10.5826/dpc.1401a65
Introduction: Psoriasis is a chronic cutaneous disorder with underlying systemic inflammation. The systemic immune inflammation (SII) and systemic inflammation response indexes (SIRI) are novel biomarkers that indicate systemic inflammation.
Objectives: We aimed to evaluate the effect of biological agent treatment on SII and SIRI in psoriasis patients.
Methods: Between April 2019 and October 2022, SII and SIRI were retrospectively evaluated in patients with psoriasis before and three months after the initiation of biological agents.
Results: This study included 220 patients, 101 females and 119 males. SIRI was significantly higher in male patients compared to females (P &lt; 0.001). Although not statistically significant, SII and SIRI were higher in obese patients, patients with severe psoriasis, longer disease duration, nail involvement and patients who received previous biological agent treatment. SII was also higher in patients with hypertension, diabetes, hepatic steatosis, depression and coronary artery disease (P = 0.801, P = 0.752, P = 0.706, P = 0.079, P = 0.861, respectively), whereas SIRI was higher in patients with diabetes and depression (P = 0.263, P = 0.777, respectively). Both SII and SIRI statistically significantly decreased after treatment with adalimumab, infliximab, ixekizumab, secukinumab, ustekinumab and risankizumab.
Conclusions: SII and SIRI may indicate the severity of psoriasis as well as SII may be associated with psoriatic arthritis, hypertension, hepatic steatosis and coronary artery disease in patients with psoriasis. There is no consensus on the biomarkers that can be used to create an optimized treatment strategy in psoriasis. Therefore, SII and SIRI may be helpful in making the choice of treatment and in the follow-up of patients with psoriasis treated with biological agents.
text/xml
2160-9381
3647
en
Ahmet Burhan  Aksakal
https://creativecommons.org/licenses/by-nc/4.0
Dermatology Practical & Conceptual
treatment
Effect of Treatment With Biologic Agents on the Novel Inflammatory Biomarkers Systemic Immune Inflammation Index and Systemic Inflammation Response Index for Psoriasis
Text.Serial.Journal
https://dpcj.org/index.php/dpc
Original Article
2024-01-31
2023-06-29
2024-01-31
2024-02-21
e2024065
Dermatol Pract Concept
Introduction: Psoriasis is a chronic cutaneous disorder with underlying systemic inflammation. The systemic immune inflammation (SII) and systemic inflammation response indexes (SIRI) are novel biomarkers that indicate systemic inflammation.
Objectives: We aimed to evaluate the effect of biological agent treatment on SII and SIRI in psoriasis patients.
Methods: Between April 2019 and October 2022, SII and SIRI were retrospectively evaluated in patients with psoriasis before and three months after the initiation of biological agents.
Results: This study included 220 patients, 101 females and 119 males. SIRI was significantly higher in male patients compared to females (P &lt; 0.001). Although not statistically significant, SII and SIRI were higher in obese patients, patients with severe psoriasis, longer disease duration, nail involvement and patients who received previous biological agent treatment. SII was also higher in patients with hypertension, diabetes, hepatic steatosis, depression and coronary artery disease (P = 0.801, P = 0.752, P = 0.706, P = 0.079, P = 0.861, respectively), whereas SIRI was higher in patients with diabetes and depression (P = 0.263, P = 0.777, respectively). Both SII and SIRI statistically significantly decreased after treatment with adalimumab, infliximab, ixekizumab, secukinumab, ustekinumab and risankizumab.
Conclusions: SII and SIRI may indicate the severity of psoriasis as well as SII may be associated with psoriatic arthritis, hypertension, hepatic steatosis and coronary artery disease in patients with psoriasis. There is no consensus on the biomarkers that can be used to create an optimized treatment strategy in psoriasis. Therefore, SII and SIRI may be helpful in making the choice of treatment and in the follow-up of patients with psoriasis treated with biological agents.
Ahmet Burhan  Aksakal
2024/01/31
10.5826/dpc.1401a65
e2024065
Department of Dermatology, Gazi University School of Medicine, Ankara, Turkey
2160-9381
treatment
en
e2024065
Jiménez C, Bordagaray MJ, Villarroel JL, et al. Biomarkers in oral fluids as diagnostic tool for psoriasis. Life. 2022;12(4):501. DOI: 10.3390/life12040501. PMID: 35454992. PMCID: PMC9027180.
Effect of Treatment With Biologic Agents on the Novel Inflammatory Biomarkers Systemic Immune Inflammation Index and Systemic Inflammation Response Index for Psoriasis
https://dpcj.org/index.php/dpc/article/download/3647/2449
        Effect of Treatment With Biologic Agents
    on the Novel Inflammatory Biomarkers Systemic
       Immune Inflammation Index and Systemic
       Inflammation Response Index for Psoriasis
                           Funda Tamer1, Yusuf Can Edek1, Ahmet Burhan Aksakal1


