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      Resolution of post-adalimumab vitiligo with secukinumab in a patient with psoriasis vulgaris

      case-report
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      Publication date (Electronic):
      Journal: Oxford Medical Case Reports
      Publisher: Oxford University Press

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          Abstract

          Plaque psoriasis is a chronic debilitating condition, and biologic agents that inhibit tumor necrosis factor-α (TNF-α) are widely employed in management of the condition. Notwithstanding, several paradoxical adverse reactions have been reported with TNF-α inhibitors, including vasculitis, vitiligo, alopecia areata, sarcoidosis and other granulomatous diseases. Herein, we report the case of a 63-year-old man who developed vitiligo while on therapy with adalimumab following failure of conventional agents for plaque psoriasis. After discontinuation of adalimumab and initiation of secukinumab, vitiligo and other psoriatic symptoms gradually resolved. After 1 year of treatment, only small plaque areas were present in the flexor site with complete remission in the extensor area along with near complete resolution of depigmented areas. In this case of possible adalimumab-induced vitiligo in a patient with plaque psoriasis, secukinumab resolved both the symptoms of psoriasis and the likely adalimumab-related vitiligo.

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          Secukinumab demonstrates high sustained efficacy and a favourable safety profile in patients with moderate‐to‐severe psoriasis through 5 years of treatment ( SCULPTURE Extension Study)

          R Bissonnette, T Luger, D. Thaci … (2018)
          Abstract Background Secukinumab, a fully human monoclonal antibody that selectively neutralizes IL‐17A, has been shown to have significant efficacy and a favourable safety profile in the treatment of moderate‐to‐severe psoriasis and psoriatic arthritis. Objective To assess the efficacy and safety of secukinumab through 5 years of treatment in moderate‐to‐severe psoriasis. Methods In the core SCULPTURE study, Psoriasis Area and Severity Index (PASI) 75 responders at Week 12 continued receiving subcutaneous secukinumab until Year 1. Thereafter, patients entered the extension phase and continued treatment as per the core trial. Treatment was double‐blinded until the end of Year 3 and open‐label from Year 4. Here, we focus on the 300 mg fixed‐interval (every 4 weeks) treatment, the recommended per label dose. Efficacy data are primarily reported as observed, but multiple imputation (MI) and last observation carried forward (LOCF) techniques were also undertaken as supportive analyses. Results At Year 1, 168 patients entered the extension study and at the end of Year 5, 126 patients completed 300 mg (every 4 weeks) treatment. PASI 75/90/100 responses at Year 1 (88.9%, 68.5% and 43.8%, respectively) were sustained to Year 5 (88.5%, 66.4% and 41%). PASI responses were consistent regardless of the analysis undertaken (as observed, MI, or LOCF). The average improvement in mean PASI was approximately 90% through 5 years compared with core study baseline. DLQI (dermatology life quality index) 0/1 response also sustained through 5 years (72.7% at Year 1 and 65.5% at Year 5). The safety profile of secukinumab remained favourable, with no cumulative or unexpected safety concerns identified. Conclusion Secukinumab 300 mg treatment delivered high and sustained levels of skin clearance and improved quality of life through 5 years in patients with moderate‐to‐severe psoriasis. Favourable safety established in the secukinumab phase 2/3 programme was maintained through 5 years.
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            Paradoxical reactions under TNF-α blocking agents and other biological agents given for chronic immune-mediated diseases: an analytical and comprehensive overview

