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reports of guselkumab efficacy in EP are scarce&#46; This study aims to report two cases of EP treated with guselkumab with sustained efficacy and perform a literature review of guselkumab in the treatment of EP&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">We present a 65-year-old woman with a 4-year history of psoriasis previously treated with topical steroids&#46; Her disease flared involving &#62;90&#37; of her BSA&#46; Skin examination demonstrated symmetrical erythematous scaly plaques &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>A&#41;&#46; A punch biopsy was compatible with psoriasis&#46; Guselkumab &#40;100 mg via subcutaneous injection at week 0 and week 4&#44; followed by a dose every 8 weeks&#41;&#44; topical steroids&#44; and emollients were started&#46; The patient achieved a complete response &#40;PASI100&#41; by week 12 &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>B&#41; and has maintained it for over 32 months&#46; The second case is a 51-year-old man with a 1-year history of plaque-type psoriasis treated with topical steroids&#46; He presented with erythematous plaques on his extremities and trunk that spread to a PASI 40&#46; Histopathological analysis was compatible with psoriasis&#46; Treatment with guselkumab as mentioned previously resulted in complete resolution by week 12 which has persisted for 2-years&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">We performed a literature review of EP treated with guselkumab on August 15&#44; 2022&#44; through MEDLINE &#40;PubMed&#41; with keywords erythroderm&#42; AND guselkumab&#46; Of the 10 results&#44; we excluded 3 as they were about other conditions &#40;non-erythrodermic psoriasis&#44; pustulotic arthro-osteitis&#44; palmoplantar pustulosis&#44; palmoplantar psoriasis&#44; psoriatic arthritis&#44; erythrodermic ichthyosis&#41; and 3 that were reviews&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">We included 4 articles with 26 patients combined with EP in treatment with guselkumab&#46; Most patients were men &#40;n &#61; 24&#41;&#44; and the mean age was 49&#46;9 years&#46;<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#8211;4</span></a> All patients showed a good response during treatment&#44; except one with concomitant Castleman&#8217;s disease and one that withdrew consent from the study&#46;<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#8211;4</span></a> Sano et al&#46;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> reported 10 &#40;90&#46;9&#37;&#41; patients with &#8220;treatment success&#8221; at week 16&#46; Ten &#40;90&#46;9&#37;&#41; patients reported a mean PASI of 3&#46;9 &#40;SD &#61; 4&#46;27&#41; with a median improvement of 94&#46;1&#37; by week 52&#46; Chiang et al&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> reported 13 patients in follow-up for 28 weeks&#44; where 8 &#40;61&#46;5&#37;&#41; reached PASI 50 response by week 12&#46; Megna et al&#46;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> reported one patient with PASI 100 at 20 weeks and sustained effect by week 48&#46; Zanelli et al&#46;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> reported a patient with multicentric Castleman&#8217;s disease and EP that did not respond to guselkumab therapy&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">The two patients reported herein had a PASI 100 response by week 12 with sustained effect at the last follow-up at 24 and 32 months and no adverse events&#46; IL-23 inhibitors have shown higher PASI90 and PASI100 response rates compared to anti-TNF alpha inhibitors in moderate and severe psoriasis with a similar adverse event profile&#46;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> Our review found few cases and case series of EP treated with guselkumab but a high response rate&#46; Reported adverse events were infrequent and mild&#46; Several factors influence treatment decisions&#44; including infections &#40;e&#46;g&#46;&#44; tuberculosis or hepatitis B&#47;C&#41;&#44; affordability&#44; comorbidities&#44; and accessibility&#46; Our study suggests that guselkumab is an efficient treatment for EP&#44; given the results&#44; safety&#44; and long-term effectiveness it has shown&#46; Comparative studies&#44; that include other biologics like risankizumab and tildrakizumab&#44; are needed to define the best treatment for patients with EP&#46;</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Financial support</span><p id="par0030" class="elsevierStylePara elsevierViewall">None declared&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Authors&#8217; contributions</span><p