Patients with controlled psoriasis still face systemic inflammation, cardiometabolic risks

Key takeaways:

• Some patients had residual inflammation 1 year after biologic therapy or stable biologic maintenance treatment.
• BMI and female sex were associated with having residual inflammation.

Residual inflammation persisted among patients with psoriasis despite optimal disease response to biologic therapies, putting them at risk for broader health conditions, according to a study.

As Healio previously reported, psoriasis is an independent risk factor for cardiovascular diseases, primarily driven by systemic inflammation. According to a study published in the Journal of Investigative Dermatology, patients with well-controlled psoriasis can still experience residual inflammation — a concept that was first introduced to describe patients with features of high-risk atherosclerosis and high-sensitivity C-reactive protein (CRP) greater than 2mg/L, despite receiving optimal medial therapy.

In this study, the authors assessed residual inflammation in 209 patients from three international cohorts: the Early Detection and Progression of Subclinical Atherosclerosis in Psoriasis cohort (Spain; mean age, 48 years); the Psoriasis Atherosclerosis and Cardiometabolic Disease Initiative (United States; mean age, 53 years); and DermaReg (Sweden; mean age, 46.2 years). Participants achieved a PASI score equal to or less than 2 after stable biologic therapy.

Most participants had overweight or obesity and most were men.

Across the cohorts, results showed that an average of 36.28% of patients had residual inflammation 1 year after biologic therapy or stable biologic maintenance treatment. Those with a baseline high sensitivity CRP lower than 2 mg/L maintained that score after 1 year whereas 62.3% of those with a baseline high sensitivity CRP greater than or equal to 2 mg/L remained at that level in the same time frame, researchers reported.

“These findings are a stark reminder that many patients with psoriasis will have residual systemic inflammation despite excellent control of their skin disease, which puts them at risk for adverse cardiometabolic outcomes,” Joel M. Gelfand, MD, MSCE, FAAD, James J. Leyden Professor of Clinical Investigation, professor of dermatology and epidemiology at University of Pennsylvania’s Perelman School of Medicine, Healio Dermatology’s Chief Medical Editor and one of the investigators of this study, told Healio.

Multiple characteristics were associated with residual inflammation among patients with controlled psoriasis.

First, an analysis stratifying by BMI across cohorts showed that the presence of residual inflammation was considerably higher among those with obesity (50%-63.6%) and overweight (29.6%-37%) compared with those with normal weight (14.3%-25%).

The authors also found that baseline systemic inflammation and hepatic steatosis were consistently elevated among patients with residual inflammation. Researchers also observed visceral adiposity, which is the main component of central obesity, among these patients.

Female sex was considered an independent risk factor for having residual inflammation across all three cohorts.

“It is widely known that autoimmune diseases are more frequent in women and in the general population, higher CRP levels are usually found in women than in men,” Gelfand and colleagues wrote. “In fact, sex-specific CRP cutoff points have been suggested for cardiovascular risk evaluation.”

Lastly, patients treated with anti-tumor necrosis factor medications had a lower proportion of residual inflammation than those treated with other biologic treatments, researchers reported. On the other hand, treatment with anti-interleukin-12/23s was linked to higher residual inflammation rates.

“Despite treatment with biologic drugs and adequate skin control, a significant proportion of patients persisted with systemic inflammation, suggesting that nonvisible inflammation may still contribute to cardiovascular risk,” Gelfand and colleagues wrote. “Addressing residual inflammation in patients with psoriasis could ultimately lead to more comprehensive treatment strategies aimed at reducing both skin and systemic inflammation.”

For more information:

Joel M. Gelfand, MD, MSCE, FAAD, can be reached at dermatology@healio.com.