Anti-tumor necrosis factor-alpha therapy improves endothelial function and arterial stiffness in patients with moderate to severe psoriasis: A 6-month prospective study

The aim of the present study was to determine if the use of the anti-tumor necrosis factor (TNF)-alpha monoclonal antibody adalimumab could improve endothelial function and arterial stiffness in patients with moderate to severe psoriasis. This was a prospective study on a series of consecutive patients with moderate to severe psoriasis who completed 6 months of therapy with adalimumab. Patients with history of cardiovascular events, diabetes mellitus, kidney disease, hypertension or body mass index of 35 kg/m(2) or more were excluded. Assessment of endothelial function by brachial artery reactivity measuring flow-mediated endothelial dependent vasodilatation (FMD%), and carotid arterial stiffness by pulse wave velocity (PWV) was performed at the onset of treatment (time 0) and at month 6. Twenty-nine patients were studied. Anti-TNF-alpha adalimumab therapy yielded a significant improvement of endothelial function. The mean +/- standard deviation (SD) FMD% values increased from 6.19 +/- 2.44% at the onset of adalimumab to 7.46 +/- 2.43% after 6 months of treatment with this biologic agent (P = 0.008). Likewise, following the use of adalimumab, PWV levels decreased from 6.28 +/- 1.04 m/s at the onset of adalimumab to 5.69 +/- 1.31 m/s at 6 months (P = 0.03). In conclusion, patients with moderate to severe psoriasis exhibit improvement of endothelial function and arterial stiffness following anti-TNF-alpha therapy. These findings are of potential relevance due to increased risk of cardiovascular disease in patients with severe psoriasis.