The clinical indicators predicting the efficacy of acitretin in the treatment of psoriasis

doi:10.21203/rs.3.rs-3291700/v1

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The clinical indicators predicting the efficacy of acitretin in the treatment of psoriasis

https://doi.org/10.21203/rs.3.rs-3291700/v1

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To identify the related factors affecting the efficacy of acitretin treatment for psoriasis and the correlations between these factors, thereby guiding the use of acitretin in psoriasis patients.156 cases of hospitalized psoriasis patients who received conventional acitretin treatment from 2018–2022 were collected. Psoriasis Area and Severity Index (PASI) was used as an observation indicator for efficacy. Treatment efficacies were divided into four Grades according to PASI50, PASI75, and PASI90. The patients' basic information, clinical features, laboratory examinations and other factors were retrospectively analyzed for correlations. The ROC curve of Hs-CRP predicting PASI90 was drawn, and the logistic multivariate regression model of AST and efficacy was established. PASI score was positively correlated with acitretin efficacy (r = 0.410, p < 0.001). Aspartate aminotransferase (AST) was negatively correlated with acitretin efficacy (r=-0.160, P < 0.046). The pre-treatment serum parameters of white blood cell count (WBC), neutrophil count (NEU), neutrophil ratio (NEU-R), highly sensitive C-reactive protein (Hs-CRP) and albumin (Alb) were different in four efficacy Grades and had a very good correlation. In the ROC curve of PASI90 predicted by Hs-CRP, the area under the curve was 0.731, and the cutoff point was 18.65.Acitretin treatment showed significant efficacy for psoriasis. AST had the highest correlation with therapeutic response and was significant for predicting treatment efficacy. Hs-CRP was meaningful for predicting PASI90. Hs-CRP, NEU-R and Alb had some guiding value in predicting treatment response to acitretin.

Health sciences/Diseases/Immunological disorders/Inflammatory diseases

Health sciences/Risk factors

Health sciences/Diseases/Skin diseases

Acitretin

Psoriasis

Treatment predication

AST

PASI90

Research has demonstrated that psoriasis is a chronic inflammatory immune-mediated skin disease, which characterized by abnormal activation of T lymphocytes under a background of polygenic inheritance, manifesting as epidermal hyperplasia and inflammatory cell infiltration^1,2. The incidence in Asia is about 1.3%-12.5%^3,4.

Experts have pointed out that psoriasis has a complex pathogenesis, related not only to genetics, immune regulation, environment and other factors, but also to infection induction by bacteria and viruses. Such infections not only exacerbate psoriatic inflammation but also increase diagnostic and therapeutic difficulties⁵. Among the manifestations of inflammation and infection in psoriasis, the acute phase response is an important intermediary process in the pathogenesis of psoriasis. CRP is an acute phase reactant protein that can promote the release of inflammatory mediators, which is positively correlated with the degree of inflammation and tissue damage, serving as a sensitive marker of inflammatory response, and Hs-CRP is a more sensitive acute phase protein compared to CRP.

Psoriasis patients have extensive desquamation leading to loss of skin proteins. If the lesions persist for years without healing and become widespread, it may result in hypoproteinemia. Insufficient serum albumin can cause organ edema, prevent medications from taking effect, and is detrimental to disease recovery. Studies have shown that serum TNF-α and CRP levels in patients with vulgaris psoriasis are also significantly higher compared to healthy individuals and correlate with the degree of psoriatic inflammation. Therefore, statistical analysis of various inflammatory markers in psoriasis patients prior to treatment, along with examination of their correlation with treatment efficacy, is very important for appropriate medication use and efficacy assessment.

In clinical practice, it has been found that acitretin monotherapy has good efficacy for pustular psoriasis, erythrodermic psoriasis, and moderate-to-severe vulgaris psoriasis, gradually becoming a first-line medication widely used to treat psoriasis^6,7. Its mechanism involves regulating the terminal differentiation stage of epidermal cells, inhibiting hyperkeratosis and neutrophil chemotaxis, reducing abnormal proliferation, differentiation, and infiltration of neutrophils in the lesions, thereby achieving a therapeutic effect. Post-treatment WBC serum calcium and albumin can serve as important references for evaluating psoriasis severity and disease course. DP-1, CRP, MCP-1, RANTES can be used to evaluate the efficacy of acitretin treatment for psoriasis.

