Biologics May Chip Away at Clogged Arteries After Just 1 Year
Plaque burden stabilized or reduced in patients on psoriasis biologics
Nicole Lou,April 27, 2018
SAN DIEGO -- Biologic drugs for psoriasis were associated not only with improved skin condition but, as an added bonus, reduced atherosclerotic plaque burden, according to late-breaking data presented here. Although total plaque index -- the sum of all plaque volumes of segment divided by segment length -- didn't budge with biologic treatment for psoriasis (going from 1.36 to 1.28 mm2 at 1 year, P=0.160), it actually got worse in patients not receiving such agents (1.18 to 1.39 mm2, P=0.002), according to Youssef Elnabawi, BS, a medical student at Tufts University School of Medicine in Boston and Medical Research Scholar Program Fellow at the NIH, at the annual conference of The Society for Cardiovascular Angiography and Interventions.
Other measures from coronary CT angiography at baseline and 1-year follow-up showed reductions or stabilization in plaque burden over time with biologic drugs:
Dense calcified plaque index did not change with either biologic treatment (0.07 to 0.11 mm2, P=0.14) or non-biologic treatment (0.09 to 0.10 mm2, P=0.44)
Non-calcified plaque index fell with biologics (1.29 to 1.17 mm2, P=0.03) but increased with controls (1.09 to 1.29 mm2, P=0.007)
Focal plaque volume dropped from 2.5 to 1.5 mm3 after 1 year of biologic therapy (P=0.002). Over the same time, it became elevated with non-biologic therapy (3.3 to 6.3 mm3, P=0.04)
Maximal stenosis had a reduction with the former (49.7% to 46.6%, P=0.01) but grew worse with the latter (42.9% to 55.4%, P=0.02)
Ultimately, any change in plaque volume was associated with change in IL-1β levels over 1 year, even after adjusting for multiple factors (P=0.03).
Biologic therapy was associated with regressing coronary plaque burden over 1 year, Elnabawi told the audience, concluding that it may be of benefit to target proinflammatory cytokines related to cardiovascular disease.
That was notably already suggested by the CANTOS trial, which tied canakinumab (Ilaris), a monoclonal antibody targeting the IL-1β cytokine, to cardiovascular benefits among MI survivors, he recalled. Findings of that study were reported after a median follow-up of 3.7 years.
"To see a reduction in coronary plaque after just 1 year of biologic therapy alone is incredible and very assuring. It's the first time we're seeing treatment of a skin disease with biologic therapy have an impact specifically on plaque in the coronary," according to principal investigator Nehal Mehta, MD, MSCE, of the National Heart, Lung, and Blood Institute, in a press release.
"Our study results further emphasize the importance of patients maintaining and treating psoriasis to decrease the risks of adverse cardiovascular events occurring. This also opens the door for us to look at other disease states and see how anti-inflammatory therapy options could impact coronary plaque over time."
Another take-away of note was the usefulness of coronary CT angiography.
Compared to intravascular ultrasound, "which is of course invasive and very laborious," this technique offers lots of advantages, being non-invasive and able to offer a view of the entire coronary tree, said William Penny, MD, of University of California San Diego.
"You can do studies like this in a relatively small number of patients that would usually require thousands and thousands of patients. I think it's fantastic for us to have CT to investigate new therapies," agreed John Hodgson, MD, of Cleveland's Case Western Reserve University School of Medicine, on the same discussion panel.
Hodgson noted, however, that the resolution of coronary CT angiography is still "not that high" and nothing like optical coherence tomography so far.
The report by Elnabawi came from a collaboration of the Psoriasis, Atherosclerosis and Cardiometabolic Disease Initiative (PACI). Of the 84 consecutive study participants with psoriasis who had follow-up scans available for analysis, 57 wound up getting biologic treatment -- largely anti-TNF agents -- while 27 got non-biologic treatment. Excluded from the study were those who started statin treatment.
Over the course of 1 year, the biologic treatment group developed a higher incidence of hyperlipidemia, while the controls gained a higher body mass index.
Each patient had three major arteries analyzed. There was one single blinded reader who interpreted all coronary CT angiography scans.
At 1 year, IL-1β levels dipped from 2.6 to 2.4 μg/L (P=0.03) on biologic treatment; it tended to go the opposite way on alternatives (1.9 to 2.5 μg/L, P=0.05).
However, over the same time, psoriasis severity scores went down in both groups, going from 13 to 3 with biologics (P<0.001) and 6 to 5 with non-biologics (P=0.005), Elnabawi's group reported. Both treatment arms had C-reactive protein levels drop significantly as well. Noting the small and observational nature of the PACI study, the investigators suggested that larger trials assessing the potential benefits of anti-inflammatory therapy in subclinical cardiovascular disease are needed.
Elnabawi disclosed no relevant conflicts of interest. Study lead investigator reported receiving institutional grants from AbbVie, Janssen, Celgene, and Novartis.
Reviewed by Henry A. Solomon, MD, FACP, FACC Clinical Associate Professor, Weill Cornell Medical College and Dorothy Caputo, MA, BSN, RN, Nurse Planner