Treating Psoriasis With Biologics May Have Cardiac Benefits

The use of biologics to treat psoriasis has increased over time, and a recent study has demonstrated that these drugs may have benefits that extend well beyond clearing patients’ skin. The study, published in Cardiovascular Research, found that biologic therapy for psoriasis was associated with a reduction in coronary artery disease.

The study’s authors built on the knowledge that psoriasis is linked with the development of high-risk coronary plaque. They hypothesized that they could observe a reduction in inflammatory-driven phenotypes of coronary plaque, including noncalcified coronary plaque burden and lipid-rich necrotic core, in patients who were treated with inflammation-reducing biologic therapy after 1 year versus patients who were treated with drugs other than biologics.

The study evaluated enrolled 290 participants in the NIH Psoriasis Atherosclerosis Cardiometabolic Initiative cohort, all of whom had moderate to severe psoriasis and low cardiovascular risk at baseline, from 2013 to 2018. In total, 215 of those patients completed 1 year of follow-up. Of the total number of participants, 121 initiated treatment with biologics.

The researchers found that, at 1 year, biologic therapy was associated with a 6% reduction in noncalcified plaque burden (P = .005), a reduction in necrotic core (P = .03), and no effect on fibrous burden (P = .71) versus no biologic treatment.

The decrease in noncalcified plaque burden in the patients treated with biologics was significant compared with slow plaque progression in those treated without biologics, and it was associated with biologic treatment beyond adjustment for traditional cardiovascular risk factors.

“This appears to be an anti-inflammatory effect. In the absence of improvement in other cardiovascular risk factors, and without adding new cholesterol medications, patients’ soft plaque still improved. The only change was the severity of their skin disease,” said Nehal N. Mehta, MD, head of the Lab of Inflammation and Cardiometabolic Diseases at the National Heart, Lung, and Blood Institute, and one of the study’s authors, in a statement on the team’s findings.

“Classically a heart attack is caused by 1 of 5 risk factors: diabetes, hypertension, high cholesterol, family history, or smoking,” said Mehta. “Our study presents evidence that there is a sixth factor, inflammation; and that it is critical to both the development and the progression of atherosclerosis to heart attack.”

Larger, randomized trials will be needed to better understand the association between biologic therapy for psoriasis and the positive impacts on cardiac health, concluded the authors, noting that the current study highlights the importance of systemic inflammation in coronary artery disease.

Reference

Elnabawi YA, Dey AK, Goyal A, et al. Coronary artery plaque characteristics and treatment with biologic therapy in severe psoriasis: results from a prospective observational study. Cardiovasc Res. 2019;115(4):721-728. doi: 10.1093/cvr/cvz009.