Table_1_Precision medicine based on the phenotypic differences in peripheral T helper cells in patients with psoriatic arthritis: One year follow-up outcomes.DOCX

PurposeWe validated the one-year effectiveness of strategic treatment with biological disease-modifying anti-rheumatic drugs (bDMARDs) based on peripheral T-lymphocytic phenotyping and explored the impact of treatment on T helper lymphocytic phenotypes.
MethodsNinety-seven patients were registered in this study. One-year treatment response was compared between the two groups: the strategic bDMARDs treatment group (n = 41), in which bDMARDs were selected based on peripheral blood lymphocyte analysis, and the standard bDMARDs treatment group (n = 56), in which the patients underwent no strategic selection of bDMARDs and phenotyping. Changes in helper T lymphocytic phenotypes were evaluated after 1-year post-treatment.
ResultsIn the standard bDMARDs treatment group, 23 patients (42.6%) achieved disease activity in psoriatic arthritis (DAPSA)-remission (REM), and 23 of 46 (50.0%) achieved PASI 90. In the strategic bDMARDs treatment group, 22 (53.7%) achieved DAPSA-REM, and 26 of 35 (74.2%) achieved PASI90. The rate of achieving minimal disease activity (MDA) and DAPSA-REM at month 6, DAPSA-low disease activity (LDA) at months 6 and 12, and PASI 90 at month 12 were significantly higher in the strategic bDMARDs treatment group. After treatment with ustekinumab, the proportion of aTh1/CD4 (%) significantly decreased. The percent reduction in activated Th17 cells was significantly higher in IL-17-i cells than in UST/TNF-i cells.
ConclusionsThe results of this study demonstrate the 1-year effectiveness of precision medicine based on peripheral T-lymphocytic phenotyping in terms of DAPSA and MDA. Analysis of data from real-world clinical practice showed that the impact on the immune system varied among bDMARDs. However, because psoriatic arthritis has very high heterogeneity, it may be necessary to conduct studies with a larger sample size, perhaps drawing samples from multiple institutions.

研究目的：本研究基于外周T淋巴细胞表型分析（peripheral T-lymphocytic phenotyping），验证生物改善病情抗风湿药（biological disease-modifying anti-rheumatic drugs, bDMARDs）策略性治疗的1年有效性，并探讨该治疗方案对辅助性T淋巴细胞表型的影响。
研究方法：本研究共纳入97例患者。将患者分为两组以比较1年治疗应答情况：策略性bDMARDs治疗组（n=41），其bDMARDs选择基于外周血淋巴细胞分析；常规bDMARDs治疗组（n=56），该组患者未进行bDMARDs的策略性选择及表型分析。治疗1年后评估辅助性T淋巴细胞表型的变化。
研究结果：常规bDMARDs治疗组中，23例患者（42.6%）达到银屑病关节炎疾病活动度（Disease Activity in Psoriatic Arthritis, DAPSA）缓解（REM），46例患者中23例（50.0%）达到银屑病面积和严重程度指数90（Psoriasis Area and Severity Index 90, PASI 90）。策略性bDMARDs治疗组中，22例（53.7%）达到DAPSA缓解，35例患者中26例（74.2%）达到PASI 90。策略性bDMARDs治疗组在第6个月达到最低疾病活动度（minimal disease activity, MDA）和DAPSA缓解、第6及12个月达到DAPSA低疾病活动度（low disease activity, LDA），以及第12个月达到PASI 90的比例均显著更高。接受乌司奴单抗（ustekinumab）治疗后，活化Th1/CD4细胞的占比显著降低。IL-17抑制剂治疗组的活化Th17细胞百分比降幅显著高于乌司奴单抗/肿瘤坏死因子抑制剂治疗组。
研究结论：本研究结果证实，基于外周T淋巴细胞表型分析的精准医学治疗在DAPSA及MDA指标上具有1年有效性。真实世界临床实践数据显示，不同bDMARDs对免疫系统的影响存在差异。但由于银屑病关节炎具有极高的异质性，或许有必要开展更大样本量的研究，例如从多中心招募受试者。