1 Department of Dermatology, Gazi University School of Medicine, Ankara, Turkey



Key words: biological agents, psoriasis, systemic immune inflammation index, systemic inflammation response index, treatment
Citation: Tamer F, Edek YC, Aksakal AB. Effect of Treatment With Biologic Agents on the Novel Inflammatory Biomarkers Systemic
Immune Inflammation Index and Systemic Inflammation Response Index for Psoriasis. Dermatol Pract Concept. 2024;14(1):e2024065.
DOI: https://doi.org/10.5826/dpc.1401a65
Accepted: April 9, 2023; Published: January 2024
Copyright: ©2024 Tamer et al. This is an open-access article distributed under the terms of the Creative Commons Attribution-
NonCommercial License (BY-NC-4.0), https://creativecommons.org/licenses/by-nc/4.0/, which permits unrestricted noncommercial use,
distribution, and reproduction in any medium, provided the original authors and source are credited.
Funding: None.
Competing Interests: None.
Authorship: All authors have contributed significantly to this publication.
Corresponding Author: Funda Tamer, Gazi Universitesi Hastanesi, Emniyet Mahallesi, 29, 06560, Ankara/ Turkey. Tel: +903122026129.
E-mail: fundatmr@yahoo.com.




  ABSTRACT             Introduction: Psoriasis is a chronic cutaneous disorder with underlying systemic inflammation. The
                       systemic immune inflammation (SII) and systemic inflammation response indexes (SIRI) are novel
                       biomarkers that indicate systemic inflammation.
                       Objectives: We aimed to evaluate the effect of biological agent treatment on SII and SIRI in psoriasis
                       patients.
                       Methods: Between April 2019 and October 2022, SII and SIRI were retrospectively evaluated in pa-
                       tients with psoriasis before and three months after the initiation of biological agents.
                       Results: This study included 220 patients, 101 females and 119 males. SIRI was significantly higher
                       in male patients compared to females (P < 0.001). Although not statistically significant, SII and SIRI
                       were higher in obese patients, patients with severe psoriasis, longer disease duration, nail involvement
                       and patients who received previous biological agent treatment. SII was also higher in patients with
                       hypertension, diabetes, hepatic steatosis, depression and coronary artery disease (P = 0.801, P = 0.752,
                       P = 0.706, P = 0.079, P = 0.861, respectively), whereas SIRI was higher in patients with diabetes and de-
                       pression (P = 0.263, P = 0.777, respectively). Both SII and SIRI statistically significantly decreased after
                       treatment with adalimumab, infliximab, ixekizumab, secukinumab, ustekinumab and risankizumab.




Original Article | Dermatol Pract Concept. 2024;14(1):e2024065                                                                        1
                      Conclusions: SII and SIRI may indicate the severity of psoriasis as well as SII may be associated
                      with psoriatic arthritis, hypertension, hepatic steatosis and coronary artery disease in patients with
                      psoriasis. There is no consensus on the biomarkers that can be used to create an optimized treatment
                      strategy in psoriasis. Therefore, SII and SIRI may be helpful in making the choice of treatment and in
                      the follow-up of patients with psoriasis treated with biological agents.




