Mean neutrophil-to-lymphocyte ratio improves over time with guselkumab treatment vs. placebo in the VOYAGE 1 and VOYAGE 2 clinical trials

Background: Neutrophil-to-lymphocyte ratio (NLR) is a marker of systemic inflammation and an independent risk factor for the development of cardiovascular disease [1,2]. This post hoc analysis investigated NLR changes over time with guselkumab treatment and whether NLR correlates with psoriasis severity. Patients with moderate-to-severe psoriasis from the VOYAGE 1 and 2 trials, who were initially randomised to guselkumab or placebo, were included. In patients with both Psoriasis Area and Severity Index (PASI) and NLR data available, Pearson correlation coefficients were calculated for baseline values and changes from baseline to Week (W)16 for NLR vs. PASI. In VOYAGE 1, the median NLR changes at W16 were -0.21 for patients receiving guselkumab (n=317) vs. +0.01 for those receiving placebo (n=161); in VOYAGE 2, the changes were -0.36 for guselkumab (n=470) and -0.05 for placebo (n=227). In the guselkumab groups, a modest but nominally significant correlation was observed between NLR and PASI at baseline (VOYAGE 1, r=0.115, p=0.037; VOYAGE 2, r=0.140, p=0.002) and for changes in NLR and PASI from baseline to W16 (VOYAGE 1, r=0.179, p=0.001; VOYAGE 2, r=0.161, p=0.001). In conclusion, systemic inflammation as measured by NLR was reduced through W16 with guselkumab treatment. Change in NLR correlated with change in PASI from baseline to W16 in patients treated with guselkumab, demonstrating that guselkumab treatment is associated with modulation of a marker of systemic inflammation and cardiovascular risk in patients with psoriasis.