Psoriasis is a T helper type 17 autoimmune disease associated with an increased risk
cardiovascular events and mortality. Ustekinumab, an antibody to p40, blocks cytokines
IL-12 and IL-23, and is a highly effective and safe treatment for psoriasis. We conducted
a randomized double-blinded placebo-controlled trial to determine the effect of ustekinumab
on aortic vascular inflammation (AVI) measured by imaging, and key biomarkers of inflammation,
lipid, and glucose metabolism in the blood of patients with moderate-to-severe psoriasis.
A total of 43 patients were randomized, and at week 12, ustekinumab-treated patients
had a -18.65% (95% confidence interval = -29.45% to -7.85%) reduction in AVI, a reduction
in inflammatory biomarkers, and an increase in apolipoprotein B lipoproteins compared
with placebo. At week 12, placebo patients were crossed over such that all patients
received ustekinumab for 52 weeks. At the end of 52 weeks of ustekinumab treatment,
there was no change in AVI compared with baseline, inflammatory markers were reduced,
and there were increases in selected measures of lipids and leptin. These results
show that blockade of IL-12 and/or IL-23 may transiently reduce AVI, with more durable
reduction in inflammatory cytokines associated with cardiovascular disease.