Biologic Does Not Reduce Vascular Inflammation

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Adalimumab (Humira) was not associated with reduced vascular inflammation in patients with psoriasis, according to a recent study conducted by Joel M. Gelfand, MD, and colleagues. The findings of the study were published in Circulation: Cardiovascular Imaging. 

In the trial, 97 participants with moderate to severe psoriasis were randomized to adalimumab, phototherapy, or placebo for 12 weeks. A total of 92 participants completed the first phase of the study, of whom 81 went on to the 52-week extension period and received adalimumab. Sixty-one participants completed the entire study. The primary outcomes included changes in vascular inflammation, assessed using 18F-fluorodeoxyglucose positron emission tomography and computed tomography, and biomarkers of inflammation, insulin resistance, and lipoproteins.

The researchers did not observe any differences in vascular inflammation between adalimumab, placebo, and phototherapy groups at week 12, and found no differences in vascular inflammation after 52 weeks of treatment with adalimumab.
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While adalimumab and phototherapy decreased inflammation by serum C-reactive protein and interleukin-6, only adalimumab reduced tumor necrosis factor and glycoprotein at weeks 12 and 52. In addition, adalimumab and phototherapy did not impact metabolic markers, including insulin, adiponectin, and leptin. Phototherapy was also associated with increases in high-density lipoprotein-p at week 12. At week 52, adalimumab treatment was associated with reduced cholesterol efflux and high-density lipoprotein-p.

“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,” the researchers concluded.  

“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.”

Reference

Mehta NN, Shin DB, Joshi AA, et al. Effect of 2 psoriasis treatments on vascular inflammation and novel inflammatory cardiovascular biomarkers: a randomized placebo-controlled trial [published online May 18, 2018]. Circ Cardiovasc Imaging. https://doi.org/10.1161/CIRCIMAGING.117.007394.