Summary:
Introduction: Psoriasis is a common, benign, chronic inflammatory systemic
disease in the pathogenesis of which are involved numerous inflammatory cells
and mediators. Treatment includes biological agents, i.e. anti-TNF-α and
anti-IL-12/23 agents , and non- biological, especially cyclosporine.
Purpose: The purpose of this study is to compare the effects of treatment using
biological agents with the effects of treatment using classical therapies, on
oxidative stress markers and markers of inflammation in patients with plaque
type psoriasis.
Patients and methods: Three groups of patients will be examined: the first
group (32 patients) will receive as treatment anti-IL12/23 agent (ustekinumab),
the second one (34 patients) will receive anti-TNF-α agent (infliximab) and the
third one (48 patients) will receive cyclosporine. Blood samples will be taken
at the beginning of the treatment (baseline) and four-month post baseline.
Then, oxidative stress markers (protein carbonyls and malondialdehyde) and
inflammatory markers (IL-6, IL-10, IL-12, IL-17, IL- 23, TNF-α, fetuin) will be
assessed.
Results: All the patients, four months post baseline, showed a decrease in the
levels of: IL-6 (in pg/ml, from 2.27 to 2.01, p=0.03), IL-17 (in pg/ml, from
3.2 to 1.3, p=0.03), MDA (in nM/L, from 1.68 to 1.10, p=0.04) and TNF/IL-10
(4.34 to 3.40, p=0.02). The group of patients which received ustekimumab,
showed significant decrease in the levels of MDA (in nM/L from 1.41 to 1.03,
p=0.02), unlike the other two groups. Significant reduction in levels of IL-6
and IL-17 is observed in both groups of ustekinumab (IL-6 from 2.30 to 1.90,
p=0.04, IL-17 from 1.79 to 1.31, p=0.04) and cyclosporine (IL-6 from 2.70 to
1.80, p=0.05, IL-17 from 4.43 to 1.18, p=0.03). The group that received
ustekinumab presented significant increase in levels of fetuin (in mg/ml, from
28.60 to 40.30, p=0.03), and therefore an improvement of the disease, whereas
the group that received cyclosporine presented decrease (38.80 to 20.60,
p=0.05), indicating worsening of the inflammation. Significant increase in
IL-12 levels occurred in the group of cyclosporin (in pg/ml from 1.43 to 1.49,
p=0.02), thus worsening inflammation, while other groups were not evaluated.
Conclusions: The groups that received as treatment anti-IL-12/23 agent and
cyclosporine, presented an improvement to both oxidative stress markers
(decrease of MDA) and inflammation biomarkers, while ustekinumab appears to be
more efficient than the cyclosporine, in terms of fetuin and IL-12. The therapy
with biological anti-TNFα agent did not lead to reliable conclusions.
Keywords:
Psoriasis, Ustekinumab, anti-TNFα, cyclosporine, Inflammation biomarkers, Oxidative stress