Currently, data-based systematic analyses on factors influencing acitretin efficacy in psoriasis are scarce, making it difficult to clarify the correlations between various inflammatory markers and acitretin treatment efficacy, and unable to predict treatment effects and provide accurate clinical recommendations in advance. Therefore, statistical analysis of various inflammatory markers in psoriasis patients prior to treatment, along with evaluations of post-treatment diagnostic and therapeutic efficacy and their correlations, is of great significance for guiding medication use in subsequent patients.

Clinical Data

A retrospective review was conducted on 1,500 hospitalized psoriasis patients who were treated with acitretin at the Department of Dermatology, Sichuan Provincial People's Hospital (Chengdu, China) between February 2018 and January 2022 A total of 156 psoriasis patients were included for analysis, and the demographic data and clinical characteristics of the study as shown in Table 1.

Inclusion criteria: Patients diagnosed with psoriasis in the outpatient clinic.

This study has been approved by ethics committee of The First Affiliated Hospital of Chengdu Medical College and the informed consent was obtained from all subjects. All methods were performed in accordance with the relevant guidelines and regulations.

Table 1

Baseline demographic, clinical features of patients
No.	Parameters	Data, rate and details
1	Gender, Patients, n (%)	Males 116 (74.36%)	Females 402 (25.64%)	-	-
2	Types, patients, n (%)	Vulgaris 87 (55.77)	Pustular 47 (30.13)	Erythrodermic 21 (13.46)	Arthropathic 1 (0.64)
3	Stage patients, n (%)	Progress period 78 (50.00)	Stable period 78 (50.00)	Extinction period 0 (0)	-
4	Season of onset, patients, n (%)	Spring 45 (28.85)	Summer 28 (17.95)	Autumn 44 (28.21)	Winter 39 (25.00)
6	Age of onset, patients, n (%)	Children 2 (1.28)	Youth 34 (21.79)	Middle age 76 (48.72)	Old age 44 (28.21)
5	Family history, patients, n (%)	-	14 (8.79)	-	-
6	Age, years, mean ± SD (range)	-	47.705士16.500 (6–75)	-	-
7	Disease duration, years, mean ± SD (range)	-	13.159士10.8411 (0.08-50)	-	-
8	Weight, Kg, mean ± SD (range)	-	63.994士12.034 (20–105)	-	-
9	Lesion area, %, mean ± SD (range)	-	94.917士5.610 (50–100)	-	-
10	PASI Score, mean ± SD (range)	-	13.949士3.895 (1.6–23.0)	-	-
11	Dose, mg/day, mean ± SD (range)	-	34.955士8.665 (10–60)	-	-
12	Unit dose, mg/day, mean ± SD (range)	-	0.560士0.158 (0.24–1.06)	-	-

SD, Standard deviation.

Exclusion criteria: (i) Patients who had received methotrexate, cyclosporine, cyclophosphamide, leflunomide, sulfasalazine, mycophenolate mofetil, biologics, tripterygium, or systemic glucocorticoids within the past 6 months, or intravenous immunoglobulin within the past 3 months; (ii) Patients with severe cardiopulmonary disease, severe renal or hepatic dysfunction, or other diseases affecting laboratory test results; (iii) Pregnant or lactating patients; (iv) Patients who had overexertion, alcohol abuse, strenuous exercise, stayed up late, or consumed greasy food in the 3 days prior to admission that could affect aminotransferase results; (v) Patients who were unavailable for retrospective follow-up.

Data Collection

A standardized data collection form was elaborated to collect the date of possible influencing factors from the hospital clinical records. All blood samples were fasting blood collected in the morning after a full-night rest.

The clinical data included: disease subtype, stage, affected skin area, acitretin dosage, treatment duration, PASI scores before and after treatment, adverse reactions after medication (skin dryness, pruritus, cheilitis), etc.

