Blood Cell Biomarkers of Inflammation and Cytokine Levels as Predictors of Response to Biologics in Patients with Psoriasis

Abstract

For people with psoriasis, biomarkers aiding in the personalization of treatment with biologics are needed. We examined the usefulness of several biomarkers of inflammation in this respect. The neutrophil-to-lymphocyte ratio (NLR), the platelet-to-lymphocyte ratio (PLR), and the systemic immune–inflammation index (SII) were measured in patients with psoriasis initiating TNF-α inhibitors (n = 131), IL-17/IL-17R inhibitors (n = 65), or IL-23/IL-12/23 inhibitors (n = 50). The blood levels of tumor necrosis factor (TNF)-α, interleukin (IL)-1β, interferon (IFN)-γ, IL-17A, IL-6, soluble IL-6 receptor (sIL-6R), and soluble IL-6 signal transducer (sIL-6ST) were measured in patients initiating adalimumab (n = 62) or IL-17/IL-17R inhibitors (n = 24). Treatment response was defined by a psoriasis area and severity index (PASI) ≤ 2 three months after treatment initiation. Responders to TNF-α inhibitors had a lower NLR at baseline than non-responders (median and interquartile range (IQR) 2.15 (1.67–2.86) vs. 2.54 (1.88–3.55); p = 0.04). Responders to treatment with adalimumab had lower IL-6 levels at baseline than non-responders (0.99 (0.42–1.4) vs. 1.62 (0.96–2.41) pg/mL; p = 0.02). For the majority of patients, the IL-17A, IL-1β, and IFN-γ levels were below quantification limits. NLR and IL-6 may serve as predictive biomarkers of treatment response to TNF-α inhibitor therapy in patients with psoriasis.

The Unknown Role of Periostin in Psoriatic Epidermal Hyperplasia

“…In the study, we demonstrated that the concentrations of IL-6, IL-17, IL-22, TNF-α and IFN-γ were statistically significantly higher in the group of patients with psoriasis compared to the healthy group. Similar results have been also confirmed in other scientific studies [11][12][13]. Furthermore, we confirmed increasing concentrations of these cytokines with the severity of psoriasis, as expressed by the PASI score.…”

“…Immune cells release pro-inflammatory cytokines such as TNF-α, IFN-γ and IL-1β, which, in turn, facilitate the activation of myeloid dendritic cells. These cells release IL-12 and IL-23, which are key cytokines for the differentiation of naive T cells into Th1, Th22 and Th17 cells [10,11]. In patients with psoriasis, increased activity of Th17 and Th22 cells has been confirmed compared to the healthy group.…”

Positive association between insulin resistance and fatty liver disease in psoriasis: evidence from a cross-sectional study

“…Previous studies have demonstrated the effectiveness of SII, NLR, and dNLR in evaluating the severity of psoriasis disease activity and treatment effectiveness ( 28 , 29 ). Some studies also have indicated their association with liver steatosis and NAFLD.…”

Plasma Cytokines for Prediction of the Effectiveness of TNFα Inhibitors Etanercept, Infliximab, and Adalimumab in the Treatment of Psoriasis

“…In a study by Andersen et al, it was shown that in patients who responded to treatment with adalimumab, the initial level of IL6 in the blood was lower than in those who did not respond (0.99 (0.42-1.4) vs 1.62 (0.96-2.41) pg/ml; p = 0.02). Therefore, the authors concluded that IL6 can serve as a perspective marker to predict the response to TNFα inhibitors in 2 psoriasis [10]. Meanwhile, the authors noted that IL17A, IL1β and IFNγ concentrations were below the quantification limits in most cases [10].…”

“…Therefore, the authors concluded that IL6 can serve as a perspective marker to predict the response to TNFα inhibitors in 2 psoriasis [10]. Meanwhile, the authors noted that IL17A, IL1β and IFNγ concentrations were below the quantification limits in most cases [10]. This fact intricates the use of cytokines as prognostic markers.…”