Vascular Inflammation in Psoriasis - Apremilast

Study Overview
=================
Brief Summary
-----------------
The purpose of the VIP-A study is to determine the effect of apremilast on aortic vascular inflammation, cardiometabolic biomarkers and body composition in patients with moderate-severe psoriasis.

Detailed Description
-----------------
The primary objectives of this study are to determine the effect of apremilast on aortic vascular inflammation, cardiometabolic biomarkers and body composition in patients with moderate-severe psoriasis. Fluorodeoxyglucose (FDG) - positron emission tomography (PET)/computed tomography (CT) will be used to assess vascular inflammation, with multi-volumetric product, tissue-to-background ratio and total atherosclerotic burden, and body composition via volumetric quantification. This is a year-long, single arm, open label study.

Official Title
-----------------
A Phase IV, Open Label Study of the Effects of Apremilast on Vascular Inflammation and Cardiometabolic Function in Psoriasis

Conditions
-----------------
Psoriasis, Cardiovascular Diseases

Intervention / Treatment
-----------------
* Drug: Apremilast


Participation Criteria
=================
Eligibility Criteria
-----------------
Inclusion Criteria: Males and females 18 years of age and older. Clinical diagnosis of psoriasis for at least 6 months as determined by medical history interview and confirmation of diagnosis through physical examination by Investigator. Stable plaque psoriasis for at least 2 months before screening and at baseline (Week 0) as determined by medical history interview. Moderate to severe psoriasis defined by ≥ 10 percent Body Surface Area (BSA) involvement at the baseline (Week 0) visit. Psoriasis Area and Severity Index (PASI) score of ≥ 12 at the Baseline (Week 0) visit. Participant is a candidate for systemic therapy and has active psoriasis despite prior treatment with topical agents. Women are eligible to participate in the study if they meet one of the following criteria: Females of childbearing potential (FCBP) must have a negative pregnancy test at screening and baseline. Women of childbearing potential must undergo periodic pregnancy testing during the study and agree to use at least one of the following methods of contraception throughout the study duration and for at least 28 days after taking the last dose of investigational product: Oral contraceptives Transdermal contraceptives Injectable or implantable methods Intrauterine devices Vaginal ring Vasectomized partner Barrier methods (Male or female condom (latex condom or non-latex condom NOT made out of natural [animal] membrane [for example, polyurethane]; PLUS one additional barrier method: (a) diaphragm with spermicide; (b) cervical cap with spermicide; or (c) contraceptive sponge with spermicide.); Women who are postmenopausal (for at least one year), sterile, or hysterectomized; Women who have undergone tubal ligation will be required to undergo periodic pregnancy testing during the duration of the study Sexual abstinence, defined as total abstinence from sexual intercourse, is considered an adequate form of contraception. (Agreement to comply with sexual abstinence must be recorded in the source document). Participants using oral or parenteral forms of contraceptives must have been using these methods for at least 90 days prior to baseline visit. Men (including those who have had a vasectomy), who engage in activity in which conception is possible, are eligible to participate if they: Use barrier contraception (male latex condom or non-latex condom NOT made out of natural [animal] membrane [for example, polyurethane]) while on investigational product and for at least 28 days after the last dose of investigational product. Participant is judged to be in good general health as determined by the Principal Investigator based upon the results of medical history, laboratory profile and physical examination performed at screening. Exclusion Criteria: Prior treatment with apremilast. Diagnosis of erythrodermic psoriasis, generalized or localized pustular psoriasis, medication-induced or medication-exacerbated psoriasis, or new onset guttate psoriasis. Diagnosis of other active skin diseases or skin infections (bacterial, fungal, or viral) that may interfere with evaluation of psoriasis. Cannot avoid topical prescription medications for psoriasis for at least 14 days prior to the baseline visit (week 0) and during the study, with the exception of hydrocortisone 2.5% for the face and intertriginous areas. Cannot avoid ultraviolet B (UVB) phototherapy or Excimer laser for at least 14 days prior to the Baseline (Week 0) visit and during the study. Cannot avoid psoralen-ultraviolet A (UVA) phototherapy for at least 30 days prior to the Baseline (Week 0) visit and during the study. Use of systemic therapies for the treatment of psoriasis, or systemic therapies known to improve psoriasis, during the study: Systemic therapies must be discontinued at least 30 days prior to the Baseline (Week 0) visit except for biologics. All biologics, except interleukin (IL)-12/IL-23 antagonists, must be discontinued for at least 90 days prior to Baseline (Week 0). Any IL-12/IL-23 antagonist (e.g., ustekinumab, briakinumab) must be discontinued for at least 180 days prior to Baseline (Week 0). Investigational agents must be discontinued at least 30 days or 5 half-lives (whichever is longer) prior to the Baseline (Week 0) visit. Participant is ≥ 300lbs Participant is taking or requires oral or injectable corticosteroids during the study. Inhaled corticosteroids for stable medical conditions are allowed. Participant is taking a medication that interferes with metabolism of apremilast, including but not limited to rifampin, phenobarbital, carbamazepine, phenytoin Poorly controlled medical condition, such as unstable ischemic heart disease, cerebrovascular accident or myocardial infarction