Psoriasis Induced by Biological Therapy

Secukinumab Loss of Efficacy Is Perfectly Counteracted by the Introduction of Combination Therapy (Rescue Therapy): Data from a Multicenter Real-Life Study in a Cohort of Italian Psoriatic Patients That Avoided Secukinumab Switching

Since psoriasis (PsO) is a chronic inflammatory disease, patients may experience a drug failure also with very effective drugs (i.e., secukinumab) and, consequently, dermatologists have two therapeutic options: switching or perform a combination therapy (rescue therapy) to save the drug that had decreased its efficacy. At the moment no studies focused on combination/rescue therapy of secukinumab, so we performed a 52-weeks multicenter retrospective observational study that involved 40 subjects with plaque psoriasis that experienced a secondary failure and were treated with combination therapy (ciclosporin (n = 11), MTX (n = 15), NB-UVB (n = 7) and apremilast (n = 7)). After 16 weeks of rescue/combination therapy, PASI and a DLQI varied respectively from 8 [7.0-9.0] and 13 [12.0-15.0], to 3 [2.8-4.0] and 3 [2.0-3.3]), suggesting a significant improvement of daily functionality and quality of life. Results were maintained at 52 weeks. No side effects were experienced during the study. Secukinumab remains a safety and effective drug for PsO patients also in the IL-23 and JAK inhibitors era. The rescue therapy is a valid therapeutic option in case of secukinumab secondary failure.

Revisiting the question of psoriasis classification

Currently there are a large number of psoriasis classifications, slightly different from each other, used worldwide. Some of these classifications contain the disease forms allocated descriptively, without the pathogenesis characteristics in their basis. Among the dermatologists, there is lack of common understanding of various psoriasis forms peculiarities. And that affects both the diagnostic process and the approaches to therapy. The authors propose a revised unified clinical classification of psoriasis, including psoriatic arthritis. This method reflects the up-to-date view on the classification of psoriasis in Russia and globally.

Tumor necrosis factors-α inhibition-induced paradoxical psoriasis: A case series and literature review

Today, anti-12/IL23, anti-IL17, and anti-IL23 provide more efficacious and/or safer treatment options for psoriasis. Though, anti-TNF remains a gold standard in the therapy of chronic inflammatory diseases. Paradoxical psoriasis has been reported to occur in patients treated with TNF-α inhibitors. According to the existing literature, including case reports, most patients with paradoxical psoriasis chose to stop the treatment immediately. This article presents a case series involving 150 patients with psoriasis who received treatments with TNF-α inhibitors. We observed 10 (6.7%) patients developing paradoxical psoriasis, and they rejected the recommendation of immediate discontinuation and decided to continue the original treatment. Surprisingly, 80% of them achieved remission again after the aggravation of symptoms and did not have any other serious adverse event. However, there is currently little research that has clarified the mechanism of paradoxical psoriasis. Therefore, we also presented a review of the literature to determine the pathogenesis of paradoxical psoriasis and speculated on the possible causes of the observed transient exacerbation cases. Investigation of the pathogenesis of this paradoxical adverse reaction not only is helpful to guide clinicians to better manage patients, but also may contribute to the discovery of new therapeutic targets in the future.