The laboratory data included: WBC, NEU, NEU-R, Hb, PIT, PCT, Hs-CRP, CD4 + T, CD8 + T, IgE, creatinine, glomerular filtration rate, serum calcium, potassium, sodium, magnesium, phosphorus, AST, ALT, uric acid, albumin, globulin, cholesterol, triglycerides, L-LDL, H-LDL, ALP, total bilirubin, etc., before and after acitretin treatment.

Efficacy Evaluation

PASI score is selected as the standard for assessment of extensive psoriasis⁸. PASI score improvement rate= (pre-treatment PASI score - post-treatment PASI score) / pre-treatment PASI score ×100%. Treatment efficacy were divided into four Grades according to PASI50, PASI75, and PASI90, and responders were defined as Grade 1, Grade 2, or Grade 3, as follows:

Ineffective group (Grade 0): PASI score improvement<50%.

Effective group (Grade 1): 50% =< PASI score improvement < 75%.

Significantly effective group (Grade 2): 75% =< PASI score improvement < 90%.

Clinically cured group (Grade 3): PASI score improvement > = 90%

Analysis Method

All analyses were performed using the software programs SPSS 17.0. Spearman correlation was applied to assess the correlation between acitretin efficacy and relevant clinical and laboratory data. Logistic multiple regression model was established to evaluate the association of AST with acitretin efficacy. Receiver operating characteristic (ROC) analysis was performed to examine the accuracy and specificity of Hs-CRP predicting PASI90. Quantitative data were analyzed by t-test, one-way analysis of variance (ANOVA) test, Kruskal-Wallis H test or Scheffe test. Statistical significance was set at P = 0.05. P values less than 0.05 were considered significant.

Correlation Results

PASI Score

After acitretin treatment, 147 patients (94.2%) achieved PASI50, 81 patients (51.9%) achieved PASI75 and 16 patients (10.3%) achieved PASI90. The overall rate of efficacy was 94.2% (147/156), in which, 42.3% in Grade 1, 41.7% in Grade 2 and 10.3% were in Grade 3.

AST Correlation Analysis

Statistical analysis showed that treatment efficacy was positively correlated with pretreatment PASI score (r = 0.410, p < 0.001). No significant correlations were found between efficacy and other clinical characteristics such as age, gender, obesity, disease duration, treatment season, mean daily acitretin dose, family history, etc. Pre-treatment serum AST (r=-0.160, P = 0.046) was significantly correlated with acitretin efficacy. Table 2 reports the correlations between acitretin efficacy and patient demographics, clinical and laboratory data.

Table 2

The correlation between acitretin efficacy and demographics, clinical and laboratory data of patients
No.	Potential risk	r Value^*	P Value
1	Age	0.049	0.547
2	Weight	0.079	0.333
3	Duration	0.077	0.339
4	Daily dose	0.041	0.610
5	Unit dose	-0.018	0.821
6	Treatment	0.152	0.059
Blood routine
7	WBC	0.03	0.713
8	NEU	0.012	0.883
9	EOS	-0.061	0.453
10	NEU-R	-0.084	0.297
11	Hb	0.029	0.724
12	PLT	-0.029	0.724
13	Hs-CPR	0.063	0.465
A liver function test
14	AST	-0.160	0.046
15	ALT	0.032	0.687
16	Glb	0.023	0.775
17	Alb	0.112	0.164
18	ALP	-0.070	0.387
19	TBIL	0.053	0.514
Renal functions
20	Cr	0.153	0.057
21	eGFR	-0.046	0.702
22	UA	0.016	0.845
23	K	0.091	0.259
24	Na	0.037	0.644
25	Ca	-0.009	0.908
26	Mg	0.028	0.731
27	P	0.040	0.627
A lipid profile
28	TG	-0.028	0.732
29	TC	0.460	0.575
30	LDL	0.004	0.960
31	HDL	0.071	0.390
32	CD4 + T	0.117	0.509
33	CD8 + T	0.102	0.568