within the prior 6 months, psychiatric disease requiring frequent hospitalization, and any other condition, which, in the opinion of the Investigator, would put the participant at risk by participation in the study. Prior history of suicide attempt at any time in the participant's life time prior to screening or randomization, or major psychiatric illness requiring hospitalization within the last 3 years. Uncontrolled hypertension, with measured systolic blood pressure >180 mmHg or diastolic blood pressure >95 mmHg Participant has infection or risk factors for severe infections, for example Positive serology or known history of HIV, hepatitis B or C, or other severe, recurrent, or persistent infections; Excessive immunosuppression or other factors associated with it, including human immunodeficiency virus infection; Active tuberculosis (TB) disease; Any other significant infection requiring hospitalization or intravenous (IV) antibiotics in the 30 days prior to baseline; Infection requiring treatment with oral or parenteral (other than IV) antibiotics within 14 days prior to baseline; Participant has received vaccination with a live viral agent within 30 days prior to screening or will require a live vaccination during study participation including up to 30 days after the last dose of study drug. Participant has history of hematological or solid malignancy other than successfully treated basal cell carcinoma, non-metastatic cutaneous squamous cell carcinoma or cervical intraepithelial neoplasia or carcinoma in situ of cervix with no evidence of recurrence within the previous 5 years. Female participant who is pregnant or breast-feeding or considering becoming pregnant during the study. Screening clinical laboratory analyses showing any of the following abnormal results: White blood cell (WBC) count <3.0 x 109/L. (Subject can be included if WBC count is <3.0 x 109/L and absolute neutrophil count (ANC) is >1000 cells / mm3.) WBC count > 15 x 109/L; Hemoglobin (Hgb) < 9.0 x 109/L; Platelet count < 100 x 109/L; Serum creatinine >1.5 mg/dL ; Serum aspartate transaminase or alanine transaminase >2.0 upper limits of normal Recent history of substance abuse or psychiatric illness that could preclude compliance with the protocol. History of substance abuse within 365 days of screening visit. Alcohol use of more than 14 drinks per week within 14 days of the baseline visit If subject is on cholesterol-lowering medication (e.g. statin), dose and form of medication must be stable for 90 days prior to week 0 and remain stable throughout the duration of the study.

Ages Eligible for Study
-----------------
Minimum Age: 18 Years

Sexes Eligible for Study
-----------------
All

Accepts Healthy Volunteers
-----------------
No

Study Plan
=================
How is the study designed?
-----------------

Design Details

Primary Purpose: Treatment
Intervention Model: Single Group Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Other: Apremilast<br>Apremilast (Otezla), 30mg oral tablet twice per day for 52 weeks. Single arm, open label study. | Drug: Apremilast<br>* Apremilast (brand name Otezla) is a medication for the treatment of certain types of psoriasis and psoriatic arthritis.<br>* Other names: Otezla;|

What is the study measuring?
-----------------
Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Change in Total Vascular Inflammation of the Aorta as Measured by FDG-PET/CT Between Baseline and Week 16. | The primary analysis will consist of comparisons of total vascular inflammation of the aorta between week 16 and baseline using [18F]-Fluorodeoxyglucose (FDG) Positron Emission Tomography (PET) / Computed Tomography (CT) (FDG-PET/CT). Tissue-to-background ratio (TBR) of the standardized uptake value (SUV) is used to assess the level of inflammation of the aorta relative to the venous blood pool (background reference). | After the completion of week 16 visit by all study participants. | 
| Changes in Cardiometabolic Markers Between Baseline and Week 16: Ferritin | Ferritin is a marker of inflammation. | After the completion of week 16 visit by all study participants. | 
| Changes in Cardiometabolic Markers Between Baseline and Week 16: C Reactive Protein (CRP) | CRP is a marker of inflammation. | After the completion of week 16 visit by all study participants. | 
| Changes in Cardiometabolic Markers Between Baseline and Week 16: Intercellular Adhesion Molecule (ICAM)-1 | ICAM-1 is a marker of inflammation. | After the completion of week 16 visit by all study participants. | 
| Changes in Cardiometabolic Markers Between Baseline and Week 16: Serum Amyloid-A (SAA) | SAA is a marker of inflammation. | After the completion of week 16 visit by all study participants. | 
| Changes in Cardiometabolic Markers Between Baseline and Week 16: Vascular Cell Adhesion Molecule (VCAM)-1 | VCAM-1 is a marker of inflammation. | After the completion of week 16 visit by all study participants. | 
| Changes in Cardiometabolic Markers Between Baseline and Week 16: Interferon (IFN)-Gamma | IFN-gamma is a marker of inflammation. | After the completion of week 16 visit by all study participants. | 
| Changes in Cardiometabolic Markers Between Baseline and Week 16: Interleukin (IL)-1b | IL-1b is a marker of inflammation. | After the completion of week 16 visit by all study participants. | 
| Changes in Cardiometabolic Markers Between Baseline and Week 16: IL-10 | IL-10 is a marker of inflammation. | After the completion of week 16 visit by all study participants. | 
| Changes in Cardiometabolic Markers Between Baseline and Week 16: IL-17A | IL-17A is a marker of inflammation. | After the completion of week 16 visit by all study participants. | 
| Changes in Cardiometabolic Markers Between Baseline and Week 16: IL-6 | IL-6 is a marker of inflammation. | After the completion of week 16 visit by all study participants. | 
