1
|
Cho H, Kim YJ, Moon IJ, Lee WJ, Won CH, Lee MW, Chang SE, Jung JM. Risk of major adverse cardiovascular events and all-cause mortality among patients with psoriatic disease treated with tumor necrosis factor-α and interleukin-12/23 inhibitors: a nationwide population-based cohort study in Korea. J DERMATOL TREAT 2024; 35:2321194. [PMID: 38403279 DOI: 10.1080/09546634.2024.2321194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2023] [Accepted: 02/13/2024] [Indexed: 02/27/2024]
Abstract
PURPOSE Few studies have investigated the impact of biologics on the risk of major adverse cardiovascular events (MACEs) among Korean patients with psoriatic diseases. We compared the risk of MACEs and all-cause mortality among patients with psoriatic disease treated with tumor necrosis factor (TNF)-α and interleukin (IL)-12/23 inhibitors in Korea. METHODS Patients with psoriatic disease prescribed with TNF-α and IL-12/23 inhibitors since 2016 were selected from the Korean National Health Insurance Service (NHIS) Database. Follow-up data for MACEs and all-cause mortality between 2016 and 2020 were collected. A total of 2886 individuals were included, including 1987 IL-12/23 inhibitor users and 899 TNF-α inhibitor users. RESULTS Compared with IL-12/23 inhibitor users, TNF-α inhibitor users had a higher prevalence of dyslipidemia and a significantly higher risk of all-cause mortality but not MACE. After controlling for age, female TNF-α inhibitor users had a significantly increased risk of all-cause mortality. Meanwhile, after controlling for sex, TNF-α inhibitor users aged 60 years or older demonstrated a significantly elevated risk of all-cause mortality. In conclusion, No statistically significant difference in MACE risk was observed between patients who used TNF-α and IL-12/23 inhibitors. Nevertheless, the use of IL-12/23 inhibitors, especially among older and female patients, resulted in a lower overall mortality.
Collapse
Affiliation(s)
- Hyesoo Cho
- Department of Dermatology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Ye-Jee Kim
- Department of Clinical Epidemiology and Biostatistics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Ik Jun Moon
- Department of Dermatology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Woo Jin Lee
- Department of Dermatology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Chong Hyun Won
- Department of Dermatology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Mi Woo Lee
- Department of Dermatology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Sung Eun Chang
- Department of Dermatology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Joon Min Jung
- Department of Dermatology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| |
Collapse
|
2
|
Zhao X, Li J, Li X. Association between systemic immune-inflammation index and psoriasis: a population-based study. Front Immunol 2024; 15:1305701. [PMID: 38504983 PMCID: PMC10948528 DOI: 10.3389/fimmu.2024.1305701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Accepted: 02/21/2024] [Indexed: 03/21/2024] Open
Abstract
Background The systemic immune-inflammation index (SII),as measured by lymphocyte, neutrophil and platelet counts in peripheral blood, is regarded as a favorable indicator of both inflammatory state and immune response. Psoriasis is an immune-mediated disease notable for its chronic inflammation of the entire system. Our research sought to explore the latent link between psoriasis and SII. Methods We performed a cross-sectional investigation utilizing data extracted from the National Health and Nutrition Examination Survey (NHANES, 2009-2014). Employing multivariate linear regression models and subgroup analysis, we sought to uncover the association between SII and psoriasis. Results This study enrolled a total of 17,913 participants as part of its research cohort. Our multivariate linear regression analysis revealed a notable and positive correlation between SII and psoriasis [1.013 (1.000, 1.026)]. As SII tertiles increased, the risk of psoriasis demonstrated an upward trend. The significant dependence on this positive association were maintained in women, BMI(≥ 30 kg/m2),non-stroke and non-cancer subjects in subgroup analysis and interaction tests. Furthermore, we identified a significant association between SII and psoriasis, characterized by two consecutive inverted U-shaped patterns. Notably, the analysis revealed the most prominent inflection point at a specific value of 797.067. Conclusions The results indicate a significant correlation between elevated SII levels and the presence of psoriasis. However, to corroborate and strengthen these results, additional large-scale prospective studies are required.
Collapse
Affiliation(s)
- Xiya Zhao
- Ninth Clinical College of Medicine, Shanxi Medical University, Taiyuan, China
- Department of Dermatology, Taiyuan Central Hospital, Shanxi Medical University, Taiyuan, China
- Key Laboratory of Stem Cells for Immunologic Skin Diseases, Taiyuan Central Hospital, Taiyuan, China
| | - Junqin Li
- Department of Dermatology, Taiyuan Central Hospital, Shanxi Medical University, Taiyuan, China
- Key Laboratory of Stem Cells for Immunologic Skin Diseases, Taiyuan Central Hospital, Taiyuan, China
| | - Xinhua Li
- Department of Dermatology, Taiyuan Central Hospital, Shanxi Medical University, Taiyuan, China
- Key Laboratory of Stem Cells for Immunologic Skin Diseases, Taiyuan Central Hospital, Taiyuan, China
| |
Collapse
|
3
|
Kaiser H, Näslund-Koch C, Kvist-Hansen A, Skov L. Does Systemic Anti-Psoriatic Treatment Impact the Risk of Cardiovascular Disease? A Review Over Cardiovascular Imaging Studies. Dermatol Ther (Heidelb) 2024; 14:303-321. [PMID: 38291285 PMCID: PMC10891014 DOI: 10.1007/s13555-024-01098-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2023] [Accepted: 01/10/2024] [Indexed: 02/01/2024] Open
Abstract
Psoriasis is an immune-mediated inflammatory disease associated with an increased risk of cardiovascular disease (CVD). The risk of CVD increases with the severity of psoriasis, and exposure to systemic inflammation may partly explain the increased risk of CVD in these patients. This raises the question of whether anti-psoriatic treatment, in addition to treating the skin lesions, also lowers the risk of developing CVD. Different types of studies have examined the impact of systemic anti-psoriatic treatments on the risk of CVD in patients with psoriasis and epidemiological observational studies with, e.g., myocardial infarction and stroke as outcomes, and clinical studies investigating circulating inflammatory biomarkers in the blood indicate that anti-psoriatic therapy has a protective effect; however, no randomized controlled trial (RCT) has examined the impact of systemic anti-psoriatic treatment on future hard cardiovascular endpoints. This narrative review provides an overview of the clinical cardiovascular imaging studies examining the effect of systemic anti-psoriatic treatment on the risk of subclinical CVD in patients with psoriasis. We found a total of 24 clinical imaging studies, where 16 of these were observational cohort studies and eight were RCTs. The observational studies suggest an improvement in the risk of subclinical CVD based on different cardiovascular imaging biomarkers; however, the RCTs showed inconsistent results and mainly included vascular inflammation as the outcome. Future RCTs including other imaging biomarkers as surrogates for subclinical CVD, with longer follow-up and with hard cardiovascular endpoints are warranted to address whether systemic anti-psoriatic treatments reduce the risk of CVD.