WBC, Leukocyte count; NEU, Neutrophil count; E0S, Eosinophilic granulocyte; NEU-R, Neutrophil rate; Hb, Hemoglobin; PLT, Platelet count; Hs-CRP, High-sensitivity C-reactive protein; AST, Aspartate aminotransferase; ALT, Alanine ami-notransferase; Glb, Globulin; Alb, Albumin; ALP, Alkaline phosphatase; TBIL, Total bilirubin; Cr, Creatinine; eGFR, Glomerular filtration rate; UA, Uric acid; K, Potassium; Na, Sodium; Ca, Calcium; Mg, Magnesium; P, Phosphorus; TG, Triglyceride; TC, Cholesterol; LDL, Low density lipoprotein; HDL, High-density lipoprotein; CD4⁺T, CD4⁺ T-lymphocyte count; CD8⁺T, CD8⁺ T- lymphocyte count.

*Spearman correlation coefficient.

Normal AST is between 15–40 U/L. In our study, the mean AST differed significantly between Grades, with a mean of 43.89 U/L in Grade 0, 31.65 U/L in Grade 1, 29.95 U/L in Grade 2, and 25.81 U/L in Grade 3. Which indicates that treatment efficacy improved with decreasing AST value. ANOVA showed a P value of 0.045 (P < 0.05), which was statistically significant.

Multivariate logistic regression models were built to evaluate the relationship between AST, gender, age and acitretin efficacy found that this association persisted after adjusting for gender and age. However, the association disappeared when more blood biochemical markers were added, as they could not be included in the model due to significant correlations, as shown in Table 3. After adjusting for gender and age, the regression coefficient for AST was − 0.019 (P = 0.041), which was statistically significant (P < 0.05). The adjusted odds ratio (OR = e-0.019) was 0.98, less than 1. The results indicate that AST is a protective factor.

Table 3

Logistic regression model estimation and test results
Parameters estimation
-		β	SD	Wald	Variance	P Value	95% confidence interval
-		β	SD	Wald	Variance	P Value	Lower confidence limite	Upper confidence limite
Threshold Value	[Grade = 0]	-3.031	0.672	20.324	1	0.000	-4.349	-1.713
	[Grade = 1]	-0.249	0.581	0.184	1	0.668	-1.388	0.889
	[Grade = 2]	2.032	0.619	10.783	1	0.001	0.819	3.245
Position	AST	-0.019	0.009	4.189	1	0.041	-0.037	-0.001
	Age	0.009	0.009	1.027	1	0.311	-0.009	0.028
	[Grade = 0]	-0.124	0.348	0.126	1	0.723	-0.806	0.559
	[Grade = 1]	0	-	-	0	-	-	-

SD, Standard deviation; AST, aspartate aminotransferase.

†Partial regression coefficient.

*correlation function L: Logarithm.

a means this parameter is redundant and is set to be zero.

Pretreatment serum Hs-CRP, WBC, NEU, NEU-R and Alb seemed to contain some kind of trends among different efficacy improvement Grade and the difference of Hs-CRP, NEU-R and Alb was statistically significant (P < 0.05). The results were summarized in table IV.

WBC、NEU、NEU-R、Hs-CRP、Alb Correlation Analysis

The normal ranges for WBC and NEU are (3.50–9.50)×10⁹/L and (1.80–6.30)×10⁹/L respectively. Comparison of mean values across Grades showed declining trends with increasing Grade from 0 to 2, and values below normal ranges, as shown in Table 4. Lower values were indicative of potentially better efficacy and higher PASI Grade after treatment. In the PASI90 group, the mean of WBC was 10.607×10⁹/L and the mean of NEU was 8.233×10⁹/L, markedly higher than normal ranges, indicating that patients with this range could achieve better efficacy with acitretin treatment for psoriasis. ANOVA showed P values of 0.294 and 0.162 for WBC and NEU respectively, both greater than 0.05. Therefore, the differences in these two indices were not statistically significant.

