Effects of Treatment With Biological Agents on Vascular and Cardiac Function in Psoriasis
Primary Purpose
Psoriasis
Status
Recruiting
Phase
Phase 4
Locations
Greece
Study Type
Interventional
Intervention
etanercept
ustekinumab
cyclosporine
Secukinumab
Apremilast
Sponsored by
About this trial
This is an interventional treatment trial for Psoriasis
Eligibility Criteria
Inclusion Criteria:
- patients with psoriasis
- Age and sex matched patients with CAD, with untreated hypertension and healthy subjects
Exclusion Criteria:
- for psoriasis patients were presence of wall motion abnormalities and ejection fraction ≤ 50%, psoriatic arthritis, history of acute coronary syndrome, familial hyperlipidemia, insulin dependent-diabetes mellitus, chronic obstructive pulmonary disease or asthma, moderate or severe valvular heart disease, primary cardiomyopathies and malignant tumors. CAD was excluded in psoriasis patients by absence of clinical history, angina and reversible myocardial ischemia, as assessed by dobutamine stress echocardiography or thallium scintigraphy
- regarding the group of CAD patients, we only included patients without history of ST elevation myocardial infarction in order to exclude the presence of transmural scar compromising myocardial function indices. Thus, CAD patients with wall motion abnormalities and ejection fraction of ≤ 50% were excluded. In addition, exclusion criteria, were history of acute coronary syndrome without ST-segment elevation within the last year, familial hyperlipidemia, insulin dependent-diabetes mellitus, chronic obstructive pulmonary disease or asthma, moderate or severe valvular heart disease, primary cardiomyopathies and malignant tumor
- in normal controls, CAD was excluded by the presence of normal ECG, absence of clinical history and absence of reversible ischemia by means of treadmill test or dobutamine stress echocardiography
Sites / Locations
- Attikon HospitalRecruiting
Arms of the Study
Arm 1
Arm 2
Arm 3
Arm 4
Arm 5
Arm Type
Active Comparator
Active Comparator
Active Comparator
Active Comparator
Active Comparator
Arm Label
Anti-TNFa regimen
Anti IL12/23 regimen
Cyclosporine regimen
anti-interleukin 17 A regimen
inhibitor of phosphodiesterase-4
Arm Description
Etanercept 50 mg
ustekinumab 45 mg
Cyclosporine 2.5-3 mg/kg
secukinumab 300 mg
apremilast 30mg
Outcomes
Primary Outcome Measures
Comparison of effect (improvement or deterioration) of treatment with biological vs. non biological agents on endothelial function in psoriasis
Comparison of effect (improvement or deterioration) of treatment with biological agents (anti-tumor necrosis factor-a, anti-interleukin 12/23, anti-interleukin 17A, or apremilast regimen) with the effects of cyclosporine on endothelial function as assessed by flow mediated dilatation of the brachial artery, coronary flow reserve and endothelial glycocalyx thickness
Comparison of effect (improvement or deterioration) of treatment with biological vs. non biological agents on vascular function in psoriasis
Comparison of effect (improvement or deterioration) of treatment with biological agents (anti-tumor necrosis factor-a, anti-interleukin 12/23, anti-interleukin 17A, or apremilast regimen) with the effects of cyclosporine on vascular function as assessed by pulse wave velocity, augmentation index and central aortic blood pressure,
Comparison of effect (improvement or deterioration) of treatment with biological vs. non biological agents on cardiac function in psoriasis
Comparison of effect (improvement or deterioration) of treatment with biological agents (anti-tumor necrosis factor-a, anti-interleukin 12/23 ,anti-interleukin 17A, or apremilast regimen) with the effects of cyclosporine on cardiac function as assessed by longitudinal myocardial deformation, twisting and untwisting of the left ventricle
Secondary Outcome Measures
Differences and similarities in endothelial function between psoriasis and control groups
Differences in endothelial function between psoriasis and normal controls, and similarities in endothelial function between psoriasis and coronary artery disease patients and untreated hypertension patients before and after 4 week of anti-inflammatory treatment in patients with psoriasis .The following parameters will be compared among the study subgroups endothelial function as assessed by flow mediated dilatation of the brachial artery, coronary flow reserve and endothelial glycocalyx thickness
Differences and similarities in vascular function between psoriasis and control groups
Differences in vascular function between psoriasis and normal controls, and similarities in vascular function between psoriasis and coronary artery disease patients and untreated hypertension patients before and after 4 week of anti-inflammatory treatment in patients with psoriasis .The following parameters will be compared among the study subgroups vascular function as assessed by pulse wave velocity, augmentation index and central aortic blood pressure,
Differences and similarities in cardiac function between psoriasis and control groups
Differences in cardiac function between psoriasis and normal controls, and similarities in cardiac function between psoriasis and coronary artery disease patients and untreated hypertension patients before and after 4 week of anti-inflammatory treatment in patients with psoriasis The following parameters will be compared among the study subgroups cardiac function as assessed by longitudinal myocardial deformation, twisting and untwisting of the left ventricle
Effects of anti-inflammatory treatment on prognosis for major adverse cardiovascular events
Effects of anti-inflammatory treatment on myocardial infarction, stroke, hospitalization because of heart failure, and cardiovascular death
Full Information
1. Study Identification
Unique Protocol Identification Number
NCT02144857
Brief Title
Effects of Treatment With Biological Agents on Vascular and Cardiac Function in Psoriasis
Official Title
Effects of Treatment With Biological Agents on Endothelial Glycocalyx,Arterial Elastic Properties, Coronary Flow, Myocardial Deformation and Twisting in Psoriasis. Comparative Study With Patients With CAD or Untreated Hypertension.
