Tato kazuistika popisuje případ pacienta, u kterého se během několika let progresivně vyvinula závažná forma ložiskové psoriázy. U pacienta postupně selhaly všechny možnosti konvenční systémové terapie. Kontrolu nad onemocněním přinesla až terapie brodalumabem, který kromě zhojení kožního postižení dokázal potlačit i intenzivní pruritus. Pacient je aktuálně léčen brodalumabem již déle než 4,5 roku, efekt je dlouhodobě stabilní, dosud bez jakýchkoli nežádoucích účinků.
This case report describes a patient in whom a severe form of plaque psoriasis developed progressively over several years. ALL conventional systemic therapies have subsequently failed in this patient. The control over the disease was achieved only after therapy with brodalumab, which, in addition to clearing the skin involvement, was able to suppress the intense pruritus. The patient is currently on brodalumab therapy for more than 4.5 years, the effect is stable in the long term, without any side effects so far.
Atopic dermatitis is a chronic inflammatory intensively pruritic skin disease. Patients with moderate-to-severe atopic dermatitis or with difficult-to-treat areas are candidates for systemic therapy, especially when topical therapy is inadequate. Currently, we have available not only conventional immunosuppressive systemic therapy, but also targeted biological therapy, which has shown a remarkable reduction in clinical severity with a good safety profile. Dupilumab has been approved to treat moderate-to-severe atopic dermatitis. Even though the therapy has been available for more than 3 years, there are still limited data regarding the treatment of patients with concomitant cancer. Previous immunosuppressive treatment for atopic dermatitis, such as cyclosporine or azathioprine, poses a safety risk for patients with malignant disease. We present a case series of three patients with advanced cancer and severe atopic dermatitis treated with dupilumab for an average of 17 months with a great response toward atopic dermatitis without cancer recurrence. One patient had colorectal cancer' the second and the third both had cancer duplicity-colorectal and kidney cancer and penile squamous cell carcinoma with prostate cancer. Our cases suggest that dupilumab can safely control atopic dermatitis in patients with advanced cancer.
- Publikační typ
- kazuistiky MeSH
BACKGROUND: Real-world data on the long-term use of guselkumab for treatment of psoriasis are still limited. OBJECTIVE: We aimed to evaluate long-term efficacy, safety, and drug survival of guselkumab in a real-world setting. METHODS: This is a retrospective study analyzing Czech Republic registry (BIOREP) data of patients treated with guselkumab. RESULTS: In total, 333 patients were included. Improvement in Psoriasis Area and Severity Index (PASI) score was significant. Mean PASI score decreased from 16 at baseline to 0.7, 0.9, and 0.8 after 12, 24, and 36 months, respectively. Absolute PASI scores of ≤ 3 and ≤ 1 were achieved in 93.9% and 77.9%, 94.2% and 71.0%, and 94.8% and 70.7% of patients after 12, 24, and 36 months, respectively. Response PASI 90 and PASI 100 were attained in 81.8% and 57.1%, 75.4% and 50.7%, and 75.9% and 55.2% of patients after 12, 24, and 36 months, respectively. The percentage of patients achieving PASI 90 and PASI 100 responses was higher throughout the study in bio-naive and in normal-weight patients, while presence of psoriatic arthritis had no influence. Improvement in Dermatology Life Quality Index (DLQI) score was also significant; mean DLQI score decreased from 14.2 at baseline to 0.9, 1.0, and 0.7 after 12, 24, and 36 months, respectively. Patients with PASI 100 had lower mean DLQI throughout the study compared with patients with PASI 90. Major reason for discontinuation was loss of effectiveness in 7.1% of patients, while only 0.6% were due to adverse events. Overall cumulative drug survival was high, with only a minimal decline over time, reaching 91.6%, 87.0%, and 85.5% after 12, 24, and 36 months, respectively. Drug survival was not affected by previous biological treatment, patient weight, or presence of psoriatic arthritis. CONCLUSIONS: This real-world study demonstrated the long-term effectiveness, good safety profile, and high drug survival of guselkumab treatment over a period of 36 months.
- Publikační typ
- časopisecké články MeSH
Tato kazuistika popisuje případ 65letého muže s novými afekcemi v oblasti pupku. Na základě výsledku histopatologického vyšetření bylo zjištěno, že se jedná o tzv. "noduly sestry Marie Josefy", metastázy málo diferencovaného karcinomu pankreatu.
This case report describes a 65-year-old man with new lesions in the umbilical region. Based on histopathological examination, it was found to be "Sister Mary Joseph's nodules", metastases of poorly differentiated pancreatic cancer.
