Peristomal Pyoderma Gangrenosum Responding to Risankizumab

Abstract

Evidence to support available therapies for pyoderma gangrenosum (PG) is limited. Many patients do not respond to topical therapies such as tacrolimus or topical steroids. Currently favored oral systemic treatments (eg, cyclosporine and steroids) achieve complete remission in only 50% of patients and have unfavorable adverse effect profiles. There is a growing body of evidence to support biologic agents for the treatment of PG, but their exact role remains unclear. Here the authors present a patient with peristomal PG, the first reported case of PG responding to treatment with risankizumab, an anti-interleukin 23 monoclonal antibody. Risankizumab may represent an effective and relatively safe treatment for PG that merits additional exploration in prospective, controlled studies.

Recalcitrant Ulcerative Pyoderma Gangrenosum of the Leg Responsive to Tildrakizumab: A Case Report

“…This is the first case report of tildrakizumab treatment achieving a positive response in recalcitrant ulcerative leg PG, notably the most common PG subtype at its most common anatomical site. 1 Our findings are consistent with recent case reports of other IL-23p19 inhibitors [19][20][21][22] and suggest that incorporating IL-23 inhibitors such as tildrakizumab as part of the systemic treatment ladder for PG could be beneficial. More studies are needed to confirm our observations.…”

“… 6 , 7 Significant improvement was observed in 2 patients, a 59-year-old woman with refractory leg PG and a 43-year-old woman with peristomal PG, following treatment with the IL-23p19 inhibitor risankizumab. 19 , 20 Two other cases of ulcerative PG of the leg successfully resolved within 4 months of treatment with guselkumab, another IL-23p19 inhibitor. 21 , 22 A single case of successful treatment of penile PG with tildrakizumab was previously described, while Murrell and Sheriff (2021) reported a case of recalcitrant PG responsive to tildrakizumab and ustekinumab combination therapy.…”

Pyoderma gangrenosum: A systematic review of the molecular characteristics of disease

“…Risankizumab, an IL‐23p19 antagonist, has been shown to induce significant ulcer healing within a patient who had large ulcerative PG of the leg and received four doses of this agent (150 mg at week 0, 4, 16 and 28) 41 . It also has demonstrated a moderate improvement of surrounding erythema and size of a peristomal PG in another patient who received a single dose of risankizumab (150 mg) 42 …”

“…41 It also has demonstrated a moderate improvement of surrounding erythema and size of a peristomal PG in another patient who received a single dose of risankizumab (150 mg). 42 IL-17R inhibition through brodalumab (210 mg/1.5 ml either weekly or second weekly) has also demonstrated rapid resolution of PG ulcers in two patients, with complete healing achieved in 3 months by one patient, and 6 months in the other. 43 The rapid and sustained resolution of PG in these six cases strongly suggests that the Th17 axis plays a central role in the pathophysiology of PG, and that biological agents blocking the Th17 axis represents a suitable therapeutic option.…”

Modified dose of guselkumab for treatment of pyoderma gangrenosum

“…5 Additionally, treatment with risankizumab resulted in significant clinical improvement in the recent reports of 2 patients with refractory PG ulcers. 6 , 7 …”