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

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-a 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)-alpha, interleukin (IL)-1 beta, interferon (IFN)-alpha, 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-a 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-1 beta, and IFN-alpha levels were below quantification limits. NLR and IL-6 may serve as predictive biomarkers of treatment response to TNF-alpha inhibitor therapy in patients with psoriasis.

Automated summary

This study examined the usefulness of various inflammation biomarkers in personalizing biologic treatment for psoriasis patients. It was found that the neutrophil-to-lymphocyte ratio (NLR) and interleukin-6 (IL-6) levels could serve as predictive biomarkers for treatment response to TNF-alpha inhibitor therapy. The study also measured other biomarkers such as TNF-alpha, IL-1 beta, IFN-alpha, IL-17A, IL-6, soluble IL-6 receptor (sIL-6R), and soluble IL-6 signal transducer (sIL-6ST) in different patient groups.