An updated review highlights the role of dysregulated adipokines in cardiovascular comorbidities in psoriasis and finds that biologics exert a cardioprotective role in some cases.
Psoriasis is a prevalent chronic, inflammatory, multi-organ, systemic disease affecting millions worldwide. Its most common form, plaque psoriasis, manifests as erythematous plaques with silvery scales, notably on the elbows, knees, scalp, and lumbar regions. Beyond skin symptoms, psoriasis is a systemic disease associated with various comorbidities, notably cardiovascular diseases (CVDs), which increase the risk of major adverse cardiovascular events (MACEs) such as myocardial infarction and stroke. Traditional risk factors like smoking, obesity, and metabolic syndrome in psoriasis patients further increase this risk.
This updated review published in Dermatology and Therapy explores whether some of the commonly used biologics to manage the condition can lower the risk of cardiovascular issues in patients.
Biologics Appear Safe and Cardioprotective in Some Cases
Properly assessing psoriasis severity is crucial for determining treatment. Assessment tools like the Psoriasis Area Severity Index (PASI) and body surface area (BSA) guide clinical decisions. Moderate-to-severe psoriasis, often refractory to topical treatments, necessitates systemic therapy. Conventional options like cyclosporine and methotrexate, though effective, have safety limitations, especially in patients with cardiovascular comorbidities.
Biologic drugs, including anti-TNF-α, anti-IL-12/23, and anti-IL-17 agents, revolutionized psoriasis management, offering superior efficacy with favorable safety profiles. However, their use requires consideration of potential risks, such as reactivation of latent tuberculosis or exacerbation of inflammatory bowel diseases.
Adipokines, signaling molecules secreted by adipose tissue, play a modulating role in psoriatic pathogenesis. Leptin, upregulated in psoriasis, promotes inflammation and cardiovascular risk, while adiponectin, reduced in psoriasis, exhibits anti-inflammatory properties. Dysregulation of adipokines exacerbates psoriasis and contributes to cardiovascular risk.
Studies evaluating biologic drugs' impact on cardiovascular risk in psoriasis patients provide promising insights. Anti-TNF-α therapy reduces myocardial infarction risk, improves lipid profiles, and attenuates inflammation. Ustekinumab, an IL-12/23 inhibitor, demonstrates cardioprotective effects by reducing inflammatory cytokines and improving endothelial function. Similarly, anti-IL-23 agents like guselkumab and risankizumab show promising results in reducing MACE risk. However, the impact of anti-IL-17 agents on cardiovascular risk requires further investigation.
Apart from biologics, small molecules like apremilast offer additional treatment options for psoriasis. Apremilast, an oral PDE-4 inhibitor, improves cardiometabolic markers and exhibits a favorable cardiovascular safety profile.
The Bottom Line
Psoriasis management should consider cardiovascular risk factors, aiming for a personalized approach. Biologic drugs are among the more promising therapeutic options, not only for skin clearance but also for potentially reducing cardiovascular comorbidities. Further research is essential to fully understanding the cardioprotective effects of biological therapies in psoriasis patients.
Source:
Potestio, L., Tommasino, N., Lauletta, G., Fabbrocini, G., & Megna, M. (2024). Psoriasis and Molecular target therapies: Evidence of efficacy in Preventing cardiovascular comorbidities. Dermatology and Therapy. https://doi.org/10.1007/s13555-024-01152-w