Table 4

The mean and standard deviation of serum AST, WBC, NEU, NEU-R, Hs-CRP and Alb
Parameters	Grade 0	Grade 1	Grade 2	Grade 3	Normal value	F value	P value (P < 0.05)
PASI score improvement rate	PASI score improvement < 50%	50%=<PASI score improvement < 75%	75%=<PASI score improvement < 90%	PASI score improvement > = 90%	-	-	-
Patients, n (%)	9 (5.8%)	66 (42.3%)	65 (41.7%)	16 (10.3%)	-	-	-
AST (U/L)	43.890士33.728	31.650士18.393	25.950士12.078	25.810士14.702	15–40	2.349	0.045
WBC (10⁹/L)	9.312士4.794	8.371士3.667	8.377士4.869	10.607士3.907	3.50–9.50	1.248	0.294
NEU (109/L)	7.410士4.666	6.148士3.581	5.851士4.705	8.233士4.408	1.80–6.30	1.735	0.162
NEU-R	0.763士0.106	0.699士0.128	0.654士0.117	0.748士0.116	0.40–0.75	4.494	0.005
Alb (g/L)	35.433士6.173	37.769士5.550	39.857士5.308	34.800士5.963	40–55	4.143	0.007
Hs-CRP (mg/L)	50.769士58.306	29.531士48.176	20.839士38.494	69.554士62.135	0–5	x² = 4.425	0.005

PASI, Psoriasis area and severity index; AST, Aspartate aminotransferase; WBC, Leukocyte count; NEU, Neutrophil count; NEU-R, Neutrophil rate; Hs-CRP, High-sensitivity C-reactive protein; Alb, Albumin.

†one-way analysis of variance test.

‡chi-square test.

The normal range for NEU-R is 0.40 to 0.75. In this study, the mean deviations of NEU-R were 0.763 for Grade 0, 0.699 for Grade 1, 0.654 for Grade 2, and 0.748 for Grade 3, as shown in Fig. 1. ANOVA showed a P value of 0.005 (P < 0.05), indicating a statistically significant. Scheffe Test revealed that the mean NEU-R showed a gradual declining trend from Grade 0 to 2, and lower mean NEU-R was associated with higher post-treatment Grade and better treatment efficacy.

The normal range for Hs-CRP is 0–5 mg/L, the mean Hs-CRP was 50.769 mg/L for Grade 0, 29.531 mg/L for Grade 1, 20.839 mg/L for Grade 2, and 69.554 mg/L for Grade 3, as shown in Table 4. The Kruskal-Wallis H Test showed x² = 4.425 and P = 0.005 (P < 0.05), indicating a statistically significant. The mean of Hs-CRP for all 4 Grades were markedly higher than the normal range, with a clear declining trend from Grade 0 to 2. Scheffe Test also showed statistically significant differences in Hs-CRP between Grade 3 and Grade 2 (P = 0.009) as well as Grade 1 (P = 0.049), which was analytically meaningful. The receiver operating characteristic (ROC) analysis curve of Hs-CRP predicting PASI90 was plotted to evaluate the accuracy and sensitivity of the efficacy of acitretin treatment. Analysis showed the area under the curve (AUC) was 0.731 (0.7 < AUC < 0.9), indicating good accuracy of Hs-CRP for prediction. By calculating the highest Youden index, the 18.65 mg/L of Hs-CRP was considered to be the cutoff point, as shown in Fig. 2.

The normal range for serum Alb is 40–55 g/L. In this analysis data, the mean of Alb was 35.433 g/L for Grade 0, 37.769 g/L for Grade 1, 39.857 g/L for Grade 2, and 34.800 g/L for Grade 3. ANOVA showed a P value of 0.007 (P < 0.05), indicating significant differences that were statistically meaningful. Scheffe Test showed statistically significant differences in mean Alb only between Grade 3 and 2 (P = 0.021). Higher improvement Grades could be achieved with increasing mean Alb. In PASI90, the mean of Alb was 34.800 g/L, markedly below normal, this value range showed significant therapeutic efficacy of acitretin.

