Letter - Therapy
Erythrodermic psoriasis treatment with Guselkumab: report of two cases and literature review
Esperanza Welsha, Jesus Alberto Cardenas-de la Garzab,
, José Alberto García-Lozanoc, Diana Paola Flores-Gutierrezb
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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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González”, Autonomous Universitiy of Nuevo León, Monterrey, Nuevo León, Mexico" "etiqueta" => "c" "identificador" => "aff0015" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 934 "Ancho" => 2508 "Tamanyo" => 204427 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0060" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">(A) Erythrodermic psoriasis; (B) Remission after guselkumab therapy.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Erythrodermic psoriasis (EP) is an uncommon and possibly fatal psoriasis presentation involving more than 80% of the body surface area (BSA).<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> Controlled clinical trials and current treatment choices for EP are limited and, compared to plaque-type psoriasis, EP patients seem to have a worse clinical response to standard therapies.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> Guselkumab is a human monoclonal antibody against Interleukin-23 (IL-23), that joins the p19 subunit of IL-23 and has exhibited excellent and sustained treatment effects in moderate-to-severe plaque-type psoriasis.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> However, reports of guselkumab efficacy in EP are scarce. 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.</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. Her disease flared involving >90% of her BSA. Skin examination demonstrated symmetrical erythematous scaly plaques (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>A). A punch biopsy was compatible with psoriasis. Guselkumab (100 mg via subcutaneous injection at week 0 and week 4, followed by a dose every 8 weeks), topical steroids, and emollients were started. The patient achieved a complete response (PASI100) by week 12 (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>B) and has maintained it for over 32 months. The second case is a 51-year-old man with a 1-year history of plaque-type psoriasis treated with topical steroids. He presented with erythematous plaques on his extremities and trunk that spread to a PASI 40. Histopathological analysis was compatible with psoriasis. Treatment with guselkumab as mentioned previously resulted in complete resolution by week 12 which has persisted for 2-years.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">We performed a literature review of EP treated with guselkumab on August 15, 2022, through MEDLINE (PubMed) with keywords erythroderm* AND guselkumab. Of the 10 results, we excluded 3 as they were about other conditions (non-erythrodermic psoriasis, pustulotic arthro-osteitis, palmoplantar pustulosis, palmoplantar psoriasis, psoriatic arthritis, erythrodermic ichthyosis) and 3 that were reviews.</p><p id="par0020" class="elsevierStylePara elsevierViewall">We included 4 articles with 26 patients combined with EP in treatment with guselkumab. Most patients were men (n = 24), and the mean age was 49.9 years.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1–4</span></a> All patients showed a good response during treatment, except one with concomitant Castleman’s disease and one that withdrew consent from the study.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1–4</span></a> Sano et al.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> reported 10 (90.9%) patients with “treatment success” at week 16. Ten (90.9%) patients reported a mean PASI of 3.9 (SD = 4.27) with a median improvement of 94.1% by week 52. Chiang et al.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> reported 13 patients in follow-up for 28 weeks, where 8 (61.5%) reached PASI 50 response by week 12. Megna et al.<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. Zanelli et al.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> reported a patient with multicentric Castleman’s disease and EP that did not respond to guselkumab therapy.</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. 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.<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. Reported adverse events were infrequent and mild. Several factors influence treatment decisions, including infections (e.g., tuberculosis or hepatitis B/C), affordability, comorbidities, and accessibility. Our study suggests that guselkumab is an efficient treatment for EP, given the results, safety, and long-term effectiveness it has shown. Comparative studies, that include other biologics like risankizumab and tildrakizumab, are needed to define the best treatment for patients with EP.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Financial support</span><p id="par0030" class="elsevierStylePara elsevierViewall">None declared.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Authors’ contributions</span><p id="par0035" class="elsevierStylePara elsevierViewall">Esperanza Welsh: Collected the clinical data and reviewed the draft of the manuscript. Approval of the final version of the manuscript.</p><p id="par0040" class="elsevierStylePara elsevierViewall">Jesus Alberto Cardenas-de la Garza: Collected the clinical data, adapted the clinical image, and wrote a draft of the manuscript. Approval of the final version of the manuscript.</p><p id="par0045" class="elsevierStylePara elsevierViewall">José Alberto García-Lozano: Collected the clinical data and obtained the figure. Approval of the final version of the manuscript.</p><p id="par0050" class="elsevierStylePara elsevierViewall">Diana Paola Flores-Gutierrez: Collected the clinical data and wrote a draft of the manuscript. Approval of the final version of the manuscript.</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/or speaker for Merz, Leo Pharma, and Janssen.</p><p id="par0060" class="elsevierStylePara elsevierViewall">Jesus Alberto Cardenas-de la Garza has been a consultant for Leo Pharma.</p><p id="par0065" class="elsevierStylePara elsevierViewall">José Alberto García-Lozano and Diana Paola Flores-Gutierrez have nothing to disclose.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:5 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Financial support" ] 1 => array:2 [ "identificador" => "sec0010" "titulo" => "Authors’ contributions" ] 2 => array:2 [ "identificador" => "sec0015" "titulo" => "Conflicts of interest" ] 3 => array:2 [ "identificador" => "xack761229" "titulo" => "Acknowledgments" ] 4 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2023-02-23" "fechaAceptado" => "2023-05-20" "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Study conducted at Welsh Dermatology & Associates, Monterrey, NL, Mexico.</p>" ] ] "multimedia" => array:1 [ 0 => array:8 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 934 "Ancho" => 2508 "Tamanyo" => 204427 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0060" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">(A) Erythrodermic psoriasis; (B) Remission after guselkumab therapy.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:5 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Treatment response of patients with erythrodermic psoriasis after switching to Guselkumab" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "C.Y. 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| Ano/Mês | Html | Total | |
|---|---|---|---|
| 2024 Novembro | 16 | 7 | 23 |
| 2024 Outubro | 114 | 67 | 181 |
| 2024 Setembro | 160 | 130 | 290 |
| 2024 Agosto | 173 | 171 | 344 |
| 2024 Julho | 141 | 119 | 260 |
| 2024 Junho | 130 | 106 | 236 |
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| 2024 Abril | 240 | 116 | 356 |
| 2024 Março | 353 | 80 | 433 |
| 2024 Fevereiro | 89 | 84 | 173 |
| 2024 Janeiro | 72 | 50 | 122 |
| 2023 Dezembro | 80 | 74 | 154 |