Introduction                                                        Methods
Psoriasis is a chronic inflammatory cutaneous disorder              Gazi University Ethics Committee approved this study
which has been related to comorbidities such as psoriatic ar-       ­(approval number: 2022-1108). Medical records of patients
thritis, diabetes, obesity, cardiovascular diseases and depres-     who were admitted for the treatment of psoriasis between
sion due to underlying systemic inflammation [1]. It has been       April 2019 and October 2022 were retrospectively reviewed.
suggested that proinflammatory cytokines, which have been           Patients with psoriasis aged 18 years and over and who were
implicated in the development of cutaneous findings such as         treated with biological agents were included in this study.
tumor necrosis factor (TNF)-α, interleukin (IL)-17, IL-23,          Psoriasis type, psoriasis duration, accompanying psoriatic
were increased in both skin and the circulation [2]. Although       arthritis and systemic diseases, psoriasis treatment, psoriasis
the systemic inflammatory response, which is not limited to         area and severity index (PASI) and body mass index (BMI)
the skin, may lead to tissue and organ dysfunction, the risk        were noted.
for the development of the disease and pathogenesis of the              PASI less than 10 was regarded as mild to moderate
systemic involvement have not been fully understood [3]. It         psoriasis, whereas PASI greater than 10 was severe dis-
has been suggested that biological agents used in the treat-        ease [12]. Obesity was defined as body mass index (BMI)
ment of psoriasis might reduce the risk of the development of       ≥ 30 kg/m2 [13]. In addition, SII and SIRI were evaluated
systemic comorbidities and prevent the progression of exist-        before and three months after treatment with biological
ing comorbidities due to their anti-inflammatory effects [4].       agents. SII and SIRI were calculated using the data obtained
    It is important to identify biomarkers that can indicate        from complete blood count; SII= platelet count (x103/µL) X
disease activity and remission in psoriasis. Inflammatory           neutrophil count (x103/µL) / lymphocyte count (x103/µL)
biomarkers, especially obtained from blood samples, may             and SIRI= neutrophil count (x103/µL) X monocyte count
be easily performed and used in the follow-up of patients           (x103/µL) / lymphocyte count (x103/µL) [14,15].
with psoriasis [5]. Various biomarkers such as neutrophil/              Statistical analysis was performed using SPSS version
lymphocytes ratio, platelet/lymphocytes ratio and systemic          25.0. Continuous variables were presented as mean ± stan-
immune inflammation index have been proposed to be used             dard deviation or median (interquartile range), whereas cat-
to detect systemic inflammation in patients with psoria-            egorical variables were presented as counts and percentages.
sis [1,5]. However, there is no consensus on the biomarkers         Kolmogorov-Smirnov test was used to detect the normality
that can be used to create an optimized treatment strategy in       of the distribution of the variables. The differences between
the management of psoriasis [5].                                    the groups were evaluated by Mann-Whitney U test and
    Systemic immune inflammation index (SII) and systemic           ­Wilcoxon signed ranks test. P < 0.05 was considered statis-
inflammation response index (SIRI) are new biomarkers that          tically significant.
have been reported to indicate systemic inflammation [6]. SII
and SIRI have been associated with various disorders such as
                                                                    Results
hepatic steatosis, cardiovascular diseases, risk of cancer devel-
opment and depression [6-9]. In a few studies, high SII levels      This study included 220 patients, 101 (45.9%) females
have been reported in patients with psoriasis [10,11]. Recently,    and 119 (54.1%) males with a mean age of 49.61±13.29
Sugimoto et al reported that patients with psoriatic arthritis      years (range: 20-77 years) (Table 1). The median psoriasis
were likely to have high SIRI levels [1]. However, SII and SIRI     duration was 20 (16) years in male patients and 15 (18)
have not been adequately studied in patients with psoriasis.        years in females (p=0.006). The median PASI and BMI was
                                                                    14 (8.5) and 28.6 (8) kg/m2, respectively. Sixty-six (30%)