Correlations Between Serum Parameters

Correlation analysis between serum parameters showed good correlations among WBC, NEU, NEU-R, Hs-CRP, and Alb: WBC was positively correlated with NEU (r = 0.959, P < 0.001), NEU-R (r = 0.675, P < 0.001) and Hs-CRP (r = 0.389, P < 0.001); NEU was positively correlated with NEU-R (r = 0.830, P < 0.001) and Hs-CRP (r = 0.431, P < 0.001); Alb was negatively correlated with WBC (r=-0.345, P < 0.001), NEU (r=-0.353, P < 0.001), NEU-R (r=-0.389, P < 0.001) and Hs-CRP (r=-0.348, P < 0.001), as shown in Table 5.

Table 5

Correlation analysis of WBC, NEU, NEU-R, Hs-CRP and Alb
Parameters	NEU	NEU-R	Hs-CRP	Alb
WBC	r = 0.959	r = 0.675	r = 0.389	r = 0.345
	P = 0.000 < 0.05	P = 0.000 < 0.05	P = 0.000 < 0.05	P = 0.000 < 0.05
	n = 155	n = 155	n = 137	n = 155
NEU		r = 0.830	r = 0.431	r = 0.353
		P = 0.000 < 0.05	P = 0.000 < 0.05	P = 0.000 < 0.05
		n = 155	n = 137	n = 155
NEU-R			r = 0.477	r=-0.389
			P = 0.000 < 0.05	P = 0.000 < 0.05
			n = 137	n = 156
Hs-CRP				r = 0.348
				P = 0.000 < 0.05
				n = 138

WBC, Leukocyte count; NEU, Neutrophil count; NEU-R, Neutrophil rate; Hs-CRP, High-sensitivity C-reactive protein; Alb, Albumin.

In summary, WBC, NEU, NEU-R and Hs-CRP were positively correlated with each other (P < 0.05), and negatively correlated with Alb (P < 0.05). AST was the only clinical parameter correlated with acitretin efficacy, but not correlated with other serum parameters (P > 0.05).

AST

Currently, acitretin has become the standard medication for moderate-to-severe psoriasis, providing hope for treatment to patients who have long suffered from the disease⁹. However, even relatively safe acitretin has high adverse effects such as teratogenicity and hepatotoxicity^10,11, leading to few patients willing to take the risks when treatment efficacy is uncertain. Therefore, scholars hope to find accurate clinical predictors of acitretin efficacy in psoriasis based on big data from clinical cases.

It has been reported that certain clinical features like daily dosage, phenotypes, severity of psoriasis, morphology of skin lesions, disease duration, and comorbidities may influence acitretin efficacy¹², but some studies do not support these associations. This study found that acitretin efficacy was positively correlated with pretreatment PASI score, and only pre-treatment AST was correlated with acitretin treatment efficacy.

Analysis shows that patients with abnormal liver function had poorer efficacy. As a fat-soluble vitamin, acitretin is mainly metabolized by mitochondrial α-oxidation in hepatocytes, with a small portion through bilirubin metabolism. Abnormal liver function may affect the metabolism and absorption of acitretin. AST catalyzes the transamination reaction between L-aspartate and α-ketoglutarate to generate L-glutamate and oxaloacetate. Meanwhile, another transaminase ALT mainly exists in non-mitochondria, while about 80% of AST is present in mitochondria. Mitochondrial membrane damage can lead to AST release¹³. Some scholars have proposed an interesting question of why AST but not ALT, both being aminotransferase markers of liver injury, is correlated with acitretin efficacy. We speculate that the bioactivity of acitretin, and even the pathogenesis of psoriasis, may be related to the role of mitochondria in inflammasomes¹⁴. Currently, the relevant associations and mechanisms are unclear and warrant further research.

