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Biologic Therapy Improves Psoriasis and Reduces CV Inflammation

Psoriasis confers a significant risk of comorbidity, but is psoriasis associated with increased coronary inflammation and is this risk attenuated by biologic therapy? 

JAMA Cardiology has published a cohort study of 134 consecutive patients with moderate to severe psoriasis, showing that biologic therapy was associated with a significant decrease in coronary inflammation as assessed by perivascular fat attenuation index, a marker of coronary inflammation associated with cardiovascular outcomes. Patients not receiving biologic therapy had no change in perivascular fat attenuation index at 1 year.

Researchers assessed coronary inflammation using the perivascular fat attenuation index (FAI), an assessment of coronary inflammation coronary computed tomography angiography (CCTA).

Most of the 134 psoriasis patients (mean 51.1 years; 62.5% male) had low cardiovascular (CV) risk with 10-year Framingham Risk Score of 3% (1%-7%) and moderate to severe skin disease.

Biologic agents were used in 82/134 patients and not used in the remaining 52.  Biologic therapies included TNF inhibitors, anti-IL-12/23, or anti–IL-17 agents.

Focal coronary atherosclerotic plaque was seen in 46 patients at baseline.

Biologic therapy was associated with a significant decrease in FAI at 1 year (baseline FAI −71.22 HU vs −76.09 HU at 1 year; P < .001) concurrent with skin disease improvement (median baseline PASI = 7.7 vs  PASI = 3.2 at 1 year; P < .001).

For those not on biologics, there was no change in FAI (baseline FAI, −71.98 vs −72.66 at 1 year; P = .39).

FAI changes were consistent among patients receiving different biologic agents (TNFi, IL-12/23 or IL-17 inhibitors). 

Control of moderate to severe psoriasis with biologic agents was associated with reduced coronary inflammation assessed by perivascular FAI. 

The author has no conflicts of interest to disclose related to this subject

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