Objectives                                                          patients were treated with ustekinumab, 56 (25.5%) with
                                                                    ixekizumab, 43 (19.5%) with adalimumab, 24 (10.9%) with
The aim of this study was to evaluate the SII and SIRI in           secukinumab, 15 (6.8%) with infliximab, 11 (5%) with ri-
patients with psoriasis treated with biological agents.             sankizumab and 5 (2.3%) with guselkumab.

2                                                                        Original Article | Dermatol Pract Concept. 2024;14(1):e2024065
                              Table 1. The characteristics of the patients with psoriasis.
                                                            Characteristics
 Gender, N (%)                                                         Female, 101 (45.9%)
                                                                       Male, 119 (54.1%)
 Mean age±SD (years)                                                   49.61±13.29
 Psoriasis type, N (%)                                                 Psoriasis vulgaris, 195 (88.6%)
                                                                       Palmoplantar psoriasis, 13 (5.9%)
                                                                       Generalized pustular, 12 (5.5%)
 Psoriasis duration, median (IQR) (years)                              18 (16)
 Psoriatic arthritis, N (%)                                            Present, 66 (30%)
                                                                       None, 154 (70%)
 Nail findings, N (%)                                                  Present, 104 (47.3%)
                                                                       None, 116 (52.7%)
 Past medical history, N (%)                                           Unremarkable, 100 (45.5%)
                                                                       Hypertension, 59 (26.8%)
                                                                       Hyperlipidemia, 45 (20.5%)
                                                                       Diabetes mellitus, 32 (14.5%)
                                                                       Hepatic steatosis, 24 (10.9%)
                                                                       Hepatitis B virus carriage, 20 (9.1%)
                                                                       Depression, 19 (8.6%)
                                                                       Coronary artery disease, 16 (7.3%)
                                                                       Thyroid disease, 9 (4.1%)
                                                                       Asthma, 6 (2.7%)
 Previous treatment, N (%)                                             Conventional treatment, 214 (97.3%)
                                                                       Biological agents, 93 (42.3%)
                                                                       Phototherapy, 70 (31.8%)

IQR = interquartile range; SD = Standard deviation.
This study included 220 patients with a mean age of 49.61±13.29 years. Most of the patients (88.6%) had psoriasis vulgaris. The frequency
of psoriatic arthritis was 30%.



