Use of Biologics in Pityriasis Rubra Pilaris: A Case Report and Review of the Literature

Pityriasis rubra pilaris (PRP) is an inflammatory papulosquamous disorder of unknown etiology. It is characterized by hyperkeratotic scaling plaques with an orange-red hue, “islands of sparing,” and palmoplantar keratoderma; it may cause erythroderma. There have been no completed controlled clinical trials for the treatment of PRP, and there are no FDA approved treatments at this time; most treatment evidence is derived from case reports. This review of the literature explores the use of various biologics which have been attempted for treatment of widespread or treatment resistant PRP. Some case reports have demonstrated efficacy of anti-IL-17 and anti-IL12/23 agents for PRP treatment. IL-17, a pro-inflammatory cytokine, has been found in increased levels in the skin of patients with PRP, and reductions in the level of IL-17 have been correlated with improvement in the histopathologic findings. In this case report and review of the literature, the use of ixekizumab, a humanized IgG4 monoclonal antibody which selectively binds IL-17A and inhibits the IL-17A receptor is explored in the treatment of widespread PRP in a 63 year old woman with treatment resistant erythrodermic PRP. The patient experienced significant resolution of her palmoplantar keratoderma and erythroderma after treament with ixekizumab. Conclusions: Treatment of PRP, particularly treatment resistant PRP, is still in experimental stages. Anti-IL-17 biologics such as ixekizumab and secukinumab show significant promise in the treatment of refractory PRP, as shown by this patient and multiple other case reports. The finding of elevated levels of IL-17 in lesional skin further supports the use of these IL-17 blocking agents

Remdesivir for the Treatment of COVID-19: A Systematic Review of the Literature

In March 2020, the World Health Organization declared the spread of SARS-CoV-2 a global pandemic. To date, coronavirus disease-2019 (COVID-19) has spread to over 200 countries, leading to over 1.6 million cases and over 99,000 deaths. Given that there is neither a vaccine nor proven treatment for COVID-19, there is currently an urgent need for effective pharmacotherapy. To address the need for an effective treatment of SARS-CoV-2 during the worldwide pandemic, this systematic review of intravenous (IV) remdesivir was performed. Remdesivir, an anti-viral prodrug originally developed to treat Ebola virus disease, has shown broad spectrum activity against the Coronavirus family. A recent case report reported improvement of clinical symptoms with remdesivir in a patient with COVID-19. After conducting a systematic search of 18 clinical trial registries and three large scientific databases, we identified 86 potentially eligible items. Following removal of duplicates (n = 21), eligible studies were reviewed independently by two authors. After the first round of screening, inter-rater agreement was 98.5% (κ = 0.925). After the second round of full-text screening, inter-rater agreement was 100%. A total of seven ongoing and recruiting clinical trials of remdesivir (100-200 milligrams, intravenous [IV]) were included. We identified the following primary outcomes: patients discharged (n = 2); time to clinical status improvement (n = 2); improved O2 saturation (n = 2); body temperature normalization (n = 2); and clinical status (n = 1). Secondary outcomes in all identified studies included documentation of adverse events. Phase 3 trials are expected to be completed between April 2020–2023. Therefore, despite supportive data from in vitro and in vivo studies, the clinical effectiveness of IV remdesivir for treatment of COVID-19 and potential side effects remain incompletely defined in the human population