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Treatment of erythrodermic psoriasis with biologics: A systematic review - 19/06/20

Doi : 10.1016/j.jaad.2020.03.073 
Osward Y. Carrasquillo, MD, MPH a, , Gabriela Pabón-Cartagena, MD b, Leyre A. Falto-Aizpurua, MD a, Marely Santiago-Vázquez, MD a, Karina J. Cancel-Artau, BS c, Gabriel Arias-Berrios, MD a, Rafael F. Martín-García, MD a
a Department of Dermatology, University of Puerto Rico School of Medicine, San Juan, Puerto Rico 
b Transitional Year Program, University of Puerto Rico School of Medicine, San Juan, Puerto Rico 
c University of Puerto Rico School of Medicine, San Juan, Puerto Rico 

Correspondence to: Osward Y. Carrasquillo, MD, MPH, University of Puerto Rico School of Medicine, Department of Dermatology, PO Box 365067, San Juan, PR 00936-5067.University of Puerto Rico School of MedicineDepartment of DermatologyPO Box 365067San JuanPR00936-5067

Abstract

Background

Biologic medications for plaque psoriasis have been used to treat erythrodermic psoriasis (EP). Since the guidelines for management of EP were published, new biologic medications have been approved for the treatment of plaque psoriasis.

Objective

To analyze the evidence of biologic medications in the treatment of EP based on response and tolerability.

Methods

A comprehensive search was conducted with the PubMed, Cochrane Library, Embase, and Scopus databases through December 31, 2018. Studies reporting 1 or more cases of EP, defined as >75% body surface area involvement, in patients aged ≥18 years treated with biologics were included. Baseline Psoriasis Area and Severity Index score, score improvement, and adverse events were documented. Adequate response to treatment was defined as Psoriasis Area and Severity Index ≥50.

Results

Included were 43 articles, yielding a total of 179 patients. Most patients responded at some point during treatment, with a higher level of evidence for infliximab, ustekinumab, ixekizumab, and guselkumab. Infection was the most common adverse event (n = 35).

Limitations

Data are limited to case reports, case series, and uncontrolled studies.

Conclusion

Patients with EP treated with biologics demonstrated positive responses and treatment was well-tolerated, with a weak recommendation and limited quality of evidence in favor of infliximab, ustekinumab, ixekizumab, and guselkumab.

Le texte complet de cet article est disponible en PDF.

Key words : adalimumab, biologics, erythrodermic psoriasis, etanercept, golimumab, guselkumab, infliximab, ixekizumab, psoriasis, secukinumab, ustekinumab

Abbreviations used : AE, EP, PASI


Plan


 Funding sources: None.
 Conflicts of interest: None disclosed.
 IRB approval status: Not necessary for this systematic review due to all the data being taken from public, anonymous literature.
 Reprints are not available from the authors.


© 2020  American Academy of Dermatology, Inc.. Publié par Elsevier Masson SAS. Tous droits réservés.
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Vol 83 - N° 1

P. 151-158 - juillet 2020 Retour au numéro
Article précédent Article précédent
  • Long-term safety of nine systemic medications for psoriasis: A cohort study using the Spanish Registry of Adverse Events for Biological Therapy in Dermatological Diseases (BIOBADADERM) Registry
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