OMEGA-3 FATTY ACID-BASED LIPID INFUSION IN PATIENTS WITH CHRONIC PLAQUE PSORIASIS - RESULTS OF A DOUBLE-BLIND, RANDOMIZED, PLACEBO-CONTROLLED, MULTICENTER TRIAL

Background: Profound changes in the metabolism of eicosanoids with inc reased concentrations of free arachidonic acid (AA) and its proinflamm atory metabolites have been observed in psoriatic lesions. Free eicosa pentaenoic acid (EPA) may compete with Liberated AA and result in an a ntiinflammatory effect. Objective: Our purpose was to assess the effic acy and safety of intravenously administered fish-oil-derived lipid em ulsion on chronic plaque-type psoriasis.Methods: A double-blind, rando mized, parallel group study was performed in eight European centers. E ighty-three patients hospitalized for chronic plaque-type psoriasis wi th a severity score of at least 15 according to the Psoriasis Area and Severity Index (PASI) participated in a 14-day trial. They were rando mly allocated to receive daily infusions with either a omega-3 fatty a cid-based lipid emulsion (Omegavenous; 200 ml/day with 4.2 gm of both EPA and docosahexaenoic acid (DHA); 43 patients) or a conventional ome ga-6-lipid emulsion (Lipovenous; EPA+DHA < 0.1 gm/100 ml; 40 patients) . The groups were well matched with respect to demographic data and ps oriasis-specific medical history. Efficacy of therapy was evaluated by changes in PASI, in an overall assessment of psoriasis by the investi gator, and a self-assessment by the patient. In one center neutrophil 4- versus 5-series leukotriene (LT) generation and platelet 2- versus 3-thromboxane generation were investigated and plasma-free fatty acids were determined. Results: The total PASI score decreased by 11.2 +/- 9.8 in the omega-3 group and by 7.5 +/- 8.8 in the omega-6 group (p = 0.048). In addition, the omega-3 group was superior to the omega-6 gro up with respect to change in severity of psoriasis per body area, chan ge in overall erythema, overall scaling and overall infiltration, as w ell as change in overall assessment by the investigator and self-asses sment by the patient. Response (defined as decrease in total PASI of a t least 50% between admission and last value) was seen in 16 of 43 pat ients (37%) receiving the omega-3 emulsion and 9 of 40 patients (23%) receiving omega-6 fatty acid-based lipid emulsion. No serious side eff ects were observed. Within the first few days of omega-3 lipid adminis tration, but not in the omega-6 supplemented patients, a manifold incr ease in plasma-free EPA concentration, neutrophil leukotriene B-5 and platelet thromboxane B-3 generation occurred. Conclusion: Intravenous omega-3-fatty acid administration is effective in the treatment of chr onic plaque-type psoriasis. This effect may be related to changes in i nflammatory eicosanoid generation.