Collapse
Affiliation(s)
- Hannah Kaiser
- Department of Dermatology and Allergy, University Hospital-Herlev and Gentofte, Gentofte Hospitalsvej 15, 2900, Hellerup, Denmark.
| | - Charlotte Näslund-Koch
- Department of Dermatology and Allergy, University Hospital-Herlev and Gentofte, Gentofte Hospitalsvej 15, 2900, Hellerup, Denmark
| | - Amanda Kvist-Hansen
- Department of Dermatology and Allergy, University Hospital-Herlev and Gentofte, Gentofte Hospitalsvej 15, 2900, Hellerup, Denmark
| | - Lone Skov
- Department of Dermatology and Allergy, University Hospital-Herlev and Gentofte, Gentofte Hospitalsvej 15, 2900, Hellerup, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| |
Collapse
|
4
|
Kleinrensink NJ, Spierings J, Vonkeman HE, Seddiqi N, Herman A, Suijkerbuijk KPM, Heijstek MW, Jansen MP, de Jong PA, Foppen W. Increased vascular inflammation on PET/CT in psoriatic arthritis patients in comparison with controls. RMD Open 2024; 10:e003547. [PMID: 38296307 PMCID: PMC10836343 DOI: 10.1136/rmdopen-2023-003547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Accepted: 01/05/2024] [Indexed: 02/05/2024] Open
Abstract
BACKGROUND Patients with psoriatic arthritis (PsA) have an increased risk of cardiovascular disease, possibly due to a chronic inflammatory state. OBJECTIVES The main objective of this study was to investigate the difference in vascular inflammation, measured with 18-fluorodeoxyglucose positron emission tomography/CT (PET/CT), in PsA patients and controls. We conducted a secondary analysis to assess the association between clinical parameters of disease activity with vascular inflammation in PsA. METHODS We included a total of 75 PsA patients with active peripheral arthritis (defined as ≥2 tender and swollen joints) from an ongoing clinical trial (EudraCT 2017-003900-28) and a retrospective group of 40 controls diagnosed with melanoma, without distant metastases and not receiving immunotherapy. The main outcome measure was aortic vascular inflammation which was measured on PET/CT scans using target-to-background ratios. Clinical disease activity in PsA was assessed with joint counts, body surface area and the Disease Activity index for PsA. Laboratory assessments included C reactive protein and erythrocyte sedimentation rate. RESULTS Vascular inflammation was increased in patients with PsA in comparison with controls (mean target-to-background ratio for entire aorta, respectively, 1.63±0.17 vs 1.49±0.16; p=<0.001). This association remained significant after correction for gender, age, body mass index, mean arterial pressure and aortic calcification (p=0.002). Vascular inflammation was not associated with disease-related parameters. CONCLUSIONS Aortic vascular inflammation was significantly increased in patients with active PsA compared with controls. This evidence supports the theory that inflammation in PsA is not limited to the skin and joints but also involves the vascular system.
Collapse
Affiliation(s)
- Nienke J Kleinrensink
- Department of Rheumatology & Clinical Immunology, UMC Utrecht, Utrecht, Netherlands
- Department of Radiology, UMC Utrecht, Utrecht, Netherlands
| | - Julia Spierings
- Department of Rheumatology & Clinical Immunology, UMC Utrecht, Utrecht, Netherlands
| | - Harald E Vonkeman
- Department of Rheumatology and Clinical Immunology, Medisch Spectrum Twente, Enschede, Netherlands
- Department of Psychology, Health & Technology, University of Twente, Enschede, Netherlands
| | - Negina Seddiqi
- Department of Radiology, UMC Utrecht, Utrecht, Netherlands
| | - Amin Herman
- Department of Rheumatology, Sint Antonius Hospital, Nieuwegein, Netherlands
| | | | - Marloes W Heijstek
- Department of Rheumatology & Clinical Immunology, UMC Utrecht, Utrecht, Netherlands
| | - Mylène P Jansen
- Department of Rheumatology & Clinical Immunology, UMC Utrecht, Utrecht, Netherlands
| | - Pim A de Jong
- Department of Radiology, UMC Utrecht, Utrecht, Netherlands
| | - Wouter Foppen
- Department of Radiology, UMC Utrecht, Utrecht, Netherlands
| |
Collapse
|
5
|
Yarahmadi P, Nguyen PK. PET-FDG for vascular imaging: a "visual barometer" for inflammatory risk? J Nucl Cardiol 2023; 30:1653-1655. [PMID: 37127724 DOI: 10.1007/s12350-023-03250-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Accepted: 02/27/2023] [Indexed: 05/03/2023]
Affiliation(s)
- Pourya Yarahmadi
- Division of Cardiovascular Medicine, Department of Medicine, Stanford University, Stanford, CA, USA
- Stanford Cardiovascular Institute, Stanford, CA, USA
| | - Patricia K Nguyen
- Division of Cardiovascular Medicine, Department of Medicine, Stanford University, Stanford, CA, USA.
- Stanford Cardiovascular Institute, Stanford, CA, USA.
| |
Collapse
|
6
|
Boczar KE, Beanlands RS, Glassman SJ, Wang J, Zeng W, deKemp RA, Ward NC, Fehlmann CA, Wells GA, Karsh J, Dwivedi G. Anti-inflammatory effect of biologic therapy in patients with psoriatic disease: A prospective cohort FDG PET study. J Nucl Cardiol 2023; 30:1642-1652. [PMID: 36754934 PMCID: PMC10372102 DOI: 10.1007/s12350-023-03204-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Accepted: 12/07/2022] [Indexed: 02/10/2023]
Abstract
AIM The aim of the study was to evaluate the changes in central vascular inflammation measured by FDG PET and myocardial blood flow reserve (MFR) determined by 82Rb PET following therapy with biologic agents for 6 months in patients with psoriatic arthritis (PsA) and/or cutaneous psoriasis (PsO) (group 1) and compare with PsO subjects receiving non-biologic therapy (group 2) and controls (group 3). METHODS AND RESULTS Target-to-background ratio (TBR) by FDG PET in the most diseased segment of the ascending aorta (TBRmax) was measured to assess vascular inflammation. 82Rb PET studies were used to assess changes in left ventricular MFR. A total of 34 participants were enrolled in the study (11 in group 1, 13 in group 2, and 10 controls). A significant drop in the thoracic aorta uptake was observed in the biologic-treated group (ΔTBRmax: - .46 ± .55) compared to the PsO group treated with non-biologic therapy (ΔTBRmax: .23 ± .67). Those showing response to biologic agents maintained MFR compared to who showed no response. CONCLUSION In a cohort of psoriasis patients treated with biologics, FDG uptake in the thoracic aorta decreased over the study period. Patients who demonstrated a significant anti-inflammatory response on FDG PET imaging maintained their MFR compared to non-responders.
Collapse
Affiliation(s)
- Kevin E Boczar
- University of Ottawa Heart Institute, Ottawa, ON, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
- University of Ottawa, Ottawa, ON, Canada
- Division of Cardiology, Department of Medicine, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, PA, USA
| | | | | | - Jerry Wang
- University of Ottawa Heart Institute, Ottawa, ON, Canada
| | - Wanzhen Zeng
- University of Ottawa Heart Institute, Ottawa, ON, Canada
- University of Ottawa, Ottawa, ON, Canada
| | | | - Natalie C Ward
- School of Medicine, University of Western Australia, Perth, WA, Australia
| | - Christophe A Fehlmann
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
- The Ottawa Hospital Research Institute, Ottawa, ON, Canada
- Division of Emergency Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - George A Wells
- University of Ottawa Heart Institute, Ottawa, ON, Canada
- Research Methods Centre, University of Ottawa Heart Institute, Ottawa, ON, Canada
| | - Jacob Karsh
- Division of Rheumatology, The Ottawa Hospital, Ottawa, ON, Canada
| | - Girish Dwivedi
- University of Ottawa Heart Institute, Ottawa, ON, Canada.
- University of Ottawa, Ottawa, ON, Canada.
- School of Medicine, University of Western Australia, Perth, WA, Australia.
- Department of Advanced Clinical and Translational Cardiovascular Imaging, Harry Perkins Institute of Medical Research, Murdoch, Australia.
- Department of Cardiology, Fiona Stanley Hospital, Murdoch, WA, Australia.
