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      Successful secukinumab treatment of erythrodermic psoriasis and psoriatic arthritis concomitant with severe noninfectious uveitis: a case report

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          Abstract

          Uveitis is considered a relatively rare but serious ocular complication of psoriasis. We report the first successful treatment of severe noninfectious uveitis with secukinumab in a 70-year-old woman with erythrodermic psoriasis and psoriatic arthritis. Anti-tumor necrosis factor (TNF) agents were administered for 5 years for the treatment of erythrodermic psoriasis and psoriatic arthritis. Although the symptoms improved, she later developed noninfectious uveitis, resulting in a sharp decline in vision. After switching to secukinumab, her vision slightly improved, her skin lesions subsided, and her joint symptoms were relieved. Given the rarity of psoriasis combined with uveitis, it is unclear whether uveitis is related to anti-TNF therapy. In addition, the selection of effective biological agents for the treatment of uveitis remains a challenge and requires extensive clinical experience.

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          Psoriasis.

          Wolf-Henning Boehncke, Michael P. Schön (2015)
          Psoriasis is an immune-mediated, genetic disease manifesting in the skin or joints or both. A diverse team of clinicians with a range of expertise is often needed to treat the disease. Psoriasis provides many challenges including high prevalence, chronicity, disfiguration, disability, and associated comorbidity. Understanding the role of immune function in psoriasis and the interplay between the innate and adaptive immune system has helped to manage this complex disease, which affects patients far beyond the skin. In this Seminar, we highlight the clinical diversity of psoriasis and associated comorbid diseases. We describe recent developments in psoriasis epidemiology, pathogenesis, and genetics to better understand present trends in psoriasis management. Our key objective is to raise awareness of the complexity of this multifaceted disease, the potential of state-of-the-art therapeutic approaches, and the need for early diagnosis and comprehensive management of patients with psoriasis.
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            Immunosuppression for the Uveitides

            Douglas A Jabs (2018)
            The uveitides are a collection of over 30 diseases, characterized by intraocular inflammation. Many cases of juvenile idiopathic arthritis-associated uveitis, many cases of intermediate uveitis, and most cases of posterior and panuveitides needing treatment are treated with corticosteroids and immunosuppression. Disease-specific, time-updated modelling of clinical data for several uveitides suggests superior prevention of ocular complications and of visual outcomes with immunosuppression. These studies also suggest that oral corticosteroids at doses low enough for safe long-term therapy (i.e. ≤ 7.5 mg/day) are ineffective, implying that immunosuppression should be part of the initial regimen. The Multicenter Uveitis Steroid Treatment (MUST) Trial and Follow-up Study was a randomized comparative effectiveness trial comparing systemic therapy with oral corticosteroids and immunosuppression to regional corticosteroid treatment. It demonstrated that, when used properly, oral corticosteroids and immunosuppression can be given safely for up to 7 years with no evident increased risk of systemic side effects compared to regional corticosteroid therapy, except for greater antibiotic use for infections. The Systemic Treatment for Eye Diseases (SITE) Cohort Study suggested long-term safety for this approach, when the immunosuppressive agents were either antimetabolites or calcineurin inhibitors. Hence, oral corticosteroids and immunosuppression may be a preferred initial therapy for many non-infectious, intermediate, posterior, and panuveitides. Non-alkylating-agent immunosuppression has a low rate of sustained, drug-free remissions, <10%/year. Non-alkylating-agent immunosuppression for ≥3 years with control of the inflammation for ≥2 years is associated with a decreased risk of relapse after discontinuing immunosuppression. Alkylating agents can induce sustained drug-free remissions but likely increase the lifetime risk of cancer. Biologics, which target specific cytokines and pathways, hold promise for the future. Monoclonal antibodies directed against tumor necrosis factor (TNF)-α, have been studied most often, and one, adalimumab, is United States Food and Drug Administration approved for the treatment of non-infectious, intermediate, posterior, and panuveitides.
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              Efficacy and safety of intravenous secukinumab in noninfectious uveitis requiring steroid-sparing immunosuppressive therapy.

              Erik Letko, Steven Yeh, C Foster … (2015)
              Secukinumab, a fully human anti-interleukin-17A monoclonal antibody, exhibited promising activity in a proof-of-concept study when administered in intravenous (IV) doses to patients with active, chronic, noninfectious uveitis. This study compared the efficacy and safety of different IV and subcutaneous (SC) doses of secukinumab in patients with noninfectious uveitis.
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                Author and article information

                Journal
                Journal ID (nlm-ta): J Int Med Res
                Journal ID (iso-abbrev): J Int Med Res
                Journal ID (publisher-id): IMR
                Journal ID (hwp): spimr
                Title: The Journal of International Medical Research
                Publisher: SAGE Publications (Sage UK: London, England )
                ISSN (Print): 0300-0605
                ISSN (Electronic): 1473-2300
                Publication date (Electronic): 8 November 2020
                Publication date Collection: November 2020
                Volume: 48
                Issue: 11
                Electronic Location Identifier: 0300060520969494
                Affiliations
                [1 ]Department of Dermatology, Shanghai Skin Disease Hospital, Tongji University School of Medicine, Shanghai, China
                Author notes
                [*]

                These authors contributed equally to this work.

                [*]Ying Li, Department of Dermatology, Shanghai Skin Disease Hospital, Tongji University School of Medicine, Shanghai, 1278 Baode Road, Shanghai, 200443, China. Email: liying631116@ 123456163.com
                Author information
                https://orcid.org/0000-0002-4041-2646
                Article
                Publisher ID: 10.1177_0300060520969494
                DOI: 10.1177/0300060520969494
                PMC ID: 7658516
                PubMed ID: 33161790
                SO-VID: f8b76342-299c-454b-82b4-a35f4facdbe2
                Copyright © © The Author(s) 2020
                License:

                Creative Commons Non Commercial CC BY-NC: This article is distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 License ( https://creativecommons.org/licenses/by-nc/4.0/) which permits non-commercial use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access pages ( https://us.sagepub.com/en-us/nam/open-access-at-sage).

                History
                Date received : 22 July 2020
                Date accepted : 8 October 2020
                Funding
                Funded by: Youth Project of Shanghai Health and Family Planning Commission, Shanghai, China;
                Award ID: 20184Y0061, 20174Y0029
                Categories
                Subject: Case Report
                Custom metadata
                typesetter ts2

                Keywords: uveitis,erythrodermic psoriasis,psoriatic arthritis,secukinumab,etanercept,infliximab
                Data availability:
                Keywords: uveitis, erythrodermic psoriasis, psoriatic arthritis, secukinumab, etanercept, infliximab

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