Effectiveness of Biological Therapy in Psoriasis: Real-World Evaluation of SII and SIRI as Biomarkers of Systemic Inflammation
Keywords:
psoriasis, Systemic Inflammation Response Index, Systemic Immune Inflammation Index, Biological drugsAbstract
Introduction: Psoriasis is a chronic inflammatory skin disease characterized by accelerated keratinocyte turnover and systemic inflammation mediated by an altered immune response. Biological drugs have significantly improved treatment outcomes in moderate to severe psoriasis. The Systemic Inflammation Response Index (SIRI) and the Systemic Immune-Inflammation Index (SII) have emerged as potential biomarkers for assessing systemic inflammation.
Objective: The primary objective of this study was to assess changes in SIRI and SII over six and 12 months across different biological therapies (TNF-α, IL-17, IL-12/23, and IL-23 inhibitors) in patients with moderate-to-severe psoriasis. Secondary objectives included evaluating the impact of sex and comorbidities (obesity, metabolic syndrome, or psoriatic arthritis) on inflammatory markers reduction.
Methods: A retrospective observational single-center study was conducted analyzing records from January 2010 to December 2024. Patients with moderate-to-severe psoriasis (PASI >10) and at least one comorbidity were included. The study excluded those with other chronic inflammatory diseases or immunosuppressive treatment.
Results: Among 98 patients, TNF-α and IL-17 inhibitors showed the greatest SII reduction, while TNF-α and IL-12/23 inhibitors had the most significant SIRI reduction. Males exhibited a greater reduction in both indices. Among comorbidities, obesity was associated with the most pronounced decrease in inflammatory indices, followed by metabolic syndrome and psoriatic arthritis, which showed significant but less marked reductions.
Conclusions: SII and SIRI may serve as valuable biomarkers for monitoring systemic inflammation in psoriasis patients undergoing biological therapy. Further studies are needed to validate their role in routine disease management.
References
Raharja A, Mahil SK, Barker JN. Psoriasis: A brief overview. Clin Med (Lond). 2021;21(3) :170-173. DOI: 10.7861/clinmed.2021-0257. PMID: 34001566.
Wu M, Dai C, Zeng F. Cellular Mechanisms of Psoriasis Pathogenesis: A Systemic Review. Clin Cosmet Investig Dermatol. 2023 Sep 14;16:2503-2515. DOI: 10.2147/CCID.S420850. PMID: 37727872.
Enamandram M, Kimball AB. Psoriasis epidemiology: The interplay of genes and the environment. J Invest Derm. 2013 Feb;133(2):287-9. DOI: 10.1038/jid.2012.434. PMID: 23318785.
Yamazaki F. Psoriasis: Comorbidities. J Dermatol. 2021;48(6):732-740. DOI:10.1111/1346-8138.15840. PMID: 33763899.
Honma M, Nozaki H. Molecular Pathogenesis of Psoriasis and Biomarkers Reflecting Disease Activity. J Clin Med. 2021;10(15):3199. DOI:10.3390/jcm10153199. PMID: 34361983.
Coates LC, Helliwell PS. Psoriatic arthritis: state of the art review. Clin Med (Lond). 2017;17(1):65-70. DOI:10.7861/clinmedicine.17-1-65. PMID: 28148584.
Azuaga AB, Ramírez J, Cañete JD. Psoriatic Arthritis: Pathogenesis and Targeted Therapies. Int J Mol Sci. 2023;24(5):4901. DOI:10.3390/ijms24054901. PMID: 36902329
Armstrong AW, Lin SW, Chambers CJ, Sockolov ME, Chin DL. Psoriasis and hypertension severity: results from a case-control study. PLoS One. 2011;6(3):e18227. DOI:10.1371/journal.pone.0018227. PMID: 21479272.
Brazzelli V, Maffioli P, Bolcato V, et al. Psoriasis and Diabetes, a Dangerous Association: Evaluation of Insulin Resistance, Lipid Abnormalities, and Cardiovascular Risk Biomarkers. Front Med (Lausanne). 2021;8:605691. DOI:10.3389/fmed.2021.605691. PMID: 33834030.
Tablazon ILD, Al-Dabagh A, Davis SA, Feldman SR. Risk of cardiovascular disorders in psoriasis patients: current and future. Am J Clin Dermatol. 2013;14(1):1-7. DOI:10.1007/s40257-012-0005-5. PMID: 23329076.
Barros G, Duran P, Vera I, Bermúdez V. Exploring the Links between Obesity and Psoriasis: A Comprehensive Review. Int J Mol Sci. 2022;23(14):7499. DOI:10.3390/ijms23147499
Wu JJ, Kavanaugh A, Lebwohl MG, Gniadecki R, Merola JF. Psoriasis and metabolic syndrome: implications for the management and treatment of psoriasis. J Eur Acad Dermatol Venereol. 2022;36:797-806. DOI: 10.1111/jdv.18044. PMID: 35238067.
