Blood Monocyte Count Can Predict Early Response to Secukinumab Therapy in Patients With Psoriasis

Early response to treatment with biologics, defined as Psoriasis Area and Severity Index (PASI) of 2 or less six months after initiation of therapy, seems to be associated with more stable psoriasis and a lower risk of flares and treatment discontinuation. This study aimed to identify markers that can predict early response to treatment with secukinumab in patients with plaque psoriasis. Treatment with secukinumab was initiated in 29 biologic-naive patients with plaque psoriasis (75.9% males). After six months, the patients were stratified as (1) PASI 2 or less responders or (2) PASI greater than 2 responders. Patients who achieved PASI 2 or less six months after initiation of secukinumab therapy already had significantly greater PASI reductions after the first month of therapy compared to those with PASI greater than 2 six months after treatment. Baseline blood monocyte counts significantly correlated with PASI, both before and six months after initiating secukinumab therapy. A lower monocyte count with a cutoff value set at less than 0.69 × 103/microL (based on ROC curve analysis) was found in multivariate analysis to be an independent factor for achieving PASI 2 or less six months after initiation of therapy with secukinumab (R2 = 0.7; beta = -0.67; P = 0.03). We showed that baseline monocyte count may be useful for predicting early response to secukinumab therapy in plaque psoriasis patients. Identifying such a marker may help clinicians choose the most appropriate biologics for patients with plaque psoriasis and help avoid the expense of switching from one biologic to another. J Drugs Dermatol. 2024;23(2):74-77.     doi:10.36849/JDD.7525.