Beyond Psoriasis Skin Clearance: Effects of Bimekizumab and Tildrakizumab on Systemic Inflammation and Immune-Nutrition Status

Background/Objectives: Psoriasis is a chronic immune-mediated inflammatory disease associated with a high systemic burden. Inhibition of the IL-23/IL-17 axis is the cornerstone of therapy, although the evaluation of immune-nutritional status in the assessment of psoriatic disease-associated comorbidities is an equally crucial topic. The aim of the study was to document the efficacy, safety and systemic impact of Bimekizumab and Tildrakizumab in patients with chronic plaque psoriasis by analyzing clinimetric indices, atherogenic risk, and immune-nutritional markers. Methods: This was a descriptive real-world clinical study, including 52 psoriasis patients treated with Bimekizumab or Tildrakizumab, who were followed for 52 weeks. In particular, we analyzed the clinimetric (evaluated by PASI and DLQI) and inflammatory (CRP, ESR, NLR, PLR, and LMR ratios; SII) indices, atherogenic risk (by evaluating the lipid profile), and immuno-nutritional markers (HALP score and CONUT score). Assessments were performed at baseline and after 52 weeks. Results: Both treatments led to a significant reduction in the PASI at week 52. The systemic inflammatory marker CRP decreased in both groups. A trend of reduction from baseline to week 52 was reported for both the NLR and PLR. Conversely, a trend of increase was reported for the LMR. The HALP index increased significantly in the Bimekizumab group but not in the Tildrakizumab group, while the CONUT score was significantly lower, suggesting an improvement in the immune-nutritional status. Conclusion: In conclusion, the integrated assessment of hematological ratios, inflammatory indices and immune-nutritional markers provides clinically useful information for a more complete and personalized management of psoriatic patients.