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Associations between HLA-Cw1 and Systemic Treatment Response of Asian Psoriasis Patients
Shin-Shin Ho1, Tsen-Fang Tsai2,3
1National Taiwan University Hospital, No. 7 Chung San South Road, Taipei, Taiwan.
Insights
Patients with psoriasis negative for the HLA-Cw1 gene were more likely to respond to biologic treatments, particularly ustekinumab. This finding suggests HLA-Cw1 influences biologic therapy effectiveness in psoriasis patients.
Area of Science:
- Immunogenetics
- Dermatology
- Pharmacogenomics
Background:
- Psoriasis is a chronic inflammatory skin disease with a significant genetic component.
- Human Leukocyte Antigen (HLA)-Cw6 is a known major susceptibility locus for psoriasis.
- However, HLA-Cw1 prevalence is higher than HLA-Cw6 in some Asian populations.
Purpose of the Study:
- To investigate the association between HLA-Cw1 status and treatment response in patients with moderate to severe plaque psoriasis.
- To determine if HLA-Cw1 influences the efficacy of biologic and non-biologic systemic therapies.
Main Methods:
- A retrospective case-control study of 126 patients with moderate to severe plaque psoriasis.
- Patients were genotyped for HLA-Cw1 and their treatment responses to various therapies were analyzed.
- Comparison between HLA-Cw1-positive and HLA-Cw1-negative patient groups.
Main Results:
- HLA-Cw1-negative patients showed a significantly higher likelihood of responding to biologic treatments (OR 1.99, p=0.0122), especially ustekinumab (OR 3.27, p=0.0496).
- A dose effect for the HLA-Cw1 allele was observed.
- Treatment response to non-biologic systemic therapies, including phototherapy, was not affected by HLA-Cw1 status.
Conclusions:
- HLA-Cw1 status is associated with differential treatment responses to biologics in Asian patients with moderate to severe psoriasis.
- The findings suggest HLA-Cw1 may play a role in predicting biologic therapy effectiveness.
- Further research is needed to elucidate the precise mechanism and role of HLA-Cw1 in psoriasis treatment response.
Introduction:
Psoriasis is a chronic inflammatory disease with a strong genetic background, particularly the human leukocyte antigen (HLA). HLA-Cw6 has been shown to be the major disease susceptibility locus and affects the phenotypes and treatment response in psoriasis; however, the prevalence of HLA-Cw6 is far lower than HLA-Cw1 in some Asian countries.
Objectives:
The aim of this study was to determine whether HLA-Cw1 predisposes psoriasis patients to different treatment responses of biologics and other systemic therapy.
Methods:
This retrospective case-control study included 126 patients with moderate to severe plaque-type psoriasis who had been genotyped and treated in a special psoriasis clinic. HLA-Cw1-positive and -negative patients were compared.
Results:
Our results showed that HLA-Cw1-negative patients were significantly more likely to respond (achieve Psoriasis Area and Severity Index [PASI] 75 after a 12- to 16-week treatment course) to biologics (including etanercept, adalimumab, ustekinumab, secukinumab, ixekizumab, and guselkumab; odds ratio [OR] 1.99, 95% confidence interval [CI] 1.17-3.44, p = 0.0122) and especially to ustekinumab (OR 3.27, 95% CI 1.03-11.30; p = 0.0496). An HLA-Cw1 allele dose effect was also found. The results remained after multivariate logistic regression analysis. HLA-Cw1-negative patients also showed significantly greater improvement of PASI in ustekinumab and biologics (p = 0.0044 and p = 0.0064, respectively), with other biologics showing non-significant trends. HLA-Cw1 status did not affect the treatment responses of non-biologic systemic treatment, including phototherapy.
Conclusion:
There is an association between HLA-Cw1 and treatment response to biologics, but not to non-biologics, in our Asian population of patients with moderate to severe psoriasis; however, the exact mechanism and role of HLA-Cw1 remain to be investigated.
