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The following is a summary of “Treatment of plaque psoriasis with guselkumab reduces systemic inflammatory burden as measured by neutrophil/lymphocyte ratio, platelet/lymphocyte ratio and monocyte/lymphocyte ratio: A post hoc analysis of three randomised clinical trials,” published in the April 2025 issue of Dermatology by Kearney et al. 

Psoriasis was linked with an elevated risk of cardiovascular disease (CVD), and prior studies showed that treatment with tumor necrosis factor or interleukin (IL)-17 inhibitors reduced systemic inflammation biomarkers, including neutrophil/lymphocyte ratio (NLR), platelet/lymphocyte ratio (PLR), and monocyte/lymphocyte ratio (MLR).  

Researchers conducted a retrospective study to assess the changes in NLR, PLR, and MLR with guselkumab compared to placebo (VOYAGE I/II), adalimumab (VOYAGE I/II), and secukinumab (ECLIPSE) and to assess the correlation with disease severity, C-reactive protein (CRP) levels and treatment response.  

They analyzed data from VOYAGE I, VOYAGE II, and ECLIPSE Phase III randomized trials on guselkumab for moderate-to-severe plaque psoriasis. The NLR, PLR, and MLR were assessed at baseline and Week 16 in VOYAGE I and II and at baseline and Week 12 in ECLIPSE. Mean changes were analogized between groups using a student’s t-test, and Pearson’s test was applied for correlation analyses.  

The results showed that VOYAGE I included 837 patients, VOYAGE II had 992, and ECLIPSE enrolled 1048 patients. In VOYAGE I, guselkumab treatment reduced PLR (P =0.015), NLR (P =0.011), and MLR (P =0.004) after 16 weeks compared to placebo. In VOYAGE II, guselkumab also led to greater reductions in NLR (P =0.003), PLR (P =0.006), and MLR (P =0.001) compared to placebo. Adalimumab resulted in a greater reduction (P <0.001) in these biomarkers than guselkumab, while secukinumab showed similar decreases in NLR, PLR, and MLR compared to guselkumab (P =0.413, P =0.650, P =0.498). All biomarkers weakly correlated with the Psoriasis Area Severity Index (PASI) at baseline and had modest correlations with CRP levels. Biomarkers in PASI90 responders were similar across all active treatment groups at baseline.  

Investigators concluded that guselkumab, a highly efficacious treatment for plaque psoriasis, had demonstrated the potential benefit of reducing systemic inflammation as measured by NLR, PLR, and MLR, which appeared independent of psoriasis response. 

Source: karger.com/drm/article/doi/10.1159/000545148/925534/Treatment-of-plaque-psoriasis-with-guselkumab