-Original-

Change in Antinuclear Antibody Titers during Biologic Treatment for Psoriasis

Shun Miyazaki¹, Saeko Ozaki¹, Susumu Ichiyama¹, Michiko Ito¹, Toshihiko Hoashi¹, Naoko Kanda² and Hidehisa Saeki¹

¹Department of Dermatology, Nippon Medical School, Tokyo, Japan
²Department of Dermatology, Nippon Medical School Chiba Hokusoh Hospital, Chiba, Japan

Background: We previously evaluated blood screening data, including antinuclear antibodies (ANA), before initiating biologic treatment for patients with psoriasis in a real-world setting. However, we did not analyze change in ANA titers after the start of biologics. No previous study has comprehensively investigated change in ANA titers over time in individual patients or the effectiveness of certolizumab pegol or tildrakizumab.
Objectives: This study evaluated change in ANA titers in individual patients during treatment with biologics, including certolizumab pegol and tildrakizumab.
Methods: 111 patients were included in this study. Change in ANA was regarded as significant when the ANA titer was ×80 or more in patients with a previously undetectable ANA titer or when it increased by fourfold or more in those with a detectable ANA titer before treatment.
Results: The ratios of patients with a significant change in ANA titer who were treated with a tumor necrosis factor (TNF) inhibitor, interleukin (IL)-17 inhibitor, or IL-23 inhibitor were 34.9% (15/43), 0.0% (0/32), and 0.0% (0/36), respectively. There were 4 patterns of significant change in ANA titer: (i) an increase (n=8), (ii) a decrease after an increase (n=4), (iii) a decrease after an increase with a drug change (n=2), and (iv) an increase after a decrease after an increase (n=1). No symptom suggesting lupus syndrome was noted.
Conclusions: ANA titers must be carefully monitored throughout treatment with biologics, especially TNF inhibitors, and the possibility of lupus-like syndrome should be excluded.

J Nippon Med Sch 2023; 90: 96-102

Keywords
antinuclear antibodies, biologics, changes, psoriasis, tumor necrosis factor inhibitor

Correspondence to
Hidehisa Saeki, MD, Department of Dermatology, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo 113-8603, Japan
h-saeki@nms.ac.jp

Received, August 5, 2022
Accepted, September 28, 2022