Psoriasis and the risk of diabetes: A prospective population-based cohort study

Psoriasis and the risk of diabetes: A prospective population-based cohort study. placebo patients crossed Rabbit Polyclonal to E-cadherin over such that all patients received ustekinumab for a total of 52 weeks. At the end of 52 weeks of ustekinumab treatment there was no change in aortic vascular inflammation compared to baseline, inflammatory markers were reduced and there were increases in selected measures of Dox-Ph-PEG1-Cl lipids and leptin. Conclusions: These results demonstrate blockade of IL12/23 may transiently reduce aortic vascular inflammation with more durable reduction in inflammatory cytokines associated with cardiovascular disease. Introduction: Psoriasis is a chronic inflammatory disease affecting over 125 million people worldwide (Kurd and Gelfand, 2009, Parisi et al., 2013). The cause of psoriasis is unknown but is believed to be the result of genetic susceptibility and environmental factors (such as obesity, smoking, and infection with Streptococcus pyogenes) that result in auto-reactive T cells targeting keratinocyte and melanocyte derived peptides (Hawkes et al., 2017). Once disease is established, the pathophysiology is characterized by upregulation of antigen Dox-Ph-PEG1-Cl presentation, inflammatory cytokines, epidermal proliferation, and angiogenesis (Nestle et al., 2009). Clinically, increasing psoriasis severity, as assessed by treatment patterns or body surface area affected is associated with an increased risk of diabetes mellitus, major cardiovascular events, and mortality independent of traditional risk factors for these outcomes (Gelfand et al., 2006, Gelfand et al., 2007, Noe et al., 2018, Wan et al., 2018). As a result, present guidelines from major dermatology and cardiology organizations define psoriasis as a disease associated with increased risk for cardiovascular disease warranting more intense screening and treatment of traditional cardiovascular risk factors (Elmets et al., 2019, Grundy et al., 2018). The biologic mechanisms linking psoriasis to adverse cardiometabolic outcomes is multifactorial and complex given multiple pathways involved in atherosclerotic-disease related cardiovascular events (Sajja et al., 2018). These phenotypically distinct clinical states share many immune (such as increases in interleukin (IL)-1), IL-6, tumor necrosis factor (TNF), C-reactive protein (CRP) and metabolic (dyslipidemias and insulin resistance) abnormalities (Azfar and Gelfand, 2008, Mehta et al., 2012a, Sajja et al., 2018). Indeed, IL-1 and IL-6 have been causally linked to cardiovascular disease through clinical trials and Mendelian randomization studies, respectively(Consortium, 2012, Ridker et al., 2017). Furthermore, we and others have demonstrated that psoriasis and its severity are associated with increased aortic vascular inflammation as measured by 18F-2-fluorodeoxyglucose-positron emission tomography/computed tomography (FDG-PET/CT)(Dey et al., 2017, Hjuler et al., 2017, Kaur et al., 2018, Mehta et al., 2011). In this cardiovascular imaging modality, radiolabeled glucose (i.e., FDG) taken up by CD68+ macrophages in early, inflamed, wall of the aorta is measured by PET/CT(Bural et al., 2008, Chen et al., 2009). The quantity of uptake of FDG throughout the aorta Dox-Ph-PEG1-Cl has been referred to as aortic vascular inflammation. FDG uptake in the aorta has been shown to be associated with future cardiovascular events independent of traditional risk factors and there is evidence to suggest that FDG activity changes (as early as 4-12 weeks) with initiation of treatments (such as statins) known to lower the risk of major cardiovascular events (Lee et al., 2008). These characteristics make aortic vascular inflammation an attractive surrogate for early stage clinical trials of treatments for the prevention of CV events(Lee et al., 2008, Mehta et al., 2012b, Tahara et al., 2006). The objective of this trial was to determine the effect of ustekinumab, an antibody to the p40 subunit shared by cytokines IL-12 and IL-23, on aortic vascular inflammation, and blood-based markers of inflammation, lipid, and glucose metabolism compared to placebo in patients with moderate to severe psoriasis. Results: Sixty-three patients were assessed for eligibility of whom 43 were randomized, 22 to ustekinumab and 21 to placebo (Supplemental Figure 2). All patients randomized to ustekinumab completed the study through week 12 whereas 19 (86%) initially assigned to placebo completed until week 12. Thirty-four (79%) patients completed the study throughout the open label extension period. Recruitment started on August 14, 2014 and the last patient last visit occurred on September 10, 2018. Patients were an average age of 42 years (SD 13.38), 70% male, predominantly white (72%), had an average body mass index (BMI) of 33, and an average body surface area (BSA) and psoriasis area and severity index (PASI) of 25% and 20, respectively (Table 1). The baseline characteristics were similar between the two groups but those assigned to placebo were numerically older, less likely to be white or have hyperlipidemia, and more likely to have hypertension and a prior diagnosis of psoriatic arthritis. Table 1. Baseline Demographics and Clinical Characteristics. value) ***Statistically significant findings Patients assigned to ustekinumab had a ?6.58%.