Prevalence of metabolic syndrome in children with moderate to severe psoriasis treated with TNF inhibitors in comparison to conventional agents

Abstract

Association of childhood psoriasis with metabolic syndrome has not been studied well. TNF-alfa contributes to the inflammation seen in metabolic syndrome, and recently etanercept has shown to reduce the levels of inflammatory markers. Assessment of prevalence of metabolic syndrome in juvenile psoriasis patients in Kuwait. We included 236 patients with moderate to severe psoriasis below 18 years treated for at least 24 weeks with TNF inhibitors (Group A), and equal number of age and sex matched cases treated with conventional medications (Group B). The metabolic syndrome (MBS) was defined according to the International Diabetes Foundation (IDF 2007 criteria for children). Increased waist circumference was seen in 56.77% of cases in Group A. Triglyceridemia was less frequent in Group A. MBS was higher in Group B [41·52% vs. 50·42%, odds ratio (OR) 1·76, 95% CI 1.19-2.41; p = .005]. Psoriasis is associated with higher prevalence of metabolic syndrome in children. Six months of anti TNF treatment showed lesser association with metabolic syndrome. With fasting blood glucose, and serum TG seen in significantly lesser number of patients in this group.

Biologicals for moderate-to-severe plaque type psoriasis in pediatric patients

“…Six months of anti-TNF-α treatment showed lesser association with MBS. Fasting blood glucose and serum TG were also significantly lower in a number of patients in this group [40]. These data clearly suggested that the anti-TNF-α treatment is not only beneficial for the treatment of the skin lesions of psoriasis but also has a positive effect on MBS.…”

“…Ixekizumab provided sustained treatment responses with a PASI 75 and sPGA 0/1 of 90% and 81% at 48 weeks, respectively. In terms of safety, 56% of the patients treated with ixekizumab reported AEs against 45% of the patients in the placebo group [40]. Ixekizumab was recently FDA-approved for the treatment of plaque type psoriasis in children ≥6 years of age.…”

Psoriasis Comorbidities in Childhood

“…По данным ряда авторов, ранние метаболические нарушения, изменение состава и функций липидов связаны с системным воспалением при псориазе [31]. По результатам одного крупного ретроспективного исследования, терапия ингибиторами TNF ␣ уменьшает распространенность метаболического синдрома у детей с псориазом, что также свидетельствует в пользу концепции о роли системного воспаления в развитии метаболического синдрома [32]. Сдвиг липидного профиля в сторону преобладания атерогенных фракций липидов повышает риск развития сердечно-сосудистых заболеваний у детей с псориазом ввиду нарушения процессов экстракции макрофагами липидов из сосудистой стенки [31,33].…”