Study Type
Interventional
2. Study Status
Record Verification Date
May 2023
Overall Recruitment Status
Recruiting
Study Start Date
May 30, 2014 (Actual)
Primary Completion Date
September 30, 2023 (Anticipated)
Study Completion Date
December 31, 2023 (Anticipated)
3. Sponsor/Collaborators
Responsible Party, by Official Title
Principal Investigator
Name of the Sponsor
University of Athens
4. Oversight
Data Monitoring Committee
No
5. Study Description
Brief Summary
Psoriasis has been associated with an increasing risk for atherosclerosis. The investigators investigated whether surrogate markers of subclinical atherosclerosis, vascular dysfunction and myocardial dysfunction are impaired in patients with psoriasis compared to normal controls ,coronary artery disease patients and untreated hypertension subjects. The investigators also examined the effect of treatment with biological vs no biological agents on vascular and LV function in psoriasis.
Detailed Description
The investigators will compare patients with psoriasis with age and sex matched normal controls as well as patients with angiographically documented CAD and patients with untreated hypertension (HYP) used as positive control groups
Patients with psoriasis (PS) will be randomized to receive an anti-tumor necrosis-a (TNF-a) ,an anti- interleukin 12/23 regimen, an interleukin 17A antagonist, apremilast (inhibitor of phosphodiesterase-4) or a cyclosporine regimen.
The anti-TNF-agent, Etanercept will be given at a dose 50mg twice weekly for 12 weeks and after then once weekly.
The anti-IL12/23 regimen, Ustekinumab will be given at a dose 45 mg at the first visit, at 4 weeks and every 12 weeks if body weight is up to 90 kgr. For body weight >90kgr dose will be adjusted accordingly.
The IL-17A antagonist regimen namely secukinumab 300 mg SC at weeks 0, 1, 2, 3, and 4 and 300 mg SC once monthly afterwards Apremilast will be given at a dose of 30mg orally twice daily Cyclosporine will be administered at a dose 2.5-3mg/kgr daily.
At baseline , after 12 weeks and one year of treatment, the investigators will measure:
pulse wave velocity (PWVc) augmentation index (AI) central systolic blood pressure (cSBP) (Complior, Alam Medical and Arteriograph,TensioMed)
flow-mediated dilation of the brachial artery (FMD)
carotid intima-media thickness (IMT) by ultrasonography
coronary flow reserve of the LAD (CFR) by Doppler echocardiography
E'/A of mitral annular velocities ,LV longitudinal (GLS -%),strain, and strain rate (LongSr-l/s), peak twisting (Tw -deg),peak twisting (Tw-deg/sec)velocity,untwisting at mitral valve opening (unTw) and untwisting (unTw) velocity using speckle tracking echocardiography .
Perfused boundary region (PBR)of the sublingual arterial microvessels (ranged from 5-25 microns) using Sideview Darkfield imaging. (Microscan, Glycocheck) .The PBR in microvessels is the cell-poor layer which results from the phase separation between the flowing red blood cells (RBC) and plasma.The PBR includes the most luminal part of glycocalyx that does allow cell penetration. Increased PBR is considered an accurate index of reduced endothelial glycocalyx thickness because of a deeper RBC penetration in the glycocalyx.
