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Circ Cardiovasc Imaging. 2018 Jun;11(6):e007394. doi: 10.1161/CIRCIMAGING.117.007394.

Effect of 2 Psoriasis Treatments on Vascular Inflammation and Novel Inflammatory Cardiovascular Biomarkers: A Randomized Placebo-Controlled Trial.

Author information

1
Cardiopulmonary Branch, National Heart, Lung, and Blood Institute, Bethesda, MD (N.N.M., A.A.J., A.K.D., C.L.H., M.P.P.). nehal.mehta@nih.gov Joel.Gelfand@uphs.upenn.edu.
2
Department of Dermatology, Perelman School of Medicine (D.B.S., Z.C.F., J.T., S.B.V., J.M.G.).
3
Cardiopulmonary Branch, National Heart, Lung, and Blood Institute, Bethesda, MD (N.N.M., A.A.J., A.K.D., C.L.H., M.P.P.).
4
University of Pennsylvania, Philadelphia. Department of Dermatology, University of Southern California, Los Angeles (A.W.A.).
5
Department of Dermatology, University of Utah, Salt Lake City (K.C.D.).
6
Department of Epidemiology and Biostatistics, Perelman School of Medicine (R.A.H., J.T., A.B.T., J.M.G.).
7
The Center for Clinical Epidemiology and Biostatistics (R.A.H., J.T., J.M.G.).
8
Department of Dermatology, Buffalo School of Medicine and Biomedical Sciences, State University of New York (R.E.K.).
9
Department of Dermatology, Baylor University Medical Center, Dallas, TX (A.M.).
10
Department of Genetics (D.J.R.).
11
Department of Cardiology, Division of Medicine, Vagelos College of Physician and Surgeons, and the Irving Institute for Clinical and Translational Research, Columbia University Irving Medical Center, New York, NY (M.P.R.).
12
Department of Dermatology, Oregon Health & Science University, Portland (E.L.S.).
13
Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia (D.A.T., T.J.W., A.A.).
14
Department of Dermatology, McGovern Medical School at Houston, TX (S.K.T.).
15
Department of Dermatology, Eastern Virginia Medical School, Norfolk (A.S.V.V.).
16
Department of Radiology and Imaging Sciences, National Institutes of Health Clinical Research Center, Bethesda, MD (M.A.A.).
17
Department of Dermatology, Perelman School of Medicine (D.B.S., Z.C.F., J.T., S.B.V., J.M.G.) nehal.mehta@nih.gov Joel.Gelfand@uphs.upenn.edu.

Abstract

BACKGROUND:

Psoriasis is a chronic inflammatory disease associated with dyslipidemia, cardiovascular events, and mortality. We aimed to assess and compare the effect of treatment of moderate-to-severe psoriasis with adalimumab or phototherapy on vascular inflammation and cardiovascular biomarkers.

METHODS AND RESULTS:

Randomized, double-blind, trial of adalimumab, phototherapy, and placebo (1:1:1) for 12 weeks, with crossover to adalimumab for 52 weeks total. Outcomes included vascular inflammation by 18F-fluorodeoxyglucose positron emission tomography/computed tomography and biomarkers of inflammation, insulin resistance, and lipoproteins. Ninety-seven patients were randomized, 92 completed the randomized controlled trial portion; 81 entered the adalimumab extension with 61 completing 52 weeks of adalimumab. There was no difference in change in vascular inflammation at week 12 in the adalimumab group (change compared with placebo, 0.64%; 95% confidence interval, -5.84% to 7.12%) or the phototherapy group (-1.60%; 95% confidence interval, -6.78% to 3.59%) or after 52-week adalimumab treatment (0.02% compared with initiation; 95% confidence interval, -2.85% to 2.90%). Both adalimumab and phototherapy decreased inflammation by serum CRP, interleukin-6. Only adalimumab reduced tumor necrosis factor and glycoprotein acetylation at 12 and 52 weeks. Neither had an impact on metabolic markers (insulin, adiponectin, and leptin). Only phototherapy increased high-density lipoprotein-p at 12 weeks. At 52-week of adalimumab cholesterol efflux and high-density lipoprotein-p were reduced.

CONCLUSIONS:

Adalimumab reduced key markers of inflammation including glycoprotein acetylation compared with phototherapy with no effect on glucose metabolism and vascular inflammation, and potential adverse effects on high-density lipoprotein. Glycoprotein acetylation improvement may partially explain the beneficial effects of adalimumab seen in observational studies. Larger studies with more detailed phenotyping of vascular disease should assess the comparative differences in the effects of adalimumab and phototherapy seen in our study.

CLINICAL TRIAL REGISTRATION:

URL: https://www.clinicaltrials.gov. Unique identifiers: NCT01866592 and NCT01553058.

KEYWORDS:

adalimumab; biomarkers; inflammation; psoriasis

Comment in

PMID:
29776990
PMCID:
PMC5991103
DOI:
10.1161/CIRCIMAGING.117.007394
[Indexed for MEDLINE]
Free PMC Article

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