Apremilast reduces epicardial adipose tissue in psoriasis patients

Summary: Psoriasis is associated with increased risk of cardiometabolic morbidity and mortality as well as a greater burden of epicardial adipose tissue (EAT), an independent and modifiable risk factor for coronary artery disease and marker of cardiovascular risk. Little is known about the impact of existing psoriasis treatments on EAT. To address this evidence gap, we investigated the impact of apremilast, a phosphodiesterase-4 inhibitor shown to decrease visceral adiposity in psoriasis patients, on EAT burden. Using data from the VIP-A trial (NCT03082729), an open-label, single-arm, interventional trial of 70 patients with moderate to severe psoriasis treated with apremilast, we assessed changes in EAT volume on computed tomography images from baseline to 16 weeks and 52 weeks after apremilast initiation. Patients were 23% female, with mean age 48, psoriasis duration 19 years, PASI 19, BSA 22%, and PGA 3.2. Mean BMI was 30, 27% had hypertension, 23% had dyslipidemia, 9% had diabetes, and 76% currently or ever smoked. Baseline EAT (mean volume 108.5 cm³) was positively associated with age (2.6 cm³/year, p<0.001), BMI (9.3 cm³/[kg/m²], p=0.004), visceral adipose tissue (0.6 cm³/cm³, p<0.001), and serum biomarkers and indices for insulin resistance and dyslipidemia, including the Homeostatic Model Assessment for Insulin Resistance (3.4 cm³/point, p=0.007), Diabetes Risk Index (1.2 cm³/point, p=0.004), and large VLDL particles (2.6 cm³/[nmol/L], p=0.018). EAT volume decreased by a mean of 6.3 cm³ (95% CI: 1.8 to 10.7, p=0.009) or 4.3% from baseline after 16 weeks of treatment and by 11.4 cm³ (95% CI: 5.9 to 17.0, p<0.001) or 9.0% from baseline after 52 weeks. These findings provide evidence that greater EAT burden in psoriasis patients is associated with worse biomarkers for cardiovascular risk and that apremilast may reduce EAT burden and associated cardiovascular risks in psoriasis patients. William B. Song¹, Andrew Li¹, Mohanad Ghonim¹, Abass Alavi¹, Michael Garshick², Nehal Mehta³, Gianluca Iacobellis⁴, Daniel Shin¹, Joel M. Gelfand¹ 1. University of Pennsylvania, Philadelphia, PA, United States. 2. New York University, New York, NY, United States. 3. The George Washington University, Washington, DC, United States. 4. University of Miami, Coral Gables, FL, United States. Clinical Research: Interventional Research