Coronary artery plaque characteristics and treatment with biologic therapy in severe psoriasis: results from a prospective observational study
Coronary artery plaque characteristics and treatment with biologic therapy in severe psoriasis: results from a prospective observational study
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DOI：
10.1093/cvr/cvz009
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发表时间：
2019-03-15
影响因子：
10.8
通讯作者：
Mehta, Nehal N.
中科院分区：
文献类型：
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作者：
Elnabawi, Youssef A.;Dey, Amit K.;Mehta, Nehal N.
在过去的十年中，生物疗法的使用已经远远超出了原发性自身免疫性疾病。事实上，最近的一项使用抗IL-β抗体的试验减少了患有MI的患者的第二次心肌梗死（MI）。银屑病是一种慢性炎症性疾病，严重时通常使用生物制剂治疗，与MI风险增加相关，部分原因是冠状动脉计算机断层扫描血管造影术（CCTA）显示的高风险冠状动脉斑块表型。我们假设，我们将观察到减少炎症驱动的表型的冠状动脉斑块，包括非钙化冠状动脉斑块负荷和脂质丰富的坏死核心，在那些与非生物治疗一年后相比，方法和结果在一项前瞻性，观察性研究，2013年1月1日至2018年10月31日招募了290名参与者，其中215名完成了一年的随访。在这238例患者中，纳入了121例基线时未接受过生物制剂治疗的连续受试者。盲法阅片者（对患者人口统计学、就诊和治疗不知情）使用专用软件（QAngio，Medis，Netherlands）量化三个>2 mm的主要冠状动脉血管中的总冠状动脉斑块负荷和斑块子成分（钙化和非钙化）。银屑病患者为中年人[平均（标准差）年龄，50.5（12.1）岁]，大多数为男性（n = 70，58%），Fragrance评分显示心血管风险较低[中位数（四分位距，IQR），3（1-6）]，基线时有中度至重度皮肤病[中位数（IQR）银屑病面积严重程度指数，PASI，8.6（5.3-14.0）]。生物治疗与非钙化斑块负荷减少6%（P = 0.005）、坏死核心减少（P = 0.03）相关，对纤维负荷无影响（P = 0.71）。与非生物制剂治疗组斑块进展缓慢相比，生物制剂治疗组非钙化斑块负荷显著减少。（Delta，-0.07 mm（2）vs. 0.06 mm（2）; P = 0.02），并与传统心血管危险因素调整以外的生物治疗相关结论在这项观察性研究中，我们证实了严重银屑病的生物治疗与CCTA对冠状动脉斑块指数的有利调节有关。这些发现强调了全身炎症在冠状动脉疾病中的重要性，并支持进行更大规模的随机试验。
Aims The use of biologic therapy has increased over the past decade well beyond primary autoimmune diseases. Indeed, a recent trial using an anti-IL-'beta antibody reduced second myocardial infarction (MI) in those who have had MI. Psoriasis is a chronic inflammatory disease often treated with biologics when severe, is associated with increased risk of MI, in part driven by high-risk coronary plaque phenotypes by coronary computed tomography angiography (CCTA). We hypothesized that we would observe a reduction in inflammatory-driven phenotypes of coronary plaque, including non-calcified coronary plaque burden and lipid-rich necrotic core in those treated with biologic therapy after one-year compared with non-biologic therapy.Methods and results In a prospective, observational study, 290 participants were recruited from 1 January 2013 through 31 October 2018 with 215 completing one-year follow-up. Of the 238, 121 consecutive participants who were biologic treatment naive at baseline were included. A blinded reader (blinded to patient demographics, visit and treatment) quantified total coronary plaque burden and plaque subcomponents (calcified and non-calcified) in the three main coronary vessels >2 mm using dedicated software (QAngio, Medis, Netherlands). Psoriasis patients were middle-aged [mean (standard deviation) age, 50.5 (12.1) years], mostly male (n = 70, 58%) with low cardiovascular risk by Framingham score [median (interquartile range, IQR), 3 (1-6)] and had moderate to severe skin disease at baseline [median (IQR) Psoriasis Area Severity Index, PASI, 8.6 (5.3-14.0)]. Biologic therapy was associated with a 6% reduction in non-calcified plaque burden (P = 0.005) reduction in necrotic core (P = 0.03), with no effect on fibrous burden (P = 0.71). Decrease in non-calcified plaque burden in the biologic treated group was significant compared with slow plaque progression in non-biologic treated (Delta, -0.07 mm( )(2)vs. 0.06 mm(2) ; P = 0.02) and associated with biologic treatment beyond adjustment for traditional cardiovascular risk factors (beta = 0.20, P = 0.02).Conclusion In this observational study, we demonstrate that biologic therapy in severe psoriasis was associated with favourable modulation of coronary plaque indices by CCTA. These findings highlight the importance of systemic inflammation in coronary artery disease and support the conduct of larger, randomized trials.