| Changes in Cardiometabolic Markers Between Baseline and Week 16: IL-8 | IL-8 is a marker of inflammation. | After the completion of week 16 visit by all study participants. | 
| Changes in Cardiometabolic Markers Between Baseline and Week 16: IL-9 | IL-9 is a marker of inflammation. | After the completion of week 16 visit by all study participants. | 
| Changes in Cardiometabolic Markers Between Baseline and Week 16: Monocyte Chemoattractant Protein (MCP)-1 | MCP-1 is a marker of inflammation. | After the completion of week 16 visit by all study participants. | 
| Changes in Cardiometabolic Markers Between Baseline and Week 16: Tumor Necrosis Factor (TNF)-Alpha | TNF-alpha is a marker of inflammation. | After the completion of week 16 visit by all study participants. | 
| Changes in Cardiometabolic Markers Between Baseline and Week 16: IL2RA | IL2RA is a marker of inflammation. | After the completion of week 16 visit by all study participants. | 
| Changes in Cardiometabolic Markers Between Baseline and Week 16: GlycA | GlycA is a marker of inflammation. | After the completion of week 16 visit by all study participants. | 
| Changes in Cardiometabolic Markers Between Baseline and Week 16: Cholesterol Efflux Capacity | Cholesterol Efflux Capacity is a marker of lipid function and metabolism. The ability to promote cholesterol efflux from macrophages is a classic function of HDL that is thought to be an important mechanism by which HDL protects against atherosclerosis. HDL cholesterol efflux capacity assays are performed based on published methods using J774 cells derived from a murine macrophage cell line (Mehta NN Atherosclerosis 2012). Efflux is calculated as a unitless measure by using the following formula: [(µCi of 3H-cholesterol in media containing apoB-depleted subject plasma - µCi of 3H-cholesterol in plasma-free media) / (µCi of 3H-cholesterol in media containing apoB-depleted pooled control plasma-µCi of 3H-cholesterol in pooled control plasma-free media)]. Cholesterol efflux capacity is inversely correlated with incidence of cardiovascular events (i.e. higher cholesterol efflux capacity is better for patients). | After the completion of week 16 visit by all study participants. | 
| Changes in Cardiometabolic Markers Between Baseline and Week 16: Triglyceride | Triglyceride is a marker of lipid function and metabolism. | After the completion of week 16 visit by all study participants. | 
| Changes in Cardiometabolic Markers Between Baseline and Week 16: Total Cholesterol | Total Cholesterol is a marker of lipid function and metabolism. | After the completion of week 16 visit by all study participants. | 
| Changes in Cardiometabolic Markers Between Baseline and Week 16: High-density Lipoprotein (HDL) - Cholesterol (C) | HDL-C is a marker of lipid function and metabolism. | After the completion of week 16 visit by all study participants. | 
| Changes in Cardiometabolic Markers Between Baseline and Week 16: HDL-Particle Number (P) | HDL-P is a marker of lipid function and metabolism. | After the completion of week 16 visit by all study participants. | 
| Changes in Cardiometabolic Markers Between Baseline and Week 16: HDL-Particle Size (Z) | HDL-Z is a marker of lipid function and metabolism. | After the completion of week 16 visit by all study participants. | 
| Changes in Cardiometabolic Markers Between Baseline and Week 16: Small (S)-HDL-P | S-HDL-P is a marker of lipid function and metabolism. | After the completion of week 16 visit by all study participants. | 
| Changes in Cardiometabolic Markers Between Baseline and Week 16: Medium (M)-HDL-P | M-HDL-P is a marker of lipid function and metabolism. | After the completion of week 16 visit by all study participants. | 
| Changes in Cardiometabolic Markers Between Baseline and Week 16: Large and Medium (LM)-HDL-P | LM-HDL-P is a marker of lipid function and metabolism. | After the completion of week 16 visit by all study participants. | 
| Changes in Cardiometabolic Markers Between Baseline and Week 16: Large (L)-HDL-P | L-HDL-P is a marker of lipid function and metabolism. | After the completion of week 16 visit by all study participants. | 
| Changes in Cardiometabolic Markers Between Baseline and Week 16: Low-density Lipoprotein (LDL)-C | LDL-C is a marker of lipid function and metabolism. | After the completion of week 16 visit by all study participants. | 
| Changes in Cardiometabolic Markers Between Baseline and Week 16: LDL-P | LDL-P is a marker of lipid function and metabolism. | After the completion of week 16 visit by all study participants. | 
| Changes in Cardiometabolic Markers Between Baseline and Week 16: LDL-Z | LDL-Z is a marker of lipid function and metabolism. | After the completion of week 16 visit by all study participants. | 
| Changes in Cardiometabolic Markers Between Baseline and Week 16: S-LDL-P | S-LDL-P is a marker of lipid function and metabolism. | After the completion of week 16 visit by all study participants. | 
| Changes in Cardiometabolic Markers Between Baseline and Week 16: L-LDL-P | L-LDL-P is a marker of lipid function and metabolism. | After the completion of week 16 visit by all study participants. | 
| Changes in Cardiometabolic Markers Between Baseline and Week 16: Very Large (VL)-LDL-P | VL-LDL-P is a marker of lipid function and metabolism. | After the completion of week 16 visit by all study participants. | 
| Changes in Cardiometabolic Markers Between Baseline and Week 16: Very Low-density Lipoprotein (VLDL)-P | VLDL-P is a marker of lipid function and metabolism. | After the completion of week 16 visit by all study participants. | 
| Changes in Cardiometabolic Markers Between Baseline and Week 16: VLDL-Z | VLDL-Z is a marker of lipid function and metabolism. | After the completion of week 16 visit by all study participants. | 
| Changes in Cardiometabolic Markers Between Baseline and Week 16: VLDL-Triglycerides (TG) | VLDL-TG is a marker of lipid function and metabolism. | After the completion of week 16 visit by all study participants. | 
