Occasionally a medication will be approved by the Food and Drug Administration for a specific use, and after it has been on the market and extensively used, it will have some surprising, beneficial side effects that had not been discovered previously. Recently, researchers noted that patients who were taking either interleukin-17 (IL-17) inhibitors or anti-tumor necrotic factors (TNFs), such as the drugs used to treat psoriasis, were having less cardiovascular events than were expected.1
Severe psoriasis can increase a patient’s risk of having a heart attack, or myocardial infarction (MI), up to 200% and patients with psoriasis can have clogging of the arteries that is similar to a person who has had high cholesterol and is 10 years older.1 Two separate studies showed there was a connection between IL-17 and anti-TNF medications and the reduced risk of MIs.
A look at the research
The first, a study known as CANTOS, found that there was a 15% decrease in cardiovascular events such as MIs in patients who were taking Ilaris®, a monoclonal antibody related to IL-17 medications, but not specifically used to treat psoriasis. Researchers were not sure if this was due to a general reduction of inflammation, or if the drug somehow reduced the buildup of plaque on the artery walls. Researchers created a second study to further investigate how these medications may help patients with psoriasis.
The second study looked at a small group of 84 middle-aged patients (average age of 51) who were diagnosed with psoriasis, all of whom had never been treated for their condition.1 57 patients received IL-17 or anti-TNF therapy to treat their psoriasis, and 27 had light therapy or received topical medications to treat their psoriasis. All of the patients had CT scans of their arteries before they started treatment, and again a year later.
A decrease in plaque volumes
Patients who had IL-17 or anti-TNF therapy had a decrease in plaque volumes of about 40%, and a decrease in their C-reactive protein tests, (which show if a patient is experiencing inflammation).1 Patients who received topical or light therapies had plaque volumes that almost doubled, though they also had a decrease in their C-reactive protein tests. These tests gave researchers the insight that IL-17 and anti-TNF therapies may not just be decreasing inflammation, but somehow are affecting plaque buildup and progression.
While this study was very small, it paves the way for larger studies that will attempt to repeat the same tests and hopefully get the same results. Researchers need to determine what therapies will work best in the treatment of arterial plaque for psoriasis patients. IL-17 and anti-TNF therapies are expensive and have side effects like increased risk for infection, so they may not be the best treatment for all patients.1 This study also has many limitations, both in size and the selection of patients, which can change the way data is interpreted, so further studies will have to be done. Researchers are in the early stages of planning a larger version of this trial.
While research such as this takes time, it is always wonderful to see breakthroughs like these. Even if this study doesn’t change the way we treat heart health in psoriasis, it has the potential to lead to other treatments that can help both psoriasis and cardiovascular patients stay healthy.
Biologic Therapies for Psoriasis May Benefit Coronary Arteries. Medscape. Available at: https://www.medscape.com/viewarticle/896369. Accessed 06/01/2018.