Influence of biologic therapy on folic acid and homocystein serum concentration in psoriasis vulgaris patients

Abstract

Introduction: Numerous scientific reports indicate an increased risk of developing cardiovascular disease among patients with psoriasis vulgaris, which is related to, among others, elevated concentration of homocysteine and reduced concentration of folic acid. The long-term effect of biological therapy on the concentration of these substances has not been previously studied. The aim of this study was to evaluate the homocysteine and folic acid concentration in the sera of patients with psoriasis vulgaris under biological therapy (adalimumab, etanercept, infliximab, and ustekinumab).

Material and methods: The study group consisted of 42 patients with psoriasis vulgaris treated with biologic therapy from 2008 to 2013 in the Department of Dermatology and Venereology, Medical University of Lodz. Blood samples were taken to determine the folic acid and homocysteine concentration before and at 12th, 52th, 104th and 156th weeks of treatment. The control group consisted of 20 healthy volunteers. The effectiveness of biological therapy was assessed on the basis of PASI.

Results: There was a significant (p < 0.05) decrease in PASI under the influence of biological treatment (week 0. 14.5; 12th week 3.6; 52th week 2.9; 104th per week 2.5; 156th week 1.7). The concentration of homocysteine in the patients was similar to the control group (16.16 and 16.40 respectively nmol/l). Its level dropped slightly during treatment (0 week 16.16 nmol/l; 12th week 16.46 nmol/l; 52th week 15.56 nmol/l; 104 per week 14.17 nmol/l; p > 0.05). Folate concentration in psoriatic patients’ sera was significantly lower than in healthy controls (respectively 5.12 vs 8.76 ng/ml, p < 0.001). Folic acid concentration was slightly increasing during the course of therapy (week 0. 5.12 ng/ml; 12th week 5.15 ng/ml; 52th week 6.41 ng/ml; 104 per week 5.48 ng/ml; p > 0.05).

Conclusions: Reduced levels of folic acid, and slightly increased — homocysteine in the serum of patients with psoriasis may indicate that the dermatosis is one of the risk factors for atherosclerosis and cardiovascular. Studies involving larger groups of patients would clearly assess the impact of biological therapy on the level of homocysteine and folic acid, as well as the development of cardiovascular complications in psoriasis.