Chu M, Shen S, Zhu Z, et al. Association of psoriasis with depression, anxiety, and suicidality: A bidirectional two-sample Mendelian randomization study. J Dermatol. 2023;50(12):1629-1634. DOI:10.1111/1346-8138.16941. PMID: 37697936.
Bardazzi F, Bonci C, Sacchelli L, et al. Suicide risk and depression in patients with psoriasis. Ital J Dermatol Venerol. 2022;157(6):497-501. DOI:10.23736/S2784-8671.22.07184-5. PMID: 36651203.
Bardazzi F, A Chessa M, Patrizi A, et al. The impact of psoriasis on quality of life of children and their caregivers: an Italian experience. Eur J Dermatol. 2021;31(5):649-650. DOI:10.1684/ejd.2021.4127. PMID: 34642135.
Rendon A, Schäkel K. Psoriasis Pathogenesis and Treatment. Int J Mol Sci. 2019;20(6):1475. DOI:10.3390/ijms20061475. PMID: 30909615.
Griffiths CEM, Armstrong AW, Gudjonsson JE, Barker JNWN. Psoriasis. Lancet. 2021;397(10281):1301-1315. DOI:10.1016/S0140-6736(20)32549-6. PMID: 33812489.
Korman NJ. Management of psoriasis as a systemic disease: what is the evidence? Br J Dermatol. 2020;182(4):840-848. DOI:10.1111/bjd.18245. PMID: 31225638.
Gargiulo L, Ibba L, Malagoli P, et al. Drug survival of IL-12/23, IL-17 and IL-23 inhibitors for moderate-to-severe plaque psoriasis: a retrospective multicenter real-world experience on 5932 treatment courses - IL PSO (Italian landscape psoriasis). Front Immunol. 2023;14:1341708. DOI:10.3389/fimmu.2023.1341708. PMID: 38274801.
Colombo D, Bianchi L, Fabbrocini G, et al. Real-world evidence of biologic treatments in moderate-severe psoriasis in Italy: Results of the CANOVA (EffeCtiveness of biologic treAtmeNts for plaque psOriasis in Italy: An obserVAtional longitudinal study of real-life clinical practice) study. Dermatol Ther. 2022;35(1):e15166. DOI:10.1111/dth.15166. PMID: 34676662
Viviani F, Spazzoli G, Clarizio G, Piraccini BM, Bardazzi F. Efficacy and safety of biologics for the treatment of moderate-to-severe psoriasis in older adults: a single-centre Italian experience. Clin Exp Dermatol. 2025;50(3):573-579. DOI:10.1093/ced/llae347
Morariu SH, Cotoi OS, Tiucă OM, et al. Blood-Count-Derived Inflammatory Markers as Predictors of Response to Biologics and Small-Molecule Inhibitors in Psoriasis: A Multicenter Study. J Clin Med. 2024;13(14):3992. DOI:10.3390/jcm13143992
Ma R, Cui L, Cai J, et al. Association between systemic immune inflammation index, systemic inflammation response index and adult psoriasis: evidence from NHANES. Front Immunol. 2024;15:1323174. DOI:10.3389/fimmu.2024.1323174. PMID: 39192384.
Sugimoto E, Matsuda H, Shibata S, et al. Impact of Pretreatment Systemic Inflammatory Markers on Treatment Persistence with Biologics and Conventional Systemic Therapy: A Retrospective Study of Patients with Psoriasis Vulgaris and Psoriatic Arthritis. J Clin Med. 2023;12(8):3046. DOI:10.3390/jcm12083046. PMID: 37109382.
Tamer F, Edek YC, Aksakal AB. Effect of Treatment With Biologic Agents on the Novel Inflammatory Biomarkers Systemic Immune Inflammation Index and Systemic Inflammation Response Index for Psoriasis. Dermatol Pract Concept. 2024 Jan 1;14(1):e2024065. DOI: 10.5826/dpc.1401a65. PMID: 38364414.
Chokshi A, Demory Beckler M, Laloo A, Kesselman MM. Paradoxical Tumor Necrosis Factor-Alpha (TNF-α) Inhibitor-Induced Psoriasis: A Systematic Review of Pathogenesis, Clinical Presentation, and Treatment. Cureus. 2023 Aug 1;15(8):e42791. DOI: 10.7759/cureus.42791. PMID: 37664349.
Patra P. Exploring the Relationship between Psoriasis and Pregnancy: A Systematic Literature Review. Int J Med Stud. 2023;11(2):128-133. DOI:10.5195/ijms.2023.1714
Jawaheer D, Olsen J, Hetland ML. Sex Differences in Response to Anti-Tumor Necrosis Factor Therapy in Early and Established Rheumatoid Arthritis — Results from the DANBIO Registry. J Rheumatol. 2012;39(1):46-53. DOI:10.3899/jrheum.110548. PMID: 22089458.
Stienstra R, Duval C, Müller M, Kersten S. PPARs, Obesity, and Inflammation. PPAR Res. 2007;2007:95974. DOI:10.1155/2007/95974. PMID: 17389767.
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