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Changes in the FIB-4 index with IL-23 vs IL-17 inhibitors in psoriasis: a retrospective cohort study
Gozde Ulutaş Demirbaş1, Abdullah Demirbaş2, Esin Diremsizoglu2
1Department of Dermatology, Kocaeli City Hospital, Kocaeli, Turkiye.
Background And Objectives:
Psoriasis is associated with risk of hepatic fibrosis, but the comparative hepatic profiles of interleukin (IL)-17 and IL-23 inhibitors remain uncertain.
Methods:
This two-center retrospective cohort included adults with psoriasis treated with IL-17 or IL-23 inhibitors. Six-month changes in the Fibrosis-4 index (FIB-4) and aspartate aminotransferase-to-platelet ratio index (APRI), and 12-month ultrasonographic steatosis outcomes, were compared. Month-6 FIB-4 was analyzed using analysis of covariance adjusted for baseline FIB-4 and covariates.
Results:
Among 261 patients (IL-17, n = 129; IL-23, n = 132), 140 had ultrasonography. Median ΔFIB-4 was -0.005 (interquartile range (IQR), -0.054 to 0.046) and -0.050 (-0.143 to -0.011), respectively. Adjusted showed lower month-6 FIB-4 with IL-23 treatment (β = -0.063, 95% confidence interval (CI) -0.091 to -0.034). FIB-4 improvement occurred in 12.4% and 32.6%, respectively. Among patients with baseline FIB-4 ≥ 1.30, median changes were -0.030 and -0.222 (adjusted β = -0.199, 95% CI - 0.265 to -0.133). Median ΔAPRI was -0.003 and -0.022. Platelet counts changed by -4.0 and +14.5 × 109/L, respectively (p = 0.031), while unadjusted transaminase changes did not differ. ΔPsoriasis Area and Severity Index (PASI) and ultrasonographic steatosis changes were comparable; no hepatic events occurred.
Conclusions:
IL-23 inhibition was associated with greater reductions in FIB-4 and APRI than IL-17 inhibition, particularly among patients with elevated baseline FIB-4. Prospective validation with elastographic confirmation is needed.