- School of Biomedical Sciences, Curtin University, Bentley, WA, Australia.
| |
Collapse
|
7
|
Lee GW, Kim K, Kim SJ, Shin K, Kim H, Ko HC, Kim MB, Kim B. Therapeutic Effect of Dupilumab on Systemic and Vascular Inflammation in Adults with Severe Atopic Dermatitis: Feasibility Study Using 18F-Fluorodeoxyglucose Positron Emission Tomography-Computed Tomography. Acta Derm Venereol 2023; 103:adv5320. [PMID: 37219501 DOI: 10.2340/actadv.v103.5320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Accepted: 04/06/2023] [Indexed: 05/24/2023] Open
Abstract
Atopic dermatitis (AD) is an inflammatory skin disease associated with increased systemic and vascular inflammation. Although dupilumab has been proven to be effective against severe AD, imaging studies analysing its inflammation-reducing effect have rarely been reported. The aim of this study was to evaluate the effect of dupilumab on systemic and vascular inflammation in adult patients with severe AD, using 18F-fluorodeoxyglucose positron emission tomography-computed tomography (18F-FDG PET/CT). A total of 33 adult patients with severe AD and 25 healthy controls underwent 18F-FDG PET/CT at baseline. Patients on dupilumab treatment underwent 18F-FDG PET/CT again after achieving a 75% reduction from baseline on the Eczema Area and Severity Index (EASI-75). Patients with AD exhibited increased 18F-FDG uptake values in the liver, spleen, pancreas, and carotid artery compared with healthy controls. However, compared with baseline, there was no statistically significant difference in 18F-FDG uptake in major organs and arteries after achieving EASI-75 with dupilumab treatment. In conclusion, while dupilumab treatment resulted in a significant clinical improvement and reduced serum inflammatory markers in adult patients with severe AD, no changes in systemic and vascular inflammation were observed on 18F-FDG PET/CT imaging.
Collapse
Affiliation(s)
- Gi-Wook Lee
- Department of Dermatology, School of Medicine, Pusan National University Hospital, Busan, Korea
| | - Keunyoung Kim
- Department of Nuclear Medicine, Pusan National University Hospital, Busan, Korea
| | - Seong-Jang Kim
- Department of Nuclear Medicine, Pusan National University Hospital, Busan, Korea
| | - Kihyuk Shin
- Department of Dermatology, School of Medicine, Pusan National University Hospital, Busan, Korea
| | - Hoonsoo Kim
- Department of Dermatology, School of Medicine, Pusan National University Hospital, Busan, Korea
| | - Hyun-Chang Ko
- Department of Dermatology, School of Medicine, Pusan National University Hospital, Busan, Korea
| | - Moon-Bum Kim
- Department of Dermatology, School of Medicine, Pusan National University Hospital, Busan, Korea
| | - Byungsoo Kim
- Department of Dermatology, School of Medicine, Pusan National University, Busan, Korea.
| |
Collapse
|
8
|
Kommoss KS, Enk A, Heikenwälder M, Waisman A, Karbach S, Wild J. Cardiovascular comorbidity in psoriasis - psoriatic inflammation is more than just skin deep. J Dtsch Dermatol Ges 2023. [PMID: 37186503 DOI: 10.1111/ddg.15071] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Accepted: 02/24/2023] [Indexed: 05/17/2023]
Abstract
BACKGROUND There is a growing understanding of inflammation in psoriasis beyond its dermatological manifestation, towards systemic inflammation. Management of possible comorbidities encompassing psychological, metabolic and cardiovascular disease is recommended in national and international dermatology guidelines for treatment of psoriasis patients. Vice versa, psoriasis is being recognized as a new risk factor for cardiovascular inflammation within the cardiological community. METHODS A review of the literature was conducted. Key points regarding epidemiological, mechanistic and management aspects were summarized and put into context for physicians treating psoriasis patients. RESULTS Efforts are currently being made to better understand the mechanistic underpinnings of systemic inflammation within psoriatic inflammation. Studies looking to "hit two birds with one stone" regarding specifically cardiovascular comorbidities of psoriasis patients using established systemic dermatological therapies have so far provided heterogeneous data. The diagnosis of psoriasis entails preventive and therapeutic consequences regarding concomitant diseases for the individual patient. CONCLUSIONS The knowledge of comorbidities in psoriasis calls for pronounced interdisciplinary care of psoriasis patients, to which this article highlights efforts regarding vascular inflammation and cardiovascular disease.
Collapse
Affiliation(s)
- Katharina S Kommoss
- Department of Dermatology, University Hospital Heidelberg, Heidelberg, Germany
- Division of Chronic Inflammation and Cancer, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Alexander Enk
- Department of Dermatology, University Hospital Heidelberg, Heidelberg, Germany
| | - Mathias Heikenwälder
- Division of Chronic Inflammation and Cancer, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Ari Waisman
- Institute for Molecular Medicine, University Medical Center of Mainz, Mainz, Germany
- Research Center for Immunotherapy, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Susanne Karbach
- Center for Cardiology - Cardiology I, University Medical Center Mainz, Mainz, Germany
- Center for Thrombosis and Hemostasis, University Medical Center Mainz, Mainz, Germany
- German Center for Cardiovascular Research (DZHK) - Partner site RheinMain, Germany
| | - Johannes Wild
- Center for Cardiology - Cardiology I, University Medical Center Mainz, Mainz, Germany
- Center for Thrombosis and Hemostasis, University Medical Center Mainz, Mainz, Germany
- German Center for Cardiovascular Research (DZHK) - Partner site RheinMain, Germany
| |
Collapse
|
9
|
Looking beyond the Skin: Pathophysiology of Cardiovascular Comorbidity in Psoriasis and the Protective Role of Biologics. Pharmaceuticals (Basel) 2022; 15:ph15091101. [PMID: 36145322 PMCID: PMC9503011 DOI: 10.3390/ph15091101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Revised: 08/23/2022] [Accepted: 08/25/2022] [Indexed: 11/16/2022] Open
Abstract
Psoriasis is a chronic systemic inflammatory disease associated with a higher incidence of cardiovascular disease, especially in patients with moderate to severe psoriasis. It has been estimated that severe psoriasis confers a 25% increase in relative risk of cardiovascular disease, regardless of traditional risk factors. Although the underlying pathogenic mechanisms relating psoriasis to increased cardiovascular risk are not clear, atherosclerosis is emerging as a possible link between skin and vascular affection. The hypothesis that the inflammatory cascade activated in psoriasis contributes to the atherosclerotic process provides the underlying basis to suggest that an anti-inflammatory therapy that improved atherosclerosis would also reduce the risk of MACEs. In this sense, the introduction of biological drugs which specifically target cytokines implicated in the inflammatory cascade have increased the expectations of control over the cardiovascular comorbidity present in psoriasis patients, however, their role in vascular damage processes remains controversial. The aim of this paper is to review the mechanistic link between psoriasis and cardiovascular disease development, as well as analyzing which of the biological treatments could also reduce the cardiovascular risk in these patients, fueling a growing debate on the modification of the general algorithm of treatment.
Collapse
|
10
|
Anyfanti P, Margouta A, Goulas K, Gavriilaki M, Lazaridou E, Patsatsi A, Gkaliagkousi E. Endothelial Dysfunction in Psoriasis: An Updated Review. Front Med (Lausanne) 2022; 9:864185. [PMID: 35755028 PMCID: PMC9226899 DOI: 10.3389/fmed.2022.864185] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Accepted: 05/24/2022] [Indexed: 12/24/2022] Open
Abstract
Although psoriasis is predominantly a chronic inflammatory skin disorder, epidemiological data provide a solid link between psoriasis, especially in its more severe forms, and increased risk for cardiovascular morbidity and mortality. Apart from the increased prevalence of traditional cardiovascular risk factors, chronic inflammation appears to act synergistically with the underlying process of endothelial dysfunction toward the development of accelerated atherosclerosis, subclinical vascular injury and subsequently, clinically evident cardiovascular manifestations. Endothelial dysfunction is regarded as an early precursor of atherosclerosis with a predictive value for the development of future cardiovascular events. A thorough understanding of the mechanisms of endothelial dysfunction in psoriasis might pave the path for the development of more accurate cardiovascular risk prediction tools and possible therapeutic targets aiming to alleviate the increased cardiovascular burden associated with the disease. The present review summarizes the available evidence about the role of chronic inflammation and other important pathophysiological mechanisms involved in the development of endothelial dysfunction in psoriasis. An overview of studies implementing the most widely applied circulating and vascular biomarkers of endothelial dysfunction in psoriasis patients will be provided, and the impact of systemic psoriasis treatments on endothelial dysfunction and patients' cardiovascular risk will be discussed.