Fetuin serum levels, markers of oxidative stress such as malondialdehyde (MDA) serum levels, protein carbonyls aw well as thrombosis and inflammation biomarkers
6. Conditions and Keywords
Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Psoriasis
7. Study Design
Primary Purpose
Treatment
Study Phase
Phase 4
Interventional Study Model
Parallel Assignment
Masking
Investigator
Allocation
Randomized
Enrollment
200 (Anticipated)
8. Arms, Groups, and Interventions
Arm Title
Anti-TNFa regimen
Arm Type
Active Comparator
Arm Description
Etanercept 50 mg
Arm Title
Anti IL12/23 regimen
Arm Type
Active Comparator
Arm Description
ustekinumab 45 mg
Arm Title
Cyclosporine regimen
Arm Type
Active Comparator
Arm Description
Cyclosporine 2.5-3 mg/kg
Arm Title
anti-interleukin 17 A regimen
Arm Type
Active Comparator
Arm Description
secukinumab 300 mg
Arm Title
inhibitor of phosphodiesterase-4
Arm Type
Active Comparator
Arm Description
apremilast 30mg
Intervention Type
Drug
Intervention Name(s)
etanercept
Other Intervention Name(s)
Enbrel
Intervention Description
50 mg
Intervention Type
Drug
Intervention Name(s)
ustekinumab
Other Intervention Name(s)
Stelara
Intervention Description
45 mg
Intervention Type
Drug
Intervention Name(s)
cyclosporine
Other Intervention Name(s)
Neoral
Intervention Description
Cyclosporine 2.5-3 mg/kgr
Intervention Type
Drug
Intervention Name(s)
Secukinumab
Other Intervention Name(s)
Cosentyx
Intervention Description
300 mg
Intervention Type
Drug
Intervention Name(s)
Apremilast
Other Intervention Name(s)
Otezla
Intervention Description
30mg
Primary Outcome Measure Information:
Title
Comparison of effect (improvement or deterioration) of treatment with biological vs. non biological agents on endothelial function in psoriasis
Description
Comparison of effect (improvement or deterioration) of treatment with biological agents (anti-tumor necrosis factor-a, anti-interleukin 12/23, anti-interleukin 17A, or apremilast regimen) with the effects of cyclosporine on endothelial function as assessed by flow mediated dilatation of the brachial artery, coronary flow reserve and endothelial glycocalyx thickness
Time Frame
12 weeks
Title
Comparison of effect (improvement or deterioration) of treatment with biological vs. non biological agents on vascular function in psoriasis
Description
Comparison of effect (improvement or deterioration) of treatment with biological agents (anti-tumor necrosis factor-a, anti-interleukin 12/23, anti-interleukin 17A, or apremilast regimen) with the effects of cyclosporine on vascular function as assessed by pulse wave velocity, augmentation index and central aortic blood pressure,
Time Frame
12 weeks
Title
Comparison of effect (improvement or deterioration) of treatment with biological vs. non biological agents on cardiac function in psoriasis
Description
Comparison of effect (improvement or deterioration) of treatment with biological agents (anti-tumor necrosis factor-a, anti-interleukin 12/23 ,anti-interleukin 17A, or apremilast regimen) with the effects of cyclosporine on cardiac function as assessed by longitudinal myocardial deformation, twisting and untwisting of the left ventricle
Time Frame
12 weeks
Secondary Outcome Measure Information:
Title
Differences and similarities in endothelial function between psoriasis and control groups
Description
Differences in endothelial function between psoriasis and normal controls, and similarities in endothelial function between psoriasis and coronary artery disease patients and untreated hypertension patients before and after 4 week of anti-inflammatory treatment in patients with psoriasis .The following parameters will be compared among the study subgroups endothelial function as assessed by flow mediated dilatation of the brachial artery, coronary flow reserve and endothelial glycocalyx thickness
Time Frame
0 and 12 weeks
Title
Differences and similarities in vascular function between psoriasis and control groups
Description
Differences in vascular function between psoriasis and normal controls, and similarities in vascular function between psoriasis and coronary artery disease patients and untreated hypertension patients before and after 4 week of anti-inflammatory treatment in patients with psoriasis .The following parameters will be compared among the study subgroups vascular function as assessed by pulse wave velocity, augmentation index and central aortic blood pressure,
Time Frame
0 and 12 weeks
Title
