Biologic Drugs May Prevent Heart Disease in Patients With Severe Psoriasis

A biologic therapy used to treat severe psoriasis and other inflammatory conditions may help prevent heart disease in individuals with the condition, according to a new study.

The study, published in Cardiovascular Research, found that biologic therapies used for the management of psoriasis improved coronary artery plaque similar to the effect of a low-dose statin.

Psoriasis, a chronic inflammatory skin disease, affects approximately 3% of the population. When severe, the disease is associated with early heart attack risk by more than 50%. Severe psoriasis is typically treated with biologic therapy, allowing the researchers to study the potential effect of biologic drugs on coronary vasculature.

For the study, the researchers evaluated 209 patients with severe psoriasis from January 1, 2013, through October 31, 2015, with 215 completing 1-year follow up. Of these patients, 89 took a biologic therapy and 32 used topical treatment. All patients underwent imaging of their coronary arteries with coronary computed tomography angiography at baseline and 1 year later to assess the amount of high-risk plaques. The researchers observed the reduction in non-calcified plaque across all 3 classes of biologic agents in the study with varying degrees.

Tumor necrosis factor (TNF) inhibitors, which are often used as a first-line biologic agent in managing psoriasis, have been previously linked to worsening of cardiometabolic risk factors, such as weight gain. However, observational studies have shown that TNF inhibitors can reduce the risk of a heart attack, the researchers noted.

In the current study, the researchers found that the greatest benefit for reducing non-calcified plaque burden was shown in anti-IL17 therapy. According to the researchers, the reduction in necrotic core suggests a potential role for IL17 in atherosclerotic pathways.

“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,” study author Nehal Mehta, MD, chief of Inflammation and Cardiometabolic Diseases at the National Heart, Lung, and Blood Institute, National Institutes of Health, said in a press release. “This occurred in the absence of changes in traditional cardiovascular risk factors including blood pressure and blood lipids.”

Overall, the study showed that biologic therapy was associated with a 6% reduction in non-calcified plaque burden reduction in necrotic core, with no effect on fibrous burden. This decrease in the biologic-treated group was significant compared with slow plaque progression in the non-biologic treated group, according to the study. In patients who did not take a biologic, coronary plaque burden increased by 2%.

The study results indicate that biologic therapy is associated with coronary plaque reduction and stabilization, the researchers concluded.

“These findings support the conduct of larger randomized trials of biologic therapy on cardiovascular disease in psoriasis and potentially other inflammatory diseases,” they wrote.

References

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. Cardiovascular Research. 2019. https://doi.org/10.1093/cvr/cvz009.

Psoriasis medication may improve heart disease in patients with the skin condition [news release]. European Society of Cardiology. https://www.escardio.org/The-ESC/Press-Office/Press-releases/Psoriasis-medication-may-improve-heart-disease-in-patients-with-the-skin-condition. Accessed February 5, 2019.