Background and Importance Psoriasis is a chronic inflammatory skin disease. Biological treatments against tumour necrosis factor (anti-TNF) are effective in treating this disease, however, not all patients respond to this treatment, and it can cause serious side effects. Biomarkers involved in the TNF cytokine may be implicated in the response to the anti-TNF drug.
Aim and Objectives To determine the utility of Single Nucleotide Polymorphisms of HLA-B and TNF-238, TNF857, TNF-308, TNF-1031, TNFRSF1B as prognostic and predictive markers in patients diagnosed with moderate-severe psoriasis treated with adalimumab, etanercept or infliximab. As well as, to evaluate the efficacy of anti-TNF treatment in the induction phase.
Material and Methods A prospective cohort study was performed. Data and DNA were obtained from saliva samples of 103 patients residing in the province of Granada with moderate and severe psoriasis who had been treated with anti-TNF. The genotypes were determined by Taqman PCR Real Time.
Results Patients' mean age was 54.19 ± 13.65 years; 54 male (54/103); 100 had plaque psoriasis (100/103), 90 located in trunk and extremities, and 89 on scalp and face, 42 with psoriatic arthritis (42/103), 33 smokers (33/103), 36 drinkers (36/103), 62 had psoriasis family history (62/103). These 103 patients have been treated with 135 anti-TNF (adalimumab, ADA=80; etanercept, ETN=39; infliximab, INF=16). Also 20 received oral administration of the concomitant methotrexate (20/135).
In reference to efficacy, 74 patients had a response to anti-TNF (74/135), and 61 do not show the expected response in the induction phase (61/135). Concerning PASI75 values, 55 patients treated with ADA achieved PASI75 at 3-6 months (55/80), 12 patients treated with ETN (12/39), and 7 patients treated with INF (7/16).
Furthermore, patients carrying TNFRSF1B-rs1061622-G allele an association with ADA response at 3 months (p=0.0026) and patients carrying TNFα-1031-rs1799964-T an association with ETN response at 6 months (p=0.0047), also patients carrying TNFα-238- rs361525-G treated with INF have a response at 6 months (p=0.045).
Conclusion and Relevance In conclusion, response to anti-TNF drugs was associated with different single nucleotide allelic polymorphisms of the TNF gene. Nonetheless, further studies with large cohorts of patients have to be performed to confirm these data in order to apply for this personalised medicine in routine clinical practice.
Conflict of Interest No conflict of interest
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