id="par0035" class="elsevierStylePara elsevierViewall">Esperanza Welsh&#58; Collected the clinical data and reviewed the draft of the manuscript&#46; Approval of the final version of the manuscript&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">Jesus Alberto Cardenas-de la Garza&#58; Collected the clinical data&#44; adapted the clinical image&#44; and wrote a draft of the manuscript&#46; Approval of the final version of the manuscript&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">Jos&#233; Alberto Garc&#237;a-Lozano&#58; Collected the clinical data and obtained the figure&#46; Approval of the final version of the manuscript&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">Diana Paola Flores-Gutierrez&#58; Collected the clinical data and wrote a draft of the manuscript&#46; Approval of the final version of the manuscript&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Conflicts of interest</span><p id="par0055" class="elsevierStylePara elsevierViewall">Esperanza Welsh has been a consultant and&#47;or speaker for Merz&#44; Leo Pharma&#44; and Janssen&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">Jesus Alberto Cardenas-de la Garza has been a consultant for Leo Pharma&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">Jos&#233; Alberto Garc&#237;a-Lozano and Diana Paola Flores-Gutierrez have nothing to disclose&#46;</p></span></span>"
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Letter - Therapy
Erythrodermic psoriasis treatment with Guselkumab: report of two cases and literature review
Esperanza Welsha, Jesus Alberto Cardenas-de la Garzab,
Corresponding author
cardenasdelagarza@gmail.com

Corresponding author.
, José Alberto García-Lozanoc, Diana Paola Flores-Gutierrezb
a Welsh Dermatology and Associates, Monterrey Nuevo Leon, Mexico
b Rheumatology Departament, Universidad Autónoma de Nuevo León, Hospital Universitario ‘Dr José Eleuterio González’, Monterrey NL, México
c Department of Clinical Introduction, Faculty of Medicine and University Hospital “Dr. José E. González”, Autonomous Universitiy of Nuevo León, Monterrey, Nuevo León, Mexico
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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Erythrodermic psoriasis &#40;EP&#41; is an uncommon and possibly fatal psoriasis presentation involving more than 80&#37; of the body surface area &#40;BSA&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> Controlled clinical trials and current treatment choices for EP are limited and&#44; compared to plaque-type psoriasis&#44; EP patients seem to have a worse clinical response to standard therapies&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> Guselkumab is a human monoclonal antibody against Interleukin-23 &#40;IL-23&#41;&#44; that joins the p19 subunit of IL-23 and has exhibited excellent and sustained treatment effects in moderate-to-severe plaque-type psoriasis&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> However&#44; reports of guselkumab efficacy in EP are scarce&#46; This study aims to report two cases of EP treated with guselkumab with sustained efficacy and perform a literature review of guselkumab in the treatment of EP&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">We present a 65-year-old woman with a 4-year history of psoriasis previously treated with topical steroids&#46; Her disease flared involving &#62;90&#37; of her BSA&#46; Skin examination demonstrated symmetrical erythematous scaly plaques &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>A&#41;&#46; A punch biopsy was compatible with psoriasis&#46; Guselkumab &#40;100 mg via subcutaneous injection at week 0 and week 4&#44; followed by a dose every 8 weeks&#41;&#44; topical steroids&#44; and emollients were started&#46; The patient achieved a complete response &#40;PASI100&#41; by week 12 &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>B&#41; and has maintained it for over 32 months&#46; The second case is a 51-year-old man with a 1-year history of plaque-type psoriasis treated with topical steroids&#46; He presented with erythematous plaques on his extremities and trunk that spread to a PASI 40&#46; Histopathological analysis was compatible with psoriasis&#46; Treatment with guselkumab as mentioned previously resulted in complete resolution by week 12 which has persisted for 2-years&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">We performed a literature review of EP treated with guselkumab on August 15&#44; 2022&#44; through MEDLINE &#40;PubMed&#41; with keywords erythroderm&#42; AND guselkumab&#46; Of the 10 results&#44; we excluded 3 