Collapse
Affiliation(s)
- Panagiota Anyfanti
- Department of Internal Medicine, Papageorgiou Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Anastasia Margouta
- Department of Internal Medicine, Papageorgiou Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Kyriakos Goulas
- Department of Internal Medicine, Papageorgiou Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Maria Gavriilaki
- Postgraduate Course, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Elizabeth Lazaridou
- Department of Dermatology and Venereology, School of Medicine, Papageorgiou Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Aikaterini Patsatsi
- Department of Dermatology and Venereology, School of Medicine, Papageorgiou Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Eugenia Gkaliagkousi
- Department of Internal Medicine, Papageorgiou Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| |
Collapse
|
11
|
Hong JJ, Hadeler EK, Mosca ML, Brownstone ND, Bhutani T, Liao WJ. TNF-alpha inhibitors and ustekinumab for the treatment of psoriasis: therapeutic utility in the era of IL-17 and IL-23 inhibitors. JOURNAL OF PSORIASIS AND PSORIATIC ARTHRITIS 2022; 7:79-92. [PMID: 35757187 PMCID: PMC9229820 DOI: 10.1177/24755303211047479] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Psoriasis is a chronic inflammatory condition for which eleven FDA-approved biologic therapies are approved. Over the past decade, studies have documented the higher efficacy of IL-17 and IL-23 inhibitors for the treatment of psoriasis compared to the TNF-alpha inhibitors and ustekinumab, an IL-12/23 inhibitor. Despite this, there remains an important role for the use of TNF-alpha inhibitors and ustekinumab in the treatment of psoriasis. Here, we review how considerations of infection and malignancy risk, patient demographics, treatment resistance, and co-morbidities may make certain TNF-alpha inhibitors or ustekinumab an excellent choice for therapy in particular patient subgroups.
Collapse
Affiliation(s)
- Julie J Hong
- University of California San Francisco, Department of Dermatology, Psoriasis and Skin Treatment Center
| | - Edward K Hadeler
- University of California San Francisco, Department of Dermatology, Psoriasis and Skin Treatment Center
| | - Megan L Mosca
- University of California San Francisco, Department of Dermatology, Psoriasis and Skin Treatment Center
| | - Nicholas D Brownstone
- University of California San Francisco, Department of Dermatology, Psoriasis and Skin Treatment Center
| | - Tina Bhutani
- University of California San Francisco, Department of Dermatology, Psoriasis and Skin Treatment Center
| | - Wilson J Liao
- University of California San Francisco, Department of Dermatology, Psoriasis and Skin Treatment Center
| |
Collapse
|
12
|
Kleinrensink NJ, Pouw JN, Leijten EFA, Takx RAP, Welsing PMJ, de Keizer B, de Jong PA, Foppen W. Increased vascular inflammation on PET/CT in psoriasis and the effects of biologic treatment: systematic review and meta-analyses. Clin Transl Imaging 2022. [DOI: 10.1007/s40336-021-00476-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
13
|
Lee TL, Tsai TF. Non-immune functions of inflammatory cytokines targeted by anti-psoriatic biologics: a review. Inflamm Res 2022; 71:157-168. [PMID: 34981130 DOI: 10.1007/s00011-021-01528-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Revised: 11/25/2021] [Accepted: 11/25/2021] [Indexed: 12/01/2022] Open
Abstract
PURPOSE Psoriasis is an inflammatory disease characterized by skin thickening with silvery white desquamation due to dysregulated inflammatory pathways and elevated levels of inflammatory cytokines. Biologic agents targeting these inflammatory cytokines have brought about significant improvement in clearing psoriatic lesions in patients with moderate-to-severe psoriasis. Moreover, biologics exert both beneficial and detrimental effects on comorbidities in psoriasis, which include increased risk of cardiovascular events, metabolic syndrome, among other conditions. However, non-immune functions of cytokines targeted by biologics, and, hence, the potential risks and benefits of biologics for psoriasis to different organs/systems and comorbidities, have not been well elucidated. RESULTS This review summarizes current understanding of the pathogenesis of psoriasis-related comorbidities and emerging discoveries of roles of cytokines targeted in psoriasis treatment, including tumor necrosis factor α and interleukins 12, 23, and 17, aiming to complete the safety profile of each biologics and provide therapeutic implications on psoriasis-related comorbidities, and on diseases involving other organs or systems.
Collapse
Affiliation(s)
- Tung-Lin Lee
- Department of Medical Education, National Taiwan University Hospital, Taipei, Taiwan
| | - Tsen-Fang Tsai
- Department of Dermatology, National Taiwan University Hospital and National Taiwan University College of Medicine, 7 Chung-Shan S. Rd., Taipei, 100, Taiwan.
| |
Collapse
|
14
|
Ramírez J, Azuaga-Piñango AB, Celis R, Cañete JD. Update on Cardiovascular Risk and Obesity in Psoriatic Arthritis. Front Med (Lausanne) 2021; 8:742713. [PMID: 34692732 PMCID: PMC8531250 DOI: 10.3389/fmed.2021.742713] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Accepted: 09/13/2021] [Indexed: 12/23/2022] Open
Abstract
PsA is characterized by a high prevalence of cardiovascular (CV) comorbidities. Recognizing these comorbidities is critical due to their influence on the quality of life and the choice of therapy. Imaging techniques also play an important role in the evaluation of the CV risk in psoriatic disease, improving the prediction of CV events when combined with clinical scores as a predictive tool. Meta-analyses point to a significant reduction in the incidence of CV events associated with the suppression of inflammatory activity when using systemic therapies. Consequently, the mortality rate in PsA patients has fallen in the last 40 years and is now similar to that of the general population, including cardiovascular causes. Obesity is an especially relevant CV comorbidity in patients with psoriatic disease, most of whom are overweight/obese. Body mass index (BMI) is a risk factor for PsA and a causal relationship with psoriasis has been demonstrated by Mendelian randomized studies. The study of fat distribution shows that patients with psoriasis are characterized by visceral fat accumulation, which correlates with CV risk measurements. These findings suggest that approaches to the prevention and treatment of psoriatic disease might come from targeting adiposity levels, in addition to the immune pathways. Weight loss treatment with low energy diets in patients with PsA has been associated with significant improvements in disease activity. Novel strategies using a multimorbidity approach, focused more on patients outcomes, are necessary to better address comorbidities, improve clinical outcomes and the quality of life of patients with psoriatic disease.
Collapse
Affiliation(s)
- Julio Ramírez
- Arthritis Unit, Department of Rheumatology, Hospital Clínic, Barcelona, Spain
| | | | - Raquel Celis
- Arthritis Unit, Department of Rheumatology, Hospital Clínic, Barcelona, Spain
| | - Juan D Cañete
- Arthritis Unit, Department of Rheumatology, Hospital Clínic, Barcelona, Spain
| |
Collapse
|
15
|
Yan D, Blauvelt A, Dey AK, Golpanian RS, Hwang ST, Mehta NN, Myers B, Shi ZR, Yosipovitch G, Bell S, Liao W. New Frontiers in Psoriatic Disease Research, Part II: Comorbidities and Targeted Therapies. J Invest Dermatol 2021; 141:2328-2337. [PMID: 33888321 PMCID: PMC8464483 DOI: 10.1016/j.jid.2021.02.743] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2020] [Revised: 01/27/2021] [Accepted: 02/09/2021] [Indexed: 12/12/2022]
Abstract
Although psoriasis and psoriatic arthritis (PsA) have been classically considered to be diseases of the skin and joints, respectively, emerging evidence suggests that a combination of innate and environmental factors creates widespread immune dysfunction, affecting multiple organ systems. A greater understanding of the pathogenesis of psoriasis and the systemic effects of psoriatic inflammation has allowed for the development of new, more effective treatments. The second portion of this two-part review series examines the comorbidities associated with psoriasis and PsA as well as the most recent advances in targeted systemic therapies for these conditions.
