Guselkumab effectiveness and survival in patients with psoriasis and psoriatic arthritis: Multicenter analysis in daily clinical practice by the Spanish Psoriasis Group

INTRODUCTION

Guselkumab is a monoclonal antibody that selectively blocks the p19 subunit of interleukin 23 and has been approved for the treatment of moderate to severe psoriasis and active psoriatic arthritis in adult patients due to its efficacy in different clinical trials. Therefore, it is important to know the behavior of guselkumab in this setting of patients in clinical practice given that a high percentage of them are not represented in these studies.

OBJECTIVE

to evaluate the effectiveness and tolerability of guselkumab in clinical practice in the first patients with psoriasis and psoriatic arthritis treated since the date of its approval for psoriasis in Spain, in joint dermatology-rheumatology clinics.

MATERIAL AND METHODS

a multicenter retrospective data collection was carried out, in which 14 hospitals participated, including a total of 90 patients with psoriatic arthritis confirmed by a rheumatologist. Data collection was recorded at baseline and at weeks 12, 24, and 52 for both the articular and cutaneous domains.

RESULTS

Ninety PsA patients started treatment with guselkumab and therefore were included in this study. 93% of them had already failed to at least to one biologic therapy prior guselkumab prescription. The median age was 55 years, 61% were female and 46% had a BMI ≥ 30 kg/m² . Sixty-nine percent suffered from peripheral arthritis, and in 34% an axial involvement was also detected; dactylitis or enthesitis were present in 24% and 29% respectively. Guselkumab was effective in controlling both articular and skin manifestations of PsA patients. Absolute PASI significantly decreased from 10.5 to 4.8, 1.9 and 1.3 at weeks 12, 24 and 52 respectively. In 29 out of 61 (48%) of cases DAPSA was moderate or high, and patient showed a significant reduction in DAPSA at 12, 24 and 52 weeks of treatment (mean DAPSA values at baseline were 29, 20, 16 and 14, respectively). Patients with DAPSA in low activity or in remission at the time of initiation of Guselkumab maintained a response at the end of the study period. No new safety concerns were detected. Seventy-eight out of 90 patients (84.4%). Nine out of ten patients persisted after two years follow up.

CONCLUSIONS

Our experience suggests that guselkumab is an effective drug for PsA and PsO patients in clinical practice with good tolerability and no additional safety signals, making it a new therapeutic alternative for the treatment of these combine domains of the disease. These are one of the first and large data from routine clinical practice in patients with PsO and PsA. This article is protected by copyright. All rights reserved.

Effectiveness and safety of guselkumab for the treatment of psoriasis in real-world settings at 24 weeks: A retrospective, observational, multicentre study by the Spanish Psoriasis Group

BACKGROUND

Data on the effectiveness and safety of a drug in real-world clinical practice complement the evidence from clinical trials, which are carried out in a different setting. Little has been published on the effectiveness and safety of guselkumab in the treatment of psoriasis in clinical practice.

OBJECTIVES

To assess the effectiveness and safety of guselkumab at 24 weeks in patients with moderate to severe plaque psoriasis in routine clinical practice.

METHODS

Retrospective, multicentre study of adult patients with moderate to severe plaque psoriasis treated with guselkumab for at least 24 weeks in Spain.

RESULTS

We studied 343 patients, 249 of whom were followed for 24 weeks. By week 24, the mean (SD) Psoriasis Area and Severity Index (PASI) had decreased from 11.1 (7.3) to 1.7 (2.8) (-9.3; [-10.2;-8.4]), 85.9% of the patients had achieved PASI score of 4 or less and 77.9% a PASI score of 2 or less. In terms of relative PASI response, 59.4% of the patients achieved a PASI-90 response and 49.0% a PASI-100 response. On multivariate analysis, 2 factors reduced the probability of a PASI of 2 or less at 24 weeks: a BMI ≥30 (OR, 0.44; 95% CI, 0.22-0.88) and a greater previous exposure to biologic therapy (OR, 0.69; 95% CI, 0.56-0.84]). Adverse events were rare (9.9%) and led to withdrawal from treatment in only 9 patients (2.6%) by the end of the follow-up period.

CONCLUSION

The results of this study confirm the high efficacy and safety of guselkumab indicated by the clinical trial data. In clinical practice, the absolute PASI score appears to be a better marker of response to treatment than the relative value.

