Combining secukinumab with dimethyl fumarate for treatment of a patient with psoriasis and recent diagnosis of multiple sclerosis

Results We report the case of a 44-year-old male patient referred to our department in 2006 for evaluation and management of psoriasis and psoriatic arthritis not responding to previous topical therapies and to conventional systemic treatments. On initial evaluation, his Psoriasis Area and Severity Index (PASI) was 23 so it was decided to start a biological therapy. Etanercept was firstly introduced with partial control of both cutaneous and articular manifestations and stopped after 2 years due to a loss of efficacy. Then, other different biological drugs were administered but discontinued for loss of efficacy or no clinical response. In 2017, we started a treatment with secukinumab with significant clinical improvement. These results were still maintained after 2 years. In January 2019, due to several episodes of hypoesthesia and paraesthesia, the patient performed a neurological examination and a brain magnetic resonance imaging (MRI) with gadolinium revealing multiple encephalic and spinal hyperintense lesions compatible with focal demyelinated areas. A diagnosis of relapsing-remitting multiple sclerosis was made and therapy with dimethyl fumarate (240 bid) started. Secukinumab therapy was maintained but decreasing the dose to 150 mg/month in order to reduce the immunosuppressive risks. After 12 months of follow-up, the patient tolerates the association of the two therapies and presents good control of both diseases. To the best of our knowledge, this is the first case of a combination of two immunosuppressive drugs, secukinumab and dimethyl fumarate, for the treatment of a patient with concomitant psoriasis and multiple sclerosis. Among the widely different conventional therapies available to treat these two diseases, only dimethyl fumarate has been approved for both conditions. Moreover, interleukin 17 (IL-17) appears to play a key role in the pathogenesis of both diseases; it is produced by lymphocytes Th17, but also by CD8+ cells, Tγδ lymphocytes and some cells of the central nervous system, such as astrocytes and oligodendrocytes, in the context of active lesions of multiple sclerosis. Currently, the efficacy of anti IL-17 has been described only in few cases of multiple sclerosis. In conclusion, our case emphasizes the potential efficacy and safety of combination therapy of secukinumab and dimethyl fumarate, which may be a therapeutic option for such challenging patients

Secukinumab demonstrates improvements in absolute and relative psoriasis area severity indices in moderate-to-severe plaque psoriasis: results from a European, multicentric, retrospective, real-world study

AbstractObjective: This European, multicentric, retrospective study aimed to collect data on secukinumab effectiveness in a real-world setting.Research design and methods: All psoriatic patients st..

Helicobacter Pylori infection in psoriatic patients during biological therapy

Psoriasis is a relapsing inflammatory disease exacerbated by many triggers. Helicobacter Pylori (H. Pylori) is a Gram-negative bacterium causing the liberation of many cytokines and having a role in systemic inflammation. We assessed over a period of 12 months the presence of H. Pylori in psoriatic patients undergoing biologic therapy and how PASI improved after its eradication

Clinical features and in vivo reflectance confocal microscopy of an atypical presentation of Herpesvirus-2 and Cytomegalovirus co-infection of the intergluteal sulcus

[No abstract available

A New Hybrid Therapeutic Approach to Solitary Keratoacanthoma: Complete Recovery in Six Patients

Introduction: Solitary keratoacanthoma (SKA) is generally considered as a well-differentiated form of squamous cell carcinoma, but it usually runs a benign course and a not aggressive behavior. Diagnostic criteria, prognosis, and treatment of SKA are not fully defined yet. Surgical treatment with fusiform excision represents the gold standard; nonoperative intralesional therapy of KA is uncommon but may provide a valid option in some categories of patients. Case series presentation: We report our experience regarding the treatment of SKA with a hybrid treatment consisting of a minimally invasive technique such as curettage followed by intralesional corticosteroid administration in the same session. Six patients affected with KA were treated ending in a complete resolution, with good esthetic outcome, no relapse after 1 year, and satisfaction of the patients. Discussion and conclusion: The combined treatment allows us on the one hand to avoid radical surgery in selected patients and particular anatomic areas and on the other the side effects that the use of intralesional chemotherapy/immunosuppressive drugs can entail

Survey of bullous pemphigoid in an Italian University hospital: clinical-epidemiological characteristics and follow-up

The clinical-epidemiological characteristics and course of bullous pemphigoid in the general population is not clear. Few studies have been performed to date, and only one in the Italian population more than ten years ago. We decided to evaluate the characteristics and outcome of patients admitted for a bullous pemphigoid at our Hospital in the last 4 years

