A case series of early biologic therapy in guttate psoriasis: Targeting resident memory T cell activity as a potential novel therapeutic modality

Rapid Remission of Sunburn-Induced Guttate Psoriasis with Guselkumab

“…Finally, one case series study performed by Flora and Frew et al . in 2022 reported treatment and remission of acute-onset guttate psoriasis with risankizumab, an IL-23 inhibitor [ 12 ]. In this case series, four patients aged 21, 24, 37, and 42 years had initial PASI scores of 12, 10.2, 8.8, and 11.4, respectively [ 12 ].…”

“…in 2022 reported treatment and remission of acute-onset guttate psoriasis with risankizumab, an IL-23 inhibitor [ 12 ]. In this case series, four patients aged 21, 24, 37, and 42 years had initial PASI scores of 12, 10.2, 8.8, and 11.4, respectively [ 12 ]. All four patients achieved complete clearance of psoriasis (PASI-100) from between 4 weeks and 12 weeks.…”

“…All four patients achieved complete clearance of psoriasis (PASI-100) from between 4 weeks and 12 weeks. In addition, all four patients maintained PASI-100 after follow up ranging from 12 months to 24 months [ 12 ]. These data suggest promising evidence that IL-23 inhibitors such as ustekinumab, guselkumab, and risankizumab may be used in the future for treatment of guttate psoriasis, though clinical trials with larger patient cohorts and a control group are needed to improve the power and significance of these studies.…”

Rapid resolution of guttate psoriasis without recurrence for one year following two doses of guselkumab

“…They were followed up for 24 months with no disease recurrence, raising the possibility of a new therapeutic approach for inducing long-term remission in GP patients. 5 While the mechanisms underlying the sustained efficacy of IL-23 inhibitors in GP are not fully understood, these medications may suppress pathogenic Th17 cells and prevent the development and persistence of T RM . Future studies require a placebo-controlled cohort and evaluation of T RM cells in skin biopsies to determine the therapeutic potential of early IL-23 antagonism treatment followed by withdrawal in patients with GP.…”

“…All patients experienced rapid and sustained clearance after three doses of risankizumab followed by therapy withdrawal. They were followed up for 24 months with no disease recurrence, raising the possibility of a new therapeutic approach for inducing long‐term remission in GP patients 5 . While the mechanisms underlying the sustained efficacy of IL‐23 inhibitors in GP are not fully understood, these medications may suppress pathogenic Th17 cells and prevent the development and persistence of T RM .…”