Case Report: Diffuse Cutaneous Leishmaniasis by Leishmania infantum in a Patient Undergoing Immunosuppressive Therapy: Risk Status in an Endemic Mediterranean Area

This case report highlights the risk of severe cutaneous leishmaniasis (CL) by Leishmania infantum in patients undergoing immunosuppressant therapy who either live in an endemic area or are visiting in the transmission season. The case patient, resident in Majorca (Balearic Islands), presented 12 disseminated erythematous skin lesions, 1-6 cm in diameter, located on the scalp, cheek, umbilical region, and lower extremities 8 years after undergoing anti-tumor necrosis factor (TNF) therapy. Parasite presence in peripheral blood and high levels of specific antibodies were also observed, indicating a possible risk of CL shifting toward a visceral infection. However, once CL was diagnosed, anti-TNF therapy was discontinued and liposomal amphotericin B was administered, resulting in a complete healing of lesions, no Leishmania DNA detection in blood, and an important serological decrease in antibodies. The lack of data on the supposed epidemiological association between leishmaniasis and immunosuppressive therapy highlights the importance of implementing surveillance systems in endemic areas. No obvious relationship was found based on the data provided by the Balearic Islands Epidemiological System, in contrast with data reported in nearby endemic areas. This indicates that if the suspected association is to be clarified, greater efforts are needed to report information about concomitant diseases and therapies in leishmaniasis patients.

Complete response of secukinumab in palmoplantar psoriasis

Palmoplantar psoriasis is plaque psoriasis involving the palms and soles. Palmoplantar psoriasis is a treatment challenge for dermatologists and it is difficult to treat with topical and systemic therapies. Owing to its location and manifestations, palmoplantar psoriasis is associated with greater pain, functional limitations, and significant impairment of health-related quality of life. Recently a new biologic agent, secukinumab, has been approved for treatment of moderate to severe plaque psoriasis. GESTURE trial is a study of the secukinumab clinical development that evaluates efficacy and safety in this subpopulation of patients. We present a patient with palmar psoriasis refractory to systemic treatments who showed a gradual and complete response to secukinumab sustained at week 30 and without adverse events. Our patient had a significant improvement in his quality of life and work activity.

Obesity and psoriasis: inflammatory nature of obesity, relationship between psoriasis and obesity, and therapeutic implications

Obesity, particularly abdominal obesity, is currently considered a chronic low-grade inflammatory condition that plays an active role in the development of the pathophysiologic phenomena responsible for metabolic syndrome and cardiovascular disease through the secretion of proinflammatory adipokines and cytokines. In recent years clear genetic, pathogenic, and epidemiologic links have been established between psoriasis and obesity, with important implications for health. The relationship between the 2 conditions is probably bidirectional, with obesity predisposing to psoriasis and psoriasis favoring obesity. Obesity also has important implications in the treatment of psoriasis, such as a greater risk of adverse effects with conventional systemic drugs and reduced efficacy and/or increased cost with biologic agents, for which dosage should be adjusted to the patient's weight.

[Initial evaluation, diagnosis, staging, treatment, and follow-up of patients with primary cutaneous malignant melanoma. Consensus statement of the Network of Catalan and Balearic Melanoma Centers]

The consensus statement on the management of primary cutaneous melanoma that we present here was based on selection, discussion, review, and comparison of recent literature (including national and international guidelines). The protocols for the diagnosis, treatment, and follow-up used in the hospital centers throughout Catalonia and the Balearic Isles belonging to the Network of Catalan and Balearic Melanoma Centers were also considered. The main objective of this statement was to present the overall management of melanoma patients typically used in our region at the present time. As such, the statement was not designed to be an obligatory protocol for health professionals caring for this group of patients, and neither can it nor should it be used for this purpose. Professionals reading the statement should not therefore consider it binding on their practice, and in no case can this text be used to guarantee or seek responsibility for a given medical opinion. The group of dermatologists who have signed this statement was created 3 years ago with the aim of making our authorities aware of the importance of this complex tumor, which, in comparison with other types of cancer, we believe does not receive sufficient attention in Spain. In addition, the regular meetings of the group have produced interesting proposals for collaboration in various epidemiological, clinical, and basic applied research projects on the subject of malignant melanoma in our society.

Role of Leishmania spp. infestation in nondiagnostic cutaneous granulomatous lesions: report of a series of patients from a Western Mediterranean area

BACKGROUND

Leishmaniasis is a parasitic disease prevalent in countries of the Mediterranean area.

OBJECTIVES

The potential role of Leishmania as the aetiological factor for cutaneous granulomatous lesions in a series of patients from a Western Mediterranean area was evaluated. The practical usefulness of Leishmania-specific polymerase chain reaction (PCR) amplification and immunohistochemical techniques in skin biopsy specimens was assessed.