Collapse
Affiliation(s)
- Di Yan
- The Ronald O. Perelman Department of Dermatology, NYU Langone Medical Center, New York, New York, USA
| | | | - Amit K Dey
- Cardiopulmonary Branch, National Heart, Lung, and Blood Institute, Bethesda, Maryland, USA
| | - Rachel S Golpanian
- Itch Center, Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Samuel T Hwang
- Department of Dermatology, UC Davis Medical Center, Sacramento, California
| | - Nehal N Mehta
- Cardiopulmonary Branch, National Heart, Lung, and Blood Institute, Bethesda, Maryland, USA
| | - Bridget Myers
- Department of Dermatology, University of California San Francisco, San Francisco, California
| | - Zhen-Rui Shi
- Department of Dermatology, UC Davis Medical Center, Sacramento, California
| | - Gil Yosipovitch
- Itch Center, Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Stacie Bell
- National Psoriasis Foundation, Portland, Oregon, USA
| | - Wilson Liao
- Department of Dermatology, University of California San Francisco, San Francisco, California.
| |
Collapse
|
16
|
Zhu D, Yao S, Wu H, Ke X, Zhou X, Geng S, Dong S, Chen H, Yang T, Cheng Y, Guo Y. A transcriptome-wide association study identifies novel susceptibility genes for psoriasis. Hum Mol Genet 2021; 31:300-308. [PMID: 34409462 DOI: 10.1093/hmg/ddab237] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Revised: 08/09/2021] [Accepted: 08/10/2021] [Indexed: 01/17/2023] Open
Abstract
Although more than 80 psoriasis genetic risk loci have been reported through genome-wide association studies (GWASs), the genetic mechanism of psoriasis remains unclear. To identify novel candidate genes associated with psoriasis and reveal the potential effects of genetic factors in the development of psoriasis, we conducted a transcriptome-wide association study (TWAS) based on summary statistics from GWAS of psoriasis (5175 cases and 447 089 controls) and gene expression levels from six tissues datasets (blood and skin). We identified 11 conditionally independent genes for psoriasis after Bonferroni corrections, such as the most significant genes UBLCP1 (PYFS = 2.98 × 10-16), and LCE3C (PSNSE = 9.72 × 10-12, PSSE = 6.24 × 10-12). The omnibus test identified additional 5 genes associated with psoriasis via the joint association model from multiple reference tissues. Among the 16 identified genes, 5 genes (CTSW, E1F1AD, KLRC3, FIBP, and EFEMP2) were regarded as novel genes for psoriasis. We evaluated the 16 candidate genes by querying public databases and identified 11 differentially expressed genes and 8 genes proved by the knockout mice models. Through GO enrichment analyses, we found that TWAS genes were enriched in the known GO terms associated with skin development, such as cornified envelope (P = 4.80 × 10-8) and peptide cross-linking (P = 1.50 × 10-7). Taken together, our results detected multiple novel candidate genes for psoriasis, providing clues for understanding the genetic mechanism of psoriasis.
Collapse
Affiliation(s)
- Dongli Zhu
- Key Laboratory of Biomedical Information Engineering of Ministry of Education, School of Life Science and Technology, Xi'an Jiaotong University, Xi'an, Shaanxi, 710049, P. R. China
| | - Shi Yao
- Key Laboratory of Biomedical Information Engineering of Ministry of Education, School of Life Science and Technology, Xi'an Jiaotong University, Xi'an, Shaanxi, 710049, P. R. China.,National and Local Joint Engineering Research Center of Biodiagnosis and Biotherapy, The Second Affiliated Hospital, Xi'an Jiaotong University, Xi'an, Shaanxi, 710004, P. R. China
| | - Hao Wu
- Key Laboratory of Biomedical Information Engineering of Ministry of Education, School of Life Science and Technology, Xi'an Jiaotong University, Xi'an, Shaanxi, 710049, P. R. China
| | - Xin Ke
- Key Laboratory of Biomedical Information Engineering of Ministry of Education, School of Life Science and Technology, Xi'an Jiaotong University, Xi'an, Shaanxi, 710049, P. R. China
| | - Xiaorong Zhou
- Key Laboratory of Biomedical Information Engineering of Ministry of Education, School of Life Science and Technology, Xi'an Jiaotong University, Xi'an, Shaanxi, 710049, P. R. China
| | - Songmei Geng
- Department of Dermatology, The Second Affiliated Hospital, Xi'an Jiaotong University, Xi'an, Shaanxi, 710004, P. R. China
| | - Shanshan Dong
- Key Laboratory of Biomedical Information Engineering of Ministry of Education, School of Life Science and Technology, Xi'an Jiaotong University, Xi'an, Shaanxi, 710049, P. R. China
| | - Hao Chen
- Key Laboratory of Biomedical Information Engineering of Ministry of Education, School of Life Science and Technology, Xi'an Jiaotong University, Xi'an, Shaanxi, 710049, P. R. China.,Research Institute of Xi'an Jiaotong University, Hangzhou, Zhejiang, 311215, P.R. China
| | - Tielin Yang
- Key Laboratory of Biomedical Information Engineering of Ministry of Education, School of Life Science and Technology, Xi'an Jiaotong University, Xi'an, Shaanxi, 710049, P. R. China.,National and Local Joint Engineering Research Center of Biodiagnosis and Biotherapy, The Second Affiliated Hospital, Xi'an Jiaotong University, Xi'an, Shaanxi, 710004, P. R. China
| | - Ying Cheng
- Key Laboratory of Biomedical Information Engineering of Ministry of Education, School of Life Science and Technology, Xi'an Jiaotong University, Xi'an, Shaanxi, 710049, P. R. China
| | - Yan Guo
- Key Laboratory of Biomedical Information Engineering of Ministry of Education, School of Life Science and Technology, Xi'an Jiaotong University, Xi'an, Shaanxi, 710049, P. R. China.,National and Local Joint Engineering Research Center of Biodiagnosis and Biotherapy, The Second Affiliated Hospital, Xi'an Jiaotong University, Xi'an, Shaanxi, 710004, P. R. China
| |
Collapse
|
17
|
Teklu M, Parel PM, Mehta NN. Psoriasis and Cardiometabolic Diseases: The Impact of Inflammation on Vascular Health. PSORIASIS-TARGETS AND THERAPY 2021; 11:99-108. [PMID: 34322373 PMCID: PMC8312325 DOI: 10.2147/ptt.s320016] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Accepted: 07/06/2021] [Indexed: 12/24/2022]
Abstract
Psoriasis is a common chronic inflammatory condition associated with a higher risk of cardiovascular disease. Psoriasis confers a dose-dependent increase in risk for the metabolic syndrome and its components. The metabolic syndrome and its components have been associated with higher coronary atherosclerosis in psoriasis and cardiovascular events in the general population. In this review, we discuss the role of inflammation and psoriasis in cardiometabolic diseases with a focus on the metabolic syndrome and its components. We highlight the relationship between psoriasis and important cardiovascular risk factors encompassed by obesity, dyslipidemia, insulin resistance and hypertension. Furthermore, we briefly highlight literature on anti-inflammatory therapies and their impact on the components of the metabolic syndrome as well as directly quantified coronary atherosclerosis burden.
Collapse
Affiliation(s)
- Meron Teklu
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - Philip M Parel
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - Nehal N Mehta
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| |
Collapse
|
18
|
Trimethylamine N-Oxide, a Gut Microbiota-Derived Metabolite, Is Associated with Cardiovascular Risk in Psoriasis: A Cross-Sectional Pilot Study. Dermatol Ther (Heidelb) 2021; 11:1277-1289. [PMID: 33983475 PMCID: PMC8322249 DOI: 10.1007/s13555-021-00547-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Accepted: 04/30/2021] [Indexed: 02/07/2023] Open
Abstract
Introduction Trimethylamine N-oxide (TMAO), a gut microbiota metabolite from dietary phosphatidylcholine, is involved in the pathogenesis of atherosclerosis and cardiovascular diseases. Psoriasis is associated with increased cardiovascular risk that is not captured by traditional biomarkers. The aim of the present study was to assess TMAO concentration in psoriasis and evaluate the relationship between TMAO and cardiovascular risk in psoriatic patients. Methods In 72 patients with psoriasis and 40 age- and sex-matched non-psoriatic controls, we evaluated fasting plasma TMAO, measured by high-performance liquid chromatography, and cardiovascular risk assessed by various scoring systems such as Framingham, QRISK2, AHA/ACC, and Reynolds risk scores. Results In patients with psoriasis, TMAO concentration was significantly higher than in the control group (195.68 [133.54–332.58] ng/ml versus 126.06 [84.29–156.88] ng/ml, respectively; p < 0.001). Plasma TMAO concentration was significantly correlated with age, total cholesterol, triglycerides, systolic and diastolic blood pressure. Furthermore, the receiver-operating characteristic (ROC) and multiple regression analysis showed that TMAO is an independent predictor of cardiovascular risk. Conclusion TMAO is a valuable candidate for biomarker and a translational link between dysbiosis and atherosclerosis in psoriasis.
