Systemic therapy could reduce CV risk in psoriasis patients
MedWire News: Patients with severe plaque-type psoriasis who respond well to continuous systemic therapy experience a simultaneous reduction in levels of biomarkers that indicate cardiovascular risk, show study findings.
The research team observed that in patients who achieved a Psoriasis Area and Severity Index (PASI)-50 response, indicating that treatment has been effective, levels of serum high sensitivity C-reactive protein (hs-CRP) and vascular endothelial growth factor (VEGF) - both of which point toward increased cardiovascular risk - were reduced.
"This study provides good evidence for a potential cardioprotective effect of appropriate continuous anti-inflammatory therapy in psoriasis," say Wolf-Henning Boehncke (Johann Wolfgang Goethe-University, Frankfurt, Germany) and colleagues.
The study cohort included 25 severe plaque-type psoriasis patients (17 male) aged 24-70 years with PASI scores between 7.0 and 34.3 at study inclusion. The researchers evaluated the correlation between the efficacy of therapy, defined as a 50% reduction in PASI score, and changes in biomarkers of cardiovascular risk, over a 24-week period.
There was a significant improvement in PASI scores, with the median falling from 15.0 at baseline to 4.8 after 12 weeks of continuous systemic treatment. At this point, 43% of patients had achieved a PASI-50 response. By 24 weeks of therapy, the median PASI was 3.5, and 71% of patients had achieved a PASI-50 response.
Boehncke et al also found a strong positive correlation between PASI scores and VEGF, which was reduced in responders and non-responders alike. The correlation was stronger still in responders compared with non-responders, in whom hs-CRP was also found to correlate with PASI score.
Oral glucose tests also revealed a positive correlation between PASI and plasma levels of C-peptide, indicating that insulin resistance is partially mediated by the severity of psoriatic inflammation, say the researchers.
Finally, the team found a significant positive correlation between changes in resistin levels (a metabolic marker) and improved PASI in patients who received a 75% improvement in PASI score (PASI-75 response) at 24 weeks. Conversely, adiponectin - another marker of insulin function - was significantly inversely correlated with PASI change at 24 weeks, and this relationship was strongest in patients who achieved a PASI-75 rather than PASI-50 response.
"These observations suggest that the impact on the patients' metabolic state is better if the psoriatic inflammation is controlled for longer," write Boehncke and co-authors in the Journal of the European Academy of Dermatology and Venereology.
"We suggest that systemic inflammation in psoriasis causes a state of insulin resistance," they conclude, adding that "this may provide the pathophysiological basis for developing cardiovascular comorbidities which are known to be associated with severe psoriasis."
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By Sarah Guy