DEAR EDITOR, Hidradenitis suppurativa (HS) is a relapsing inflammatory skin disease. The cytokines interleukin (IL)-1b, IL-12, IL-23, IL-17 and tumour necrosis factor (TNF)-a are involved in the inflammatory process. 1 The only approved drug for the treatment of moderate-to-severe cases is adalimumab (a TNF-a inhibitor). However, long-term clinical responses range only from 52 to 57%. 2 Tildrakizumab (anti-IL-23), 3 guselkumab (anti-IL-23) 4 and ustekinumab (anti-IL-12/23) 5 have been successfully used in HS.Risankizumab is a humanized IgG1 monoclonal antibody selective to IL-23. It is currently approved for the treatment of moderate-to-severe plaque psoriasis in adults. 6 We describe two patients with severe Hurley Stage III HS, successfully treated with risankizumab:Patient 1 was a 39-year-old woman, a nonsmoker with a body mass index (BMI, kg m -2 ) of 28Á9. Her medical history included depression and multiple sclerosis (MS). Her mother and grandfather have been treated for HS. Historically, she was treated with systemic azithromycin, doxycycline, clindamycin, rifampicin, isotretinoin and, lastly, adalimumab (40 mg per week subcutaneously). Three months after starting adalimumab, she achieved a Hidradenitis Suppurativa Clinical Response (HiSCR). Loss of response (LoR) was observed after 20 months and consequently adalimumab was discontinued
The IL-17 cytokine family encompasses six different homodimers and heterodimers referred to as IL-17A-F. Due to some differences in the mechanism of IL-17 inhibition, aninsufficient effect of one IL-17 inhibitor does not necessarily imply lack of efficacy of the other agent of the same class. Aim of study was analysis of the success rate of switches among IL-17 inhibitors (secukinumab, ixekizumab, and brodalumab) in patients treated in the Czech Republic. Data were obtained from the Czech nationwide registry of psoriatic patients receiving biological/targeted therapy (BIOREP). Our analysis involved data of a total of 90 patients with severe chronic plaque psoriasis and baseline PASI scores >10 both prior to first-line biological therapy initiation and after switch to another agent of the class of IL-17 inhibitors. The most effective switch was that from secukinumab to brodalumab, with PASI 90 reached by 64.7% and 73.3% of patients at weeks 12 and 24. Among patients switched from secukinumab to ixekizumab target PASI 90 responses were achieved (at weeks 12 and 24) by 41.2% and 55.2% of patients. Among patients switched from ixekizumab to brodalumab target PASI 90 responses were achieved, at the above time points, by 30.8% and 38.5% of patients. Our analysis showed a high success rate of switches from secukinumab to ixekizumab and brodalumab, followed by the ixekizumab-to-brodalumab switch. Importantly, the therapeutic response and success rates of individual switches are independent of the patient's body weight and presence of psoriatis arthritis.
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