    Although not statistically significant, higher SII levels         patients treated with adalimumab, infliximab, ixekizumab,
were detected in male patients, patients with severe psori-           secukinumab, ustekinumab and risankizumab (P < 0.001,
asis, psoriasis duration longer than 20 years, patients with          P = 0.002, P < 0.001, P = 0.004, P < 0.001, P = 0.013, respec-
psoriatic arthritis, nail involvement, obese patients and             tively) (Table 4) (Figure 1).
­patients previously treated with biological agents (P = 0.855,           SIRI statistically significantly decreased in all patients
P = 0.267, P = 0.466, P = 0.968, P = 0.210, P = 0.071,                with psoriasis three months after biological agent treat-
P = 0.921, respectively). SII was also higher in patients with        ment (P < 0.001). SIRI also significantly decreased in pa-
hypertension, diabetes, hepatic steatosis, depression and             tients treated with adalimumab, infliximab, ixekizumab,
coronary artery disease (P = 0.801, P = 0.752, P = 0.706,             ­secukinumab, ustekinumab and risankizumab (P < 0.001,
P = 0.079, P = 0.861, respectively) (Table 2).                        P = 0.001, P = 0.002, P = 0.018, P < 0.001, P = 0.041, respec-
    SIRI was statistically significantly higher in male patients      tively) (Table 5 and Figure 2).
compared to females (P < 0.001). Although not statistically sig-
nificant, higher SIRI levels were detected in patients with severe
                                                                      Conclusions
psoriasis, nail findings, psoriasis duration longer than 20 years,
obese patients and patients previously treated with biological        SII and SIRI have been proposed as novel biomarkers which
agents (P = 0.295, P = 0.904, P = 0.381, P = 0.185, P = 0.921,        might indicate systemic inflammation, however, the use of
respectively). SIRI was also higher in patients with diabetes and     SII and SIRI in patients with psoriasis was evaluated in lim-
depression (P = 0.263, P = 0.777, respectively) (Table 3).            ited studies [1]. For instance, Yorulmaz et al reported higher
    SII statistically significantly decreased in all patients         SII levels in patients with psoriasis compared to healthy in-
with psoriasis three months after biological agent treat-             dividuals as well as SII was positively correlated with PASI
ment (P < 0.001). In addition, SII significantly decreased in         and presence of psoriatic arthritis [10]. Similarly, Melikoglu
treatment groups such as TNF-α inhibitors, IL-17 inhibitors           et al reported an association between disease severity and SII
and IL-12/23 inhibitor (P < 0.001, P < 0.001, P < 0.001,              levels in patients with psoriasis. In addition, Melikoglu et al
respectively). SII also statistically significantly decreased in      reported no difference in SII levels in patients with different


Original Article | Dermatol Pract Concept. 2024;14(1):e2024065                                                                         3
Table 2. Systemic immune inflammation index in                            Table 3. Systemic inflammation response index
             patients with psoriasis.                                                in patients with psoriasis.
     Systemic Immune Inflammation Index                                      Systemic inflammation response index
                median (IQR)                               P value                        median (IQR)                              P value
 Female                      Male                           0.855         Female                      Male                           <0.001
 618 (513)                   655 (400)                                    1.02 (0.83)                 1.28 (1.10)
 With arthritis              Without arthritis              0.968         With arthritis              Without arthritis               0.07
 656 (430)                   642 (419)                                    1.09 (0.75)                 1.21 (0.99)
 Psoriasis vulgaris          Other types                    0.456         Psoriasis vulgaris          Other types                     0.956
 644 (426)                   705 (363)                                    1.18 (0.90)                 1.19 (1.06)
 Nail involvement            Without nail                   0.210         Nail involvement            Without nail                    0.904
 696 (434)                   involvement                                  1.20 (0.87)                 involvement
                             600 (401)                                                                1.16 (0.91)
 Psoriasis duration          Psoriasis duration (>20        0.466         Psoriasis duration          Psoriasis duration (>20         0.381
 (≤20 years)                 years)                                       (≤20 years)                 years)
 643 (429)                   656 (428)                                    1.13 (0.91)                 1.25 (0.99)
 Mild/ moderate              Severe psoriasis               0.267         Mild/ moderate              Severe psoriasis                0.295
 psoriasis                   652 (490)                                    psoriasis                   1.19 (1.07)
 624 (388)                                                                1.13 (0.75)
 Non-obese                   Obese                          0.071         Non-obese                   Obese                           0.185
 642 (428)                   718 (619)                                    1.05 (0.74)                 1.30 (1.08)
 Previous biological         Biologic-naïve                 0.921         Previous biological         Biologic-naïve                  0.921
 treatment                   642 (436)                                    treatment                   1.16 (0.76)
 658 (411)                                                                1.25 (1.19)
 Unremarkable                With a chronic disease         0.763         Unremarkable                With a chronic disease          0.753
 medical history             648 (461)                                    medical history             1.19 (0.79)
 645 (395)                                                                1.16 (1.01)
 With hypertension           Without hypertension           0.801         With hypertension           Without hypertension            0.607
 687 (566)                   642 (411)                                    1.16 (1.00)                 1.19 (0.87)
 With hyperlipidemia         Without                        0.113         With hyperlipidemia         Without                         0.806
 598 (388)                   hyperlipidemia                               1.18 (0.67)                 hyperlipidemia
                             658 (436)                                                                1.20 (1.01)
 With diabetes               Without diabetes               0.752         With diabetes               Without diabetes                0.263
 mellitus                    mellitus                                     mellitus                    mellitus
 651 (611)                   645 (403)                                    1.23 (1.11)                 1.16 (0.89)
 With hepatic steatosis      Without hepatic                0.706         With hepatic steatosis      Without hepatic                 0.472
 735 (461)                   steatosis                                    1.13 (0.98)                 steatosis
                             643 (418)                                                                1.19 (0.90)
 With hepatitis B virus      Without hepatitis              0.915         With hepatitis B virus      Without hepatitis B             0.424
 carriage                    B virus carriage                             carriage                    virus carriage
 608 (431)                   650 (421)                                    1.13 (0.98)                 1.19 (0.90)
 With depression             Without depression             0.079         With depression             Without depression              0.777
 782 (239)                   608 (418)                                    1.39 (1.22)                 1.18 (0.89)
 With coronary artery        Without coronary               0.861         With coronary artery        Without coronary                0.185
 disease                     artery disease                               disease                     artery disease
 692 (521)                   643 (416)                                    1.01 (0.85)                 1.20 (0.90)

