Platelet dynamics reflect treatment response to interleukin-17 and tumor necrosis factor-alpha inhibitors in axial spondyloarthritis

Abstract

Background
Axial spondyloarthritis (axSpA) is commonly treated with tumor necrosis factor-alpha (TNF-α) inhibitors, which show good efficacy but may cause adverse effects or lose effectiveness over time. Interleukin-17 (IL-17) inhibitors offer an alternative treatment. Follow up to treatment of axSpA is crucial for favorable outcome. Since raised platelet count is being associated with inflammation, we have evaluated in this study platelet dynamics as a biomarker for treatment response.


Methods

Non-randomized (Quasi-experimental) clinical trial included 60 axSpA patients (46 males, 14 females). Two groups of patients were formed: Group A (
n
 = 25) received IL-17 inhibitors, and Group B (
n
 = 35) received TNF-α inhibitors, including adalimumab, golimumab, and etanercept. Age, sex, disease duration, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), Ankylosing Spondylitis Disease Activity Score based on CRP (ASDAS-CRP), and platelet count were recorded at baseline and after six months of biological treatment.



Results

A positive correlation was found between disease severity (ASDAS Score) and CRP, (
r
 = 0.642,
p
 < 0.001) as well as ESR (
r
 = 0.541,
p
 < 0.001) and platelet (
r
 = 0.368,
p
 = 0.002). A positive correlation was found between platelet and CRP, (
r
 = 0.222,
p
 < 0.001) as well as ESR (
r
 = 0.459,
p
 < 0.001). Both IL-17 and TNF-α inhibitors significantly reduced platelet counts and disease activity in axSpA patients.



Conclusion
Platelet counts showed a moderate association with ASDAS-CRP with reduction of platelet counts after use of IL-17 and TNF-α inhibitors. These findings suggest that platelets may provide supportive information in disease monitoring.