Change in Serum KL-6 Level during Biologic Treatment for Psoriasis

J Nippon Med Sch. 2023;90(2):194-201. doi: 10.1272/jnms.JNMS.2023_90-207.

Abstract

Background: We previously analyzed data from blood examination screenings, including serum Krebs von den Lungen (KL) -6 level, before starting biologic treatment for psoriasis in a real-world setting. However, we did not follow change in KL-6 level after the initiation of biologics. Furthermore, there has been no follow-up study of certolizumab pegol, risankizumab, or tildrakizumab. This study evaluated change in serum KL-6 levels in patients during treatment with biologics, including certolizumab pegol, risankizumab, and tildrakizumab.

Methods: We analyzed data from 111 patients. Change in KL-6 level was regarded as significant if it increased to greater than 500 U/mL at least once and if the maximum level after treatment with biologics was at least 1.5 times that of the baseline level.

Results: KL-6 level significantly changed during treatment with TNF inhibitors, IL-17 inhibitors, and IL-23 inhibitors in 9 (20.9%), 2 (6.3%), and 2 (5.6%) patients, respectively. Mean age, mean baseline KL-6 level, and frequency of TNF inhibitor use were higher in patients with a significant change in KL-6 level than those in patients without a significant change. Ten patients had minor interstitial changes on chest CT scans but no clinical signs suggesting interstitial pneumonia.

Conclusions: Older patients with psoriasis and high baseline KL-6 levels must be carefully monitored during treatment with biologics, especially TNF inhibitors. Monitoring of KL-6 level and chest CT scans is necessary to exclude the possibility of drug-induced interstitial pneumonia.

Keywords: Krebs von den Lungen-6 (KL-6); biologics; changes; psoriasis; tumor necrosis factor inhibitor.

MeSH terms

  • Biological Products* / therapeutic use
  • Biomarkers
  • Certolizumab Pegol / therapeutic use
  • Humans
  • Lung Diseases, Interstitial* / diagnosis
  • Mucin-1 / therapeutic use
  • Psoriasis* / drug therapy
  • Tumor Necrosis Factor Inhibitors / therapeutic use

Substances

  • Certolizumab Pegol
  • Tumor Necrosis Factor Inhibitors
  • Biological Products
  • Mucin-1
  • Biomarkers