The unforeseen during biotechnological therapy for moderate‐to‐severe psoriasis: How to manage pregnancy and breastfeeding, infections from Mycobacterium tuberculosis , hepatitis B virus, hepatitis C virus, and HIV , surgery, vaccinations, diagnosis of malignancy, and dose tapering

Abstract

The use of biotechnological therapies for moderate‐to‐severe psoriasis is ever‐expanding and it is becoming increasingly more frequent to encounter different unforeseen events during their use, such as fertile patients becoming pregnant and breastfeeding, development of infections due to personal habits like tuberculosis, hepatitis B virus, hepatitis C virus, or HIV, scheduling of surgical procedures, need of vaccinations, development of malignancy, and evaluation of dose tapering. As any clinician may experience at least one of these unexpected events, it should be good practice to know how to manage them. Thus, a practical analysis has been proposed in this study.

Retrospective study of psoriasis in people living with HIV: Thailand’s experience

“…Although phototherapy is a recommended and safe treatment option for psoriasis in PLHIV, 16,32 the PLHIV group in our study had a statistically lower rate of phototherapy treatment. As most Thai PLHIV are of working age and have low incomes, 33 leaving work to attend regular intensive phototherapy sessions is problematic.…”

“…As most Thai PLHIV are of working age and have low incomes, 33 leaving work to attend regular intensive phototherapy sessions is problematic. Moreover, none of the PLHIV with psoriasis in the current study received biologics despite there being increasing evidence of their safety profiles for PLHIV 16,32 . This might be because Thailand’s national health system only covers the costs of oral systemic drugs and phototherapy.…”

“…Moreover, none of the PLHIV with psoriasis in the current study received biologics despite there being increasing evidence of their safety profiles for PLHIV. 16,32 This might be because Thailand's national health system only covers the costs of oral systemic drugs and phototherapy. In Thailand, biologics (infliximab, etanercept, and secukinumab) can only be provided free of charge for public sector employees who have a moderate-tohigh psoriasis severity (BSA > 15) and have had an inadequate or failed response to systemic drugs and phototherapy.…”

Successful treatment with secukinumab in an HIV ‐positive psoriatic patient after failure of apremilast

“…should not be started during an active infection because they may potentially give rise to a multitude of infections, so should be contraindicated for HIV patients even if some authors suggested safety modalities for their use. 3,4 Nevertheless, single case reports have shown that treatment with other biologics (such as anti-IL17) or oral small molecules (i.e., apremilast) may be successful and safe in HIVpatients affected by moderate-severe psoriasis. [5][6][7][8][9] Here we describe our clinical experience with an anti-IL17A monoclonal antibody, secukinumab, in an HIV positive psoriatic man who failed an initial treatment with apremilast.…”

Brodalumab: another helpful option for HIV ‐positive psoriatic patients?

“…However, a substantial body of clinical experiences has shown that TNF-alpha inhibitors and ustekinumab may be safely administered in such special patient population. [1][2][3][4] Recently, a HIV-positive patient treated with the fully human monoclonal antibody anti-IL-17A secukinumab, was reported. 5 Here, we describe a first clinical experience with the IL-17 receptor brodalumab in a HIV-positive psoriatic patient.…”