The Role of TNF - α, IFN - γ, and IL-6 in Guiding Treatment and Predicting Prognosis in the Treatment of Severe Plaque Psoriasis with Adalimumab.

The clinical efficacy of adalimumab in treating severe plaque psoriasis is significant, but many questions and uncertainties remain. To evaluate the efficacy of adalimumab in treating patients with severe plaque psoriasis and to explore potential laboratory markers that may predict the efficacy of adalimumab. A retrospective analysis was conducted on 10 patients with severe plaque psoriasis who visited the dermatology department of our hospital from January 2020 to June 2024. Ten healthy individuals were included as a control group. Clinical scores of patients with severe plaque psoriasis were assessed, including body surface area (BSA), psoriasis area and severity index (PASI), and dermatology life quality index (DLQI). Cytokine levels in peripheral blood, including IL-2, IL-4, IL-6, IL-10, TNF-α, and IFN-γ, were measured. Changes in clinical scores and cytokine levels before and 6 months after adalimumab treatment were compared. Additionally, changes in cytokine levels in peripheral blood were analysed for six patients with severe plaque psoriasis who experienced disease relapse. For patients with severe plaque psoriasis, BSA decreased from (18.10 ± 4.89)% to (0.30 ± 0.48)%, PASI score decreased from (18.79 ± 4.91) to (0.12 ± 0.19), and DLQI score decreased from (20.50 ± 3.27) to (1.10 ± 0.32) after 6 months of adalimumab treatment. IL-2 levels decreased from (9.18 ± 4.26) pg/mL to (1.35 ± 1.36) pg/mL, IL-4 from (2.45 ± 1.25) pg/mL to (0.36 ± 0.41) pg/mL, IL-6 from (11.91 ± 6.38) pg/mL to (1.61 ± 1.07) pg/mL, IL-10 from (5.28 ± 2.10) pg/mL to (1.86 ± 0.92) pg/mL, TNF-α from (16.04 ± 17.98) pg/mL to (0.90 ± 0.74) pg/mL, and IFN-γ from (15.00 ± 7.51) pg/mL to (2.04 ± 0.88) pg/mL after 6 months of adalimumab treatment. Compared to the control group, the six cytokine levels in the peripheral blood of patients were significantly elevated before treatment and returned to normal levels after 6 months of treatment. During adalimumab treatment, a decrease in TNF-α with a significant increase in IFN-γ in peripheral blood indicated potential reduced drug efficacy; no significant increase in TNF-α and IFN-γ but an increase in IL-6 suggested the presence of other aggravating factors; significant increases in TNF-α, IFN-γ, and IL-6 indicated possible treatment discontinuation. Adalimumab can improve clinical symptoms in patients with severe plaque psoriasis by antagonising TNF-α and reducing levels of IL-2, IL-4, IL-6, IL-10, TNF-α, and IFN-γ in peripheral blood. Changes in peripheral blood levels of TNF-α, IFN-γ, and IL-6 may serve as early indicators of adalimumab efficacy in treating severe plaque psoriasis.