Could a psoriasis drug help to reduce cardiovascular risk?
The skin cells of people with psoriasis multiply faster than normal, which produces raised red bumps on the skin, often on the knees, scalp, and elbows.
Though psoriasis affects such a large proportion of adults, its causes are unclear, and it cannot currently be cured.
Ustekinumab, psoriasis, and the heart
Ustekinumab, sold as Stelara, is an antibody that interferes with the body's inflammatory response. It is prescribed for people whose psoriasis has not responded well to other treatments, or who cannot tolerate other available medicines.
The drug has also been approved by the Food and Drug Administration (FDA) to treat Crohn's disease.
Recently, researchers from the Perelman School of Medicine at the University of Pennsylvania in Philadelphia joined forces with a team from the National Heart, Lung, and Blood Institute.
They wanted to measure the effects of ustekinumab on something other than skin. Their findings were recently presented at the 2018 American Academy of Dermatology Annual Meeting, held in San Diego, CA.
Because ustekinumab reduces the inflammation associated with psoriasis, the researchers wanted to explore whether or not it could benefit heart health by reducing inflammation there, too.
First study author Dr. Joel M. Gelfand, a professor of dermatology and epidemiology, explains their thought process, saying, "The type of inflammation we see in psoriasis is similar to what we see in atherosclerosis," which he describes as "a type of heart disease that involves the buildup of fats, cholesterol, and inflammatory cells in the artery walls."
Dr. Gelfand adds, "Since ustekinumab blocks the specific pathways involved in both skin and cardiovascular inflammation, we wanted to test whether it can improve aortic vascular inflammation."
Investigating aortic inflammation
Their study involved 43 participants with psoriasis, of whom 21 were assigned to the control group and 22 received ustekinumab.
The researchers were particularly interested in one measurement: aortic inflammation, which was measured using positron emission topography and computed tomography scans. The scans took place at the start of the study and after 12 weeks.
The results were relatively clear-cut. As expected, more than three quarters of the participants who took ustekinumab saw significant improvement in psoriasis symptoms.
The most interesting changes were measured in the heart: the participants in the control group saw a 12 percent increase in aortic inflammation, whereas members of the experimental group showed a decrease of 6.6 percent.
That means that, relative to individuals not taking the drug, ustekinumab was responsible for a 19 percent reduction in aortic inflammation.
Of course, the results are important for anyone with psoriasis, but the researchers see an even greater potential for this drug.
"This is the first placebo-controlled trial of a biologic drug to show a benefit in aortic inflammation, a key marker of cardiovascular disease. The effect is similar to what we would expect if we put the patient on a statin."
Dr. Joel M. Gelfand
Of course, this is just the start of the investigative journey; much more work needs to be done, involving many more participants. The next phase of trials is already in the pipeline.
Firstly, Dr. Gelfand wants to follow-up the participants in the current study to see whether the effect on aortic inflammation persists. It is important to understand whether the improvement continues, stagnates, or declines.