Adalimumab Reduces Epicardial Adipose Tissue in Psoriasis: A Post Hoc Analysis of a Randomized Placebo-Controlled Clinical Trial.

BACKGROUND

Psoriasis is associated with increased epicardial adipose tissue (EAT), a metabolically active fat depot in direct contact with the myocardium, and a mediator of coronary artery disease and atrial fibrillation. The effects of psoriasis treatments on EAT are largely unknown. We conducted a post hoc analysis of the Vascular Inflammation in Psoriasis (VIP) trial (NCT01553058, NCT01866592).

METHODS

VIP compared, in a 1:1:1 randomized manner, placebo (n=27), adalimumab (n=31), and phototherapy (n=28) from baseline to week 12, with all subjects then receiving adalimumab for 52 weeks. EAT volume was quantified from CT imaging at baseline, week 12, and week 52, with concurrent assessment of clinical variables and metabolic and inflammatory biomarkers.

RESULTS

At baseline (N=86), EAT volume was positively correlated with age (r = 0.51, p= 2.44 × 10-), body mass index (r = 0.48, p= 2.01×10-6), and weight (r = 0.52, p= 3.17 × 10-), and with inflammatory biomarkers GlycA (r = 0.27, p= 9.48×10-3), C-reactive protein (r = 0.25, p= 9.94×10-3), and IL-6 (r = 0.23, p= 0.02). Over 12 weeks, adalimumab treatment reduced EAT volume (mean change -11.9 cm3, p=0.04; baseline mean EAT 183.1 cm3), with no improvement observed in the placebo or phototherapy groups. When compared with the placebo and phototherapy arms combined, adalimumab was associated with a greater reduction in EAT at week 12 (between-group difference -13.9 cm3, p=0.03). The reduction in EAT was not significantly associated with changes in weight or PASI. No additional reduction in EAT was observed after 52 weeks of adalimumab treatment.

CONCLUSION

Adalimumab was associated with an early reduction in EAT that was not significantly correlated with changes in weight or psoriasis activity. These findings indicate treatment-specific effects on a high-risk cardiac fat depot and suggest that TNF inhibition may influence cardiac adiposity relevant to cardiovascular disease.