Collapse
|
19
|
|
20
|
Piros ÉA, Szilveszter B, Vattay B, Maurovich-Horvat P, Szalai K, Dósa E, Merkely B, Holló P. Novel anti-inflammatory therapies to reduce cardiovascular burden of psoriasis. Dermatol Ther 2021; 34:e14721. [PMID: 33373079 PMCID: PMC8244030 DOI: 10.1111/dth.14721] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Accepted: 12/21/2020] [Indexed: 12/16/2022]
Abstract
Psoriasis mainly affects the skin and joints and has serious impacts on the physical, emotional, and financial life of patients. Recent studies have demonstrated that other comorbidities are frequently detected in psoriatic patients. A strong association with the development of cardiovascular diseases, such as hypertension, myocardial infarction, and stroke is responsible for the shortened (by 4.5‐5 years) life expectancy of severe psoriatic patients. Systemic inflammation plays an important role in the interrelationship between psoriasis and atherosclerotic plaque formation, which is a common immunopathogenic pathway that explains the multiorgan involvement in psoriasis. As far life‐threatening cardiovascular diseases are very often symptom‐free, the treating dermatologist's responsibility is to initiate interdisciplinary holistic patient care, which may lead to directly saved patients' lives. Holistic care of severe psoriatic patients should include regular cardiac monitoring using cardiovascular imaging modalities and functional testing to detect even subclinical coronary artery disease. Effective anti‐inflammatory treatment with biologic therapies may have beneficial effects on the cardiovascular state and may reduce the incidence of cardiac events. The authors review the latest findings on the shared immunopathogenic background of psoriasis and cardiovascular diseases and discuss the available data about the cardiovascular responses to the currently used biologic treatments.
Collapse
Affiliation(s)
- Éva Anna Piros
- Department of Dermatology, Venereology, and Dermatooncology, Semmelweis University, Budapest, Hungary
| | - Bálint Szilveszter
- MTA-SE Cardiovascular Imaging Research Group, Semmelweis University, Heart and Vascular Center, Budapest, Hungary
| | - Borbála Vattay
- MTA-SE Cardiovascular Imaging Research Group, Semmelweis University, Heart and Vascular Center, Budapest, Hungary
| | - Pál Maurovich-Horvat
- MTA-SE Cardiovascular Imaging Research Group, Semmelweis University, Heart and Vascular Center, Budapest, Hungary.,Department of Radiology, Semmelweis University, Medical Imaging Center, Budapest, Hungary
| | - Klára Szalai
- Department of Dermatology, Venereology, and Dermatooncology, Semmelweis University, Budapest, Hungary
| | - Edit Dósa
- Department of Interventional Radiology, Semmelweis University, Heart and Vascular Center, Budapest, Hungary.,Hungarian Vascular Radiology Research Group, Budapest, Hungary
| | - Béla Merkely
- MTA-SE Cardiovascular Imaging Research Group, Semmelweis University, Heart and Vascular Center, Budapest, Hungary
| | - Péter Holló
- Department of Dermatology, Venereology, and Dermatooncology, Semmelweis University, Budapest, Hungary
| |
Collapse
|
21
|
Papagoras C, Voulgari PV, Drosos AA. Cardiovascular Disease in Spondyloarthritides. Curr Vasc Pharmacol 2020; 18:473-487. [PMID: 31330576 DOI: 10.2174/1570161117666190426164306] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Revised: 04/13/2019] [Accepted: 04/13/2019] [Indexed: 12/15/2022]
Abstract
The spondyloarthritides are a group of chronic systemic inflammatory joint diseases, the main types being ankylosing spondylitis (AS) and psoriatic arthritis (PsA). Evidence accumulating during the last decades suggests that patients with AS or PsA carry an increased risk for cardiovascular disease and cardiovascular death. This risk appears to be mediated by systemic inflammation over and above classical cardiovascular risk factors. The excess cardiovascular risk in those patients has been formally acknowledged by scientific organizations, which have called physicians' attention to the matter. The application by Rheumatologists of new effective anti-rheumatic treatments and treat-to-target strategies seems to benefit patients from a cardiovascular point of view, as well. However, more data are needed in order to verify whether anti-rheumatic treatments do have an effect on cardiovascular risk and whether there are differences among them in this regard. Most importantly, a higher level of awareness of the cardiovascular risk is needed among patients and healthcare providers, better tools to recognize at-risk patients and, ultimately, commitment to address in parallel both the musculoskeletal and the cardiovascular aspect of the disease.
Collapse
Affiliation(s)
- Charalampos Papagoras
- 1st Department of Internal Medicine, Democritus University of Thrace, Alexandroupolis, Greece
| | - Paraskevi V Voulgari
- Rheumatology Clinic, Department of Internal Medicine, Medical School, University of Ioannina, Ioannina, Greece
| | - Alexandros A Drosos
- Rheumatology Clinic, Department of Internal Medicine, Medical School, University of Ioannina, Ioannina, Greece
| |
Collapse
|
22
|
Liu T, Li S, Ying S, Tang S, Ding Y, Li Y, Qiao J, Fang H. The IL-23/IL-17 Pathway in Inflammatory Skin Diseases: From Bench to Bedside. Front Immunol 2020; 11:594735. [PMID: 33281823 PMCID: PMC7705238 DOI: 10.3389/fimmu.2020.594735] [Citation(s) in RCA: 149] [Impact Index Per Article: 37.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Accepted: 10/20/2020] [Indexed: 12/13/2022] Open
Abstract
Interleukin-17 (IL-17) is an essential proinflammatory cytokine, which is mainly secreted by the CD4+ helper T cells (Th17 cells) and subsets of innate lymphoid cells. IL-17A is associated with the pathogenesis of inflammatory diseases, including psoriasis, atopic dermatitis, hidradenitis suppurativa, alopecia areata, pityriasis rubra pilaris, pemphigus, and systemic sclerosis. Interleukin-23 (IL-23) plays a pivotal role in stimulating the production of IL-17 by activating the Th17 cells. The IL-23/IL-17 axis is an important pathway for targeted therapy for inflammatory diseases. Emerging evidence from clinical trials has shown that monoclonal antibodies against IL-23, IL-17, and tumor necrosis factor are effective in the treatment of patients with psoriasis, atopic dermatitis, hidradenitis suppurativa, pityriasis rubra pilaris, pemphigus, and systemic sclerosis. Here, we summarize the latest knowledge about the biology, signaling, and pathophysiological functions of the IL-23/IL-17 axis in inflammatory skin diseases. The currently available biologics targeting the axis is also discussed.
