A Case of Psoriasis Vulgaris Treated with Brodalumab in a Hemodialysis Patient with End-Stage Renal Disease due to Diabetic Nephropathy

Abstract

Psoriasis vulgaris is not frequently seen in patients on hemodialysis. However, these patients have limited treatment for psoriasis due to concerns about complications. We report the case of a psoriatic patient with end-stage renal disease on hemodialysis, safely treated with brodalumab. A 60-year-old man who presented with a 20-year history of recalcitrant severe psoriasis. He had diabetes from 40 years ago, and hemodialysis was initiated due to the progression of renal dysfunction two months ago. He was treated with brodalumab, and skin lesions improved markedly. He began to have a chronic cough four months after starting brodalumab. CT showed diffuse ground-glass shadow and pleural effusion in both lungs. Transbronchial lung biopsy showed no findings suggestive of interstitial pneumonia. In bronchoalveolar lavage fluid, mycobacteria and fungi were not identified. The T-SPOT.TB test was negative. It was considered to be a symptom of overflow due to excessive fluid volume based on insufficient dietary management. Brodalumab was continued, and respiratory symptoms improved with proper weight setting and adequate dietary control. No recurrence of rash has been seen 12 months after the initiation of brodalumab. There were no serious adverse events.

Effectiveness of brodalumab in achieving treatment satisfaction for patients with plaque psoriasis: The ProLOGUE study

“…In Phase III, randomized, placebo-controlled, double-blind, parallel-group comparative studies conducted globally in patients with moderateto-severe plaque psoriasis, brodalumab has shown significant clinical benefit and an acceptable safety profile [4,15]. Although treatment with brodalumab was associated with significant reductions in the Psoriasis Area and Severity Index (PASI) score and body surface area (BSA) vs placebo in randomized controlled trials (RCTs) [4,11,15,16], evidence of its effectiveness in daily clinical practice is limited [17][18][19][20]. Moreover, the effectiveness of brodalumab in improving patient satisfaction in terms of lesion improvement has not been fully elucidated in real-life clinical settings.…”

Successful Treatment with Bimekizumab of a Psoriatic Patient Undergoing Hemodialysis: A Case Report and Review of the Literature

“…Following the exclusion of ongoing infections and organ abnormalities via hematochemical screening, and in consultation with the patient's nephrologist, it was decided to initiate treatment with bimekizumab, a monoclonal antibody targeting IL-17A and IL-17F. This decision was based on the existing literature on other drugs in the same class, which showed positive outcomes and efficacy in treating psoriasis patients with similar comorbidities [16][17][18][19][20]. The treatment plan for bimekizumab involves administering two pre-filled 160 mg pens (320 mg) every four weeks for a total of 16 weeks, followed by a maintenance regimen of 320 mg every eight weeks.…”

Maslinic acid activates renal AMPK/SIRT1 signaling pathway and protects against diabetic nephropathy in mice

“…Therefore, diabetic nephropathy is a component of diabetic systemic microangiopathy [ 4 ]. Diabetic nephropathy has been a leading cause of chronic kidney disease and end-stage renal disease (ESRD) [ 5 ]. At present, approximately 45% of ESRD patients in the United States suffer from diabetic nephropathy [ 6 ].…”