Ji Lixin, Ravi Sowmya, Wright Laura, Nguyen Vi, Wiley Jose, Vukelic Milena, Kim Sangkyu
Department of Dermatology, Tulane School of Medicine, 131 S. Robertson Street, 11th Floor, New Orleans, LA, 70112, USA.
Tulane School of Medicine, Rudolph Matas Library of Health Sciences, New Orleans, LA, USA.
Arch Dermatol Res. 2024 Dec 30;317(1):159. doi: 10.1007/s00403-024-03625-6.
This systematic review explores the relationship between achieving minimal disease activity in psoriasis and the progression of atherosclerosis. It investigates how biologic therapies and other treatments impact atherosclerosis markers, offering insights into therapeutic strategies. A comprehensive search of PubMed, Embase, and Web of Science was conducted from January 1, 2000, to April 1, 2023, using terms such as psoriasis, psoriatic arthritis, atherosclerosis, biologic therapy, vascular stiffness, carotid intima-media thickness (CIMT), and coronary computed tomography angiography (CCTA). Eligible studies were those involving human subjects over 18, written in English, that provided quantitative atherosclerosis markers, including CIMT, CCTA, arterial pulse wave velocity (aPWV), fat attenuation index (FAI), and augmentation index (Aix). From an initial pool of 217 studies, 21 were included, grouped by treatments, including TNF-α inhibitors, IL-12/23 inhibitors, IL-17 inhibitors, DMARDs, phototherapy, and fumaric acid esters. The review found that TNF-α inhibitors significantly improved atherosclerosis markers such as CIMT, aPWV, FAI, and C-reactive protein (CRP), with reductions in these markers compared to no treatment, phototherapy, and IL-12/23 inhibitors. Additionally, IL-17 inhibitors demonstrated similar reductions in FAI compared to TNF-α inhibitors but showed a greater effect in reducing non-calcified plaque burden (12% vs. 5% for TNF-α inhibitors, p < 0.001) and also decreased CRP levels. Fumaric acid improved cholesterol metabolism (p < 0.04), and TNF-α inhibitors enhanced endothelial function (p < 0.01). Mixed results were observed when compared to DMARDs, indicating that patient-specific factors should guide treatment choices. In conclusion, TNF-α inhibitors are highly effective in reducing atherosclerosis progression in psoriasis patients, consistently improving vascular health markers like CIMT, aPWV, FAI, and CRP. IL-17 inhibitors also show significant efficacy, particularly in reducing non-calcified plaque burden, making them a valuable alternative to TNF-α inhibitors. Fumaric acid's role in cholesterol metabolism suggests its potential in combination therapies. These findings support integrating TNF-α and IL-17 inhibitors into treatment protocols for psoriasis patients with comorbid atherosclerosis, improving cardiovascular outcomes.
本系统评价探讨了银屑病达到最小疾病活动度与动脉粥样硬化进展之间的关系。它研究了生物疗法和其他治疗方法如何影响动脉粥样硬化标志物，为治疗策略提供了见解。使用银屑病、银屑病关节炎、动脉粥样硬化、生物疗法、血管僵硬度、颈动脉内膜中层厚度（CIMT）和冠状动脉计算机断层扫描血管造影（CCTA）等术语，对2000年1月1日至2023年4月1日期间的PubMed、Embase和Web of Science进行了全面检索。符合条件的研究是那些涉及18岁以上人类受试者、用英文撰写、提供定量动脉粥样硬化标志物的研究，包括CIMT、CCTA、动脉脉搏波速度（aPWV）、脂肪衰减指数（FAI）和增强指数（Aix）。从最初的217项研究中，纳入了21项，按治疗方法分组，包括肿瘤坏死因子-α抑制剂、白细胞介素-12/23抑制剂、白细胞介素-17抑制剂、改善病情抗风湿药（DMARDs）、光疗和富马酸酯。该评价发现，肿瘤坏死因子-α抑制剂显著改善了CIMT、aPWV、FAI和C反应蛋白（CRP）等动脉粥样硬化标志物，与未治疗、光疗和白细胞介素-12/23抑制剂相比，这些标志物有所降低。此外，与肿瘤坏死因子-α抑制剂相比，白细胞介素-17抑制剂在降低FAI方面表现出类似的效果，但在减少非钙化斑块负担方面效果更显著（肿瘤坏死因子-α抑制剂为5%，白细胞介素-17抑制剂为12%，p<0.001），并且还降低了CRP水平。富马酸改善了胆固醇代谢（p<0.04），肿瘤坏死因子-α抑制剂增强了内皮功能（p<0.01）。与DMARDs相比，结果不一，表明应根据患者的具体因素来指导治疗选择。总之，肿瘤坏死因子-α抑制剂在降低银屑病患者的动脉粥样硬化进展方面非常有效，持续改善CIMT、aPWV、FAI和CRP等血管健康标志物。白细胞介素-17抑制剂也显示出显著疗效，尤其是在减少非钙化斑块负担方面，使其成为肿瘤坏死因子-α抑制剂的有价值替代药物。富马酸在胆固醇代谢中的作用表明其在联合治疗中的潜力。这些发现支持将肿瘤坏死因子-α和白细胞介素-17抑制剂纳入合并动脉粥样硬化的银屑病患者的治疗方案中，以改善心血管结局。
