin.

Study author Dr Nehal Mehta (US National Heart, Lung, and Blood Institute) said, “Psoriasis severity is related to the burden of coronary disease – our findings suggest treating the psoriasis may potentially benefit coronary heart disease.” It is already known than patients with the skin condition have an elevated risk of heart disease with young patients with severe psoriasis having twice the risk of having a first heart attack at 40-50 years of age.

The prospective, observational study found that patients with severe psoriasis who took biological therapy (including TNF-α inhibitors and interleukin-17 inhibitors) for one year had an 8% reduction in total and non-calcified coronary plaque burden, a frequent cause of heart attacks. The make-up of coronary plaques also improved in those taking biologicals, making them less risky. At the same time coronary plaque burden increased by 2% in patients who did not take a biological.

Dr Mehta added, “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. This occurred in the absence of changes in traditional cardiovascular risk factors including blood pressure and blood lipids.”

During the one-year study, systemic inflammation assessed by blood markers reduced only in the group taking biological therapy. Dr Mehta said it is too early to say whether biologicals exert their effects on coronary plaques directly or by reducing systemic inflammation.  However, this preliminary study provides the first evidence that biological therapy is associated with coronary plaque reduction and stabilisation, and provides strong rationale for conduct of a randomised trial testing the impact of biological therapy on the progression of coronary disease in patients with psoriasis.

Dr Mehta also noted that some patients with severe psoriasis opt not to take a biological medicine because they suppress the immune system and may increase the chance of infection. In addition, they must be injected.

Previous research has shown that in heart attack patients, anti-inflammatory biological therapy reduces the risk of another cardiovascular event (Ridker P et al. New Engl J Med 2017;377:1119-1131) and together the current study Dr Mehta urged patients with psoriasis is to take untreated inflammation seriously. He emphasised that when someone has severe psoriasis, they are at higher risk of heart attack and treating the psoriasis may reduce that risk.

*A biological (or biologic) drug is manufactured in a living system such as a microorganism, or plant or animal cells. Most biologicals are very large, complex molecules or mixtures of molecules. Many biologicals are produced using recombinant DNA technology.

Study summary

  • The observational study included 121 patients (mean age 50.5) with severe psoriasis (and low CV risk by Framingham score) who qualified for biological treatment.
  • Of those, 89 took biological therapy (one of three types) and 32 used topical treatment.
  • All patients underwent imaging of their coronary arteries with computed tomography angiography at baseline and one year later to assess the amount and characteristics of plaques such as the necrotic core which causes plaque rupture.

 

ACTION

This study shows that treatment of psoriasis with biological therapy is associated with a reduction of non-calcified coronary plaque and improvement in plaque morphology compared with those not treated with biological therapy. The findings highlight the potential role of reducing residual inflammation in CVD and risk reduction and support further randomised trials of biological therapy on CVD in psoriasis and potentially other inflammatory diseases.

 

Elnabawi Y, Dey A, Goyal A, et al. Coronary artery plaque characteristics and treatment with biologic therapy in severe psoriasis: results from a prospective observational study. Cardiovascular Research 2019; cvz009, https://doi.org/10.1093/cvr/cvz009  

Topics covered:
Category: Evidence in Practice
Edition: Volume 4 Number 2 PCCJ Online 2019

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