- MeSH
- lidé středního věku MeSH
- lidé MeSH
- metastázy nádorů MeSH
- nádory kůže sekundární MeSH
- nádory slinivky břišní * diagnóza MeSH
- uzel sestry Josefy * diagnóza etiologie patologie MeSH
- výsledek terapie MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- Publikační typ
- kazuistiky MeSH
- MeSH
- dermatitis herpetiformis * MeSH
- imunoglobulin A MeSH
- lidé MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- kazuistiky MeSH
BACKGROUND: Drug survival, defined as the length of time from initiation to discontinuation of a given therapy, allows comparisons between drugs, helps to predict patient's likelihood of remaining on a specific treatment, and achieving the best decision for each patient in daily clinical practice. OBJECTIVE: The aim of this study was to provide data on drug survival of secukinumab, ixekizumab, brodalumab, guselkumab, tildrakizumab, and risankizumab in a large international cohort, and to identify clinical predictors that might have an impact on the drug survival of these drugs. METHODS: This was a retrospective, multicentric, multi-country study that provides data of adult patients with moderate to severe psoriasis who started treatment with an interleukin (IL)-17 or IL-23 inhibitor between 1 February 2015 and 31 October 2021. Data were collected from 19 distinct hospital and non-hospital-based dermatology centers from Canada, Czech Republic, Italy, Greece, Portugal, Spain, and Switzerland. Kaplan-Meier estimator and proportional hazard Cox regression models were used for drug survival analysis. RESULTS: A total of 4866 treatment courses (4178 patients)-overall time of exposure of 9500 patient-years-were included in this study, with 3164 corresponding to an IL-17 inhibitor (secukinumab, ixekizumab, brodalumab) and 1702 corresponding to an IL-23 inhibitor (guselkumab, risankizumab, tildrakizumab). IL-23 inhibitors had the highest drug survival rates during the entire study period. After 24 months of treatment, the cumulative probabilities of drug survival were 0.92 (95% confidence interval [CI] 0.89-0.95) for risankizumab, 0.90 (95% CI 0.88-0.92) for guselkumab, 0.80 (95% CI 0.76-0.84) for brodalumab, 0.79 (95% CI 0.76-0.82) for ixekizumab, and 0.75 (95% CI 0.73-0.77) for secukinumab. At 36 months, only guselkumab [0.88 (95% CI 0.85-0.91)], ixekizumab [0.73 (95% CI 0.70-0.76)], and secukinumab [0.67 (95% CI 0.65-0.70)] had more than 40 patients at risk of drug discontinuation. Only two drugs had more than 40 patients at risk of drug discontinuation at 48 months, with ixekizumab demonstrating to have a higher cumulative probability of drug survival [0.71 (95% CI 0.68-0.75)] when compared with secukinumab [0.63 (95% CI 0.60-0.66)]. Secondary failure was the main cause for drug discontinuation. According to the final multivariable model, patients receiving risankizumab, guselkumab, and ixekizumab were significantly less likely to discontinue treatment than those receiving secukinumab. Previous exposure to biologic agents, absent family history of psoriasis, higher baseline body mass index (BMI), and higher baseline Psoriasis Area and Severity Index (PASI) were identified as predictors of drug discontinuation. CONCLUSION: The cumulative probability of drug survival of both IL-17 and IL-23 inhibitors was higher than 75% at 24 months, with risankizumab and guselkumab demonstrating to have overall cumulative probabilities ≥ 90%. Biological agent chosen, prior exposure to biologic agents, higher baseline BMI and PASI values, and absence of family history of psoriasis were identified as predictors for drug discontinuation. Risankizumab, guselkumab, and ixekizumab were less likely to be discontinued than secukinumab.
- MeSH
- dospělí MeSH
- inhibitory interleukinu MeSH
- interleukin-17 * MeSH
- interleukin-23 MeSH
- lidé MeSH
- psoriáza * farmakoterapie MeSH
- retrospektivní studie MeSH
- stupeň závažnosti nemoci MeSH
- výsledek terapie MeSH
- Check Tag
- dospělí MeSH
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- multicentrická studie MeSH
Current knowledge about human papillomavirus (HPV) infection in psoriasis patients treated with biologics is limited. In this study we evaluated the prevalence of oral and genital HPV infection in psoriasis patients treated with biologics or topical therapy for at least 6 months. The presence of HPV DNA in oral rinse and genital smears was evaluated. In total, 267 patients who met the inclusion criteria and agreed to participate were enrolled: 110 (41.2%) on topical therapy, 84 (31.5%) on anti-TNF-alpha therapy, 31 (11.6%) on anti-IL-12/23 therapy and 42 (15.7%) on anti-IL-17 therapy. The presence of genital HPV infection was detected in 34.6% of men receiving anti-TNF-α treatment, in 25.0% of patients on anti-IL-12/23 and 18.8% of patients on anti-IL-17 therapy. The difference in prevalence was not statistically different from men on topical treatment (26.3%). Prevalence of oral HPV infection was higher across all of the biologic groups (11.9% for anti-TNF-α, 12.9% for anti-IL-12/23 and 19.0% for anti-IL-17) compared to patients on topical therapy (7.3%), but statistically significant only for anti-IL-17 (p < 0.05). The presence of oral HPV infection in patients treated with biologics was significantly higher (44.0%) in patients on long-term biologic treatment (>8 years) compared to patients taking biologics for a shorter period (9.1%; p < 0.01). Our results suggest that patients on biologics for psoriasis have a higher prevalence of oral HPV infection compared to patients on topical treatment. Long-term treatment with biologics seems to be associated with a higher prevalence of oral HPV infection, independent of previous conventional immunosuppressive therapy.
