Ixekizumab successfully treated refractory psoriasis concurrent bullous pemphigoid

Xiao, Yue; Xia, Dengmei; Zhou, Xinran; Li, Wei

doi:10.1111/1346-8138.16559

Cited by 8 publications

(7 citation statements)

References 5 publications

(5 reference statements)

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“…Anti‐IL‐17A treatment significantly reduced skin lesions in antibody‐induced experimental bullous pemphigoid in adult mice 1 . Furthermore, several reports have found that secukinumab and ixekizumab could treat patients with coexisting psoriasis vulgaris and bullous pemphigoid 2,4,5 and could decrease circulating anti‐BP180‐NC16a autoantibodies 3 . Interestingly, the present two cases were paradoxical to these reports and studies.…”

Section: Discussioncontrasting

confidence: 52%

“…Interleukin (IL)‐17A inhibitors have become the first‐line treating options for moderate to severe psoriasis, with a high PASI clearance rate and its safety. In recent years, reports have shown a beneficial effect of IL‐17A inhibitors on bullous pemphigoid (BP) 1–5 . Here we report the paradoxical phenomenon by describing two cases of BP that experienced severe flares after using two major IL‐17A inhibitors, i.e., ixekizumab or secukinumab, for their psoriasis.…”

Section: Introductionmentioning

confidence: 83%

“…In recent years, reports have shown a beneficial effect of IL-17A inhibitors on bullous pemphigoid (BP). [1][2][3][4][5] Here we report the paradoxical phenomenon by describing two cases of BP that experienced severe flares after using two major IL-17A inhibitors, i.e., ixekizumab or secukinumab, for their psoriasis.…”

Section: Introductionmentioning

confidence: 94%

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Two cases with bullous pemphigoid relapsed after using interleukin‐17A inhibitors for psoriasis: A paradoxical reaction

Wang

2023

The Journal of Dermatology

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Biological drugs, including IL‐17A inhibitors, have become the first‐line treating options for moderate to severe psoriasis, and reports show a beneficial effect of IL‐17A inhibitors on bullous pemphigoid. Here, we report two cases of bullous pemphigoid in remission that experienced severe flares during treatment with two major IL‐17A inhibitors, i.e., ixekizumab or secukinumab for their psoriasis vulgaris. The patient with bullous pemphigoid induced by secukinumab became very recalcitrant to control the relapse. This is by far the first and paradoxical report on the IL‐17A inhibitors having a negative effect on bullous pemphigoid patients in previously stable status. Our reports of these two cases alert clinicians to be careful when using IL‐17A in pemphigoid patients. We also suggest that patients with psoriasis vulgaris should be asked for a detailed history of pemphigoid and its BP180 autoantibodies status be checked before using these biologicals.

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Section: Discussioncontrasting

confidence: 52%

Section: Introductionmentioning

confidence: 83%

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Two cases with bullous pemphigoid relapsed after using interleukin‐17A inhibitors for psoriasis: A paradoxical reaction

Wang

2023

The Journal of Dermatology

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“…Published data on successful biologic therapy of concomitant BP and psoriasis include one case treated with etanercept ( 49 ), one with ustekinumab ( 50 ), two cases with ixekizumab ( 51 , 52 ), and two cases with secukinumab in combination with prednisolone ( 53 , 54 ).…”

Section: Discussionmentioning

confidence: 99%

Case Report: Coexistence of bullous pemphigoid and psoriasis: Therapeutic challenge and IL17A-targeted parallel treatment strategy

2023

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Autoimmune blistering diseases of the skin have all been reported in patients with psoriasis, bullous pemphigoid (BP) being the most frequently observed. The pathophysiologic triggers for BP in psoriatic patients are unclear. Recent observational studies have suggested that chronic psoriatic inflammation may cause pathological changes to the basement membrane zone, thus inducing autoimmunity against BP antigens through cross reactivity and “epitope spreading.” The coexistence of BP and psoriasis poses challenging therapeutic dilemmas related to the incompatibility of their standard treatments. Considering the probable common immunologic mechanisms in the pathogenesis of these inflammatory skin disorders, a suitable treatment regimen should be applied for their parallel control. We report three patients, who developed BP in the course of preceding long-lasting psoriasis. Secukinumab was administered as first-line treatment with promising therapeutic effect for both skin disorders and long-term disease control in two of the cases. In the third case, parallel disease control was initially achieved with methotrexate. A few years later, secukinumab was used for the treatment of a relapse of both dermatoses but worsening of BP was observed and methotrexate was reintroduced. Our experience on the therapeutic potential of secukinumab in BP is supported by the data in the literature. Recently, it was demonstrated that the proinflammatory cytokine IL17A has a functional role in the process of skin inflammation in BP, similarly to psoriasis. IL17A inhibition has emerged as a promising therapeutic strategy in patients with extensive or refractory BP but paradoxical development of BP after secukinumab treatment for psoriasis has also been described. This controversy emphasizes the need for further investigation into the development of optimal treatment strategies and recommendations.

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“…Interestingly, only a subset of BP patients shows up-regulation of IL-17 at the baseline, without correlation with disease severity, suggesting that not all the patients could effectively benefit from therapeutic targeting of the IL-17/IL23 axis (30)(31)(32). Interestingly, targeting IL17/IL23 demonstrated efficacy in patients with coexisting BP and psoriasis, a prototype of IL17/IL23 driven disease (33,(54)(55)(56)(57). Results from ongoing clinical trials are thereby necessary to understand the impact of this treatment approach also in BP patients without coexisting psoriasis (58).…”

Section: Experimental Evidence Therapeuticsmentioning

confidence: 99%

The cytokine milieu of bullous pemphigoid: Current and novel therapeutic targets

et al. 2023

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Bullous pemphigoid (BP) is the most common autoimmune bullous disease, characterized by severe pruritus and skin blistering. The loss of tolerance against Collagen XVII, also referred to as BP180, is the main pathogenic event of BP, leading to production of IgG autoantibodies which mainly target the juxtamembranous extracellular non-collagenous 16th A (NC16A) domain of BP180. A complex inflammatory network is activated upon autoantibody binding to the basement membrane zone; this inflammatory loop involves the complement cascade and the release of several inflammatory cytokines, chemokines and proteases from keratinocytes, lymphocytes, mast cells and granulocytes. Collectively, these events disrupt the integrity of the dermal-epidermal junction, leading to subepidermal blistering. Recent advances have led to identify novel therapeutic targets for BP, whose management is mainly based on the long-term use of topical and systemic corticosteroids. As an example, targeting type-2 T-helper cell-associated cytokines, such as Interleukin-4 and interleukin-13 has shown meaningful clinical efficacy in case series and studies; targeting IL-17 and IL-23 has also been tried, owing to an important role of these cytokines in the chronic maintenance phase of BP. In this review article, we discuss the complex cytokine milieu that characterized BP inflammation, highlighting molecules, which are currently investigated as present and future therapeutic targets for this life-threatening disease.

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Ixekizumab successfully treated refractory psoriasis concurrent bullous pemphigoid

Cited by 8 publications

References 5 publications

Two cases with bullous pemphigoid relapsed after using interleukin‐17A inhibitors for psoriasis: A paradoxical reaction

Two cases with bullous pemphigoid relapsed after using interleukin‐17A inhibitors for psoriasis: A paradoxical reaction

Case Report: Coexistence of bullous pemphigoid and psoriasis: Therapeutic challenge and IL17A-targeted parallel treatment strategy

The cytokine milieu of bullous pemphigoid: Current and novel therapeutic targets

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