            Eric Toussirot, François Aubin (2016)
            Paradoxical adverse events (PAEs) have been reported during biological treatment for chronic immune-mediated diseases. PAEs are defined as the occurrence during biological agent therapy of a pathological condition that usually responds to this class of drug. A wide range of PAEs have been reported including dermatological, intestinal and ophthalmic conditions, mainly with antitumour necrosis factor α (TNF-α) agents. True PAEs include psoriasis, Crohn's disease and hidradenitis suppurativa. Other PAEs may be qualified as borderline and include uveitis, scleritis, sarcoidosis and other granulomatous diseases (granuloma annulare, interstitial granulomatous dermatitis), vasculitis, vitiligo and alopecia areata. Proposed hypotheses to explain these PAEs include an imbalance in cytokine production, the differential immunological properties between the monoclonal antibodies and TNF-α soluble receptor, an unopposed type I interferon production and a shift towards a Th1/Th2 profile. Data from registries suggest that the risk for paradoxical psoriasis is low and non-significant. We discuss management of these PAEs, which depends on the type and severity of the adverse events, pre-existing treated conditions and the possibility of alternative therapeutic options for the underlying disease. Paradoxical adverse events are not restricted to anti-TNF-α agents and close surveillance of new available biological drugs (anti-interleukin-17/23, anti-integrin) is warranted in order to detect the occurrence of new or as yet undescribed events.
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              Role of interleukin-17 in the pathogenesis of vitiligo.

              A Bassiouny, O Shaker (2011)
              Skewing of the immune response towards T helper (Th)1 or Th17 and away from regulatory T cells (Tregs) and Th2 cells may be responsible for the development and progression of autoimmune disease. An autoimmune theory has been proposed in the pathogenesis of vitiligo. No previous reports have investigated alterations in IL-17 produced by Th17 cells in lesional skin in vitiligo. To investigate the role of IL-17 in the pathogenesis of vitiligo by assessing its levels in lesional skin and serum of patients with vitiligo compared with controls. In total, 30 patients with vitiligo and 20 controls matched for age and gender were enrolled in the study. Serum and tissue IL-17 levels were measured by ELISA and compared between both groups for correlations with age, gender, family history, disease duration, activity of vitiligo and percentage of involved body surface area. A significant difference between patients and healthy controls was found for both serum and tissue IL-17 levels (P<0.001 for both). Significant positive correlations were found between disease duration and IL-17 level in both serum (r=0.42, P=0.02) and lesional skin (r=0.45, P<0.015); between extent of vitiligo and IL-17 levels in both serum (r=0.65, P<0.001) and skin (r=0.48, P<0.05); and between the serum and the tissue IL-17 levels in patients with vitiligo (r=0.54, P=0.002). Multiple factors have been implicated in the pathogenesis of vitiligo. The increased levels of IL-17 we found in serum and lesional skin suggest an important role for this cytokine in the pathogenesis of vitiligo. © The Author(s). CED © 2010 British Association of Dermatologists.
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                Author and article information

                Journal
                Journal ID (nlm-ta): Oxf Med Case Reports
                Journal ID (iso-abbrev): Oxf Med Case Reports
                Journal ID (publisher-id): omcr
                Title: Oxford Medical Case Reports
                Publisher: Oxford University Press
                ISSN (Electronic): 2053-8855
                Publication date Collection: January 2020
                Publication date (Electronic): 31 January 2020
                Publication date PMC-release: 31 January 2020
                Volume: 2020
                Issue: 1
                Electronic Location Identifier: omz134
                Affiliations
                [1] Ambulatorio di Dermatologia , Ospedale Distrettuale di Tinchi, 75015 Pisticci, MT, Italy
                Author notes
                Correspondence address. Ambulatorio di Dermatologia, Ospedale Distrettuale di Tinchi, 75015 Pisticci, MT, Italy. Tel: 339 57 25 769; E-mail: giovannipalazzo60@ 123456virgilio.it
                Article
                Publisher ID: omz134
                DOI: 10.1093/omcr/omz134
                PMC ID: 6996046
                PubMed ID: 32038878
                SO-VID: 33c1272d-3100-4bab-94c2-d88dce9eaa99
                Copyright © © The Author(s) 2020. Published by Oxford University Press.
                License:

                This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( http://creativecommons.org/licenses/by-nc/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited. For commercial re-use, please contact journals.permissions@oup.com

                History
                Date received : 30 August 2019
                Date revision received : 31 October 2019
                Date accepted : 17 November 2019
                Page count
                Pages: 4
                Categories
                Subject: Case Report

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