| Changes in Cardiometabolic Markers Between Baseline and Week 16: S-VLDL-P | S-VLDL-P is a marker of lipid function and metabolism. | After the completion of week 16 visit by all study participants. | 
| Changes in Cardiometabolic Markers Between Baseline and Week 16: M-VLDL-P | M-VLDL-P is a marker of lipid function and metabolism. | After the completion of week 16 visit by all study participants. | 
| Changes in Cardiometabolic Markers Between Baseline and Week 16: LM-VLDL-P | LM-VLDL-P is a marker of lipid function and metabolism. | After the completion of week 16 visit by all study participants. | 
| Changes in Cardiometabolic Markers Between Baseline and Week 16: L-VLDL-P | L-VLDL-P is a marker of lipid function and metabolism. | After the completion of week 16 visit by all study participants. | 
| Changes in Cardiometabolic Markers Between Baseline and Week 16: Intermediate-density Lipoprotein (IDL)-P | IDL-P is a marker of lipid function and metabolism. | After the completion of week 16 visit by all study participants. | 
| Changes in Cardiometabolic Markers Between Baseline and Week 16: Apolipoprotein A1 (ApoA1) | ApoA1 is a marker of lipid function and metabolism. | After the completion of week 16 visit by all study participants. | 
| Changes in Cardiometabolic Markers Between Baseline and Week 16: Apolipoprotein B (ApoB) | ApoB is a marker of lipid function and metabolism. | After the completion of week 16 visit by all study participants. | 
| Changes in Cardiometabolic Markers Between Baseline and Week 16: TRLTG | TRLTG is a marker of lipid function and metabolism. | After the completion of week 16 visit by all study participants. | 
| Changes in Cardiometabolic Markers Between Baseline and Week 16: (Triglyceride-Rich Lipoprotein Cholesterol) TRLC | TRLC is a marker of lipid function and metabolism. | After the completion of week 16 visit by all study participants. | 
| Changes in Cardiometabolic Markers Between Baseline and Week 16: (Triglyceride-Rich Lipoprotein) TRLP | TRLP is a marker of lipid function and metabolism. | After the completion of week 16 visit by all study participants. | 
| Changes in Cardiometabolic Markers Between Baseline and Week 16: VS-TRLP | VS-TRLP is a marker of lipid function and metabolism. | After the completion of week 16 visit by all study participants. | 
| Changes in Cardiometabolic Markers Between Baseline and Week 16: S-TRLP | S-TRLP is a marker of lipid function and metabolism. | After the completion of week 16 visit by all study participants. | 
| Changes in Cardiometabolic Markers Between Baseline and Week 16: M-TRLP | M-TRLP is a marker of lipid function and metabolism. | After the completion of week 16 visit by all study participants. | 
| Changes in Cardiometabolic Markers Between Baseline and Week 16: L-TRLP | L-TRLP is a marker of lipid function and metabolism. | After the completion of week 16 visit by all study participants. | 
| Changes in Cardiometabolic Markers Between Baseline and Week 16: VL-TRLP | VL-TRLP is a marker of lipid function and metabolism. | After the completion of week 16 visit by all study participants. | 
| Changes in Cardiometabolic Markers Between Baseline and Week 16: Insulin | Insulin is a marker of glucose metabolism. | After the completion of week 16 visit by all study participants. | 
| Changes in Cardiometabolic Markers Between Baseline and Week 16: Homeostasis Model Assessment of Insulin Resistance (HOMA-IR) | HOMA-IR is a marker of glucose metabolism. HOMA-IR, a method used to quantify insulin resistance and beta-cell function, is expressed using fasting blood glucose and insulin levels. It is calculated using the formula (HOMA-IR = fasting glucose [mg/dl] * fasting insulin [mU/ml]/405). | After the completion of week 16 visit by all study participants. | 
| Changes in Cardiometabolic Markers Between Baseline and Week 16: Glucose | Glucose is a marker of metabolism. | After the completion of week 16 visit by all study participants. | 
| Changes in Cardiometabolic Markers Between Baseline and Week 16: Diabetes Risk Index (DRI) | DRI is a marker of glucose metabolism. DRI is a nuclear magnetic resonance spectroscopy (NMR)-derived multimarker score (values 1-100) that predicts a patient's risk of developing type 2 diabetes mellitus (T2D) independent of glycemic status. DRI derives its performance from the weighted addition of the Lipoprotein Insulin Resistance Index (LP-IR) scores with simultaneously-measured levels of branched-chain amino acids (BCAA). Higher scores indicate greater risk. | After the completion of week 16 visit by all study participants. | 
| Changes in Cardiometabolic Markers Between Baseline and Week 16: Lipoprotein Insulin Resistance Index (LP-IR) | LP-IR is a marker of glucose metabolism. LP-IR is a marker of insulin resistance, and as such the LP-IR score predicts a patient's likelihood of future development of type 2 diabetes. LP-IR is a multimarker index (values 0-100) based on the concentrations of particular lipoprotein subclasses. Greater score indicates higher likelihood of developing diabetes. | After the completion of week 16 visit by all study participants. | 
| Changes in Cardiometabolic Markers Between Baseline and Week 16: Leptin | Leptin is a marker of adipose dysfunction and general metabolism. | After the completion of week 16 visit by all study participants. | 
| Changes in Cardiometabolic Markers Between Baseline and Week 16: Adiponectin | Adiponectin is a marker of adipose dysfunction and general metabolism. | After the completion of week 16 visit by all study participants. | 
| Changes in Cardiometabolic Markers Between Baseline and Week 16: Fetuin A | Fetuin A is a marker of adipose dysfunction and general metabolism. | After the completion of week 16 visit by all study participants. | 
