title: Systemic therapy of plaque-type psoriasis ameliorates endothelial cell function: results of a prospective longitudinal pilot trial.
abstract: Severe psoriasis is associated with significant cardiovascular mortality. We therefore investigated the effects of systemic therapy on the cardiovascular risk of psoriasis patients. Thirteen consecutive patients receiving fumaric acid esters were included and followed for 24 weeks both clinically and by means of laboratory monitoring, 10 completed the study. Eight of ten patients showed a PASI-50 response. Two of three patients with clinical insulin resistance (Homeostasis Model Assessment of insulin resistance >2.5) showed normal insulin responsiveness at the end of the study. Clinical improvement was paralleled by a reduction of high-sensitive CRP serum levels (median -25%). There was a trend toward reduced serum levels for the vascular endothelial growth factor (median -10%) and resistin (median -4%), while the potentially cardio-protective adiponectin showed a trend toward increased serum levels under therapy (median +19%). Systemic endothelial function assessed by venous occlusion plethysmography revealed an improvement of endothelial vasodilator function after 24 weeks of treatment (p < 0.02). This is the first prospective study documenting an amelioration of endothelial cell function in patients with moderate-to-severe plaque-type psoriasis under effective continuous systemic therapy. Future studies need to compare the cardioprotective effects of different treatment modalities, based on hard end points such as the rate of myocardial infarction.
authors.affiliation: Department of Internal Medicine, Clinic of the Johann Wolfgang Goethe-University, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Germany. Boehncke@em.uni-frankfurt.de
authors.forename: Sandra
authors.initials: S
authors.lastname: Boehncke
authors.forename: Stephan
authors.initials: S
authors.lastname: Fichtlscherer
authors.forename: Rebekka
authors.initials: R
authors.lastname: Salgo
authors.forename: Jurate
authors.initials: J
authors.lastname: Garbaraviciene
authors.forename: Heike
authors.initials: H
authors.lastname: Beschmann
authors.forename: Sandra
authors.initials: S
authors.lastname: Diehl
authors.forename: Katja
authors.initials: K
authors.lastname: Hardt
authors.forename: Diamant
authors.initials: D
authors.lastname: Thaçi
authors.forename: Wolf-Henning
authors.initials: WH
authors.lastname: Boehncke
mesh_terms: D000328:Adult; D000368:Aged; D015415:Biomarkers / Q000378:metabolism; D002097:C-Reactive Protein / Q000378:metabolism; D002318:Cardiovascular Diseases / Q000188:drug therapy* / Q000209:etiology / Q000473:pathology / Q000503:physiopathology; D018450:Disease Progression; D004730:Endothelium, Vascular / Q000187:drug effects* / Q000276:immunology / Q000378:metabolism / Q000473:pathology; D005260:Female; D005500:Follow-Up Studies; D005650:Fumarates / Q000627:therapeutic use*; D006801:Humans; D007249:Inflammation; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D011446:Prospective Studies; D011565:Psoriasis / Q000150:complications / Q000188:drug therapy* / Q000473:pathology / Q000503:physiopathology; D012306:Risk; D042461:Vascular Endothelial Growth Factor A / Q000378:metabolism
chemical_list: D015415:Biomarkers; D005650:Fumarates; D042461:Vascular Endothelial Growth Factor A; D002097:C-Reactive Protein