Collapse
Affiliation(s)
- Taoming Liu
- Department of Dermatology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Sheng Li
- Department of Dermatology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Shuni Ying
- Department of Dermatology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Shunli Tang
- Department of Dermatology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Yuwei Ding
- Department of Dermatology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Yali Li
- Department of Dermatology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Jianjun Qiao
- Department of Dermatology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Hong Fang
- Department of Dermatology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| |
Collapse
|
23
|
Ungar B, Pavel AB, Robson PM, Kaufman A, Pruzan A, Brunner P, Kaushik S, Krueger JG, Lebwohl MG, Mani V, Fayad ZA, Guttman-Yassky E. A Preliminary 18F-FDG-PET/MRI Study Shows Increased Vascular Inflammation in Moderate-to-Severe Atopic Dermatitis. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2020; 8:3500-3506. [PMID: 32721606 DOI: 10.1016/j.jaip.2020.07.018] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 06/20/2020] [Accepted: 07/14/2020] [Indexed: 02/08/2023]
Abstract
BACKGROUND Recent data suggest that patients with atopic dermatitis (AD) have increased systemic immune activation and cardiovascular risk. However, unlike psoriasis, evaluation of active vascular inflammation using state-of-the-art imaging is lacking in AD. OBJECTIVE To assess aortic and carotid vascular inflammation using 18F-fluorodeoxyglucose-positron emission tomography/magnetic resonance imaging (18F-FDG-PET/MRI) imaging in moderate-to-severe AD versus healthy individuals. METHODS A total of 27 patients with moderate-to-severe AD and 12 healthy controls were imaged using 18F-FDG-PET/MRI. Target-to-background ratio (TBR) values were calculated in multiple segments of the aorta and carotid vessels. RESULTS Patients with AD had elevated aortic max TBR (fold change [FCH] = 1.45, P = .057) versus healthy controls and significantly elevated mean TBR (FCH = 1.20; P < .05) in the right carotid (RC) arteries versus controls. When examining greatest focal inflammation (most diseased segment [MDS] TBR), patients with AD had higher aortic inflammation (FCH = 1.28; P = .052). AD clinical severity significantly correlated with C-reactive protein (ρ = 0.60, P < .01) and with RC mean TBR levels (ρ = 0.60, P = .04). Stratifying patients into moderate-to-severe and very severe AD showed greater RC mean TBR in patients with very severe AD versus controls (FCH = 1.31; P = .02) and versus patients with moderate/severe AD (FCH = 1.23, P = .05). Aortic inflammation was also significantly greater in patients with very severe AD versus controls (max TBR: FCH = 1.6, P = .04; MDS TBR: FCH = 1.73, P = .03). CONCLUSIONS This preliminary study is the first that establishes greater vascular (aorta and carotid) inflammation in moderate-to-severe AD versus healthy controls. Furthermore, very severe AD showed higher inflammation than both moderate/severe patients and healthy controls. Future studies with larger patient cohorts and evaluation before and after treatment are needed to determine the extent to which vascular inflammation in AD is modifiable.
Collapse
Affiliation(s)
- Benjamin Ungar
- Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Ana B Pavel
- Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Philip M Robson
- Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY; The BioMedical Engineering and Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Audrey Kaufman
- Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY; The BioMedical Engineering and Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Alison Pruzan
- Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY; The BioMedical Engineering and Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Patrick Brunner
- The Laboratory for Investigative Dermatology, The Rockefeller University, New York, NY
| | - Shivani Kaushik
- Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, NY
| | - James G Krueger
- The Laboratory for Investigative Dermatology, The Rockefeller University, New York, NY
| | - Mark G Lebwohl
- Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Venkatesh Mani
- Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY; The BioMedical Engineering and Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Zahi A Fayad
- Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY; The BioMedical Engineering and Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Emma Guttman-Yassky
- Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, NY; The Laboratory for Investigative Dermatology, The Rockefeller University, New York, NY; Department of Dermatology and the Immunology Institute, Icahn School of Medicine at Mount Sinai, New York, NY.
| |
Collapse
|
24
|
Schmidbauer ML, Wollenweber FA, Straube A, Kamm K. [Drug-induced reversible cerebral vasoconstriction syndrome : Ustekinumab as possible trigger?]. Schmerz 2020; 34:350-353. [PMID: 32435940 DOI: 10.1007/s00482-020-00479-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The reversible cerebral vasoconstriction syndrome (RCVS) is a common cause of thunderclap headache. Many trigger factors, such as the intake of vasoactive and less commonly immunosuppressive medication have previously been described. This article reports the first case of the occurrence of RCVS after the intake of ustekinumab in a female patient with a history of Crohn's disease.
Collapse
Affiliation(s)
- Moritz Luigi Schmidbauer
- Klinik und Poliklinik für Neurologie, Klinikum der Universität München, Campus Großhadern, Ludwig-Maximilians-Universität München, Marchioninistraße 15, 81377, München, Deutschland
| | - Frank Arne Wollenweber
- Klinik und Poliklinik für Neurologie, Klinikum der Universität München, Campus Großhadern, Ludwig-Maximilians-Universität München, Marchioninistraße 15, 81377, München, Deutschland.,Klinik für Neurologie, Helios Dr. Horst Schmidt Kliniken Wiesbaden, Wiesbaden, Deutschland
| | - Andreas Straube
- Klinik und Poliklinik für Neurologie, Klinikum der Universität München, Campus Großhadern, Ludwig-Maximilians-Universität München, Marchioninistraße 15, 81377, München, Deutschland
| | - Katharina Kamm
- Klinik und Poliklinik für Neurologie, Klinikum der Universität München, Campus Großhadern, Ludwig-Maximilians-Universität München, Marchioninistraße 15, 81377, München, Deutschland.
| |
Collapse
|
25
|
Lee MP, Desai RJ, Jin Y, Brill G, Ogdie A, Kim SC. Association of Ustekinumab vs TNF Inhibitor Therapy With Risk of Atrial Fibrillation and Cardiovascular Events in Patients With Psoriasis or Psoriatic Arthritis. JAMA Dermatol 2020; 155:700-707. [PMID: 30916734 DOI: 10.1001/jamadermatol.2019.0001] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Importance Accumulating evidence indicates that there is an increased risk of cardiovascular disease among patients with psoriatic disease. Although an emerging concern that the risk of atrial fibrillation (AF) may also be higher in this patient population adds to the growing support of initiating early interventions to control systemic inflammation, evidence on the comparative cardiovascular safety of current biologic treatments remains limited. Objective To evaluate the risk of AF and major adverse cardiovascular events (MACE) associated with use of ustekinumab vs tumor necrosis factor inhibitors (TNFi) in patients with psoriasis or psoriatic arthritis. Design, Setting, and Participants This cohort study included data from a nationwide sample of 78 162 commercially insured patients in 2 US commercial insurance databases (Optum and MarketScan) from September 25, 2009, through September 30, 2015. Patients were included if they were 18 years or older, had psoriasis or psoriatic arthritis, and initiated ustekinumab or a TNFi therapy. Exclusion criteria included history of AF or receipt of antiarrhythmic or anticoagulant therapy during the baseline period. Exposures Initiation of ustekinumab vs TNFi therapy. Main Outcomes and Measures Incident AF and MACE, including myocardial infarction, stroke, or coronary revascularization. Results A total of 60 028 patients with psoriasis or psoriatic arthritis (9071 ustekinumab initiators and 50 957 TNFi initiators) were included in the analyses. The mean (SD) age was 46 (13) years in Optum and 47 (13) in MarketScan, and 29 495 (49.1%) were male. Overall crude incidence rates (reported per 1000 person-years) for AF were 5.0 (95% CI, 3.8-6.5) for ustekinumab initiators and 4.7 (95% CI, 4.2-5.2) for TNFi initiators, and for MACE were 6.2 (95% CI, 4.9-7.8) for ustekinumab initiators and 6.1 (95% CI, 5.5-6.7) for TNFi initiators. The combined adjusted hazard ratio for incident AF among ustekinumab initiators was 1.08 (95% CI, 0.76-1.54) and for MACE among ustekinumab initiators was 1.10 (95% CI, 0.80-1.52) compared with TNFi initiators. Conclusions and Relevance No substantially different risk of incident AF or MACE after initiation of ustekinumab vs TNFi was observed in this study. This information may be helpful when weighing the risks and benefits of various systemic treatment strategies for psoriatic disease.
