Ustekinumab treatment is associated with decreased systemic and vascular inflammation in patients with moderate-to-severe psoriasis: Feasibility study.

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Ustekinumab treatment is associated with decreased systemic and vascular inflammation in patients with moderate-to-severe psoriasis: Feasibility study using 18F- fluorodeoxyglucose PET/CT Byung-Soo Kim, MD, PhD, Won-Ku Lee, MD, Kyoungjune Pak, MD, PhD, Junhee Han, PhD, Gun-Wook Kim, MD, Hoon-Soo Kim, MD, PhD, Hyun-Chang Ko, MD, PhD, Moon-Bum Kim, MD, PhD, Seong-Jang Kim, MD, PhD Journal of the American Academy of Dermatology Volume 80, Issue 5, Pages 1322-1331 (May 2019) DOI: 10.1016/j.jaad.2018.03.011 Copyright © 2018 American Academy of Dermatology, Inc. Terms and Conditions

Fig 1 Study design. Patients with psoriasis and age-matched, sex-matched healthy controls underwent baseline 18F-FDG PET/CT imaging. Among patients with psoriasis, patients with moderate-to-severe psoriasis were treated with ustekinumab, and 18F-FDG PET/CT images were obtained again after PASI75 was achieved following ustekinumab initiation. 18F-FDG PET/CT, 18F-fluorodeoxyglucose positron emission tomography–computed tomography; PASI75, 75% improvement from baseline Psoriasis Area and Severity Index score; PET/CT, positron emission tomography–computed tomography. Journal of the American Academy of Dermatology 2019 80, 1322-1331DOI: (10.1016/j.jaad.2018.03.011) Copyright © 2018 American Academy of Dermatology, Inc. Terms and Conditions

Fig 2 Comparison of 18F-FDG uptake between the psoriasis and healthy groups. The 18F-FDG uptake in the psoriasis group (n = 25) and healthy controls (n = 47) is shown. 18F-FDG PET/CT imaging showed increased 18F-FDG uptake in the liver, spleen, and 4 parts of the aorta in patients with psoriasis compared with controls. Bars indicate the mean ± SD values. *Statistically significant (P < .05). 18F-FDG PET/CT, 18F-fluorodeoxyglucose positron emission tomography–computed tomography. Journal of the American Academy of Dermatology 2019 80, 1322-1331DOI: (10.1016/j.jaad.2018.03.011) Copyright © 2018 American Academy of Dermatology, Inc. Terms and Conditions

Fig 3 Comparison of 18F-FDG uptake among patients in the psoriasis group. A, Comparison of 18F-FDG uptake among patients in the psoriasis group by PASI score. Patients with moderate-to-severe psoriasis (PASI >10) (n = 15) had significantly increased 18F-FDG uptake in the liver, spleen, and all parts of the aorta compared with patients with mild psoriasis (PASI ≤10) (n = 10). B, Comparison of 18F-FDG uptake among patients in the psoriasis group by BMI. The patients with psoriasis who were obese (BMI >25 kg/m2) (n = 11) showed increased 18F-FDG uptake in the liver, spleen, and all parts of the aorta compared with patients with psoriasis who had a normal weight (BMI ≤25 kg/m2) (n = 14). Bars indicate the mean ± SD values. *Statistically significant (P < .05). BMI, Body mass index; 18F-FDG PET/CT, 18F-fluorodeoxyglucose positron emission tomography–computed tomography; PASI, Psoriasis Area and Severity Index. Journal of the American Academy of Dermatology 2019 80, 1322-1331DOI: (10.1016/j.jaad.2018.03.011) Copyright © 2018 American Academy of Dermatology, Inc. Terms and Conditions

Fig 4 Comparison of 18F-FDG uptake before and after treatment with ustekinumab. Changes in 18F-FDG uptake on PET/CT imaging of the liver, spleen, and arteries after PASI75 was achieved with ustekinumab therapy (n = 25). 18F-FDG uptake was reduced in the liver, spleen, and all parts of the aorta after ustekinumab therapy. Bars indicate the mean ± SD values. *Statistically significant (P < .05). 18F-FDG, 18F-fluorodeoxyglucose; PASI75, 75% improvement from baseline Psoriasis Area and Severity Index score; PET/CT, positron emission tomography–computed tomography. Journal of the American Academy of Dermatology 2019 80, 1322-1331DOI: (10.1016/j.jaad.2018.03.011) Copyright © 2018 American Academy of Dermatology, Inc. Terms and Conditions

Fig 5 Ustekinumab-associated changes on the 18F-FDG PET/CT scans. 18F-FDG uptake in the liver (red arrow) and spleen (yellow arrow) was decreased after PASI75 was achieved with ustekinumab treatment: PET (A), CT (B), and PET/CT fusion (C). 18F-FDG PET/CT, 18F-fluorodeoxyglucose positron emission tomography–computed tomography; PASI75, 75% improvement from baseline Psoriasis Area and Severity Index score. Journal of the American Academy of Dermatology 2019 80, 1322-1331DOI: (10.1016/j.jaad.2018.03.011) Copyright © 2018 American Academy of Dermatology, Inc. Terms and Conditions