Background/Purpose: psoriasis is a systemic inflammatory condition that shares similarities with other inflammatory immune disorders. In this context, patients with psoriasis are at an increased risk of cardiovascular death, as it has also been reported in patients with rheumatoid arthritis, psoriatic arthritis and ankylosing spondylitis. Accelerated atherosclerosis plays an important role in this regard. Several studies have reported a beneficial effect of anti-TNF-α therapy on the mechanisms associated with accelerated atherogenesis in inflammatory arthritis, including a beneficial effect on insulin resistance. In the present study, we aimed to prospectively evaluate for the first time whether the anti-TNF-α monoclonal antibody adalimumab may improve insulin sensitivity in patients with moderate-to-severe psoriasis 

Methods: A 6-month prospective study of adult patients (>18 years old) diagnosed with moderate-to-severe psoriasis who were put on treatment with adalimumab 40 mg every other week as a subcutaneous injection based on clinical indication (Spanish guidelines). Patients with history of cardiovascular or cerebrovascular disease, hypertension, diabetes, high body mass index (>35) or treatment during the previous 6 months before recruitment with corticosteroids or biologic therapies were excluded. At the time of enrollment and after six months of treatment, all patients were assessed for insulin sensitivity using the Quantitative Insulin Sensitivity Check Index (QUICKI). Laboratory tests including glucose, insulin, serum creatinine, ultra sensitive C-reactive protein [usCRP] and erythrocyte sedimentation rate [ESR], and data regarding disease activity (percent of body surface area affected [BSA], Psoriasis Area and Severity Index [PASI], Psoriatic Arthritis Screening and Evaluation questionnaire [PASE], Nail Psoriasis Severity Index [NAPSI] and physician´s global assessment of disease severity [PGA]) were also collected at the onset of the treatment (time 0) and at month 6 

Results: thirty-three consecutive patients (52% women), with moderate-to-severe psoriasis (mean BSA 37.2±16.4%, mean PASI 18±7.9) were recruited from the Dermatology outpatient clinics of the Hospital Universitario Marques de Valdecilla (Santander, Northern Spain). The mean age was 38.6±10.7 years. A statistically significant improvement (p-value 0.008) of insulin sensitivity (QUICKI) was observed after six months of treatment with adalimumab (QUICKI at time 0: 0.35±0.04 versus 0.37±0.04 at month 6). Also a significant improvement (p<0.05) of ESR, usCRP, BSA, PASI, NAPSI, PGA and PASE was found at month 6 

Conclusion: in keeping with previous results on patients with chronic inflammatory rheumatic diseases, our findings show an improvement of insulin sensitivity following treatment with adalimumab. Therefore, adalimumab could have a beneficial effect on the mechanisms associated with accelerated atherogenesis in patients with psoriasis

AbbVie Inc. funded this study.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/adalimumab-therapy-improves-insulin-sensitivity-in-non-diabetic-psoriatic-patients-a-6-month-prospective-study/