Secukinumab retreatment associated psoriasis flare with pustules.

J Dermatolog Treat

Department of Dermatology, Faculty of Medicine, Cairo University, Cairo, Egypt.

Published: March 2022

This case report describes a patient with plaque psoriasis and psoriatic arthritis who experienced IL-17A blocking antibody secukinumab treatment-interruption followed by re-treatment. The patient showed heterogeneous responses; significant improvement at initial introduction of secukinumab with rapid deterioration after discontinuation, followed by worsening symptoms and pustular eruption with reintroduction, and skin clearance after dose escalation.

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http://dx.doi.org/10.1080/09546634.2020.1782816DOI Listing

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Article Synopsis
  • Continuous biological treatments for chronic plaque psoriasis are generally more effective than intermittent ones, according to clinical trials.
  • A systematic review of 35 articles, including 13 controlled trials, highlights that continuous therapy leads to better outcomes, especially for drugs like infliximab, etanercept, and secukinumab.
  • Temporary interruptions in therapy seem safe for most biologic agents, and patients can regain efficacy upon re-treatment, with infliximab being a possible exception.
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Current clinical recommendations suggest that continuous treatment of moderate-to-severe psoriasis with biologic agents is more effective than intermittent treatment in terms of achieving remission and maintaining it. Intermittent treatment, however, may provide an alternative approach in patients unwilling or unable to maintain a continuous regimen, such as those who would prefer a 'treatment vacation' after achieving long-term remission, those who require treatment cessation owing to adverse events, and where insurance arrangements do not provide sufficient cover for continuous treatment. We conducted a literature search of PubMed to identify publications reporting data on the efficacy and safety of intermittent treatment with biologic agents in adults with psoriasis, specifically the use of inhibitors of tumour necrosis factor (adalimumab, certolizumab pegol, etanercept and infliximab), interleukin (IL)-12/IL-23 (ustekinumab), IL-23 (guselkumab) and IL-17 (brodalumab, ixekizumab and secukinumab).

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Secukinumab retreatment associated psoriasis flare with pustules.

J Dermatolog Treat

March 2022

Department of Dermatology, Faculty of Medicine, Cairo University, Cairo, Egypt.

This case report describes a patient with plaque psoriasis and psoriatic arthritis who experienced IL-17A blocking antibody secukinumab treatment-interruption followed by re-treatment. The patient showed heterogeneous responses; significant improvement at initial introduction of secukinumab with rapid deterioration after discontinuation, followed by worsening symptoms and pustular eruption with reintroduction, and skin clearance after dose escalation.

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Secukinumab, a fully human monoclonal antibody neutralizing interleukin-17A, has been shown to have significant efficacy in the treatment of moderate to severe psoriasis. Long-term (3-year) efficacy and safety of secukinumab in Japanese patients with moderate to severe psoriasis were evaluated in an extension study of a large phase 3 global study (SCULPTURE). In the core study, 52 Japanese patients with 75% improvement of Psoriasis Area and Severity Index (PASI-75) response at week 12 were re-randomized to a fixed interval (FI; every 4 weeks) schedule and retreatment as needed (RAN), in which patients received placebo until start of relapse, at which time secukinumab was reinitiated.

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Objective: To evaluate the efficacy and safety of secukinumab in Behçet's patients with active mucocutaneous and articular manifestations refractory to previous treatments.

Methods: We retrospectively evaluated 5 patients treated with the IL17-inhibitor secukinumab and diagnosed with Behçet according to ISG/ICBD criteria. All patients had active mucocutaneous and articular manifestations refractory to colchicine, conventional DMARDs and at least one anti-TNFα agent.

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