Effects of Interleukin 17A Inhibition on Myocardial Deformation and Vascular Function in Psoriasis

A Randomized Placebo-Controlled Trial of Secukinumab on Aortic Vascular Inflammation in Moderate-to-Severe Plaque Psoriasis (VIP-S)

“…Results in this study are largely similar to a recently published trial, which found that secukinumab had minimal effect on flowmediated dilatation (a marker of early vascular disease, e.g., endothelial dysfunction) compared with placebo (von Stebut et al, 2019). The results are in contrast to a study that demonstrated an improvement in left ventricle global longitudinal strain, left ventricle twisting and untwisting, coronary flow reserve, and pulse wave velocity in patients treated with secukinumab compared with methotrexate or cyclosporine; however, this study was not placebo-controlled and did not evaluate extensive CV biomarkers of inflammation, lipid, and glucose metabolism (Makavos et al, 2020). We also evaluated the effect of secukinumab on markers of inflammation, lipoproteins, adiposity, and insulin resistance, which are dysregulated in patients with psoriasis and associated with adverse atherosclerotic outcomes and/or incident diabetes mellitus (Sajja et al, 2018).…”

Chronic inflammatory diseases, myocardial function and cardioprotection

“…Several of these cytokines have been associated with myocardial and vascular dysfunction including arterial stiffness (Pryshchep et al, 2006;Yong et al, 2013), coronary atherosclerosis (Zhang et al, 2006), left ventricular hypertrophy and cardiac remodelling (Madhur et al, 2010;Sheu et al, 2013) and myocardial ischaemia (Ikonomidis et al, 2005(Ikonomidis et al, , 2017. IL-17A, one of the main inflammatory mediators in psoriasis (Lockshin, Balagula, & Merola, 2018), has pro-atherogenic action (Karbach et al, 2014) and has been detected in patients with acute coronary syndromes (Cheng et al, 2008).…”

“…Improvement of vascular and myocardial function in psoriasis patients—greater improvement than methotrexate or cyclosporine treatment (Makavos et al, 2019)…”

“…Treatment with anti‐IL‐12/23 resulted in reduction of aortic vascular inflammation and a greater improvement of coronary microcirculatory function, arterial stiffness, and myocardial function compared to TNF‐α inhibition or cyclosporine treatment in psoriasis patients (Gelfand et al, 2019; Ikonomidis et al, 2017). Additionally, inhibition of IL‐17A resulted in a greater improvement of vascular and myocardial function compared with cyclosporine or methotrexate treatment, suggestive of a stronger beneficial effect on overall CV function in psoriasis (Makavos et al, 2019; von Stebut et al, 2019). Treatment with biological agents was associated with reduction of coronary inflammation indicated by significant reduction of perivascular fat attenuation index measured by coronary CT angiography (CCTA; Elnabawi, Oikonomou, et al, 2019).…”

Does Interleukin-17A Blockade Have a Potential Clinical Role to Reduce Cardiovascular Risk in Psoriasis?

“…27 In this issue of the Journal, Makavos et al report the results of a study evaluating the impact of IL-17A inhibition (with the use of secukinumab) on measures of cardiovascular function in patients with psoriasis. 28 The authors studied 150 patients with psoriasis who were treated with either secukinumab, cyclosporine, or methotrexate over a 12-month period. Patients were excluded if they had evidence of significant coronary artery disease, diabetes, ejection fraction < 50%, a history of acute coronary syndrome, or ventricular wall motion abnormalities at baseline.…”