Department of Dermatology, Tohoku University Graduate School of Medicine, Sendai, Japan.
Department of Dermatology, National Defense Medical College, Tokorozawa, Japan.
J Dermatol. 2021 Nov;48(11):1739-1744. doi: 10.1111/1346-8138.16102. Epub 2021 Aug 8.
Psoriasis is a chronic disease centered on tumor necrosis factor (TNF), interleukin (IL)-23, and IL-17 axis. While psoriasis patients benefit from biologics targeting TNF, IL-17s, and IL-23 nowadays, suppression of these molecules could modulate the balances of immune systems. However, the incidence of autoimmune disease and T-helper 2 reaction during biologic treatments for psoriasis patients is not well documented. We retrospectively examined antinuclear antibody (ANA), eosinophil counts, and immunoglobulin E (IgE) levels for psoriasis patients who underwent biologic treatments in our dermatology clinic from June 10, 2010 to January 29, 2020. A cumulative total of 199 biologic treatments were performed for a total of 128 psoriasis patients. Compared to the non-biologic group of 109 psoriasis patients who received non-biologic treatment, patients treated with infliximab showed more incidents of high ANA (14%, p = 0.039) and high eosinophils (14%, p = 0.021). The use of brodalumab increased incidents of high eosinophils (21%, p = 0.005) but did not affect increase in ANA and IgE. The increase in high IgE level was observed significantly more during the use of risankizumab (15%, p = 0.011). Methotrexate was the most frequently used concomitant systemic treatment, but methotrexate did not affect ANA, eosinophil counts, and IgE levels. Since the biologics for psoriasis treatment modulate the balance of T-helper cells, careful observation is required to detect unexpected changes of systemic immune conditions under biologic treatments.
银屑病是一种以肿瘤坏死因子(TNF)、白细胞介素(IL)-23 和 IL-17 轴为中心的慢性疾病。虽然银屑病患者现在受益于针对 TNF、IL-17s 和 IL-23 的生物制剂,但这些分子的抑制可能会调节免疫系统的平衡。然而,在银屑病患者的生物治疗中,自身免疫疾病和辅助性 T 细胞 2 反应的发生率尚未得到很好的记录。我们回顾性地检查了 2010 年 6 月 10 日至 2020 年 1 月 29 日在我们皮肤科诊所接受生物治疗的银屑病患者的抗核抗体(ANA)、嗜酸性粒细胞计数和免疫球蛋白 E(IgE)水平。共有 128 例银屑病患者接受了 199 次生物治疗。与接受非生物治疗的 109 例非生物组银屑病患者相比,接受英夫利昔单抗治疗的患者出现高 ANA(14%,p=0.039)和高嗜酸性粒细胞(14%,p=0.021)的情况更多。使用布罗达卢单抗会增加高嗜酸性粒细胞的发生(21%,p=0.005),但不会影响 ANA 和 IgE 的增加。在使用 risankizumab 时,高 IgE 水平的增加更为明显(15%,p=0.011)。甲氨蝶呤是最常使用的伴随全身治疗药物,但甲氨蝶呤不会影响 ANA、嗜酸性粒细胞计数和 IgE 水平。由于治疗银屑病的生物制剂会调节辅助性 T 细胞的平衡,因此需要仔细观察生物治疗下全身免疫状况的意外变化。