Objectives: We aimed to evaluate the drug retention rate and safety of secukinumab (SEC) in patients with axial spondyloarthritis (AxSpA) and psoriatic arthritis (PsA) in a real clinical setting.Methods: This multicenter retrospective... more
Objectives: We aimed to evaluate the drug retention rate and safety of secukinumab (SEC) in patients with axial spondyloarthritis (AxSpA) and psoriatic arthritis (PsA) in a real clinical setting.Methods: This multicenter retrospective observational study included all AxSpA and PsA patients who received at least one dose of SEC. Adverse events (AE) and the drug retention rate were the main study outcomes. Drug survival was analyzed by Kaplan-Meier curves while predictive factors of discontinuation were evaluated using a Cox regression analysis. The weight of these associations was estimated by hazard ratio (HR) values.Results: We included 154 patients (59 PsA and 95 AxSpA). Mean disease duration was 6.5 years (IQR 2-8). Sixty-one percent of patients were treated with two or more biologics prior to SEC. The 1 and 2-year retention rates for SEC were 66 and 43%, respectively. The main causes of discontinuation were inefficacy (59%) and AE (36%). The factors associated with lower risk of...
Generalized pustular psoriasis, the most severe form of psoriasis, is a rare variant characterized by widespread sterile pustule associated with systemic inflammation. The disease lacks of specific treatment, drugs approved for plaque... more
Generalized pustular psoriasis, the most severe form of psoriasis, is a rare variant characterized by widespread sterile pustule associated with systemic inflammation. The disease lacks of specific treatment, drugs approved for plaque psoriasis are used in the clinical practice, with variable results. We present the case of a 41-year old woman affected by a severe form of generalized pustular psoriasis, resistant to several therapies included Tumor Necrosis Factor Antagonist; in our patient we decide to use acitretin plus Secukinumab, an IL-17 inhibitor. The association was effective, achieving the complete resolution of pustulation at month-2; the result was maintained for over 14 months of follow up. No adverse events related to therapy were observed. Generalized pustular psoriasis is related to IL-36RN mutations, which lead to upregulation in IL-36 signaling; IL-36 itself could promote IL-17 pathways. Our case demonstrates that targeting IL-17 eventually associated with systemic retinoids could be a valid therapeutic option for these patients.
