Biological Therapies or Apremilast in the Treatment of Psoriasis in Patients with a History of Hematologic Malignancy: Results from a Retrospective Study in 21 Patients

Abstract

Background: Few studies addressing the safety and efficacy of biological therapy (BT) or apremilast (APR) in patients with psoriasis with a history of hematologic malignancy (HM) exist. Aim: To describe the tolerance and efficacy of BT and APR in moderate-to-severe psoriasis in patients with a history of in-remission or evolving HM. Methodology: A retrospective, multicenter chart review of the tolerance and efficacy of BT or APR in patients with moderate-to-severe psoriasis and a clinical history of in-remission or evolving HM. Results: Twenty-one patients with severe psoriasis and a history of HM were included in France by the GEM Resopso study group. Of the 16 patients treated with one or more BT lines, none showed recurrence of their HM which was considered as stable or in remission, and only 2 patients showed an evolution of their HM which had been considered as stable at the beginning of treatment. In the 10 patients treated with APR, the HM of one patient who also received BT worsened. The 3 evolutions did not impact the treatment with BT or APR. Tolerance was very satisfactory, with a low occurrence of infections. Regarding efficacy, only one patient treated with APR did not achieve any notable clinical improvement. Conclusion: Despite supportive data regarding tolerance, the heterogeneity of the analyzed population and limited available data, BT and APR should be used with caution in this patient population and investigations on larger cohorts should be conducted to further assess their tolerance in this patient population.

Apremilast in psoriasis patients with serious comorbidities: a case series and systematic review of literature

“…The systematic literature search yielded 52 studies eligible for inclusion (Figure 1). One additional study was identified after the last search date (published July 8 th 2021) and does not appear in the flow diagram (Figure 1) [13]. A total of at least 826 psoriasis patients with serious comorbidities (various malignancies -at least 456 patients -, latent / past tuberculosis -49 patients -, hepatitis B, C and HIV infections -at least 83 patients -, serious renal -7 patients -or liver impairment -at least 110 patients -, serious psychiatric disorders -49 patients -or other serious illness as was defined by Kelley [12]) were prescribed apremilast twice or once daily (Table 2).…”

“…Furthermore, many biologics (adalimumab, certolizumab pegol, etanercept, infliximab, ustekinumab, guselkumab, risankizumab, brodalumab, secukinumab, ixekizumab) can be used in patients receiving highly active antiretroviral therapy (HAART) and having undetectable viral load [19]. In case of detectable Cohen-Sors 2021 [13] Hematologic malignancy: 10 Gottlieb 2021 [36] Kahn 2019 [37] Nagata 2019 [38] Uvais 2020 [39] Vico-Alonso 2020 [40] Melis 2020 [41] Perrone 2017…”

“…Kurata 2021 [74] Cohen-Sors 2021 [13] Quality Good Good Good Case reports have been assessed through the JBI critical appraisal checklist for case reports. Cross-sectional studies have been assessed through the NIH quality assessment tool for observational cohort and cross-sectional studies.…”

Exacerbation of psoriasis induced by Nivolumab in a patient with stage IIIc gastric adenocarcinoma: A case report and literature review

“…Thirdly, for some patients being insensitive to traditional treatment, the immunomodulating agent—apremilast seems to be a good choice [ 43 , 34 , 44 ]. Apremilast is an oral phosphodiesterase 4 inhibitor that could decrease serum levels of IL-17 A, IL-22, and TNF-α [ [48] , [49] , [50] , [51] ]. Recently, A phase 3, double-blind placebo-controlled study evaluated the efficacy and safety of apremilast showing that 30 mg twice daily makes significant improvement among patients with mild to moderate psoriasis [ 49 ].…”

“…The most common treatment-emergent adverse events were diarrhea, headache, nausea, nasopharyngitis, and upper respiratory tract infection [ 49 ]. Another retrospective study evaluated the efficacy and safety of biological therapy or apremilast in treating psoriasis of patients with hematologic malignancy [ 48 ]. 76.2% (16/21) patients showed no recurrence of their hematologic malignancy, and only 2 patients showed an evolution [ 48 ].…”