Hs-CRP

It is widely recognized that psoriasis is a chronic inflammatory skin disease with certain genetic features, and inflammation plays an important role in its pathogenesis^15,16. Some studies have shown that TNF-a induces IL-6 secretion, which in turn stimulates the liver to produce the acute phase reactant C-reactive protein (CRP). It has been reported that CRP is positively correlated with serum NEU, WBC and psoriasis severity, and can serve as one of the reference indicators for evaluating psoriasis treatment efficacy and predicting prognosis^17,18. Acitretin can effectively treat psoriasis by normalizing keratinocyte differentiation and exerting anti-inflammatory effects, thereby reducing epidermal proliferation and inhibiting infiltration of inflammatory cells¹⁹. As an acute phase protein in humans, CRP or Hs-CRP can promote the release of inflammatory mediators, but there have been no reports on using it to predict acitretin efficacy in psoriasis.

This case study found that Hs-CRP can be used to predict PASI90 with acitretin, with good accuracy. Hs-CRP was positively correlated with NEU, NEU-R and WBC, suggesting that when Hs-CRP is at PASI90 levels, inflammation may be the major pathogenesis of psoriasis, which acitretin happens to be able to inhibit, thus achieving better efficacy. It has been reported that acitretin can alleviate psoriasis by reducing serum cytokine production, while regulating keratin gene expression, inhibiting epithelial tissue proliferation, and promoting terminal differentiation of the epidermis. It may also have direct immunomodulatory effects^20,21. This case study also found Hs-CRP levels in Grades 0, 1 and 2 to be lower than PASI90, suggesting that the anti-inflammatory effect of acitretin may not predominate in these groups, and it mainly regulates keratinocyte proliferation and differentiation through other mechanisms, leading to unsatisfactory efficacy. Previous studies have also shown significantly decreased serum TNF-α and CRP levels in vulgaris psoriasis patients after treatment, closely correlated with psoriasis treatment efficacy ²². Combining our research results, we speculate that Hs-CRP may aid in predicting PASI90 with acitretin treatment for psoriasis.

Alb

It has been reported that acitretin binds very tightly to plasma albumin (91% of plasma acitretin), with a binding constant of 0.7× l0⁶ M^{− 1 23}. This study speculates that serum Alb levels may affect acitretin absorption, as acitretin achieved better efficacy with increasing serum Alb levels. Clinical data analysis found that Alb was negatively correlated with unit dose (r=-1.81, p = 0.025), and the PASI90 group had the lowest mean Alb. Therefore, higher acitretin doses can promote its therapeutic efficacy in psoriasis =.

In summary, pretreatment serum AST level had the highest correlation with acitretin efficacy and has strong guiding significance for predicting acitretin efficacy. Pretreatment serum Hs-CRP, NEU-R and Alb have shown specific trends across efficacy Grades, and Hs-CRP aids in predicting PASI90 in psoriasis. In clinical practice, these easily accessible serum parameters in psoriasis patients can help guide the use of acitretin. Further in-depth research with larger sample sizes, validated through animal experiments, is warranted.

Data availability

Experimental data and images from this study are available upon request to the corresponding author.

Acknowledgments

The authors thank all the assistance with the statistical analysis.

Author contributions

L.L., Y.G., M.L.: conceptualization and methodology. L.L., Y.T., Y.Z.: formal analysis. L.L., H.Y., C.S. investigation and data curation. L.L., Y.G., Z.S.: writing—original draft preparation. L.L., M.L., Y.T., Y.Z.: writing-view and editing. All authors have read and agreed to the published version of the manuscript.

Founding

This work was financially supported by the Grants from the Natural Science Foundation of Sichuan Province (Grant No. 2022NSFSC0755)

Competing contributions

The authors declare no competing interests.

Additional information

Correspondence and requests for materials and data should be addressed to L.L., or Z.S.

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No competing interests reported.

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The clinical indicators predicting the efficacy of acitretin in the treatment of psoriasis

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Abstract

Figures

Introduction

Materials and Methods

Clinical Data

Data Collection

Efficacy Evaluation

Analysis Method

Correlation Results

PASI Score

AST Correlation Analysis

WBC、NEU、NEU-R、Hs-CRP、Alb Correlation Analysis

Correlations Between Serum Parameters

Discussion

AST

Hs-CRP

Alb

Declarations

References

Additional Declarations

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