Biologic treatment favorably modifies coronary plaque characteristics for patients with severe psoriasis, suggests a study published Feb. 5 in Cardiovascular Research. The findings raise the possibility that the anti-inflammatory drugs can both treat psoriasis and reduce cardiovascular risk.
The observational study included 121 patients with severe psoriasis, a chronic inflammatory skin condition that has been linked to accelerated atherosclerosis, a more than 50 percent increased risk of early myocardial infarction (MI) and coronary artery disease risks on par with type 2 diabetes.
Eighty-nine of the participants took one of three types of biologic therapy for one year, while the other 32 used lighter topical treatments. Both before and after that one-year follow-up period, all patients underwent coronary CT angiography to assess the plaque in their arteries.
On average, those taking the biologic therapy experienced an 8 percent reduction in total and non-calcified coronary plaque burden, while those in the other group showed a 2 percent increase in coronary plaque burden.
“In this referent group, we observed progression of coronary artery disease with conversion of fibrous burden to fibro-fatty burden, suggestive of lipid infiltration within the coronary plaque,” wrote senior author Nehal N. Mehta, MD, chief of inflammation and cardiometabolic diseases at the National Heart, Lung, and Blood Institute in Bethesda, Maryland, and co-authors.
“In those treated with biological therapy, we found that inflammatory driven phenotypes including lipid-rich plaque and the necrotic core decreased following therapy. Taken together, these data provide preliminary evidence that treatment with biologic modulates coronary artery plaque in psoriasis.”
A press release distributed by the European Society of Cardiology, which publishes Cardiovascular Research, noted the effects of the biologic therapy on coronary plaque was similar to what might be seen with a low-dose statin.
The authors acknowledged their study was limited by its observational, nonrandomized nature, as well as its small sample size and relatively short follow-up period. Also, while the trial analyzed changes in coronary artery plaque—an important risk factor for cardiovascular disease—it didn’t analyze differences in CVD event rates.
Nevertheless, Mehta et al. believe their results warrant further investigation.
“These findings highlight the potential role of quelling residual inflammation in cardiovascular disease and risk reduction,” they wrote. “These findings support the conduct of larger randomized trials of biologic therapy on cardiovascular disease in psoriasis and potentially other inflammatory diseases.”