Differences and similarities in cardiac function between psoriasis and control groups
Description
Differences in cardiac function between psoriasis and normal controls, and similarities in cardiac function between psoriasis and coronary artery disease patients and untreated hypertension patients before and after 4 week of anti-inflammatory treatment in patients with psoriasis The following parameters will be compared among the study subgroups cardiac function as assessed by longitudinal myocardial deformation, twisting and untwisting of the left ventricle
Time Frame
0 and 12 weeks
Title
Effects of anti-inflammatory treatment on prognosis for major adverse cardiovascular events
Description
Effects of anti-inflammatory treatment on myocardial infarction, stroke, hospitalization because of heart failure, and cardiovascular death
Time Frame
4-year follow-up
10. Eligibility
Sex
All
Minimum Age & Unit of Time
18 Years
Maximum Age & Unit of Time
80 Years
Accepts Healthy Volunteers
Accepts Healthy Volunteers
Eligibility Criteria
Inclusion Criteria:
patients with psoriasis
Age and sex matched patients with CAD, with untreated hypertension and healthy subjects
Exclusion Criteria:
for psoriasis patients were presence of wall motion abnormalities and ejection fraction ≤ 50%, psoriatic arthritis, history of acute coronary syndrome, familial hyperlipidemia, insulin dependent-diabetes mellitus, chronic obstructive pulmonary disease or asthma, moderate or severe valvular heart disease, primary cardiomyopathies and malignant tumors. CAD was excluded in psoriasis patients by absence of clinical history, angina and reversible myocardial ischemia, as assessed by dobutamine stress echocardiography or thallium scintigraphy
regarding the group of CAD patients, we only included patients without history of ST elevation myocardial infarction in order to exclude the presence of transmural scar compromising myocardial function indices. Thus, CAD patients with wall motion abnormalities and ejection fraction of ≤ 50% were excluded. In addition, exclusion criteria, were history of acute coronary syndrome without ST-segment elevation within the last year, familial hyperlipidemia, insulin dependent-diabetes mellitus, chronic obstructive pulmonary disease or asthma, moderate or severe valvular heart disease, primary cardiomyopathies and malignant tumor
in normal controls, CAD was excluded by the presence of normal ECG, absence of clinical history and absence of reversible ischemia by means of treadmill test or dobutamine stress echocardiography
Central Contact Person:
First Name & Middle Initial & Last Name or Official Title & Degree
Ignatios Ikonomidis, Dr
Phone
2105831264
Email
ignoik@gmail.com
First Name & Middle Initial & Last Name or Official Title & Degree
Maria Varoudi, Dr
Phone
6909001116
Email
mvaroudi@gmail.com
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Ignatios Ikonomidis, Dr
Organizational Affiliation
University of Athens
Official's Role
Principal Investigator
Facility Information:
Facility Name
Attikon Hospital
City
Athens
ZIP/Postal Code
12462
Country
Greece
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Ignatios Ikonomidis, Dr
Phone
+302105832187
Email
ignoik@gmail.com
First Name & Middle Initial & Last Name & Degree
Ignatios Ikonomidis, Dr
12. IPD Sharing Statement
Citations:
PubMed Identifier
34819613
Citation
Ikonomidis I, Pavlidis G, Lambadiari V, Rafouli-Stergiou P, Makavos G, Thymis J, Kostelli G, Varoudi M, Katogiannis K, Theodoropoulos K, Katsimbri P, Parissis J, Papadavid E. Endothelial glycocalyx and microvascular perfusion are associated with carotid intima-media thickness and impaired myocardial deformation in psoriatic disease. J Hum Hypertens. 2022 Dec;36(12):1113-1120. doi: 10.1038/s41371-021-00640-2. Epub 2021 Nov 25.
Results Reference
derived
PubMed Identifier
28899951
Citation
Ikonomidis I, Papadavid E, Makavos G, Andreadou I, Varoudi M, Gravanis K, Theodoropoulos K, Pavlidis G, Triantafyllidi H, Moutsatsou P, Panagiotou C, Parissis J, Iliodromitis E, Lekakis J, Rigopoulos D. Lowering Interleukin-12 Activity Improves Myocardial and Vascular Function Compared With Tumor Necrosis Factor-a Antagonism or Cyclosporine in Psoriasis. Circ Cardiovasc Imaging. 2017 Sep;10(9):e006283. doi: 10.1161/CIRCIMAGING.117.006283.
Results Reference
derived
Learn more about this trial
Effects of Treatment With Biological Agents on Vascular and Cardiac Function in Psoriasis
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