Treatment Response of Patients with Erythrodermic Psoriasis after Switching to Guselkumab

Abstract

Introduction Erythrodermic psoriasis (EP) is a rare variant of psoriasis. Due to its rarity, evidence supporting its treatment is limited. Patients with erythrodermic psoriasis often respond less favorably to conventional treatment and have lower biologic drug survival compared with patients with plaque-type psoriasis. Guselkumab is an anti-interleukin-23 (IL-23) monoclonal antibody and has shown excellent and sustained treatment effect in moderate-to-severe plaque-type psoriasis. Until now, there is only one phase III open-label study reporting the effectiveness of guselkumab in this patient group. Methods Patients with chronic erythrodermic psoriasis who had been commenced on guselkumab were included in this retrospective study. All except one of our patients had plaque-type psoriasis prior to EP, and they met the criteria for EP before use of guselkumab. Due to inadequate response to previous treatment, including biologics, they were switched to guselkumab treatment. There was no washout period. They received guselkumab 100 mg at weeks 0 and 4, then every 8 weeks until at least week 28. Data were collected for patient demographics, Patient Area and Severity Index (PASI), and previous treatments. Results A total of 13 patients (12 male, 1 female) were included. The mean PASI improvement at weeks 4, 12, 20, and 28 was 37.5%, 60.9%, 67.5%, and 64.7%, respectively. The percentage of PASI 75 responders at weeks 4, 12, 20, and 28 was 15.4%, 38.5%, 53.9%, and 46.2%, respectively. At week 12, eight patients (61.5%) could achieve PASI 50 response. These PASI 50 responders at week 12 showed sustained and improved effectiveness during follow-up. Conclusion Guselkumab is an effective biologic for treatment of moderate-to-severe plaque-type psoriasis, but the efficacy and drug survival are still compromised in EP patients. Our data describe the real-world experience of guselkumab treatment in this rare group of patients. Despite previous failure of other biologics, PASI response at week 12 is a good predictor of patient response and drug survival of guselkumab.

Anti-IL23 biologic therapies in the treatment of psoriasis: real-world experience versus clinical trials data

“…Others are reported in Table 1 . Moreover, RWE has widened the possibility of treating even severe forms (e.g., erythrodermic psoriasis) with guselkumab [ 38 , 40 ]. Chiang et al published a study on 13 erythrodermic psoriasis patients treated successfully and safely with guselkumab [ 38 ]: at week 28, a mean PASI improvement of 67.5% was experienced along with no common AEs reported at week 36 [ 38 ].…”

Phenotypes of Psoriasis in Patients in Need of Systemic Treatment, and Correlation with Personal Habits, Treatment History and Comorbidities: A Cross-sectional Latent Class Analysis of Data from the Italian PsoReal Registry

“…The severity and extent of disease in this class, as well as the high rate of severe pruritus, the higher number of comorbidities and the longer disease duration could explain the reported higher number of previous systemic treatments, especially biologics, in this class compared with the others. Furthermore, a treatment resistant course and a smaller drug survival of biologics could be hypothesized, as already described by others (8). The high rate of comorbidities in erythrodermic PsO is well known (9).…”

Updates on the Treatment of Erythrodermic Psoriasis

“…Megna et al reported one patient achieved PASI 100 after 20 weeks of therapy, and the effect remained until week 48. 88 Chiang et al reported 13 patients with follow-up for 28 weeks, 89 in which 8 (61.5%) patients achieved PASI 50 response at week 12, and sustained effects were observed for these PASI 50 responders. The treatment efficacy at week 12 could be seen as one predictor for patient response for guselkumab.…”

“…The treatment efficacy at week 12 could be seen as one predictor for patient response for guselkumab. 89 The most common adverse event was nasopharyngitis.…”