as they were about other conditions &#40;non-erythrodermic psoriasis&#44; pustulotic arthro-osteitis&#44; palmoplantar pustulosis&#44; palmoplantar psoriasis&#44; psoriatic arthritis&#44; erythrodermic ichthyosis&#41; and 3 that were reviews&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">We included 4 articles with 26 patients combined with EP in treatment with guselkumab&#46; Most patients were men &#40;n &#61; 24&#41;&#44; and the mean age was 49&#46;9 years&#46;<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#8211;4</span></a> All patients showed a good response during treatment&#44; except one with concomitant Castleman&#8217;s disease and one that withdrew consent from the study&#46;<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#8211;4</span></a> Sano et al&#46;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> reported 10 &#40;90&#46;9&#37;&#41; patients with &#8220;treatment success&#8221; at week 16&#46; Ten &#40;90&#46;9&#37;&#41; patients reported a mean PASI of 3&#46;9 &#40;SD &#61; 4&#46;27&#41; with a median improvement of 94&#46;1&#37; by week 52&#46; Chiang et al&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> reported 13 patients in follow-up for 28 weeks&#44; where 8 &#40;61&#46;5&#37;&#41; reached PASI 50 response by week 12&#46; Megna et al&#46;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> reported one patient with PASI 100 at 20 weeks and sustained effect by week 48&#46; Zanelli et al&#46;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> reported a patient with multicentric Castleman&#8217;s disease and EP that did not respond to guselkumab therapy&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">The two patients reported herein had a PASI 100 response by week 12 with sustained effect at the last follow-up at 24 and 32 months and no adverse events&#46; IL-23 inhibitors have shown higher PASI90 and PASI100 response rates compared to anti-TNF alpha inhibitors in moderate and severe psoriasis with a similar adverse event profile&#46;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> Our review found few cases and case series of EP treated with guselkumab but a high response rate&#46; Reported adverse events were infrequent and mild&#46; Several factors influence treatment decisions&#44; including infections &#40;e&#46;g&#46;&#44; tuberculosis or hepatitis B&#47;C&#41;&#44; affordability&#44; comorbidities&#44; and accessibility&#46; Our study suggests that guselkumab is an efficient treatment for EP&#44; given the results&#44; safety&#44; and long-term effectiveness it has shown&#46; Comparative studies&#44; that include other biologics like risankizumab and tildrakizumab&#44; are needed to define the best treatment for patients with EP&#46;</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Financial support</span><p id="par0030" class="elsevierStylePara elsevierViewall">None declared&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Authors&#8217; contributions</span><p id="par0035" class="elsevierStylePara elsevierViewall">Esperanza Welsh&#58; Collected the clinical data and reviewed the draft of the manuscript&#46; Approval of the final version of the manuscript&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">Jesus Alberto Cardenas-de la Garza&#58; Collected the clinical data&#44; adapted the clinical image&#44; and wrote a draft of the manuscript&#46; Approval of the final version of the manuscript&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">Jos&#233; Alberto Garc&#237;a-Lozano&#58; Collected the clinical data and obtained the figure&#46; Approval of the final version of the manuscript&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">Diana Paola Flores-Gutierrez&#58; Collected the clinical data and wrote a draft of the manuscript&#46; Approval of the final version of the manuscript&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Conflicts of interest</span><p id="par0055" class="elsevierStylePara elsevierViewall">Esperanza Welsh has been a consultant and&#47;or speaker for Merz&#44; Leo Pharma&#44; and Janssen&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">Jesus Alberto Cardenas-de la Garza has been a consultant for Leo Pharma&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">Jos&#233; Alberto Garc&#237;a-Lozano and Diana Paola Flores-Gutierrez have nothing to disclose&#46;</p></span></span>"
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Article information
ISSN: 03650596
Original language: English
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2024 January 72 50 122
2023 December 80 74 154

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