| Changes in Cardiometabolic Markers Between Baseline and Week 16: Citrate | Citrate is a marker of adipose dysfunction and general metabolism. | After the completion of week 16 visit by all study participants. | 
| Changes in Cardiometabolic Markers Between Baseline and Week 16: Valine | Valine is a marker of adipose dysfunction and general metabolism. | After the completion of week 16 visit by all study participants. | 
| Changes in Cardiometabolic Markers Between Baseline and Week 16: Leucine | Leucine is a marker of adipose dysfunction and general metabolism. | After the completion of week 16 visit by all study participants. | 
| Changes in Cardiometabolic Markers Between Baseline and Week 16: Isoleucine | Isoleucine is a marker of adipose dysfunction and general metabolism. | After the completion of week 16 visit by all study participants. | 
| Changes in Cardiometabolic Markers Between Baseline and Week 16: Alanine | Alanine is a marker of adipose dysfunction and general metabolism. | After the completion of week 16 visit by all study participants. | 
| Changes in Cardiometabolic Markers Between Baseline and Week 16: BCAA | Branched-chain amino acids (BCAA) is a marker of adipose dysfunction and general metabolism. | After the completion of week 16 visit by all study participants. | 
| Changes in Cardiometabolic Markers Between Baseline and Week 16: Ketone Bodies | Ketone Bodies are markers of adipose dysfunction and general metabolism. | After the completion of week 16 visit by all study participants. | 
| Changes in Cardiometabolic Markers Between Baseline and Week 16: Beta Hydroxybutyrate | Beta Hydroxybutyrate is a marker of adipose dysfunction and general metabolism. | After the completion of week 16 visit by all study participants. | 
| Changes in Cardiometabolic Markers Between Baseline and Week 16: Acetoacetic Acid | Acetoacetic Acid is a marker of adipose dysfunction and general metabolism. | After the completion of week 16 visit by all study participants. | 
| Changes in Cardiometabolic Markers Between Baseline and Week 16: Acetone | Acetone is a marker of adipose dysfunction and general metabolism. | After the completion of week 16 visit by all study participants. | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Changes in Body Composition as Measured by FDG-PET/CT Between Week 52 and and Earlier Time Points (Baseline and Week 16): Visceral Adipose Tissue | Secondary analysis will consist of comparisons of change in body composition between weeks 52, 16, and baseline. Visceral adipose tissue quantification using a single CT slice at the level of the umbilicus using computer-assisted tissue segmentation (Pescatori LC et al. Quantification of visceral adipose tissue by computed tomography and magnetic resonance imaging: reproducibility and accuracy. Radiol Bras. 2019 15(1):1-6.). The values represent the cross-sectional area of the tissue segmented on the CT slice (cm^2); higher values indicate greater amount of visceral adipose tissue. | After the completion of week 52 visit by all study participants. | 
| Changes in Body Composition as Measured by FDG-PET/CT Between Week 52 and and Earlier Time Points (Baseline and Week 16): Subcutaneous Adipose Tissue | Secondary analysis will consist of comparisons of change in body composition between weeks 52, 16, and baseline. Subcutaneous adipose tissue quantification using a single CT slice at the level of the umbilicus using computer-assisted tissue segmentation (Pescatori LC et al. Quantification of visceral adipose tissue by computed tomography and magnetic resonance imaging: reproducibility and accuracy. Radiol Bras. 2019 15(1):1-6.). The values represent the cross-sectional area of the tissue segmented on the CT slice (cm^2); higher values indicate greater amount of subcutaneous adipose tissue. | After the completion of week 52 visit by all study participants. | 
| Changes in Physician Reported Outcomes: Psoriasis Area and Severity Index (PASI) | Secondary analysis will consist of comparisons of change in PASI scores. PASI is the most widely used tool for the measurement of severity of psoriasis. PASI combines the assessment of the severity of lesions and the area affected into a single score in the range 0 (no disease) to 72 (maximal disease). | Baseline, week 16, and week 52. | 
| Changes in Physician Reported Outcomes: Physician Global Assessment (PGA) | Secondary analysis will consist of comparisons of change in PGA scores. Physician Global Assessment (PGA) is calculated by averaging three subcomponent scores (induration, erythema, and scaling) that are graded from 0 (no involvement) to 5 (maximum involvement) that are averaged over all psoriatic lesions. Higher scores indicate greater disease burden. | Baseline, week 16, and week 52. | 
| Changes in Patient Reported Outcomes: Dermatology Life Quality Index (DLQI) | Secondary analysis will consist of comparisons of change in DLQI scores. DLQI is a ten-question questionnaire used to measure the impact of skin disease on the quality of life of an affected person. The score ranges from 0 to 30; 0-1 = No effect on patient's life, 2-5 = Small effect, 6-10 = Moderate effect, 11-20 = Very large effect, 21-30 = Extremely large effect. | Baseline, week 16, and week 52. | 
| Changes in Patient Reported Outcomes: Pruritis by Visual Analog Scales (VAS) | Secondary analysis will consist of comparisons of change in Pruritus VAS scores. A visual analogue scale for pruritus (itch), ranging from 0 (no itch) to 100 (worst imaginable itch). | Baseline, week 16, and week 52. | 
| Change in Vascular Inflammation of the Five Aortic Segments as Measured by FDG-PET/CT Between Week 52, 16, and Baseline. | Secondary analysis will consist of comparisons of vascular inflammation of the five aortic segments using TBR between week 52, 16, and baseline. | After the completion of week 52 visit by all study participants. | 