- MeSH
- biologická terapie MeSH
- biologické přípravky * škodlivé účinky MeSH
- infekce papilomavirem * diagnóza epidemiologie MeSH
- inhibitory TNF MeSH
- lidé MeSH
- Papillomaviridae MeSH
- pohlavní orgány MeSH
- psoriáza * farmakoterapie epidemiologie MeSH
- sexuálně přenosné nemoci * MeSH
- Check Tag
- lidé MeSH
- mužské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
Prezentovaná kazuistika popisuje případ pacienta s psoriázou, trpícího dlouhodobými bolestmi zad, které ale nebyly nijak řešeny. Až na základě dovyšetřování na dermatovenerologické klinice vzniklo vážné podezření na možnou přítomnost dosud nerozpoznané ankylozující spondylitidy. Doplněné revmatologické vyšetření toto podezření konfirmovalo. U pacienta byla z revmatologické indikace zahájena biologická terapie, kvůli špatné compliance pacienta ale musela být ukončena. I přes neuspokojivé završení případu tato kazuistika názorně dokumentuje důležitost spolupráce mezi dermatologem a revmatologem.
The presented case report describes a case of a patient with psoriasis who had been suffering from back pain for a long time, but it had not been managed in any way. Only after further investigation at the dermatovenerology a serious suspicion of the possible presence of an unrecognized ankylosing spondylitis arose. Subsequent rheumatological examination confirmed this suspicion. Biological therapy was initiated for rheumatological indication but had to be discontinued because of a patient's poor compliance. Despite the unsatisfactory conclusion of the case, this case report demonstratively illustrates the importance of cooperation between dermatologist and rheumatologist.
- MeSH
- adherence pacienta MeSH
- ankylózující spondylitida diagnostické zobrazování farmakoterapie MeSH
- bolesti zad * diagnóza etiologie farmakoterapie MeSH
- lidé středního věku MeSH
- lidé MeSH
- methotrexát terapeutické užití MeSH
- psoriáza * farmakoterapie komplikace MeSH
- rentgendiagnostika MeSH
- TNF-alfa terapeutické užití MeSH
- výsledek terapie MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- Publikační typ
- kazuistiky MeSH
Pacienti s psoriázou trpí celou řadou komorbidit, vznikajících na přímém i nepřímém podkladě. Tyto komorbidity jsou velice heterogenní, od metabolických, přes kardiovaskulární, až po jiná autoimunitní onemocnění. Některé komorbidity mohou být i lékově indukované. Volba systémové terapie, včetně biologické terapie, proto musí případná souběžná onemocnění zohlednit, zejména vzhledem k možným kontraindikacím nebo naopak možnému společnému terapeutickému využití.
Patients with psoriasis suffer from a variety of comorbidities, arising from both direct and indirect causes. These comorbidities are very heterogeneous, ranging from metabolic, to cardiovascular, to other autoimmune diseases. Some comorbidities may also be drug-induced. Therefore, the choice of systemic therapy, including biologic therapy, must take into account possible comorbidities, especially because of possible contraindications or, conversely, possible common therapeutic use
BACKGROUND: Real-world data on the use of interleukin-17 (IL-17) inhibitors for the treatment of psoriasis are limited. OBJECTIVE: To evaluate and compare the efficacy, safety, and drug survival of IL-17 inhibitors. METHODS: This retrospective study analyzed the BIOREP registry data of patients treated with at least one IL-17 inhibitor (secukinumab, ixekizumab, and brodalumab). RESULTS: In total, 949 patients were included. The improvement in PASI score was significant for all drugs, and the proportion of patients achieving PASI 75, 90, and 100 after both 3 and 24 months of therapy was highest for brodalumab, followed by ixekizumab and secukinumab. The Dermatology Life Quality Index score decreased to ˂3 after 3 months and to ˂2 after 24 months of therapy for all inhibitors. Loss of effectiveness was the major reason for discontinuation in 17.2% of patients, followed by adverse events in 3.2% of patients. The drug survival probability was the highest for brodalumab, followed by ixekizumab and secukinumab. Negative predictors for treatment discontinuation were obesity and the number of treatment lines, whereas a positive predictor was the presence of concomitant psoriatic arthritis; sex had no influence. CONCLUSION: This real-life study demonstrated the effectiveness and good safety profile of all currently available IL-17 inhibitors.
- MeSH
- interleukin-17 * MeSH
- lidé MeSH
- monoklonální protilátky škodlivé účinky MeSH
- psoriáza * farmakoterapie chemicky indukované MeSH
- registrace MeSH
- retrospektivní studie MeSH
- stupeň závažnosti nemoci MeSH
- výsledek terapie MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- Geografické názvy
- Česká republika MeSH