Seven years-experience of adalimumab therapy for Hidradenitis Suppurativa in a real-life dermatologic setting

Introduction Hidradenitis Suppurativa (HS) often causes severe impairment of the quality of life of patients affected, as it is characterized by recurrent relapses of inflammation and predisposes to retractive scars, with severe alteration of anatomy of the affected regions. Adalimumab is currently the only approved long-term biological therapy for this disease. Material and method We retrospectively review the data of HS patients treated with Adalimumab at the ‘Hidradenitis Suppurativa Clinic’, University of Ferrara, Italy since the drug was first available to October 2020. The aim is to describe our real-life experience in a clinical outpatient service. We assessed the main demographic features, therapy duration, reasons of suspension and efficacy (evaluated by HiSCR – Hidradenitis Score) in relation to surgical procedures, hospitalization, number of areas involved by the disease and BMI > 30. We also assessed the aspects related to the use of adalimumab’s biosimilar. Results Data on 76 patients, with a mean age of 38.26 ± 14.74 years and mean BMI 28.10 ± 5.92 were collected. Most of the treated patients had Hurley stage III (58/76); mean Sartorius score was 115.5 ± 55.86, mean IHS4 was 76.1 ± 44.3. A statistically significant correlation between hospitalization and cessation of adalimumab, the loss of the achievement of the HiSCR, and surgery was found. No need to do surgery was a protective factor against the failure of adalimumab treatment, meaning that the most severe cases are more likely to fail the biological therapy. Conclusion New scenarios are opening up in clinical practice: the arrival of biosimilars allow greater sustainability of expenditure, while the anti-IL17 allow the patient who has failed therapy with adalimumab a valid and safe therapeutic option to be undertaken. A comprehensive care including hospitalization, a specific antibiotic therapy and surgical treatment is often mandatory to achieve a satisfactory control of the disease

Management of long-term therapy with biological drugs in psoriatic patients with latent tuberculosis infection in real life setting

Psoriatic patients with latent tuberculosis infection (LTBI) need a prophylaxis before starting a treatment with biological drugs. The aim of this study is to investigate the safety and efficacy of prophylaxis of LTBI in psoriatic patients receiving long-term biological drugs. The study included 56 patients (42 male and 14 female) affected by moderate-to-severe psoriasis (mean PASI: 12.8 \uc2\ub1 6.9 SD) treated with anti-TNF-\uce\ub1 and/or anti IL 12, 23 and/or anti-CD11 drugs with a diagnosis of LTBI. LTBI diagnosis was based on tuberculin skin test and/or QuantiFERON TB Gold test positivity and chest X-ray suggestive, without clinical, or microbiological evidence of active disease. All patients received prophylactic therapy for 9 months with isoniazid (INH) 300 mg/day, starting 3 weeks before the beginning of biological treatment. Fifty-four patients completed prophylaxis with INH without any adverse events or intolerance; they continue the biological treatment without appearance of active tuberculosis. One patient developed tuberculosis pleurisy in course of treatment with etanercept. The infection has been treated and after a stable remission, treatment was restarted without tuberculosis reactivation. In this retrospective analysis, the prophylaxis of LTBI whit INH was effective and safe in longer follow-up period

Combination treatment with secukinumab and dimethyl fumarate in a patient with psoriasis and recent diagnosis of multiple sclerosis

The therapeutic approach to patients with psoriasis and concomitant multiple sclerosis is challenging. We report the clinical case of a 44-year-old man affected by psoriasis and psoriatic arthritis treated with secukinumab for 2 years, who received also dimethyl fumarate because of a recent diagnosis of relapsing remitting multiple sclerosis. Moreover, a mini-review of the available literature regarding the use of secukinumab in patients with psoriasis or ankylosing spondylitis and coexisting central nervous system demyelinating diseases was performed. To the best of our knowledge, this is the first case of successfully combining secukinumab and dimethyl fumarate for the treatment of two different immune mediated inflammatory diseases with good response and safety outcomes. Our case emphasizes the potential efficacy of this combination therapy, which may represent an effective synergistic strategy to manage such challenging patients

Cross-Switch from Etanercept Originator to Biosimilar SB4 and to GP2015 in Patients with Chronic Plaque Psoriasis

Biosimilars of anti-TNF-α inhibitors have become a valid and usually less expensive alternative to their originator drugs [1]. Therefore, switching from originator to biosimilar drugs is an increasingly widespread approach because of the potential cost savings. As more biosimilars become available, switching between biosimilars of the same originator will be likely