Secukinumab for patients with plaque psoriasis affected by multiple sclerosis: a mini‐review with a representative case report

Abstract

remain high on the differential diagnosis. 2,8 Notably, peristomal skin complications are reported as high as 67%, and almost all patients with an ostomy experience some degree of irritant dermatitis. 2,9 Applying proper wound care principles to address devitalized tissue, infection and moisture imbalance are vital in the treatment of these other conditions. 10 We believe our patients' symptoms initially developed as an irritant dermatitis but were further exacerbated by poor wound healing and chronic irritation. If the clinical suspicion for PPG is low, we encourage an initial trial of aggressive wound care. After initiating proper wound care, clinical improvement without the use of immunosuppressants should raise suspicion for other common aetiologies of peristomal ulceration.

Practical recommendations for systemic treatment in psoriasis in case of coexisting inflammatory, neurologic, infectious or malignant disorders (BETA‐PSO: Belgian Evidence‐based Treatment Advice in Psoriasis; part 2)

“…There is limited data supporting IL17 inhibitors: ixekizumab and secukinumab; there is some evidence to suggest that secukinumab may reduce MRI lesion activity in these patients 26 . Acitretin may also be used as systemic treatment for psoriasis patients with MS or Guillain–Barré Syndrome 27,28 . It is also our opinion that methotrexate is effective in the treatment of psoriasis patients with MS, but it is off‐label in this indication 29,30 …”

“…26 Acitretin may also be used as systemic treatment for psoriasis patients with MS or Guillain-Barr e Syndrome. 27,28 It is also our opinion that methotrexate is effective in the treatment of psoriasis patients with MS, but it is off-label in this indication. 29,30 We advise colleagues not to use the anti-TNFa drug class, due to development of MS or worsening of pre-existing disease.…”

Treatment approaches to patients with multiple sclerosis and coexisting autoimmune disorders

“…Moreover, there are several case reports that describe a successful treatment of comorbid PsO/MS with secukinumab. 90 – 94 All patients described had a relapsing–remitting disease course and remained clinically and radiologically stable during their respective follow-up periods. Thus, more advanced monoclonal IL-17 antibodies with improved pharmacodynamics, such as brodalumab (anti-17A) or ixekizumab (anti-17A) may also be considered for application in MS.…”

Combination treatment with secukinumab and dimethyl fumarate in a patient with psoriasis and recent diagnosis of multiple sclerosis

“…5,6 Experimental data To date, few date are available regarding the use of secukinumab in patients with psoriasis or ankylosing spondylitis and coexisting CNS demyelinating diseases (Table 1). [9][10][11][12][13][14][15] The clinical efficacy of anti-IL-17 has been reported in three patients with ankylosing spondylitis and concomitant demyelinating diseases (two multiple sclerosis and one multiple sclerosis-like syndrome) and in three with psoriasis and psoriatic arthritis and concurrent multiple sclerosis. 9,[12][13][14][15] Moreover, another patient showed an improvement of psoriasis activity on secukinumab therapy, but she experienced a severe neurological relapse.…”

“…[9][10][11][12][13][14][15] The clinical efficacy of anti-IL-17 has been reported in three patients with ankylosing spondylitis and concomitant demyelinating diseases (two multiple sclerosis and one multiple sclerosis-like syndrome) and in three with psoriasis and psoriatic arthritis and concurrent multiple sclerosis. 9,[12][13][14][15] Moreover, another patient showed an improvement of psoriasis activity on secukinumab therapy, but she experienced a severe neurological relapse. 10 In this case, the Authors postulated that either IL-17 does not play a key role in the pathophysiology of multiple sclerosis or that secukinumab may not be sufficiently concentrated in the CNS.…”