IQR = interquartile range.                                               IQR = interquartile range.
Higher SII levels were detected in male patients, patients with severe   SIRI was statistically significantly higher in male patients compared
psoriasis, patients with psoriatic arthritis, nail findings and obese    to females. This result may be related to longer psoriasis duration in
patients. SII may indicate the severity of psoriasis.                    male patients than in females.




types of psoriasis [16]. However, Ibrahim et al reported that            patients with psoriasis compared to patients with dermato-
patients with pustular psoriasis had higher SII levels com-              logical disorders other than psoriasis. SII was also associated
pared to those with psoriasis vulgaris and erythrodermic                 with nail changes due to psoriasis [11]. Kelesoglu Dincer et al
psoriasis [17]. Dincer Rota et al reported higher SII levels in          reported higher SII levels in patients with psoriatic arthritis

4                                                                             Original Article | Dermatol Pract Concept. 2024;14(1):e2024065
Table 4. The effect of biological agent treatment                        Table 5. The effect of biological agent treatment
 of psoriasis on systemic immune inflammation                             of psoriasis on systemic inflammation response
                      index.                                                                   index.
                             Systemic immune                                                       Systemic inflammation
                            inflammation index                                                         response index
                                median (IQR)               P value                                      median (IQR)             P value
                            Before            After                                                  Before           After
                          treatment        treatment                                               treatment       treatment
 All patients             646 (420)         492 (324)       <0.001        All patients             1.18 (0.90)    0.95 (0.74)     <0.001
 TNF-α inhibitors         607 (384)         408 (341)       <0.001        TNF-α inhibitors         1.15 (0.73)     0.8 (0.58)     <0.001
 IL-17 inhibitors         703 (485)         528 (298)       <0.001        IL-17 inhibitors         1.16 (1.08)    1.00 (0.88)     <0.001
 IL-12/23 inhibitor       603 (468)         512 (344)       <0.001        IL-12/23 inhibitor       1.17 (0.79)    0.95 (0.68)     <0.001
 IL-23 inhibitor          689 (390)         467 (182)        0.056        IL-23 inhibitor          1.52 (1.42)    0.97 (0.78)      0.056
 Adalimumab               532 (278)         374 (327)       <0.001        Adalimumab               1.05 (0.68)    0.78 (0.58)     <0.001
 Infliximab               867 (356)         487 (469)        0.002        Infliximab               1.73 (1.14)    0.88 (1.04)      0.001
 Ixekizumab               682 (432)         539 (314)       <0.001        Ixekizumab               1.17 (1.14)    1.00 (0.93)      0.002
 Secukinumab              744 (624)         454 (276)        0.004        Secukinumab              1.07 (1.27)    1.01 (0.94)      0.018
 Ustekinumab              603 (468)         512 (344)       <0.001        Ustekinumab              1.17 (0.79)    0.95 (0.68)     <0.001
 Risankizumab             559 (392)         443 (145)        0.013        Risankizumab             1.75 (1.69)    0.88 (1.08)      0.041
 Guselkumab               859 (468)        501 (1147)        0.893        Guselkumab               1.28 (0.79)    0.98 (3.03)      0.686

