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Journal of Peking University (Health Sciences) ›› 2025, Vol. 57 ›› Issue (5): 934-940. doi: 10.19723/j.issn.1671-167X.2025.05.018

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Influence of long-term biologic therapy on metabolic biochemical parameters in moderate to severe plaque psoriasis

Xiangxian LIU1,2, Yi LIN1,2, Jinzhu GUO1,*()   

  1. 1. Department of Dermatology, Peking University Third Hospital, Beijing 100191, China
    2. Peking University Health Science Center, Beijing 100191, China
  • Received:2024-11-12 Online:2025-10-18 Published:2025-08-28
  • Contact: Jinzhu GUO
  • Supported by:
    the National Key Research and Development Program of China(2023YFC2508106); the Beijing Health Promotion Association Medical Science Research Fund(Z2022023058008)

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Abstract: Objective: To assess the impact of long-term biologic therapy on metabolic biochemical parameters in moderate to severe plaque psoriasis patients. Methods: The study included patients over 18 years old who had been treated by biological agents for at least 24 weeks for moderate to severe plaque psoriasis from Novermber 2015 to January 2024. According to the biological agents the patients used, they were divided into three groups: interleukin-17 (IL-17) inhibitor group, IL-23 and IL-12/23 inhibitor group and tumor necrosis factor-α (TNF-α) inhibitor group. The metabolic biochemical parameters of each group were evaluated and compared before and after the administration of the biologic therapies. Results: A total of 174 patients with moderate to severe plaque psoriasis were included in the long-term treatment with biologics, including 127 males (73.00%), 47 females (27.00%), with a median age of 38.00 (31.50, 49.00) years and a median duration of psoriasis of 12.00 (10.00, 20.00) years. The median duration of biologic treatment was 61.00 (49.00, 96.25) weeks, ranging from 26 to 301 weeks. There were 101 patients in the IL-17 inhibitor group, 38 patients in the IL-23 and IL-12/23 inhibitor group, and 35 patients in the TNF-α inhibitor group. After long-term treatment with IL-17 inhibitors, no statistically significant changes were observed in body weight, body mass index (BMI), alanine aminotransferase (ALT), aspartate aminotransferase (AST), fasting glucose (GLU), total cholesterol (TC), triglycerides (TG), and high-density lipoprotein cholesterol (HDL-C) compared with baseline measurements (P>0.05). However, low-density lipoprotein cholesterol (LDL-C) levels were significantly reduced [(2.90±0.75) mmol/L vs. (3.05±0.79) mmol/L, t=－2.100, P=0.038], while uric acid (UA) levels showed a significant increase [(401.13±99.13) μmol/L vs. (364.94±91.11) μmol/L, t=5.215, P < 0.001]. The group with normal UA levels before treatment showed a significant increase after long-term application of biological agents compared with before treatment [(370.69± 89.59) μmol/L vs. (324.66±64.50) μmol/L, t=5.856, P < 0.001]. Following long-term application of IL-23 and IL-12/23 inhibitors, no statistically significant differences were observed in body weight, BMI, ALT, AST, GLU, TC, TG, HDL-C and UA levels when compared with baseline measurements (P> 0.05). However, LDL-C levels exhibited a significant reduction from baseline [(2.85±0.74) mmol/L vs. (3.12±0.68) mmol/L, t=－2.082, P=0.045]. After long-term treatment with TNF-α inhibitor, there were no significant differences in body weight, BMI, ALT, AST, GLU, TC, TG, HDL-C, LDL-C and UA compared with baseline measurements (P>0.05). Conclusion: Long-term application of IL-17 inhibitors in moderate to severe plaque psoriasis patients may result in elevated uric acid levels, particularly in patients with normal uric acid levels before treatment. The long-term use of IL-17 inhibitors, IL-23 inhibitors or IL-12/23 inhibitors might reduce LDL-C levels.

Key words: Psoriasis, Biologics, Metabolic, Retrospective study

CLC Number: 

  • R758.63

Table 1

Comparison among IL-17 inhibitors group, IL-23 & IL-12/23 inhibitors group, and TNF-α inhibitors group at baseline"

