Introducing a simplified titration scheme for dimethylfumarate (DMF) in patients with moderate-to-severe psoriasis: a case series

Background: Secukinumab is an anti-IL-17A monoclonal antibody approved for the treatment of moderate-to-severe psoriasis in adult patients. Despite its favourable safety and efficacy profile in clinical trials, some patients in clinical practice fail to respond adequately to the approved maintenance regimen of 300 mg subcutaneous monthly. Some clinicians manage these patients by using off-label high-dose secukinumab regimens, which include shortening the dosing interval to 300 mg every 2 or 3 weeks instead of monthly, or increasing the monthly dose to 450 mg. Objective: This study aims to investigate the safety and efficacy of high-dose secukinumab regimens for the treatment of psoriasis to inform real-world clinical practice. Methods: We performed a retrospective chart review at 5 dermatology clinics for adult patients diagnosed with moderate-to-severe psoriasis treated with an off-label high-dose secukinumab regimen. Efficacy was measured using the Psoriasis Area and Severity Index or a Physician Global Assessment score of 0 or 1 after dose escalation. Adverse events were recorded to assess safety outcomes. Results: Twenty-five patients were included in this case series, and 14 of them achieved efficacy from dose escalation with secukinumab based on our study endpoints. There was 1 case of the common cold and 1 upper respiratory tract infection reported after dose escalation. Conclusion: Our study provides evidence that dose escalation with secukinumab results in clinical benefit and is well tolerated among patients with moderate-to-severe psoriasis who failed to respond adequately to the approved regimen. This work necessitates larger studies to fully characterize the efficacy and long-term safety profile of secukinumab dose escalation.

Download Full-text

Observational case series on a group of patients with severe psoriasis who failed to respond to antitumour necrosis factor α biologics and switched to ustekinumab

British Journal of Dermatology ◽

10.1111/j.1365-2133.2010.09832.x ◽

2010 ◽

Vol 163 (2) ◽

pp. 433-434 ◽

Cited By ~ 12

Author(s):

A.M.R. Downs

Keyword(s):

Case Series ◽

Severe Psoriasis ◽

Factor Α ◽

Necrosis Factor

Download Full-text

Successful treatment of severe psoriasis vulgaris in child with methotrexate injection

Dermatology Reports ◽

10.4081/dr.2019.8096 ◽

2019 ◽

Author(s):

Agatha Anindhita ◽

S. Sawitri

Keyword(s):

Side Effect ◽

Psoriasis Vulgaris ◽

Systemic Treatment ◽

Case Series ◽

Severe Psoriasis ◽

Expert Opinions ◽

Mild Improvement ◽

Pasi Score ◽

History Of ◽

Pediatric Disorders

Pediatric psoriasis could begin in childhood in almost one-third of the cases. There are currently no international standardized guidelines for medical treatment of pediatric psoriasis. Case: A 3-years-old girl with a 1-year history of psoriasis came to outpatient clinic. She already went to dermatologist but only reached mild improvement. The lesion became worse within 2 months. PASI score was 32. The patient was given methotrexate injection 0,5 mg/BW/week for about 3 months. PASI score was decrease and became 15 after 3 months of the therapy with no serious side effect. Discussion: The treatment approach is based primarily on guidelines for adult psoriasis, a few case series, expert opinions, or experience with systemic drugs acquired in other pediatric disorders. Systemic treatment was given to this patient because the child was categorized as severe psoriasis. Conclusion: Methotrexate treatment in this patient was showed a good progression with no serious side effect.

Download Full-text

Slow responder against methotrexate 50 mg intramuscular in severe psoriatic patients: A case series

Dermatology Reports ◽

10.4081/dr.2019.8080 ◽

2019 ◽

Cited By ~ 1

Author(s):

Niken Kusumaningrum ◽

Danar Wicaksono ◽

Dwi Retno Adi Winarni ◽

Yohanes Widodo Wirohadidjojo ◽

Sunardi Radiono

Keyword(s):

Risk Factor ◽

Treatment Modality ◽

Case Series ◽

Severity Index ◽

Severe Psoriasis ◽

Slow Response ◽

Psoriasis Area Severity Index ◽

Oral Tablet ◽

Drug Of Choice ◽

Slow Responder

Methotrexate is the drug of choice used on moderate to severe psoriasis. The limited availability of oral tablet methotrexate stimulates the initiation of the protocol therapy 50 mg intramuscular methotrexate weekly in six consecutive weeks for severe psoriasis cases. There were 30 cases treated using this treatment modality. Twenty-six cases (86%) showed a good response and achieved PASI-90(Psoriasis Area Severity Index-90), four cases (13%) showed a slow response and did not achieve PASI-90. This case report collected slow response cases and identified their risk factor of slow responsiveness with this treatment modality. The comorbidity condition like metabolic syndrome, drugs induced psoriasis, continuous trauma, the side effect of methotrexate administration (ulceration), or the possibility of allergic or irritant contact dermatitis from occupation are suspected to be the risk factor for slow responders in this treatment modality.

Download Full-text

Biologic Treatment of 4 HIV-Positive Patients: A Case Series and Literature Review

Journal of Psoriasis and Psoriatic Arthritis ◽

10.1177/2475530320954279 ◽

2020 ◽

pp. 247553032095427

Author(s):

Bridget Myers ◽

Quinn Thibodeaux ◽

Vidhatha Reddy ◽

Stephanie Chan ◽

Nicholas Brownstone ◽

...

Keyword(s):

Highly Active Antiretroviral Therapy ◽

Biologic Therapy ◽

Case Series ◽

Biologic Agents ◽

Severe Psoriasis ◽

Favorable Effect ◽

Hiv Positive ◽

Biologic Treatment ◽

Highly Active ◽

Practical Guidelines

Background: The management of psoriatic disease in HIV-positive patients is challenging. Psoriasis in HIV-positive patients is often severe, progressive, and resistant to first- and second-line therapies, including topical treatments, phototherapy, highly active antiretroviral therapy (HAART), and oral retinoids. Other systemic agents used to treat psoriasis, such as methotrexate and cyclosporine, are immunosuppressants and thus many dermatologists may not feel comfortable prescribing them to HIV-positive patients who are already immunocompromised. Biologic agents, which target specific aspects of overactive immune pathways in psoriasis, have revolutionized the management of moderate-to-severe psoriasis. However, data are limited regarding their safety and efficacy in HIV-positive patients. Objective: Report 4 cases of HIV-positive patients managed on biologic therapy and summarize the cases of psoriasis in HIV-positive patients managed on biologic therapy that have been published in dermatologic literature to date. Methods: We searched PubMed and Embase databases using the terms HIV and psoriasis or HIV and psoriatic arthritis combined with one of the 11 biologics currently approved for treating psoriasis. Results: We identified 48 cases of anti-psoriasis biologic therapy (including adalimumab, infliximab, etanercept, ustekinumab, and guselkumab) in HIV-positive patients and added 4. While data are limited, the evidence available suggests biologic agents are safe and efficacious in moderate-to-severe psoriasis and may even have a favorable effect on CD4 and HIV viral counts when used with concomitant HAART. Conclusion: Further research would be helpful to establish practical guidelines for the use of anti-psoriasis biologic therapy in the HIV population, including that of newer agents.

Download Full-text