Skin and soft tissue infections in biological therapy for psoriasis-A case report and systematic review of the literature

Secukinumab for the treatment of moderate-to-severe plaque psoriasis in pediatric patients aged six years and older

INTRODUCTION

Psoriasis (PSO) is a chronic, recurrent, inflammatory skin disorder that significantly influences patients' quality of life. The prevalence of PSO among children varies depending on the age and ranges from 0.12% at one year to 2% at 18 years. Due to systemic inflammation, PSO is associated with obesity, hypertension, inflammatory bowel disease, and cardiovascular incidences.Secukinumab is a fully human monoclonal antibody selectively targeting IL-17A. The drug has been approved for children aged 6-18 with moderate to severe plaque psoriasis. Nevertheless, only a few reports thoroughly describe its efficacy and safety in the pediatric population.

AREAS COVERED

This review aims to describe the efficacy and safety of secukinumab for the treatment of moderate-to-severe plaque PSO in pediatric patients aged six years and older.

EXPERT OPINION

Although there are only two clinical trials assessing the efficacy and safety of secukinumab in the pediatric population with plaque PSO, this therapy seems to be a significant advancement in managing those patients. Both dose regimens (depending on the weight, low-dose, 75/75/150 mg, and high-dose 75/150/300 mg) of secukinumab were more effective in achieving significant clinical improvement (PASI 75/90 and IGA response) than placebo or active-comparator. Both regimens showed good safety and tolerability profiles, with mostly mild AEs and no SAEs observed.

Secukinumab for the Treatment of Psoriasis in Pediatrics: Patient Selection and Acceptability

Psoriasis (PsO) is a chronic, systemic, immune-mediated inflammatory skin disease affecting 1% to 5% population worldwide. In one-third of patients, the first symptoms of PsO manifest in childhood, with a mean age of nine years. Psoriasis in children under 16 years of age constitutes 4% of dermatological problems in this age group. Chronic inflammation of the skin observed in PsO is associated with a development of potentially serious comorbidities, including psoriatic arthritis, hypertension, metabolic syndrome, cardiovascular diseases, inflammatory bowel disease, depression and anxiety. It is reported that among children with psoriasis between 5 and 16 years of age health-related quality of life is reduced by 30.5%. Early diagnosis and effective treatment are crucial in pediatric psoriatic patients to avoid future complications and stigmatization. Treatment for psoriasis consists of a range of topical medications, phototherapy and non-biologic and biologic systemic therapies. Approved biologics for PsO in pediatric patients include etanercept, adalimumab, ustekinumab, ixekizumab and secukinumab. Secukinumab, a recombinant, fully human monoclonal antibody targeting IL-17A, was approved by the EMA (2020) and FDA (2021) in pediatric patients above 6 years of age for the treatment of moderate to severe plaque psoriasis who are candidates for systemic therapy. This review discusses the selection and acceptability of secukinumab in children with psoriasis.

A Review of the Safety of Interleukin-17A Inhibitor Secukinumab

Secukinumab is an anti-interleukin (IL)-17A IgG1-κ monoclonal antibody approved for psoriasis, psoriatic arthritis, and ankylosing spondylitis. Its efficacy is well documented, but the complete safety profile of secukinumab, especially on long-term use, needs to be studied. IL-17 inhibitors increase the risk of infections, especially respiratory tract infections and candidiasis, and inflammatory bowel disease; the causal relationships are well described. However, evidence regarding the other adverse events is scarce, and causal associations between the adverse events and the biologic remain unresolved. This review aims to present a narrative perspective on the safety of secukinumab and identify some key areas where the safety of secukinumab may potentially be useful in understanding the scope of secukinumab therapy and making informed clinical decisions.

Biologic Therapies for the Management of Cutaneous Findings in Genodermatoses: A Review

Genodermatoses are genetically inherited dermatologic conditions. The management of cutaneous findings in genodermatoses is challenging, and first-line therapies, such as steroids and/or retinoids, are often inadequate. In recent years, research on the molecular basis of genodermatoses has led to the use of biologic therapies for intractable disease. Here, we review the evidence regarding the use of available biologic therapies for the management of dermatologic findings in genodermatoses. Biologic therapies appear to be promising therapeutic options for several recalcitrant genodermatoses, especially those with underlying immune dysregulation. However, not all genodermatoses are amenable to biologic therapies, and some have been shown to paradoxically worsen under treatment. Biologic therapies offer a novel avenue to target refractory genodermatoses. However, evidence supporting the use of biologic therapies in the management of genodermatoses is mostly limited to case reports and case series. Further studies are warranted to determine the safety and efficacy of biologic therapies for the management of cutaneous findings in genodermatoses.

Safety evaluation of secukinumab in paediatric patients with plaque psoriasis

INTRODUCTION

: Psoriasis (Ps) is a common chronic, recurrent, immune-mediated, inflammatory skin disease affecting up to 2% children. It has well-established impact on patients' quality of life. Moreover, patients with psoriasis exhibit a higher prevalence of comorbidities, including hypertension, diabetes, and inflammatory bowel disease. Secukinumab is a fully human monoclonal IL-17A antibody, which has been approved in use for children with psoriasis. Nevertheless, there is very little data on the safety of this therapy in paediatric population.

AREAS COVERED

: The aim of this article was to perform an extensive review of available data concerning secukinumab safety and efficiency in pediatric population used for the treatment of plaque psoriasis. Moreover, special attention was put to underline the adverse effects of secukinumab.

EXPERT OPINION

: Although there is very little evidence on the long-term safety of secukinumab use in pediatric population, this therapy may be a promising modality in children with moderate to severe psoriasis. The available data confirms its favorable safety profile with no serious adverse events and unexpected events. Moreover, the clinical trials revealed sustained efficiency in respect of reaching PASI 75 and decreasing impact of the disease on quality of life.