Items IL-17 (n=101) IL-23 & IL-12/23 (n=38) TNF-α (n=35) F/H/χ2 P
Psoriasis duration/years 12.00 (8.50, 20.50) 12.50 (9.75, 18.50) 12.50 (10.00, 20.00) 0.721b 0.697
Duration of treatment/weeks 64.00 (90.00, 91.50) 58.00 (49.00, 95.00) 55.00 (40.00, 105.00) 0.309b 0.857
Age/years 38.00 (31.50, 51.00) 37.00 (31.00, 45.50) 39.00 (32.00，51.00) 1.281b 0.527
Male 72 (71.3) 26 (68.4) 29 (82.9) 1.135c 0.324
Weight at baseline/kg 74.07±15.15 70.87±15.06 73.05±14.73 0.881a 0.417
BMI at baseline/(kg/m2) 25.11±4.08 24.45±3.86 24.70±4.26 2.855a 0.063
ALT at baseline/(U/L) 22.00 (13.00, 37.25) 19.00 (13.50, 31.50) 26.00 (13.00, 36.00) 0.425b 0.809
ALT elevated cases 21 (21.9) 6 (17.1) 7 (20.0) 0.359c 0.836
AST at baseline/(U/L) 21.00 (18.00, 29.00) 21.00 (17.50, 25.50) 24.54±7.36 1.241b 0.538
AST elevated cases 5 (5.2) 2 (5.7) 2 (5.7) 0.020c 0.990
GLU at baseline/(mmol/L) 5.40 (4.90, 5.70) 5.40 (5.05, 5.80) 5.48±0.78 0.754b 0.686
GLU elevated cases 14 (14.9) 7 (20.6) 4 (14.3) 0.678c 0.712
TC at baseline/(mmol/L) 4.74±0.95 4.94±0.88 4.76±0.94 0.502a 0.606
TC elevated cases 29 (30.5) 15 (40.5) 9 (29.0) 1.429c 0.490
TG at baseline/(mmol/L) 1.38 (0.91, 2.19) 1.22 (0.77, 2.10) 1.40 (0.94, 1.85) 0.461b 0.794
TG elevated cases 33 (34.4) 17 (45.9) 12 (38.7) 1.534c 0.464
HDL-C at baseline/(mmol/L) 1.11 (0.98, 1.32) 1.15 (1.02, 1.40) 1.19±0.26 1.479b 0.477
HDL-C lowered cases 37 (38.5) 10 (27.0) 8 (25.8) 2.613c 0.271
LDL-C at baseline/(mmol/L) 3.05±0.79 3.12±0.68 3.30 (2.56, 3.68) 0.947b 0.623
LDL-C elevated cases 22 (23.2) 9 (24.3) 9 (29.0) 0.437c 0.804
UA at baseline/(μmol/L) 364.94±91.11 367.78±101.13 406.34±110.71 1.805a 0.168
UA elevated cases 24 (25.3) 12 (33.3) 12 (41.3) 2.994c 0.224

Table 2

Changes in metabolic biomarkers before and after IL-17 inhibitor therapy"

Items n At baseline After treatment t/Z P
Weight/kg 78 74.07±15.15 74.79±14.55 1.260a 0.211
BMI/(kg/m2) 78 25.11±4.08 25.38±4.02 1.452a 0.151
ALT/(U/L) 96 22.00(13.00, 37.25) 23.00(15.75, 42.25) -1.901b 0.057
AST/(U/L) 96 21.00(18.00, 29.00) 23.00(18.00, 30.25) -1.730b 0.084
GLU/(mmol/L) 94 5.40(4.90, 5.70) 5.30(5.00, 5.75) -0.410b 0.682
TC/(mmol/L) 95 4.74±0.95 4.64±0.97 -1.052a 0.295
TG/(mmol/L) 96 1.38(0.91, 2.19) 1.35(1.01, 1.87) -0.226b 0.821
HDL-C/(mmol/L) 96 1.11(0.98, 1.32) 1.11(0.94, 1.29) -1.128b 0.259
LDL-C/(mmol/L) 95 3.05±0.79 2.90±0.75 -2.100a 0.038
UA/(μmol/L) 95 364.94±91.11 401.13±99.13 5.215a ＜0.001

Table 3

Changes in metabolic biomarkers before and after IL-23 & IL-12/23 inhibitor therapy"

Items n At baseline After treatment t/Z P
Weight/kg 26 70.87±15.06 71.37±14.40 0.953a 0.350
BMI/(kg/m2) 26 24.45±3.86 24.65±3.71 1.119a 0.274
ALT/(U/L) 35 19.00 (13.50, 31.50) 21.00 (16.00, 36.75) -0.659b 0.510
AST/(U/L) 35 21.00 (17.50, 25.50) 22.00 (19.00, 28.50) -1.065b 0.287
GLU/(mmol/L) 34 5.40 (5.05, 5.80) 5.40 (5.10, 5.80) -0.236b 0.814
TC (mmol/L) 37 4.94±0.88 4.77±0.76 -1.454a 0.155
TG/(mmol/L) 37 1.22 (0.77, 2.10) 1.23 (0.84, 2.04) -0.158b 0.874
HDL-C/(mmol/L) 37 1.15 (1.02, 1.40) 1.19 (1.00, 1.34) -0.883b 0.377
LDL-C/(mmol/L) 37 3.12±0.68 2.85±0.74 -2.082a 0.045
UA/(μmol/L) 36 367.78±101.13 371.00±91.79 0.287a 0.768

