Guselkumab as a treatment option for recalcitrant pyoderma gangrenosum

Baier, Cassandra; Barak, Orr

doi:10.1016/j.jdcr.2020.12.005

Cited by 22 publications

(14 citation statements)

References 5 publications

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“…This is the first case report of tildrakizumab treatment achieving a positive response in recalcitrant ulcerative leg PG, notably the most common PG subtype at its most common anatomical site. 1 Our findings are consistent with recent case reports of other IL-23p19 inhibitors [19][20][21][22] and suggest that incorporating IL-23 inhibitors such as tildrakizumab as part of the systemic treatment ladder for PG could be beneficial. More studies are needed to confirm our observations.…”

Section: Discussionsupporting

confidence: 88%

“…6,7 Significant improvement was observed in 2 patients, a 59-year-old woman with refractory leg PG and a 43-year-old woman with peristomal PG, following treatment with the IL-23p19 inhibitor 19,20 Two other cases of ulcerative PG of the leg successfully resolved within 4 months of treatment with guselkumab, another IL-23p19 inhibitor. 21,22 A single case of successful treatment of penile PG with tildrakizumab was previously described, while Murrell and Sheriff (2021) reported a case of recalcitrant PG responsive to tildrakizumab and ustekinumab combination therapy. 23 However, this is the first report of positive response to tildrakizumab monotherapy in recalcitrant ulcerative leg PG.…”

Section: Discussionmentioning

confidence: 99%

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Recalcitrant Ulcerative Pyoderma Gangrenosum of the Leg Responsive to Tildrakizumab: A Case Report

Leow¹,

Zubrzycki²

2022

CCID

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Elevated levels of inflammatory mediators-including the interleukin IL-23-are implicated in the pathogenesis of pyoderma gangrenosum (PG), an autoinflammatory neutrophilic dermatosis characterized by rapidly enlarging, suppurative ulcers and cribriform scarring. Here, we present the first case report of significant response of isolated ulcerative PG with tildrakizumab, a biologic agent directed against the p19 subunit of IL-23, in an elderly woman with extensive treatment-refractory PG on her left leg. Tildrakizumab (100 mg subcutaneously at weeks 0 and 4, then every 8 weeks, and eventually increased in frequency to every 6 weeks), combined with acetic acid soaks each morning and chemical debridement every evening with 3% hydrogen peroxide, resulted in progressive decrease in ulcer size and depth, re-epithelialization, and recovery of sensory perception. This report describes the dramatic clinical response of ulcerative PG on the leg with tildrakizumab.

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Section: Discussionsupporting

confidence: 88%

Section: Discussionmentioning

confidence: 99%

Recalcitrant Ulcerative Pyoderma Gangrenosum of the Leg Responsive to Tildrakizumab: A Case Report

Leow¹,

Zubrzycki²

2022

CCID

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“…IL‐23 inhibition through guselkumab (100 mg monthly), and IL‐12/IL‐23p40 inhibition through ustekinumab (45 mg, at week 0 and 4) has been demonstrated to produce complete or near‐complete healing of PG ulcers within approximately 3 months, although these were both examined in only one patient each 39,40 . Risankizumab, an IL‐23p19 antagonist, has been shown to induce significant ulcer healing within a patient who had large ulcerative PG of the leg and received four doses of this agent (150 mg at week 0, 4, 16 and 28) 41 .…”

Section: Discussionmentioning

confidence: 99%

“…were both examined in only one patient each. 39,40 Risankizumab, an IL-23p19 antagonist, has been shown to induce significant ulcer healing within a patient who had large ulcerative PG of the leg and received four doses of this agent (150 mg at week 0, 4, 16 and 28). 41 It also has demonstrated a moderate improvement of surrounding erythema and size of a peristomal PG in another patient who received a single dose of risankizumab (150 mg).…”

Section: Gene Expression Studies Confirm the Involvement Of Multiple ...mentioning

confidence: 99%

Pyoderma gangrenosum: A systematic review of the molecular characteristics of disease

Flora

Kozera

Frew

2022

Experimental Dermatology

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Pyoderma gangrenosum is a painful recurrent ulcerative neutrophilic dermatosis in which the pathogenesis is incompletely defined. Current evidence suggests that PG is associated with dysregulation of components of both the innate and adaptive immune system with dysregulation of neutrophil function and contribution of the Th17 immune axis. PG can be present in numerous heterogeneous clinical presentations and be associated with multiple inflammatory conditions including rheumatoid arthritis, inflammatory bowel disease and hidradenitis suppurativa. However, no critical evaluation of the observed molecular characteristics in PG studies in association with their clinical findings has been assessed. Additionally, emerging evidence suggests a potential role for other cell types and immune pathways including B cells, macrophages, autoantibodies and the complement system in PG, although these have not yet been integrated into the pathogenesis of disease. This systematic review aims to critically evaluate the current molecular observations regarding the pathogenesis of PG and discuss associations with clinical characteristics as well as the evidence supporting novel cell types and immune pathways in PG.

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“…Its utility in PG was highlighted in a recent report of a previously recalcitrant PG ulcer that healed after 3 months of treatment with guselkumab. 8 However, this patient received guselkumab at 100 mg subcutaneously monthly for 3 months and was transitioned from ustekinumab.…”

Section: Discussionmentioning

confidence: 99%