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. 2022 Jul 27:9:934937.
doi: 10.3389/fmed.2022.934937. eCollection 2022.

Precision medicine based on the phenotypic differences in peripheral T helper cells in patients with psoriatic arthritis: One year follow-up outcomes

Ippei Miyagawa  1 , Shingo Nakayamada  1 , Masanobu Ueno  1 , Yusuke Miyazaki  1 , Naoaki Ohkubo  1 , Yoshino Inoue  1 , Satoshi Kubo  1 , Yoshiya Tanaka  1
Affiliations

Precision medicine based on the phenotypic differences in peripheral T helper cells in patients with psoriatic arthritis: One year follow-up outcomes

Ippei Miyagawa et al. Front Med (Lausanne). .

Abstract

Purpose: We validated the one-year effectiveness of strategic treatment with biological disease-modifying anti-rheumatic drugs (bDMARDs) based on peripheral T-lymphocytic phenotyping and explored the impact of treatment on T helper lymphocytic phenotypes.

Methods: Ninety-seven patients were registered in this study. One-year treatment response was compared between the two groups: the strategic bDMARDs treatment group (n = 41), in which bDMARDs were selected based on peripheral blood lymphocyte analysis, and the standard bDMARDs treatment group (n = 56), in which the patients underwent no strategic selection of bDMARDs and phenotyping. Changes in helper T lymphocytic phenotypes were evaluated after 1-year post-treatment.

Results: In the standard bDMARDs treatment group, 23 patients (42.6%) achieved disease activity in psoriatic arthritis (DAPSA)-remission (REM), and 23 of 46 (50.0%) achieved PASI 90. In the strategic bDMARDs treatment group, 22 (53.7%) achieved DAPSA-REM, and 26 of 35 (74.2%) achieved PASI90. The rate of achieving minimal disease activity (MDA) and DAPSA-REM at month 6, DAPSA-low disease activity (LDA) at months 6 and 12, and PASI 90 at month 12 were significantly higher in the strategic bDMARDs treatment group. After treatment with ustekinumab, the proportion of aTh1/CD4 (%) significantly decreased. The percent reduction in activated Th17 cells was significantly higher in IL-17-i cells than in UST/TNF-i cells.

Conclusions: The results of this study demonstrate the 1-year effectiveness of precision medicine based on peripheral T-lymphocytic phenotyping in terms of DAPSA and MDA. Analysis of data from real-world clinical practice showed that the impact on the immune system varied among bDMARDs. However, because psoriatic arthritis has very high heterogeneity, it may be necessary to conduct studies with a larger sample size, perhaps drawing samples from multiple institutions.

Keywords: biological DMARDs; peripheral T lymphocyte phenotyping; precision medicine; psoriatic arthritis; treatment.

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Conflict of interest statement

YT has received speaking fees and/or honoraria from Daiichi-Sankyo, Eli Lilly, Novartis, YL Biologics, Bristol-Myers, Eisai, Chugai, Abbvie, Astellas, Pfizer, Sanofi, Asahi-kasei, GSK, Mitsubishi-Tanabe, Gilead, and Janssen; research grants from Abbvie, Mitsubishi-Tanabe, Chugai, Asahi-Kasei, Eisai, Takeda, Daiichi-Sankyo; and consultant fees from Eli Lilly, Daiichi-Sankyo, Taisho, Ayumi, Sanofi, GSK, and Abbvie. SN has received consulting fees, speaking fees, and/or honoraria from Bristol-Myers, AstraZeneca, Pfizer, GlaxoSmithKline, Astellas, Asahi-kasei, Sanofi, Abbvie, Eisai, Chugai, Gilead, and Boehringer Ingelheim, and has received research grants from Mitsubishi-Tanabe. YM has received consulting fees, speaking fees, and/or honoraria from Eli Lilly, and has received research grants from GlaxoSmithKline. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Study design. UST, ustekinumab; IL-17-I, IL-17 inhibitors; TNF-I, TNF inhibitors-index; aTh1, activated Th1 cells; aTh17, activated Th17 cells.
Figure 2
Figure 2
Changes in proportion of aTh1/Th17 cells (%) after bDMARDs treatment. Data are presented as the median (interquartile range [IQR]). *P < 0.05, Wilcoxon signed-rank test. UST, ustekinumab; IL-17-i, IL-17 inhibitors; TNF-i, TNF inhibitors, index, aTh1: activated Th1 cells; aTh17, activated Th17 cells.
Figure 3
Figure 3
Comparison of percent reduction of aTh1/Th17 cells after bDMARDs treatment. Data are presented as the median (interquartile range [IQR]). *P < 0.05, Mann-Whitney U test. UST, ustekinumab; IL-17-i, IL-17 inhibitors; TNF-i, TNF inhibitors, index, aTh1: activated Th1 cells; aTh17, activated Th17 cells.
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