Table 4

Changes in metabolic biomarkers before and after TNF-α inhibitor therapy"

Items n At baseline After treatment t/Z P
Weight/kg 31 73.05±14.73 73.77±14.73 1.160a 0.255
BMI/(kg/m2) 31 24.70±4.26 24.96±4.31 1.252a 0.220
ALT/(U/L) 35 26.00(13.00, 36.00) 25.00(18.00, 31.00) -0.094b 0.925
AST/(U/L) 35 24.54±7.36 22.00(18.00, 29.00) -0.322b 0.747
GLU/(mmol/L) 28 5.48±0.78 5.40(5.00, 6.10) -0.013b 0.990
TC/(mmol/L) 31 4.76±0.94 4.72±0.88 -0.282a 0.780
TG/(mmol/L) 31 1.40(0.94, 1.85) 1.70±0.86 0.075a 0.940
HDL-C/(mmol/L) 31 1.19±0.26 1.13(1.01, 1.26) -1.358b 0.174
LDL-C/(mmol/L) 31 3.30(2.56, 3.68) 3.08±0.81 -0.392b 0.695
UA/(μmol/L) 29 406.34±110.71 378.14±77.45 -1.572a 0.127

Table 5

Changes in uric acid levels before and after IL-17 inhibitors therapy"

Items n At baseline After treatment t P
Normal uric acid group/(μmol/L) 71 324.66±64.50 370.69±89.59 5.856 ＜0.001
Male in normal uric acid group/(μmol/L) 46 353.35±51.08 406.74±81.34 4.930 ＜0.001
Female in normal uric acid group/(μmol/L) 25 271.88±52.66 304.36±62.69 3.329 0.003
High uric acid group/(μmol/L) 24 489.08±38.01 491.17±66.44 0.538 0.596

Table 6

Analysis of influencing factors of uric acid level before and after IL-17 inhibitors therapy"

Items Ixekizumab Secukinumab
n r P n r P
Age 21 -0.185 0.423 74 -0.014 0.909
Gender 21 0.382 0.087 74 -0.003 0.977
Duration of treatment 21 0.267 0.242 74 0.027 0.819
1
中华医学会皮肤性病学分会银屑病专业委员会. 中国银屑病诊疗指南(2023版)[J]. 中华皮肤科杂志, 2023, 56(7): 573- 625.
2
Smith CH, Yiu ZN, Bale T, et al. British Association of Dermatologists guidelines for biologic therapy for psoriasis 2020: A rapid update[J]. Br J Dermatol, 2020, 183(4): 628- 637.

doi: 10.1111/bjd.19039
3
Chen L, Shen Z. Tissue-resident memory T cells and their biological characteristics in the recurrence of inflammatory skin disorders[J]. Cell Mol Immunol, 2020, 17(1): 64- 75.

doi: 10.1038/s41423-019-0291-4
4
中华医学会皮肤性病学分会, 中国医师协会皮肤科医师分会, 中国中西医结合学会皮肤性病专业委员会. 中国银屑病生物制剂治疗指南(2021)[J]. 中华皮肤科杂志, 2021, 54(12): 1033- 1047.
5
Elmets CA, Leonardi CL, Davis DMR, et al. Joint AAD-NPF guidelines of care for the management and treatment of psoriasis with awareness and attention to comorbidities[J]. J Am Acad Dermatol, 2019, 80(4): 1073- 1113.

doi: 10.1016/j.jaad.2018.11.058
6
Blauvelta A, Armstrong AW, Langley RG, et al. Efficacy of guselkumab versus secukinumab in subpopulations of patients with moderate-to-severe plaque psoriasis: Results from the ECLIPSE study[J]. J Dermatolog Treat, 2022, 33(4): 2317- 2324.

doi: 10.1080/09546634.2021.1959504
7
Papp KA, Langley RG, Sigurgeirsson B, et al. Efficacy and safety of secukinumab in the treatment of moderate-to-severe plaque psoriasis: A randomized, double-blind, placebo-controlled phase Ⅱ dose-ranging study[J]. Br J Dermatol, 2013, 168(2): 412- 421.

doi: 10.1111/bjd.12110
8
Reich K, Puig L, Mallbris L, et al. The effect of bodyweight on the efficacy and safety of ixekizumab: Results from an integrated database of three randomised, controlled Phase 3 studies of patients with moderate-to-severe plaque psoriasis[J]. J Eur Acad Dermatol Venereol, 2017, 31(7): 1196- 1207.

doi: 10.1111/jdv.14252
9
Zhao Z, Cai L,