| Change in Total Vascular Inflammation of the Aorta as Measured by FDG-PET/CT Between Week 52 and Earlier Time Points. | Secondary analysis will consist of comparisons of total vascular inflammation of the aorta using TBR between week 52, 16, and baseline. | After the completion of week 52 visit by all study participants. | 
| Changes in Cardiometabolic Markers Between Week 52 and Earlier Time Points (Baseline and Week 16): Ferritin | Ferritin is a marker of inflammation. | After the completion of week 52 visit by all study participants. | 
| Changes in Cardiometabolic Markers Between Week 52 and Earlier Time Points (Baseline and Week 16): CRP | CRP is a marker of inflammation. | After the completion of week 52 visit by all study participants. | 
| Changes in Cardiometabolic Markers Between Week 52 and Earlier Time Points (Baseline and Week 16): ICAM-1 | ICAM-1 is a marker of inflammation. | After the completion of week 52 visit by all study participants. | 
| Changes in Cardiometabolic Markers Between Week 52 and Earlier Time Points (Baseline and Week 16): SAA | SAA is a marker of inflammation. | After the completion of week 52 visit by all study participants. | 
| Changes in Cardiometabolic Markers Between Week 52 and Earlier Time Points (Baseline and Week 16): VCAM-1 | VCAM-1 is a marker of inflammation. | After the completion of week 52 visit by all study participants. | 
| Changes in Cardiometabolic Markers Between Week 52 and Earlier Time Points (Baseline and Week 16): IFN-gamma | IFN-gamma is a marker of inflammation. | After the completion of week 52 visit by all study participants. | 
| Changes in Cardiometabolic Markers Between Week 52 and Earlier Time Points (Baseline and Week 16): IL-1b | IL-1b is a marker of inflammation. | After the completion of week 52 visit by all study participants. | 
| Changes in Cardiometabolic Markers Between Week 52 and Earlier Time Points (Baseline and Week 16): IL-10 | IL-10 is a marker of inflammation. | After the completion of week 52 visit by all study participants. | 
| Changes in Cardiometabolic Markers Between Week 52 and Earlier Time Points (Baseline and Week 16): IL-17A | IL-17A is a marker of inflammation. | After the completion of week 52 visit by all study participants. | 
| Changes in Cardiometabolic Markers Between Week 52 and Earlier Time Points (Baseline and Week 16): IL-6 | IL-6 is a marker of inflammation. | After the completion of week 52 visit by all study participants. | 
| Changes in Cardiometabolic Markers Between Week 52 and Earlier Time Points (Baseline and Week 16): IL-8 | IL-8 is a marker of inflammation. | After the completion of week 52 visit by all study participants. | 
| Changes in Cardiometabolic Markers Between Week 52 and Earlier Time Points (Baseline and Week 16): IL-9 | IL-9 is a marker of inflammation. | After the completion of week 52 visit by all study participants. | 
| Changes in Cardiometabolic Markers Between Week 52 and Earlier Time Points (Baseline and Week 16): MCP-1 | MCP-1 is a marker of inflammation. | After the completion of week 52 visit by all study participants. | 
| Changes in Cardiometabolic Markers Between Week 52 and Earlier Time Points (Baseline and Week 16): TNF-alpha | TNF-alpha is a marker of inflammation. | After the completion of week 52 visit by all study participants. | 
| Changes in Cardiometabolic Markers Between Week 52 and Earlier Time Points (Baseline and Week 16): IL2RA | IL2RA is a marker of inflammation. | After the completion of week 52 visit by all study participants. | 
| Changes in Cardiometabolic Markers Between Week 52 and Earlier Time Points (Baseline and Week 16): GlycA | GlycA is a marker of inflammation. | After the completion of week 52 visit by all study participants. | 
| Changes in Cardiometabolic Markers Between Week 52 and Earlier Time Points (Baseline and Week 16): Cholesterol Efflux Capacity | Cholesterol Efflux Capacity is a marker of lipid function and metabolism. The ability to promote cholesterol efflux from macrophages is a classic function of HDL that is thought to be an important mechanism by which HDL protects against atherosclerosis. HDL cholesterol efflux capacity assays are performed based on published methods using J774 cells derived from a murine macrophage cell line (Mehta NN Atherosclerosis 2012). Efflux is calculated as a unitless measure by using the following formula: [(µCi of 3H-cholesterol in media containing apoB-depleted subject plasma - µCi of 3H-cholesterol in plasma-free media) / (µCi of 3H-cholesterol in media containing apoB-depleted pooled control plasma-µCi of 3H-cholesterol in pooled control plasma-free media)]. Cholesterol efflux capacity is inversely correlated with incidence of cardiovascular events (i.e. higher cholesterol efflux capacity is better for patients). | After the completion of week 52 visit by all study participants. | 
| Changes in Cardiometabolic Markers Between Week 52 and Earlier Time Points (Baseline and Week 16): Triglyceride | Triglyceride is a marker of lipid function and metabolism. | After the completion of week 52 visit by all study participants. | 
| Changes in Cardiometabolic Markers Between Week 52 and Earlier Time Points (Baseline and Week 16): Total Cholesterol | Total Cholesterol is a marker of lipid function and metabolism. | After the completion of week 52 visit by all study participants. | 
| Changes in Cardiometabolic Markers Between Week 52 and Earlier Time Points (Baseline and Week 16): HDL-C | HDL-C is a marker of lipid function and metabolism. | After the completion of week 52 visit by all study participants. | 
| Changes in Cardiometabolic Markers Between Week 52 and Earlier Time Points (Baseline and Week 16): HDL-P | HDL-P is a marker of lipid function and metabolism. | After the completion of week 52 visit by all study participants. | 
| Changes in Cardiometabolic Markers Between Week 52 and Earlier Time Points (Baseline and Week 16): HDL-Z | HDL-Z is a marker of lipid function and metabolism. | After the completion of week 52 visit by all study participants. | 
