Challenges in the treatment of psoriasis with biologics: vaccination, history of malignancy, human immunodeficiency virus (HIV) infection, and pediatric psoriasis

Plachouri, Kerasia‐Maria; Georgiou, Sophia

doi:10.1111/ijd.14436

Cited by 17 publications

(17 citation statements)

References 42 publications

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“…However, data are limited regarding the efficacy and safety of biologic agents in treating HIV-positive psoriasis patients as these individuals are often excluded from clinical trials. 5…”

Section: Introductionmentioning

confidence: 99%

Biologic Treatment of 4 HIV-Positive Patients: A Case Series and Literature Review

Myers

Thibodeaux

Reddy

et al. 2020

Journal of Psoriasis and Psoriatic Arthritis

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Background: The management of psoriatic disease in HIV-positive patients is challenging. Psoriasis in HIV-positive patients is often severe, progressive, and resistant to first- and second-line therapies, including topical treatments, phototherapy, highly active antiretroviral therapy (HAART), and oral retinoids. Other systemic agents used to treat psoriasis, such as methotrexate and cyclosporine, are immunosuppressants and thus many dermatologists may not feel comfortable prescribing them to HIV-positive patients who are already immunocompromised. Biologic agents, which target specific aspects of overactive immune pathways in psoriasis, have revolutionized the management of moderate-to-severe psoriasis. However, data are limited regarding their safety and efficacy in HIV-positive patients. Objective: Report 4 cases of HIV-positive patients managed on biologic therapy and summarize the cases of psoriasis in HIV-positive patients managed on biologic therapy that have been published in dermatologic literature to date. Methods: We searched PubMed and Embase databases using the terms HIV and psoriasis or HIV and psoriatic arthritis combined with one of the 11 biologics currently approved for treating psoriasis. Results: We identified 48 cases of anti-psoriasis biologic therapy (including adalimumab, infliximab, etanercept, ustekinumab, and guselkumab) in HIV-positive patients and added 4. While data are limited, the evidence available suggests biologic agents are safe and efficacious in moderate-to-severe psoriasis and may even have a favorable effect on CD4 and HIV viral counts when used with concomitant HAART. Conclusion: Further research would be helpful to establish practical guidelines for the use of anti-psoriasis biologic therapy in the HIV population, including that of newer agents.

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“…However, data are limited regarding the efficacy and safety of biologic agents in treating HIV-positive psoriasis patients as these individuals are often excluded from clinical trials. 5…”

Section: Introductionmentioning

confidence: 99%

Biologic Treatment of 4 HIV-Positive Patients: A Case Series and Literature Review

Myers

Thibodeaux

Reddy

et al. 2020

Journal of Psoriasis and Psoriatic Arthritis

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“…29 However, it has not shown a significant increase in the risk of malignancy with the use of TNF agents in trials. 30 As far as IL inhibitors are concerned, so far no clear associations with malignancies have been documented. 30 Therefore, it is difficult to determine the exact association between cancer and biological therapy in patients with psoriasis.…”

Section: Discussionmentioning

confidence: 99%

“…30 As far as IL inhibitors are concerned, so far no clear associations with malignancies have been documented. 30 Therefore, it is difficult to determine the exact association between cancer and biological therapy in patients with psoriasis. We need more time and receiving infliximab.…”

Section: Discussionmentioning

confidence: 99%

“…The current recommendations are based on case reports and few studies because of the fact that patients with a history of malignancy are usually excluded from clinical trials 29 . However, it has not shown a significant increase in the risk of malignancy with the use of TNF agents in trials 30 . As far as IL inhibitors are concerned, so far no clear associations with malignancies have been documented 30 .…”

Section: Discussionmentioning

confidence: 99%

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Retrospective analysis of patients with psoriasis receiving biological therapy: Real‐life data

Özçelik

Kılıç

Başara

2020

Dermatologic Therapy

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The aim of this study is to investigate the demographic and clinical characteristics of patients receiving biological therapy for psoriasis. All patients who received biological treatment for psoriasis were included in the study. Characteristics of patients and PASI responses' rates were evaluated at 6, 12, 16, 24, 36, and 52 weeks. One hundred and three patients enrolled. Of all, 28 patients were using adalimumab (27.2%), 26 were using secukinumab (25.2%), 22 were using infliximab (21.4%), 22 were using ustekinumab (21.4%), 5 were using ixekizumab (4.9%). PASI75 response rates at sixth and 52nd weeks; were 68.1% and 95% for infliximab, 64.3% and 100% for adalimumab, 77.3% and 100% for ustekinumab, 76.9% and 81.3% for secukinumab, respectively. The most common reason for biologic switching was secondary failure. Treatment failure was the main reason of switching therapies. In our study, no statistically significant difference was found between efficacies of biological drugs. It remains unclear in what order and how exactly biological agent switching should be done. There is a need for large-scale studies on the treatment response rates, and survival times of different biologics.

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“…Patients with psoriasis and/or receiving treatment for psoriasis have an increased risk of cancer. At the same time, use of immunosuppressants in patients with moderate to severe psoriasis and previous cancer raises concern about the safety of these therapies 1 …”

Section: Patient Number Sex Type Of Malignancy Previous Psoriasis Trementioning

confidence: 99%

Apremilast in patients with history of malignancy: a real‐life, single‐center experience

2020

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evidence on the effectiveness of macrolides for treatment of Haemophilus ducreyi infection in sexually active adults is low. Furthermore, there is a lack of data on the success rate of macrolides in cases coinfected with chancroid and HIV. 10 Until molecular techniques are freely available and a true elimination of Haemophilus ducreyi is proven, one needs to be cautious in cases with GUDs. Chancroid should always be considered as a differential diagnosis in GUD with suggestive clinical features. In the absence of diagnostic tests, empirical treatment may prevent the infection from lurking around.

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Challenges in the treatment of psoriasis with biologics: vaccination, history of malignancy, human immunodeficiency virus (HIV) infection, and pediatric psoriasis

Cited by 17 publications

References 42 publications

Biologic Treatment of 4 HIV-Positive Patients: A Case Series and Literature Review

Biologic Treatment of 4 HIV-Positive Patients: A Case Series and Literature Review

Retrospective analysis of patients with psoriasis receiving biological therapy: Real‐life data

Apremilast in patients with history of malignancy: a real‐life, single‐center experience

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