Bethesda, MD—Anti-inflammatory biologic therapies used to treat moderate-to-severe psoriasis appear to have a highly desirable side effect, according to a new study.

An article in JAMA Cardiology reports that those treatments can significantly reduce coronary inflammation in patients with the chronic skin condition.

Researchers also heralded the use of a novel imaging biomarker, the perivascular fat attenuation index (FAI), to measure the effect of the therapy in reducing the inflammation.

National Heart, Lung, and Blood Institute (NHLBI)–led authors point out that their findings also hold out promise for patients with other chronic inflammatory diseases, such as lupus and rheumatoid arthritis, which also are known to increase the risk for heart attacks and strokes.

“Coronary inflammation offers important clues about the risk of developing heart artery disease,” explained senior author Nehal N. Mehta, MD, a cardiologist and head of the Lab of Inflammation and Cardiometabolic Diseases at NHLBI. “Our findings add to the growing body of research that shows treating underlying inflammatory conditions may reduce the risk of cardiovascular diseases.”

Background information in the study noted that while psoriasis is a chronic inflammatory skin disease associated with increased coronary plaque burden and cardiovascular events, past research has suggested that biologic therapy for psoriasis might be favorably associated with luminal coronary plaque. The authors suggest, however, that is was unclear whether the associations are attributable to direct anti-inflammatory effects on the coronary arteries.

To find out, the study team sought to investigate the association of biologic therapy with coronary inflammation in patients with psoriasis using the FAI to assess coronary inflammation by mapping spatial changes of perivascular fat composition via coronary computed tomography angiography (CCTA).

For the prospective cohort study from January 1, 2013, through March 31, 2019, researchers analyzed changes in FAI in patients with moderate-to-severe psoriasis who underwent CCTA at baseline and at 1 year and were not receiving biologic psoriasis therapy at baseline.

Of the 134 patients, who had a mean age of 51.1 years and were 62.5% male, most had low cardiovascular risk by traditional risk scores (median 10-year Framingham Risk Score, 3% [interquartile range, 1%-7%]) and moderate-to-severe skin disease. Most, of the patients, 82, received biologic psoriasis therapy—anti–tumor necrosis factor alpha, anti–interleukin [IL] 12/23, or anti–IL-17) for 1 year—while the 52 patients in the control group did not receive any biologic therapy and were given topical or light therapy.

Researchers report that, at baseline, 46 patients—27 in the treated group and 19 in the untreated group—had a focal coronary atherosclerotic plaque.

Results indicate that biologic therapy was associated with a significant decrease in FAI at 1 year (median FAI -71.22 HU [interquartile range (IQR), -75.85 to -68.11 HU] at baseline vs. -76.09 HU [IQR, -80.08 to -70.37 HU] at 1 year; P <.001) concurrent with skin disease improvement (median PASI, 7.7 [IQR, 3.2-12.5] at baseline vs. 3.2 [IQR, 1.8-5.7] at 1 year; P <.001).

On the other hand, no change in FAI was noted in those not receiving biologic therapy (median FAI, -71.98 [IQR, -77.36 to -65.64] at baseline vs. -72.66 [IQR, -78.21 to -67.44] at 1 year; P = .39).

Researchers emphasize that associations with FAI “were independent of the presence of coronary plaque and were consistent among patients receiving different biologic agents.” Specifically, they reported the following results: anti–tumor necrosis factor alpha (median FAI, -71.25 [IQR, -75.86 to -66.89] at baseline vs. -75.49 [IQR, -79.12 to -68.58] at 1 year; P <.001) and anti–IL-12/23 or anti–IL-17 therapy (median FAI, -71.18 [IQR, -75.85 to -68.80] at baseline vs. -76.92 [IQR, -81.16 to -71.67] at 1 year; P <.001).

“In this study, biologic therapy for moderate to severe psoriasis was associated with reduced coronary inflammation assessed by perivascular FAI,” study authors point out. “This finding suggests that perivascular FAI measured by CCTA may be used to track response to interventions for coronary artery disease.”

“FAI is a new method of analyzing CT scans that can predict a patient’s risk of fatal heart attacks and other cardiac events years in advance, and independent of other traditional risk factors for heart disease,” explained study coauthor Charalambos Antoniades, MD, professor of cardiovascular medicine at Oxford University. “In fact, our research has found that an abnormal perivascular FAI was linked to a six-to nine-fold increased risk of major adverse cardiovascular events.”

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