| Changes in Cardiometabolic Markers Between Week 52 and Earlier Time Points (Baseline and Week 16): S-HDL-P | S-HDL-P is a marker of lipid function and metabolism. | After the completion of week 52 visit by all study participants. | 
| Changes in Cardiometabolic Markers Between Week 52 and Earlier Time Points (Baseline and Week 16): M-HDL-P | M-HDL-P is a marker of lipid function and metabolism. | After the completion of week 52 visit by all study participants. | 
| Changes in Cardiometabolic Markers Between Week 52 and Earlier Time Points (Baseline and Week 16): LM-HDL-P | LM-HDL-P is a marker of lipid function and metabolism. | After the completion of week 52 visit by all study participants. | 
| Changes in Cardiometabolic Markers Between Week 52 and Earlier Time Points (Baseline and Week 16): L-HDL-P | L-HDL-P is a marker of lipid function and metabolism. | After the completion of week 52 visit by all study participants. | 
| Changes in Cardiometabolic Markers Between Week 52 and Earlier Time Points (Baseline and Week 16): LDL-C | LDL-C is a marker of lipid function and metabolism. | After the completion of week 52 visit by all study participants. | 
| Changes in Cardiometabolic Markers Between Week 52 and Earlier Time Points (Baseline and Week 16): LDL-P | LDL-P is a marker of lipid function and metabolism. | After the completion of week 52 visit by all study participants. | 
| Changes in Cardiometabolic Markers Between Week 52 and Earlier Time Points (Baseline and Week 16): LDL-Z | LDL-Z is a marker of lipid function and metabolism. | After the completion of week 52 visit by all study participants. | 
| Changes in Cardiometabolic Markers Between Week 52 and Earlier Time Points (Baseline and Week 16): S-LDL-P | S-LDL-P is a marker of lipid function and metabolism. | After the completion of week 52 visit by all study participants. | 
| Changes in Cardiometabolic Markers Between Week 52 and Earlier Time Points (Baseline and Week 16): L-LDL-P | L-LDL-P is a marker of lipid function and metabolism. | After the completion of week 52 visit by all study participants. | 
| Changes in Cardiometabolic Markers Between Week 52 and Earlier Time Points (Baseline and Week 16): VL-LDL-P | VL-LDL-P is a marker of lipid function and metabolism. | After the completion of week 52 visit by all study participants. | 
| Changes in Cardiometabolic Markers Between Week 52 and Earlier Time Points (Baseline and Week 16): VLDL-P | VLDL-P is a marker of lipid function and metabolism. | After the completion of week 52 visit by all study participants. | 
| Changes in Cardiometabolic Markers Between Week 52 and Earlier Time Points (Baseline and Week 16): VLDL-Z | VLDL-Z is a marker of lipid function and metabolism. | After the completion of week 52 visit by all study participants. | 
| Changes in Cardiometabolic Markers Between Week 52 and Earlier Time Points (Baseline and Week 16): VLDL-TG | VLDL-TG is a marker of lipid function and metabolism. | After the completion of week 52 visit by all study participants. | 
| Changes in Cardiometabolic Markers Between Week 52 and Earlier Time Points (Baseline and Week 16): S-VLDL-P | S-VLDL-P is a marker of lipid function and metabolism. | After the completion of week 52 visit by all study participants. | 
| Changes in Cardiometabolic Markers Between Week 52 and Earlier Time Points (Baseline and Week 16): M-VLDL-P | M-VLDL-P is a marker of lipid function and metabolism. | After the completion of week 52 visit by all study participants. | 
| Changes in Cardiometabolic Markers Between Week 52 and Earlier Time Points (Baseline and Week 16): LM-VLDL-P | LM-VLDL-P is a marker of lipid function and metabolism. | After the completion of week 52 visit by all study participants. | 
| Changes in Cardiometabolic Markers Between Week 52 and Earlier Time Points (Baseline and Week 16): L-VLDL-P | L-VLDL-P is a marker of lipid function and metabolism. | After the completion of week 52 visit by all study participants. | 
| Changes in Cardiometabolic Markers Between Week 52 and Earlier Time Points (Baseline and Week 16): IDL-P | IDL-P is a marker of lipid function and metabolism. | After the completion of week 52 visit by all study participants. | 
| Changes in Cardiometabolic Markers Between Week 52 and Earlier Time Points (Baseline and Week 16): ApoA1 | ApoA1 is a marker of lipid function and metabolism. | After the completion of week 52 visit by all study participants. | 
| Changes in Cardiometabolic Markers Between Week 52 and Earlier Time Points (Baseline and Week 16): ApoB | ApoB is a marker of lipid function and metabolism. | After the completion of week 52 visit by all study participants. | 
| Changes in Cardiometabolic Markers Between Week 52 and Earlier Time Points (Baseline and Week 16): TRLTG | TRLTG is a marker of lipid function and metabolism. | After the completion of week 52 visit by all study participants. | 
| Changes in Cardiometabolic Markers Between Week 52 and Earlier Time Points (Baseline and Week 16): TRLC | TRLC is a marker of lipid function and metabolism. | After the completion of week 52 visit by all study participants. | 
| Changes in Cardiometabolic Markers Between Week 52 and Earlier Time Points (Baseline and Week 16): TRLP | TRLP is a marker of lipid function and metabolism. | After the completion of week 52 visit by all study participants. | 
| Changes in Cardiometabolic Markers Between Week 52 and Earlier Time Points (Baseline and Week 16): VS-TRLP | VS-TRLP is a marker of lipid function and metabolism. | After the completion of week 52 visit by all study participants. | 
| Changes in Cardiometabolic Markers Between Week 52 and Earlier Time Points (Baseline and Week 16): S-TRLP | S-TRLP is a marker of lipid function and metabolism. | After the completion of week 52 visit by all study participants. | 
| Changes in Cardiometabolic Markers Between Week 52 and Earlier Time Points (Baseline and Week 16): M-TRLP | M-TRLP is a marker of lipid function and metabolism. | After the completion of week 52 visit by all study participants. | 
