Durability of response to IL-17A blockade (secukinumab) varies, representing a major clinical challenge. Psoriasis is inherently linked to immunometabolic dysfunction. We hypothesized that simple, routine metabolic indices could predict long-term treatment stability, offering crucial pre-treatment stratification tools.
Methods
This was a 52-week prospective, single-center cohort study of 118 patients with moderate-to-severe plaque psoriasis initiating secukinumab. We defined Durable Response (DR) as PASI90 at Week 12 maintained as absolute PASI ≤ 2 until Week 52. Multivariable logistic regression and Cox models were used to identify independent predictors of DR and drug survival.
Results
Independent predictors of durable response were biologic-naïve status (adjusted OR = 3.52, 95% CI: 1.58-7.85) and a lower baseline TG/HDL-C ratio (adjusted OR = 0.61, 95% CI: 0.47-0.79). Conversely, obesity (BMI≥30) (OR = 0.42) and higher baseline PASI (OR = 0.91) were associated with reduced odds of DR. Conventional systemic inflammatory markers (CRP, NLR) showed no significant difference. Drug survival was significantly higher in DRs (92.6% vs 78.3% at Week 52) and was independently reduced by psoriatic arthritis.
Conclusion
The routine baseline TG/HDL-C ratio is a strong, independent predictor of sustained secukinumab efficacy. These easily accessible clinical and metabolic features capture the immunometabolic milieu influencing IL-17A inhibition durability. Integrating the TG/HDL-C ratio into pre-treatment assessment can support patient stratification and optimize long-term management strategies for plaque psoriasis.
