Differentiating Responders to Systemic Therapies From Nonresponders With Psoriasis

Treatment decisions are difficult to make in psoriasis patients, given the paucity of objective tools for evaluation of response to treatment.

Peripheral blood mononuclear cell (PBMC) profiles may differentiate those whose disease would respond to classic systemic psoriasis treatments from those whose disease would not respond to these treatments, according to a prospective, noninterventional, single-center study published in the British Journal of Dermatology. 

Treatment decisions are difficult to make for people with psoriasis, given the paucity of objective tools for evaluation of response to treatment. Therefore, identifying markers that predict response to conventional therapy assumes relevance.   

A team of scientists from Madrid, Spain, recruited study participants from La Paz University Hospital in Madrid. The clinical sample was comprised of 51 adult patients with moderate to severe psoriasis and 15 healthy controls.

At the start of the study, patients were being treated with psoralen plus ultraviolet A, methotrexate, cyclosporine, or acitretin. Blood samples were collected at 6 months during clinical assessment. Patients were accordingly assigned to either the responder (12/51) or nonresponder (39/51) group, with nonresponders being placed on biologic therapy.  

Analysis of blood samples for cell types revealed an increased percentage of monocytes (P <.0001) and B cells (P =.027) and decreased percentages of CD8+ T cells (P =.041) and CD4+ T cells (P =.037) in patients with psoriasis relative to controls. Nonresponders had higher percentages of CD19+ cells compared with controls (P =.0006) and responders (P =.003). 

Intracellular cytokine production by the aforementioned cell populations differed across groups. Monocytes produced higher levels of tumor necrosis factor (TNF)-α (P =.0003) in those with psoriasis relative to controls, whereas TNF-α production by CD4+ T cells was lower in patients vs controls (P =.042). TNF-α and interferon-γ production from CD8+ T cells was also decreased in patients (P =.001 and P =.009, respectively). CD4+ T cells in nonresponders produced lower levels of interferon-γ compared with responders (P =.009) or controls (P =.024).

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“… in this study we show that [patients with psoriasis] have a unique profile of PBMC compared [with controls], and this profile is different between responders and nonresponders to classical systemic treatments,” the authors wrote. “Therefore, a single analysis of PBMC could provide a valuable indicator to predict the need to introduce targeted therapy, avoiding loss of time and patients’ disappointment.”

Disclosures: Funding for the study was provided by Novartis Pharmaceuticals Corporation. Several authors declare affiliations with the pharmaceutical industry. 


Hernández-Breijo B, Jurado T, Rodríguez-Martin E, et al. Differential blood cellular profile in patients with moderate to severe psoriasis treated with classical systemic therapies: a step forward in personalised medicine [published online March 11, 2018]. Br J Dermatol. doi:10.1111/bjd.16537