Effect of anti‐interleukin‐17 biologics on Krebs von den Lungen‐6 level in patients with psoriasis

Psoriasis is a chronic immune‐mediated inflammatory skin disease characterized by hyperproliferation of epidermal keratinocytes. Biologics have been available for the treatment of patients with refractory psoriasis since 2010 in Japan, and as of December 2021, 10 biologics were available. The Biologics Review Committee of the Japanese Dermatological Association for Psoriasis recommends blood examination tests for antinuclear antibodies (ANA), Krebs von den Lugen (KL)‐6, hepatitis B surface antigen (HBsAg), hepatitis B surface antibodies (HBsAb), hepatitis B core antibodies (HBcAb), hepatitis C virus (HCV) antibodies, HIV antibodies, human T‐cell leukemia virus (HTLV)‐1 antibodies, β‐D‐glucan, and the T‐cell spot (T‐SPOT) test before initiation of biologics at screening. In this study, we evaluated the use of biologics for 127 psoriasis patients and the blood examination screening data before initiation of biologics in the real‐world setting. Tumor necrosis factor inhibitors, interleukin (IL)‐17 inhibitors and IL‐23 inhibitors were initiated for 54 (42.5%), 36 (28.3%), and 37 (29.1%) patients, respectively. The numbers of patients positive for ANA, HBsAg, HBsAb, HBcAb, HCV antibody, HIV antibody, HTLV‐1 antibody, and T‐SPOT were 27 (21.3%), 0 (0%), 22 (17.3%), 20 (15.7%), three (2.4%), zero (0%), one (0.8%), and 4 (3.1%), respectively. The numbers of patients whose KL‐6 and β‐D‐glucan levels were higher than the reference values were seven (5.5%) and seven (5.5%), respectively. In the real‐world setting, it is sometimes unavoidable to use biologics for those patients with abnormal data although careful monitoring is necessary.

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“…Hara et al . reported that IL‐17 inhibitors decreased KL‐6 levels in a high‐baseline KL‐6 group regardless of recognizable IP 18 . Iwata et al .…”

Section: Discussionmentioning

confidence: 96%

“…16 Kurita et al showed that treatment with TNF inhibitor increased serum KL-6 levels but that they returned to baseline levels during 2 years of secukinumab treatment. 17 Hara 18 Iwata et al…”

Section: Discussionmentioning

confidence: 99%

Real‐world blood examination screening data before initiation of biologics for psoriasis patients

Ozaki

Ichiyama

Ito

et al. 2022

The Journal of Dermatology

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“…In contrast, ustekinumab did not increase serum KL-6 level 5,6 . Furthermore, IL-17 inhibitors, including secukinumab, decreased elevated or high baseline KL-6 levels in patients with psoriasis [9][10][11] . A recent follow-up study of biologics-including TNF inhibitors (infliximab and adalimumab), IL-17 inhibitors (secukinumab, ixekizumab, and brodalumab), and IL-23 inhibitors (ustekinumab and guselkumab)-found that neither IL-17 inhibitors nor IL-23 inhibitors significantly affected serum KL-6 level 12 .…”

Section: Introductionmentioning

confidence: 99%

Change in Serum KL-6 Level during Biologic Treatment for Psoriasis

et al. 2023

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Background: We previously analyzed data from blood examination screenings, including serum Krebs von den Lungen (KL)-6 level, before starting biologic treatment for psoriasis in a real-world setting. However, we did not follow change in KL-6 level after the initiation of biologics. Furthermore, there has been no follow-up study of certolizumab pegol, risankizumab, or tildrakizumab. This study evaluated change in serum KL-6 levels in patients during treatment with biologics, including certolizumab pegol, risankizumab, and tildrakizumab. Methods:We analyzed data from 111 patients. Change in KL-6 level was regarded as significant if it increased to greater than 500 U/mL at least once and if the maximum level after treatment with biologics was at least 1.5 times that of the baseline level.Results: KL-6 level significantly changed during treatment with TNF inhibitors, IL-17 inhibitors, and IL-23 inhibitors in 9 (20.9%), 2 (6.3%), and 2 (5.6%) patients, respectively. Mean age, mean baseline KL-6 level, and frequency of TNF inhibitor use were higher in patients with a significant change in KL-6 level than those in patients without a significant change. Ten patients had minor interstitial changes on chest CT scans but no clinical signs suggesting interstitial pneumonia.Conclusions: Older patients with psoriasis and high baseline KL-6 levels must be carefully monitored during treatment with biologics, especially TNF inhibitors. Monitoring of KL-6 level and chest CT scans is necessary to exclude the possibility of drug-induced interstitial pneumonia.

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