Ustekinumab Linked to Decreased Systemic/Vascular Inflammation in Psoriasis

Treatment with ustekinumab in patients with moderate to severe psoriasis is associated with significantly decreased systemic and vascular inflammation, which is linked to the metabolic syndrome and to an elevated risk for cardiovascular disease (CVD), according to the results of a feasibility study conducted in a Korean population and published in the Journal of the American Academy of Dermatology.

The investigators sought to determine whether ustekinumab therapy reduces systemic and vascular inflammation associated with CVD and metabolic syndrome, measured with the use of ¹⁸F-fluorodeoxyglucose positron emission tomography/computed tomography (¹⁸F-FDG PET/CT) imaging.

In the current study, patients with psoriasis (n=25) and age- and sex-matched healthy control patients (n=47) underwent baseline ¹⁸F-FDG PET/CT imaging. Among those with psoriasis, 10 patients with moderate to severe disease were treated with ustekinumab and underwent ¹⁸F-FDG PET/CT imaging again after a Psoriasis Area and Severity Index of 75 (PASI75) was attained.

Patients with psoriasis had the disease for a mean duration of 13.5 years (range, 2-32 years) and had a mean body surface area of 32.9% and a mean PASI of 13.1. Disease duration in the 10 ustekinumab-treated patients ranged from 7 months to 26 years, with a mean duration of 15.0 years. Mean PASI in this group was 14.2, and mean body surface area involved was 34.1%, with the minimally affected body surface area of these patients being 14.0%. All 10 patients treated with ustekinumab attained PASI75, with the mean number of ustekinumab injections needed to achieve PASI75 being 3.2.

Once PASI75 was achieved with ustekinumab therapy, ¹⁸F-FDG PET/CT imaging revealed significantly greater increases in ¹⁸F-FDG uptake in the liver, the spleen, and 4 parts of the aorta in the psoriasis group vs the control group (P <.05).

The investigators demonstrated that patients with psoriasis had elevated hepatic, splenic, and arterial inflammation, particularly those with severe disease and those who were obese, which decreased once PASI75 was achieved with the use of ustekinumab therapy. CVD risk factor screening and management are thus recommended in this patient population.

Reference

Kim BS, Lee WK, Pak K, et al. Ustekinumab treatment is associated with decreased systemic and vascular inflammation in patients with moderate to severe psoriasis: feasibility study using 18F-fluorodeoxyglucose positron emission tomography-computed tomography [published online March 17, 2018]. J Am Acad Dermatol. doi: 10.1016/j.jaad.2018.03.011