Collapse
Affiliation(s)
- Moa P Lee
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts.,Department of Epidemiology, University of North Carolina, Chapel Hill
| | - Rishi J Desai
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Yinzhu Jin
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Gregory Brill
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Alexis Ogdie
- Center for Clinical Epidemiology and Biostatistics, Department of Epidemiology and Biostatistics, University of Pennsylvania Perelman School of Medicine, Philadelphia.,Division of Rheumatology, University of Pennsylvania Perelman School of Medicine, Philadelphia
| | - Seoyoung C Kim
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts.,Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| |
Collapse
|
26
|
Gelfand JM, Shin DB, Alavi A, Torigian DA, Werner T, Papadopoulos M, Takeshita J, Noe MH, Dey AK, Playford MP, Mehta NN. A Phase IV, Randomized, Double-Blind, Placebo-Controlled Crossover Study of the Effects of Ustekinumab on Vascular Inflammation in Psoriasis (the VIP-U Trial). J Invest Dermatol 2020; 140:85-93.e2. [PMID: 31326395 PMCID: PMC6926160 DOI: 10.1016/j.jid.2019.07.679] [Citation(s) in RCA: 77] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Revised: 06/06/2019] [Accepted: 07/03/2019] [Indexed: 02/08/2023]
Abstract
Psoriasis is a T helper type 17 autoimmune disease associated with an increased risk cardiovascular events and mortality. Ustekinumab, an antibody to p40, blocks cytokines IL-12 and IL-23, and is a highly effective and safe treatment for psoriasis. We conducted a randomized double-blinded placebo-controlled trial to determine the effect of ustekinumab on aortic vascular inflammation (AVI) measured by imaging, and key biomarkers of inflammation, lipid, and glucose metabolism in the blood of patients with moderate-to-severe psoriasis. A total of 43 patients were randomized, and at week 12, ustekinumab-treated patients had a -18.65% (95% confidence interval = -29.45% to -7.85%) reduction in AVI, a reduction in inflammatory biomarkers, and an increase in apolipoprotein B lipoproteins compared with placebo. At week 12, placebo patients were crossed over such that all patients received ustekinumab for 52 weeks. At the end of 52 weeks of ustekinumab treatment, there was no change in AVI compared with baseline, inflammatory markers were reduced, and there were increases in selected measures of lipids and leptin. These results show that blockade of IL-12 and/or IL-23 may transiently reduce AVI, with more durable reduction in inflammatory cytokines associated with cardiovascular disease.
Collapse
Affiliation(s)
- Joel M Gelfand
- Department of Dermatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA; Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
| | - Daniel B Shin
- Department of Dermatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Abass Alavi
- Department of Radiology (Nuclear Medicine), Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Drew A Torigian
- Department of Radiology (Nuclear Medicine), Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Tom Werner
- Department of Radiology (Nuclear Medicine), Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Maryte Papadopoulos
- Department of Dermatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Junko Takeshita
- Department of Dermatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA; Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Megan H Noe
- Department of Dermatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA; Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Amit K Dey
- Section of Inflammation and Cardiometabolic Diseases, National Heart Lung Blood Institute, Bethesda, Maryland, USA
| | - Martin P Playford
- Section of Inflammation and Cardiometabolic Diseases, National Heart Lung Blood Institute, Bethesda, Maryland, USA
| | - Nehal N Mehta
- Section of Inflammation and Cardiometabolic Diseases, National Heart Lung Blood Institute, Bethesda, Maryland, USA
| |
Collapse
|
27
|
Ma J, Liang N, Chen J, Bai Y. The association between biologic agents and the risk of cardiovascular events in patients with psoriasis and psoriatic arthritis: A protocol for a systematic review and meta-analysis. Medicine (Baltimore) 2019; 98:e18063. [PMID: 31764836 PMCID: PMC6882593 DOI: 10.1097/md.0000000000018063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Psoriasis (Pso) is a chronic, recurrent, and inflammatory disease involving genetic and immune factors. Psoriatic arthritis (PsA), accounting for 30% of Pso, is an inflammatory arthropathy. Pso and PsA are associated with increased cardiovascular events (CVEs). Biologic therapies for Pso and PsA are drawing arising attention for its therapeutic effects. Large evidences have shown that biologic agents could lower the risk of CVEs in patients with Pso and PsA. However, not all studies support this point. A systematic review is needed. METHODS Four databases (PubMed, Web of Science, The Cochrane Library, and EMBASE) will be searched from the inception to July 1st, 2019. Randomized controlled trials and observational studies (including case-control studies and cohort studies) reporting CVEs in patients with Pso and PsA treated with biologic agents will be included. The primary outcome is the incidence of CVEs. The secondary outcome is the incidence of each individually reported cardiovascular event. Study selection, data extraction, and assessment of quality will be conducted independently by 2 reviewers. RevMan5.3.5 software will be used for data synthesis. RESULTS The results of this study will provide evidence for the effect of biologic agents on the risk of CVEs in patients with Pso and PsA, so as to further provide guidance for clinical management. CONCLUSION The findings of this study will be published in a peer-reviewed journal. PROSPERO REGISTRATION NUMBER CRD42019142778.
Collapse
Affiliation(s)
- Jie Ma
- Beijing University of Chinese Medicine
- Department of Dermatology, China-Japan Friendship Hospital, Beijing, China
| | - Ning Liang
- Institue of Basic Research in Clinical Medicine, China Academy of Chinese Medical Sciences
| | | | - Yanping Bai
- Department of Dermatology, China-Japan Friendship Hospital, Beijing, China
| |
Collapse
|
28
|
Korman NJ. Management of psoriasis as a systemic disease: what is the evidence? Br J Dermatol 2019; 182:840-848. [PMID: 31225638 PMCID: PMC7187293 DOI: 10.1111/bjd.18245] [Citation(s) in RCA: 226] [Impact Index Per Article: 45.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/19/2019] [Indexed: 12/16/2022]
Abstract
Background Psoriasis is a chronic, systemic immune‐mediated disease characterized by development of erythematous, indurated, scaly, pruritic and often painful skin plaques. Psoriasis pathogenesis is driven by proinflammatory cytokines and psoriasis is associated with increased risk for comorbidities, including, but not limited to, psoriatic arthritis, cardiovascular disease, diabetes mellitus, obesity, inflammatory bowel disease and nonalcoholic fatty liver disease compared with the general population. Objectives To explore the pathophysiological relationship between psoriasis and its common comorbidities and discuss the need for new treatment paradigms that include strategies to reduce systemic inflammation in patients with moderate‐to‐severe psoriasis. Methods This narrative review summarizes the published evidence related to the ability of biological therapies to ameliorate the consequences of systemic inflammation in patients with psoriasis. Results Current evidence suggests that preventing damage associated with inflammation, and preventing development of future inflammatory damage and comorbidities, may be a potentially achievable treatment goal for many patients with moderate‐to‐severe plaque psoriasis when biological therapies are utilized early in the disease. Encouraging data from recent studies suggest that the loftier goal of reversing existing inflammatory damage and improving signs and symptoms of inflammatory comorbidities could also possibly be attainable. Conclusions Results from ongoing prospective studies regarding the effects of biologics on markers of systemic inflammation in patients with psoriasis will strengthen the clinical evidence base that can be used to inform treatment decisions for patients with moderate‐to‐severe psoriasis. What's already known about this topic? Psoriasis is a systemic inflammatory disease and treatments are needed to optimize patient outcomes.
What does this study add? This review discusses new psoriasis treatment paradigms that may potentially reduce effects of systemic inflammation. Evidence demonstrating that biological treatment may prevent or reverse inflammatory damage associated with psoriasis comorbidities is reviewed.
Linked Comment:https://doi.org/10.1111/bjd.18456
Collapse
Affiliation(s)
- N J Korman
- Department of Dermatology, Case Western Reserve University, Cleveland, OH, U.S.A.,University Hospitals Cleveland Medical Center, Cleveland, OH, U.S.A
| |
Collapse
|
29
|
Chiu HY, Wang TS, Chen PH, Hsu SH, Tsai YC, Tsai TF. Psoriasis in Taiwan: From epidemiology to new treatments. DERMATOL SIN 2018. [DOI: 10.1016/j.dsi.2018.06.001] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
|