METHODS

Twenty-five skin biopsies diagnosed as nonspecific granulomatous dermatoses were included in the study. A panel of histopathological features was blindly evaluated by two independent observers. Only those cases showing nondiagnostic clinicopathological features and lacking demonstrable microorganisms after bacteriological, mycological or mycobacteriological cultures and specific stains (Ziehl-Neelsen, Giemsa, Gram, periodic acid-Schiff stains) were finally selected. Quantitative real-time PCR was performed in all selected samples. In available samples, immunohistochemical detection of specific Leishmania spp. antigens was also performed.

RESULTS

From the selected 25 biopsies, Leishmania spp. DNA was detected by real-time PCR in 13 cases. In seven of eight PCR-positive cases the presence of a varying density of amastigotes could also be demonstrated immunohistochemically.

CONCLUSIONS

Leishmania infection seems to be an important aetiological factor in cutaneous granulomatous lesions showing nondiagnostic features in endemic areas. In such areas, Leishmania-specific PCR amplification and/or immunohistochemical studies may be useful diagnostic tools. These techniques may be specifically indicated in the evaluation of patients showing nonspecific granulomatous inflammatory infiltrates of unknown aetiology lacking the histopathological evidence of parasites.

Amelanotic lentigo maligna melanoma: report of a case and review of the literature

Amelanotic lentigo maligna melanoma (ALMM) is an infrequent presentation of lentigo maligna melanoma, less than thirty cases having been reported to date. Hypopigmented or erythematous macules on the face of older women, resembling Bowen's disease or eczema, are the most common clinical presentation. We report a case of ALMM in a 73-year-old woman. Therapeutic trials with cryotherapy, 5-fluorouracil, and azelaic acid were unsuccessful, and the lesions were eventually cured by surgical excision. ALMM requires early clinical suspicion and histopathologic confirmation of diagnosis in every patient presenting with a slowly enlarging erythematous or hypopigmented macule, especially when located on the face of an older woman with a light complexion.

Persistent supravenous erythematous eruption: a rare local complication of intravenous 5-fluorouracil therapy

We describe a 47-year-old man who developed a linear serpentine erythematous eruption, overlying the superficial veins on both arms, after treatment with intravenous 5-fluorouracil. No evidence of superficial phlebitis or extravasation were observed. Histologically, a prominent vacuolar alteration of basal cells, necrotic keratinocytes, pigment incontinence, and a perivascular lymphocytic infiltrate in the upper dermis were observed. In a review of the literature we encountered only 5 reports of a similar clinicopathologic picture. The term "persistent supravenous erythematous eruption" (PSEE) seems suitable to describe this rare and peculiar cutaneous eruption that develops after intravenous cytotoxic drug treatment.

Bullous pemphigoid associated with acute glomerulonephritis

We report an 82-year-old man who presented with bullous pemphigoid and who later developed an acute glomerulonephritis with the histopathological and immunofluorescence pattern of a postinfectious glomerulonephritis. Antibodies directed against 230 and 180 kDa bullous pemphigoid antigens were detected in the patient's serum by means of the immunoprecipitation technique. Staphylococcus aureus and methicillin-resistant S. aureus were isolated from the patient's skin. We consider that in this particular patient the cutaneous infection played a part in the development of the kidney complication.

Calcinosis cutis following calcium chloride electrode paste application for auditory-brainstem evoked potentials recording

Circumscribed calcification in the dermis (calcinosis cutis) has been reported following electroencephalographic and electromyographic studies at sites of electrode placement following application of an electrode paste containing calcium chloride. Prolonged exposure and skin microabrasions seem to increase the risk of this rare complication of electrode placement, which has not been previously reported following auditory brainstem evoked potential recordings. We report the appearance of localized dermal calcifications at the sites of electrode placement (forehead and retroauricular areas) following auditory brainstem evoked potential recordings in two children, aged 3 and 2 years, respectively. In both cases the electrodes were applied after gentle scrubbing with an ethanol-impregnated gauze and interposition of a calcium chloride bentonite magma paste. The recording took about 1 hour. Erythematous macules and plaques ranging from 4 to 12 mm in diameter, studded with small stony excrescences, appeared at the areas of electrode application 1 and 5 days later, respectively. Histopathologic study of 4 mm punch biopsy specimens showed amorphous dermal deposits of calcium salts. There was superficial ulceration and transepidermal elimination of the calcium deposits, as well as a foreign body tissue reaction in the surrounding dermis. In both patients small stony pellets were extruded during the healing process, which took 11 and 9 weeks, respectively, and left no scars.