Systemic psoriasis treatment is correlated with E-selectin and vascular cell adhesion molecule 1 (VCAM-1) plasma concentrations and may be associated with the risk for cardiovascular disease, according to a study in Medicina.

Researchers analyzed VCAM-1, E-selectin serum concentrations, and atherosclerosis severity in patients with plaque psoriasis and sought to determine the effects of methotrexate and adalimumab treatment for 12 weeks on the plasma levels of these molecules.

The prospective cohort study included 34 patients (27 men) with plaque psoriasis (aged 30 to 73 years) and 8 healthy volunteers (aged 30 to 57 years) as the control group. A total of 17 participants were treated with methotrexate and 17 received adalimumab. The study authors calculated the 10-year risk for fatal cardiovascular disease, body mass index (BMI), Psoriasis Area and Severity Index (PASI) score, and body surface area (BSA) for each participant. VCAM-1 and E-selectin levels were measured with an enzyme-linked immunosorbent assay at baseline and after 12 weeks.

BMI was significantly higher in the psoriasis group compared with the control group (P = .001). In addition, BMI in patients with psoriasis was significantly and positively correlated with PASI and BSA (Spearman correlation coefficients 0.5 and 0.56; P = .0007 and P = .0001, respectively). The healthy volunteers were nonsmokers, significantly younger (P = .01), and had significantly lower systolic blood pressure (P = .04) than the patients who received methotrexate treatment.


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“Therefore, the 10-year risk of fatal cardiovascular disease and atherosclerosis risk (estimated via the European Risk Chart: Systematic Coronary Risk Evaluation [SCORE]) among the healthy volunteers [was] significantly lower than the corresponding risks among psoriasis patients assigned to receive methotrexate (P = .001),” reported the investigators.

At baseline, the serum levels of VCAM-1 and E-selectin were significantly higher in patients with an estimated SCORE risk of 10% or higher compared with patients with a risk of less than 1% (P = .02 and P = .012, respectively). Baseline E-selectin and VCAM-1 levels were higher in the adalimumab group compared with levels in the methotrexate and control groups. In addition, VCAM-1 levels decreased in the adalimumab (P = .02) and methotrexate groups (P = .008), and E-selectin levels decreased in the methotrexate group (P = .004).

In this study, “E-selectin and VCAM-1 levels significantly decreased during methotrexate treatment,” stated the study authors. “Moreover, contrary to E-selectin levels, the decrease in VCAM-1 was significant in patients treated with adalimumab. The results suggest that endothelial function and the cardiovascular risk of patients with plaque psoriasis are influenced to a larger extent by methotrexate than adalimumab.”

The most significant study limitations, according to the study authors, were the low number of patients, short 12 week observation time, and volunteer self-selection of the control group.

“Compared to adalimumab, methotrexate may have a greater impact on the levels of adhesion molecules, so it might help determine the risk of cardiovascular disease development in psoriasis patients,” the researchers commented.

Reference

Zdanowska N, Owczarczyk-Saczonek A, Czerwińska J, et al. Methotrexate and adalimumab decrease the serum levels of cardiovascular disease biomarkers (VCAM-1 and E-Selectin) in plaque psoriasis. Medicina (Kaunas). 2020;56(9):E473.