INTRODUCTION
Metabolic syndrome (MetS) is a combination of factors including dysglycemia, raised blood pressure (BP), dyslipidemia (raised triglycerides [TG] and lowered high-density lipoprotein cholesterol [HDL-C]), raised fasting glucose (FG), and central obesity1 that increase the risk of cardiovascular (CV) disease,1 diabetes,1 and mortality.2 In patients with moderate-to-severe plaque psoriasis, MetS is the most prevalent comorbidity.3-5 Relative to the general population, patients with psoriasis have a higher prevalence of MetS with a reported pooled odds ratio (95% confidence interval [CI]) of 2.14 (1.84, 2.48) from 35 studies.6
The presence of MetS risk factors may influence future treatment decisions, as they reduce the efficacy of some medications in psoriasis, including anti-tumor necrosis factor alpha (TNF-α) and anti–interleukin (IL)-17 based biologic therapies,7-9 or have neutral effects with other treatments.10,11 Both ustekinumab and TNF-α antagonists have been associated with weight gain during treatment.12-15 Adalimumab, etanercept, and ustekinumab were associated with a 9% increase in serum triglyceride levels in patients with psoriasis.16 Biologic therapies for psoriasis may increase body weight and total cholesterol, triglycerides, and low density lipoprotein in patients not taking statins.12,17 Higher rates of risk for complications of preexisting obesity, hypertension, and/or hypertriglyceridemia, as well as higher rates of cardiovascular disease and new or worsening diabetes mellitus are anticipated in patients with psoriasis and concomitant MetS relative to patients without MetS while receiving biologic therapy.1 There are no published data evaluating biologic therapy-induced changes in cardiometabolic risk factors based on concomitant MetS status in psoriasis.
The presence of MetS risk factors may influence future treatment decisions, as they reduce the efficacy of some medications in psoriasis, including anti-tumor necrosis factor alpha (TNF-α) and anti–interleukin (IL)-17 based biologic therapies,7-9 or have neutral effects with other treatments.10,11 Both ustekinumab and TNF-α antagonists have been associated with weight gain during treatment.12-15 Adalimumab, etanercept, and ustekinumab were associated with a 9% increase in serum triglyceride levels in patients with psoriasis.16 Biologic therapies for psoriasis may increase body weight and total cholesterol, triglycerides, and low density lipoprotein in patients not taking statins.12,17 Higher rates of risk for complications of preexisting obesity, hypertension, and/or hypertriglyceridemia, as well as higher rates of cardiovascular disease and new or worsening diabetes mellitus are anticipated in patients with psoriasis and concomitant MetS relative to patients without MetS while receiving biologic therapy.1 There are no published data evaluating biologic therapy-induced changes in cardiometabolic risk factors based on concomitant MetS status in psoriasis.