Role of integrated hematological biomarkers of systemic inflammation in assessing the effectiveness of anticytokine therapy in patients with psoriasis

Background: Integrated hematological indices are accessible, cost-effective, and objective parameters for monitoring psoriatic inflammation both in everyday clinical practice and scientific research. Aim: The work aimed to study the effect of anticytokine therapy with an IL-17A inhibitor on NLR, PLR, MLR, SII, and SIRI indices in patients with psoriasis of varying severity. Methods: All patients enrolled in the study had systemic inflammation indices (SIRI, MLR, NLR, SII, PLR, and AISI) calculated before treatment and 6 months after therapy with the IL-17A inhibitor (netakimab). The Psoriasis Area and Severity Index (PASI) was used to assess lesion area and severity of skin involvement. Results: The main group included 77 patients with psoriasis: 33 women (42.9%) and 44 men (57.1%), mean age 41.3 ± 13.4 years, mean PASI 10.8 (3.2; 15.3). Of these, 58 patients (75.4%) had only cutaneous manifestations, and 19 (24.6%) had psoriatic arthritis. In accordance with the clinical guidelines of the Ministry of Health of the Russian Federation for the treatment of patients with psoriasis and psoriatic arthritis, a subgroup of patients receiving IL-17A inhibitor therapy was identified. Subgroup 1 included 20 patients with moderate-to-severe psoriasis, and subgroup 2 included 19 patients with psoriatic arthritis. The total observation period was 10 months. No adverse reactions or complications were observed. Almost complete skin clearance (PASI 75) was observed in all patients of the study group 6 months after initiation of therapy. Different diagnostic trends were observed during treatment with netakimab when analyzing SIRI, MLR, NLR, SII, PLR, and AISI in patients of both subgroups. In patients with psoriatic arthritis, MLR, NLR, and PLR indices showed no statistically significant changes during the treatment. SIRI demonstrated significant changes in both subgroups, whereas AISI was significant only in patients with moderate-to-severe psoriasis. The systemic inflammation index SII proved to be less sensitive and demonstrated changes only in patients with skin manifestations of psoriasis (p = 0.030). Conclusion: Integrated hematological indices of systemic inflammation are promising tools for evaluating the effectiveness of anticytokine therapy in patients with severe psoriasis. NLR, MLR, SII, and AISI can be applied to evaluate the decrease in systemic inflammation exclusively during therapy in patients with cutaneous manifestations of psoriasis, whereas SIRI proved to be effective in both patients with cutaneous psoriasis and those with psoriatic arthritis.