Dermatology Xagena

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Anti-TNF-alpha therapy: Adalimumab improves insulin sensitivity in non-diabetic patients with psoriasis

Psoriasis is a chronic inflammatory disease associated with increased risk of cardiovascular death. Several studies have shown a beneficial effect of anti-TNF-alpha therapy on the mechanisms associated with accelerated atherogenesis in patients with inflammatory arthritis, including an improvement of insulin sensitivity.
In a study, researchers aimed to determine for the first time whether the anti-TNF-alpha monoclonal antibody Adalimumab ( Humira ) may improve insulin sensitivity in non-diabetic patients with psoriasis.

Prospective study on a series of consecutive non-diabetic patients with moderate to severe psoriasis seen at the Dermatology Division of Hospital Universitario Marques de Valdecilla ( Northern Spain ) who completed 6 months of therapy with Adalimumab ( 80 mg at week 0 followed by 40 mg every other week, starting 1 week after the initial dose ).
Patients with chronic kidney disease, hypertension or body mass index greater than or equal to 35 kg/m2 were excluded.
Metabolic and clinical evaluation including assessment of insulin sensitivity using the Quantitative Insulin Sensitivity Check Index ( QUICKI ) was performed at the onset of the treatment ( time 0 ) and at month 6.

Twenty-nine patients ( 52% women; 38.6 ± 10.7 years ) with moderate to severe psoriasis [ body surface area ( BSA ) 37.9 ± 16.3% ], Psoriasis Area and Severity Index [ ( PASI ) 18.9 ± 7.8 ] were assessed.

Statistically significant improvement ( P=0.008 ) of insulin sensitivity was observed after 6 months of Adalimumab therapy ( QUICKI at time 0: 0.35 ± 0.04 vs. 0.37 ± 0.04 at month 6 ).

Significant improvement of erythrocyte sedimentation rate, ultrasensitive C-reactive protein, BSA, PASI, Nail Psoriasis Severity Index, physician global assessment and psoriatic arthritis screening and evaluation questionnaire was also observed at month 6 ( P less than 0.05 for each variable ).

In conclusion, the results support a beneficial effect of the anti-TNF-alpha blockade on the mechanisms associated with accelerated atherogenesis in patients with psoriasis. ( Xagena )

Pina T et al, J Eur Acad Dermatol Venereol 2014; Epub ahead of print