This study reveals the limitations of routine blood markers in monitoring the efficacy of IL-23 inhibitors, providing critical data support for clinical monitoring strategies in psoriasis and autoimmune diseases, and highlighting the need to explore more specific biomarkers.
Literature Overview
This article, titled "Long-Term Changes in Complete Blood Count-Derived Inflammatory Indices During Risankizumab Treatment for Psoriasis: A 208-Week Multicenter Real-World Study," published in the journal Antibodies, systematically explores the longitudinal changes in complete blood count-derived inflammatory indices, such as the neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR), during 208 weeks of risankizumab treatment for psoriasis, as well as their correlation with clinical skin scores.Background Knowledge
Pсориаз has been confirmed as a chronic systemic immune-mediated disease rather than a purely cutaneous disorder. Its pathogenesis involves persistent immune activation and is often associated with comorbidities such as psoriatic arthritis, cardiovascular disease, and metabolic syndrome. The IL-23/Th17 axis is a core driver of psoriatic inflammation. As a selective IL-23 inhibitor, risankizumab has significantly improved skin clearance rates in moderate-to-severe plaque psoriasis. However, traditional PASI scores primarily reflect visible skin lesions, are operator-dependent, and fail to comprehensively capture systemic inflammatory burden or the inflammatory background associated with comorbidities. Therefore, identifying low-cost, reproducible, and routinely available biomarkers to supplement clinical assessments during biologic therapy has become a research hotspot. Although previous studies indicate that indices such as NLR, PLR, and SII are elevated in psoriasis patients and correlate with disease severity, there remains significant controversy regarding their long-term dynamic changes during biologic treatment and their reliability as efficacy monitoring markers. This is particularly true given the scarcity of long-term real-world data focusing on single IL-23 inhibitors.
Research Methods and Experiments
This study was a multicenter retrospective real-world study (DERMIS) involving 250 adult psoriasis patients treated with risankizumab across 10 centers in Italy. The research team collected PASI scores and complete blood count data at baseline and at weeks 12, 24, 52, 104, 156, and 208 of treatment. Inflammatory indices including NLR, PLR, MLR, SII, and SIRI were calculated. Paired t-tests were used to analyze within-group changes, with Bonferroni correction applied for multiple comparisons. Sensitivity analyses based on follow-up duration (weeks 52, 104, and 208) were conducted to assess the impact of various subgroups (e.g., BMI, sex, comorbidities, prior biologic exposure) on the trajectory of inflammatory indices.Key Conclusions and Perspectives
Research Significance and Prospects
From a research perspective, this study indicates that the systemic inflammatory information captured by routine complete blood count-derived indices is not interchangeable with the clinical inflammatory activity captured by PASI. This finding holds significant implications for drug development and clinical monitoring: when evaluating the long-term efficacy of biologics such as IL-23 inhibitors, one should not over-rely on non-specific blood inflammatory ratios but should instead combine them with more specific molecular biomarkers or imaging modalities. Regarding disease modeling, future research must deeply explore why there is a dissociation between the resolution of cutaneous inflammation and the improvement of systemic blood markers. This may involve interference from non-psoriasis-specific inflammatory stimuli, such as infections, smoking, or metabolic factors.
Conclusion
Through 208 weeks of real-world data, this study challenges the traditional view of using routine complete blood count-derived inflammatory indices as markers for monitoring the efficacy of risankizumab in psoriasis treatment. Although PLR showed a certain downward trend, the fluctuation of most indices (such as NLR, SII, and SIRI) indicates that they are interfered with by various non-disease-specific factors and cannot accurately reflect the alleviation of systemic inflammation following IL-23 blockade. This finding serves as a cornerstone for the care systems of psoriasis and autoimmune diseases, suggesting that clinicians and researchers should interpret routine blood markers cautiously when formulating long-term treatment monitoring plans, avoiding their use as the sole basis for judging disease activity or treatment response. Future research should focus on developing more specific biomarkers to precisely capture the true changes in systemic inflammation, thereby optimizing individualized treatment strategies and improving patient outcomes.
