Impact of effective tumor necrosis factor-alfa inhibitor treatment on arterial intima-media thickness in psoriasis: Results of a pilot study - 24/07/13

Doi : 10.1016/j.jaad.2013.06.019

Hajnalka Jókai, MD ^⁎ , József Szakonyi, MD, Orsolya Kontár, MD, Márta Marschalkó, DsC, PhD, Klára Szalai, MD, Sarolta Kárpáti, DsC, PhD, Péter Holló, PhD
Department of Dermatovenerology and Oncodermatology, Semmelweis University, Budapest, Hungary

^∗Correspondence to: Hajnalka Jókai, MD, Department of Dermatovenerology and Oncodermatology, Semmelweis University, Mária Street 41, Budapest 1085, Hungary.

Sous presse. Épreuves corrigées par l'auteur. Disponible en ligne depuis le Wednesday 24 July 2013

Abstract

Background

Psoriasis is associated with higher incidence of atherosclerotic comorbidities. Sustained arterial wall inflammation mediated by common cytokines of psoriasis and atherogenesis precedes atherosclerotic plaque development. Increased intima-media thickness (IMT) is an accepted indicator of subclinical atherosclerosis and has been reported in severe psoriasis.

Objective

This pilot study aimed to clarify whether effective long-term tumor necrosis factor-alfa inhibition decreases IMT in psoriasis.

Methods

In 16 patients with severe psoriasis, the Psoriasis Area and Severity Index score was calculated before therapy (etanercept, infliximab, adalimumab) and after 6-month treatment. Simultaneously, carotid and brachial IMT was measured by high-resolution, B-mode ultrasonography. Difference between initial and 6-month IMT values was determined for monitored arteries collectively and separately in carotid and brachial arteries.

Results

All of 16 patients achieved Psoriasis Area and Severity Index 75, and 14 of 16 achieved Psoriasis Area and Severity Index 90 improvement. In the group of patients without initial calcified atherosclerotic plaques (13 of 16) significant IMT decrease was detected when arteries were measured collectively (P = .0002). Initial and follow-up data differed significantly also at individual analysis of carotid (P = .011) and brachial (P = .006) arteries. Eleven of 13 patients had initial carotid IMT exceeding age-adjusted normal values. The other group (3 of 16) with initial manifest plaques showed increasing IMT tendency. Their baseline ultrasonography revealed carotid IMT above the upper limit of healthy adults’ age-adjusted values.

Limitations

Study limitation involves small patient numbers, self-controlled study design, and lack of patients’ stratification according to common cardiovascular risk factors.

Conclusion

In our pilot study effective tumor necrosis factor-alfa inhibition was found to decrease IMT in psoriatic patients without irreversible atherosclerotic plaques. Further analysis is recommended to confirm and complete our primary observations.

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Key words : arterial intima-media thickness, atherosclerosis, cardiovascular risk, high-resolution B-mode ultrasonography, psoriasis vulgaris, tumor necrosis factor-alfa inhibitor

Abbreviations used : CT, FDG, IMT, PASI, PET, TNF, Th