Prevalence of metabolic syndrome and chronic inflammation in psoriasis before and after biologic therapy: a prospective study

Abstract

Background: As a chronic inflammatory disease, psoriasis affects not only the skin but also the metabolic profile of the patients. Biologic therapies, including tumor necrosis alpha (TNF-a) inhibitors and interleukin (IL)-12/23 and IL-17 antagonists, have proven effective in the reduction of psoriasis severity; however their impact on the metabolic and chronic inflammatory profiles of the patients remains incompletely elucidated.

Methods: We performed a longitudinal case-control study on 106 psoriasis patients and an equal number of controls without the disease, as well as a prospective study on the patient group with the end point being 6 months of biologic therapy. Patients received either ixekizumab, secukinumab, guselkumab, certolizumab, ustekinumab, risankizumab, or adalimumab. Abdominal circumference, serum fasting glucose, triglycerides (TG), high-density lipoproteins (HDL), erythrocyte sedimentation rate (ESR) and C reactive protein (CRP) were measured for both patients and controls, with an additional measurement for patients after 6 months.

Results: At baseline, the number of psoriasis patients suffering from obesity, metabolic syndrome, and chronic inflammation significantly outnumbered controls (p<0.05), with the calculated odds ratio being 1.88, 6.83, and 81.84 for these conditions in psoriasis, respectively. Biologic therapies increased the abdominal circumference of patients in a slight but significant fashion (p<0.05), as well as significantly improved HDL, CRP, ESR levels at 6 months (p<0.05). Moreover, after 6 months, the number of patients meeting the diagnostic criteria for metabolic syndrome and chronic inflammation was significantly lower than at baseline (p<0.001).

Conclusions: According to our results, biologic therapies improve the overall metabolic and inflammatory profiles of psoriasis patients, the most significant ameliorations being noticed for serum HDL, CRP, and ESR.

Keywords: abdominal circumference; chronic inflammation; diabetes; metabolic syndrome; obesity; psoriasis.

Figure 1

Histograms of the comparative values at therapy initiation (left) and after 6 months (right) for the studied components of the metabolic syndrome: abdominal circumference (in cm) – first row, serum triglyceride (TG, in mg/dL) – second row, high-density lipoproteins (HDL, in mg/dL) – third row, and fasting glucose (in mm/dL) – last row. Abscissa: corresponding values of measured parameters; Ordinate: total frequency of values.

Figure 2

Histograms of the comparative values at therapy initiation (left) and after 6 months (right) for the components of chronic inflammation: erythrocyte sedimentation rate (ESR, in mm/h) – first row, C reactive protein (CRP, in mg/dL) – second row. Abscissa: corresponding values of measured parameters; Ordinate: total frequency of values.

Figure 3

Linear correlation graphs between PASI (left column) and DLQI (right column) on the one hand, and abdominal circumference (top row), serum triglycerides (TG – second row), high-density lipoproteins (HDL – third row), glucose (fourth row), erythrocyte sedimentation rate (ESR – fifth row), and C reactive protein (CRP – final row) on the other. The only statistically significant correlations were between PASI and ESR, PASI and CRP, DLQI and ESR, and DLQI and CRP. Abscissa: PASI (left) or DLQI (right) score. Ordinate: values on respective measurement scales.

Figure 4

Box plot graph displaying the comparison of age medians between psoriatic patients without hypertension (HTN) or diabetes and those with hypertension, type II diabetes, and HTN and concomitant diabetes, respectively. Overall median is 49 years. Ordinate: age in years.

Figure 5

Applying the Independent-Samples Kruskal-Wallis Test for the evaluation of differences in erythrocyte sedimentation rate (dESR) (A) and C reactive protein (dCRP) (B) between treatment onset and 6 months of therapy for each biologic agent used. The most significant decreases in ESR are found for Ixekizumab and Ustekinumab. The most significant decreases in CRP belong to ixekizumab and guselkumab, and the least marked to certolizumab. Abscissa: A) dESR, difference (in mm/h) between the two measurements; B) dCRP, difference (in mm/h) between the two moments.