IL = interleukin; IQR = interquartile range;TNF-α = tumor necrosis       IL = interleukin; IQR = interquartile range; TNF-α = tumor necrosis
factor-α.                                                                factor-α.
Systemic immune inflammation index decreased in patients treated         Systemic inflammation response index decreased in treatment
with adalimumab, infliximab, ixekizumab, secukinumab, usteki-            groups such as TNF-α inhibitors, IL-17 inhibitors and IL-12/23 in-
numab and risankizumab. Systemic immune inflammation index may           hibitor. Systemic inflammation response index may be useful in the
be useful in the follow-up of patients treated with biological agents.   follow-up of patients treated with biological agents.




        Figure 1.​​​​​​​ The effect of biological agents on systemic immune inflammation index. Systemic immune inflammation index
        decreased in all treatment groups.


than in healthy controls as well as positive correlation be-             in healthy individuals. On the other hand, a positive rela-
tween SII and severity of psoriatic arthritis [18]. Sugimoto             tionship was detected between PASI and both SII and SIRI.
et al reported no significant difference in SII and SIRI levels          Sugimoto et al also revealed that SIRI might indicate higher
in patients with psoriasis vulgaris and psoriatic arthritis and          possibility of the diagnosis of psoriatic arthritis. In addition,

Original Article | Dermatol Pract Concept. 2024;14(1):e2024065                                                                             5
        ​​​​​​​Figure 2. The effect of biological agents on systemic inflammation response index. Systemic inflammation response index
               decreased in all treatment groups.



adherence to biological agent treatment of patients with pso-            with adalimumab, infliximab, ixekizumab, secukinumab,
riasis vulgaris and psoriatic arthritis was not related to high          ustekinumab and risankizumab significantly reduced SII and
SII or SIRI levels [1].                                                  SIRI levels in patients with psoriasis. Herein, we presented a
    Within this study, SII was higher in males, obese patients,          unique and comprehensive study on SII and SIRI in patients
patients with severe psoriasis and longer disease duration,              with psoriasis treated with biological agents. Although a va-
patients with psoriatic arthritis, nail findings and patients            riety of biological agents have been developed to be used in
who received previous biological agent treatment. SII was                the treatment of psoriasis, there is lack of biomarkers widely
also higher in patients with comorbidities such as hyperten-             preferred to asses disease severity, psoriatic arthritis and co-
sion, diabetes, hepatic steatosis, depression and coronary               morbidities and to be used during the course of treatment of
artery disease. On the other hand, SIRI was statistically sig-           psoriasis with biological agents [5,19-21]. Our results will
nificantly higher in male patients compared to females. This             contribute to the literature on the use of SII and SIRI in the
result may be related to longer psoriasis duration in male pa-           management of psoriasis patients with biological agents.
tients than in females. SIRI was also higher in obese patients,          Since SII and SIRI can be easily performed, in clinical prac-
patients with severe psoriasis, longer disease duration and              tice both biomarkers may be helpful in making treatment
nail involvement and patients who received previous biolog-              choice and in the follow-up of patients with psoriasis treated
ical agent treatment. In addition, SIRI was higher in patients           with biological agents.
with comorbidities such as diabetes and depression. SII and
SIRI were similar in patients with psoriasis vulgaris and in             References
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Original Article | Dermatol Pract Concept. 2024;14(1):e2024065                                                                                   7