| Changes in Cardiometabolic Markers Between Week 52 and Earlier Time Points (Baseline and Week 16): L-TRLP | L-TRLP is a marker of lipid function and metabolism. | After the completion of week 52 visit by all study participants. | 
| Changes in Cardiometabolic Markers Between Week 52 and Earlier Time Points (Baseline and Week 16): VL-TRLP | VL-TRLP is a marker of lipid function and metabolism. | After the completion of week 52 visit by all study participants. | 
| Changes in Cardiometabolic Markers Between Week 52 and Earlier Time Points (Baseline and Week 16): Insulin | Insulin is a marker of glucose metabolism. | After the completion of week 52 visit by all study participants. | 
| Changes in Cardiometabolic Markers Between Week 52 and Earlier Time Points (Baseline and Week 16): HOMA-IR | HOMA-IR is a marker of glucose metabolism. HOMA-IR, a method used to quantify insulin resistance and beta-cell function, is expressed using fasting blood glucose and insulin levels. It is calculated using the formula (HOMA-IR = fasting glucose [mg/dl] * fasting insulin [mU/ml]/405). | After the completion of week 52 visit by all study participants. | 
| Changes in Cardiometabolic Markers Between Week 52 and Earlier Time Points (Baseline and Week 16): Glucose | Glucose is a marker of glucose metabolism. | After the completion of week 52 visit by all study participants. | 
| Changes in Cardiometabolic Markers Between Week 52 and Earlier Time Points (Baseline and Week 16): DRI | DRI is a marker of glucose metabolism. DRI is a nuclear magnetic resonance spectroscopy (NMR)-derived multimarker score (values 1-100) that predicts a patient's risk of developing type 2 diabetes mellitus (T2D) independent of glycemic status. DRI derives its performance from the weighted addition of the Lipoprotein Insulin Resistance Index (LP-IR) scores with simultaneously-measured levels of branched-chain amino acids (BCAA). Higher scores indicate greater risk. | After the completion of week 52 visit by all study participants. | 
| Changes in Cardiometabolic Markers Between Week 52 and Earlier Time Points (Baseline and Week 16): LP-IR | LP-IR is a marker of glucose metabolism. LP-IR is a marker of insulin resistance, and as such the LP-IR score predicts a patient's likelihood of future development of type 2 diabetes. LP-IR is a multimarker index (values 0-100) based on the concentrations of particular lipoprotein subclasses. Greater score indicates higher likelihood of developing diabetes. | After the completion of week 52 visit by all study participants. | 
| Changes in Cardiometabolic Markers Between Week 52 and Earlier Time Points (Baseline and Week 16): Leptin | Leptin is a marker of adipose dysfunction and general metabolism. | After the completion of week 52 visit by all study participants. | 
| Changes in Cardiometabolic Markers Between Week 52 and Earlier Time Points (Baseline and Week 16): Adiponectin | Adiponectin is a marker of adipose dysfunction and general metabolism. | After the completion of week 52 visit by all study participants. | 
| Changes in Cardiometabolic Markers Between Week 52 and Earlier Time Points (Baseline and Week 16): Fetuin A | Fetuin A is a marker of adipose dysfunction and general metabolism. | After the completion of week 52 visit by all study participants. | 
| Changes in Cardiometabolic Markers Between Week 52 and Earlier Time Points (Baseline and Week 16): Citrate | Citrate is a marker of adipose dysfunction and general metabolism. | After the completion of week 52 visit by all study participants. | 
| Changes in Cardiometabolic Markers Between Week 52 and Earlier Time Points (Baseline and Week 16): Valine | Valine is a marker of adipose dysfunction and general metabolism. | After the completion of week 52 visit by all study participants. | 
| Changes in Cardiometabolic Markers Between Week 52 and Earlier Time Points (Baseline and Week 16): Leucine | Leucine is a marker of adipose dysfunction and general metabolism. | After the completion of week 52 visit by all study participants. | 
| Changes in Cardiometabolic Markers Between Week 52 and Earlier Time Points (Baseline and Week 16): Isoleucine | Isoleucine is a marker of adipose dysfunction and general metabolism. | After the completion of week 52 visit by all study participants. | 
| Changes in Cardiometabolic Markers Between Week 52 and Earlier Time Points (Baseline and Week 16): Alanine | Alanine is a marker of adipose dysfunction and general metabolism. | After the completion of week 52 visit by all study participants. | 
| Changes in Cardiometabolic Markers Between Week 52 and Earlier Time Points (Baseline and Week 16): BCAA | BCAA is a marker of adipose dysfunction and general metabolism. | After the completion of week 52 visit by all study participants. | 
| Changes in Cardiometabolic Markers Between Week 52 and Earlier Time Points (Baseline and Week 16): Ketone Bodies | Ketone Bodies are markers of adipose dysfunction and general metabolism. | After the completion of week 52 visit by all study participants. | 
| Changes in Cardiometabolic Markers Between Week 52 and Earlier Time Points (Baseline and Week 16): Beta Hydroxybutyrate | Beta Hydroxybutyrate is a marker of adipose dysfunction and general metabolism. | After the completion of week 52 visit by all study participants. | 
| Changes in Cardiometabolic Markers Between Week 52 and Earlier Time Points (Baseline and Week 16): Acetoacetic Acid | Acetoacetic Acid is a marker of adipose dysfunction and general metabolism. | After the completion of week 52 visit by all study participants. | 
| Changes in Cardiometabolic Markers Between Week 52 and Earlier Time Points (Baseline and Week 16): Acetone | Acetone is a marker of adipose dysfunction and general metabolism. | After the completion of week 52 visit by all study participants. |