The effectiveness of the IL-17A inhibitor in generalized pustular psoriasis: a clinical case

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Abstract

The first clinical case of the effective use of a domestic biological drug inhibitor netakimab ― IL-17A ― in a patient with persistently progressive, torpid to therapy generalized pustular psoriasis Tsumbush is presented. This rare systemic dermatosis refers to severe forms of psoriasis that threaten the patient’s life and require intensive therapy from the very first hours of the manifestation of the disease. The development of pustular psoriasis can be promoted by: long-term therapy with systemic glucocorticosteroids, cytostatics, oral contraceptives, as well as prolonged use of irritating external agents. In some cases, the disease is associated with high emotional stress, stress. In severe generalized pustular psoriasis, biological drugs, cyclosporine, methotrexate, and acitretin are effective.

The article presents summary data on the effectiveness of first- and second-line drugs in the treatment of pustular psoriasis. According to the literature, patients with severe pustular psoriasis, torpid to standard therapy, demonstrate a positive response to treatment with biological drugs in most cases. Anti-TNF-α are the most available biological drugs for the treatment of pustular psoriasis, and anti-IL-12/23 and anti-IL-17A can be considered as the first or second line of therapy for moderate-severe and refractory pustular psoriasis.

The choice of effective therapy for the treatment of pustular psoriasis is an urgent problem of modern dermatology and the presented clinical case demonstrates the effectiveness and pronounced positive therapeutic effect of the IL-17A inhibitor for 1 day in the treatment of generalized pustular psoriasis resistant to previously conducted therapy, which allows us to count on the prospect of further successful use of this targeted drug in the treatment of severe pustular psoriasis.

 

 

 

 

 

About the authors

Olga Yu. Olisova

I.M. Sechenov First Moscow State Medical University (Sechenov University)

Author for correspondence.
Email: Olisovaolga@mail.ru
ORCID iD: 0000-0003-2482-1754
SPIN-code: 2500-7989

MD, Dr. Sci. (Med.), Professor

Russian Federation, Moscow

Elena S. Snarskaya

I.M. Sechenov First Moscow State Medical University (Sechenov University)

Email: snarskaya-dok@mail.ru
ORCID iD: 0000-0002-7968-7663
SPIN-code: 3785-7859

MD, Dr. Sci. (Med.), Professor

Russian Federation, Moscow

Nikolay G. Kochergin

I.M. Sechenov First Moscow State Medical University (Sechenov University)

Email: nkocha@yandex.ru
ORCID iD: 0000-0001-7136-4053
SPIN-code: 1403-3031

MD, Dr. Sci. (Med.), Professor

Russian Federation, Moscow

Natalia P. Teplyuk

I.M. Sechenov First Moscow State Medical University (Sechenov University)

Email: teplyukn@gmail.com
ORCID iD: 0000-0002-5800-4800
SPIN-code: 8013-3256

MD, Dr. Sci. (Med.), Professor

Russian Federation, Moscow

Dmitry V. Ignatyev

I.M. Sechenov First Moscow State Medical University (Sechenov University)

Email: dmitrywork@list.ru
ORCID iD: 0000-0001-8751-3965
SPIN-code: 6743-7960
Russian Federation, Moscow

Alana R. Tavitova

I.M. Sechenov First Moscow State Medical University (Sechenov University)

Email: alatavitova@mail.ru
ORCID iD: 0000-0003-1930-0073
SPIN-code: 2113-9091

Graduate Student

Russian Federation, Moscow

William Makhmudi

I.M. Sechenov First Moscow State Medical University (Sechenov University)

Email: dr.williamm@mail.ru
ORCID iD: 0000-0001-6075-411X
Russian Federation, Moscow

References

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  2. Olisova OY, Khobeish MM, Znamenskaya LF, Bakulev AL. Federal clinical guidelines for the management of patients with psoriasis. Moscow; 2013. 68 р. (In Russ).
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  5. Johnston A, Xing X, Wolterink L, et al. IL-1 and IL-36 are dominant cytokines in generalized pustular psoriasis. J Allergy Clin Immunol. 2017;140(1):109–120. doi: 10.1016/j.jaci.2016.08.056
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  11. Komine M, Morita A. Generalized pustular psoriasis: current management status and unmet medical needs in Japan. Expert Rev Clin Immunol. 2021;17(9):1015–1027. doi: 10.1080/1744666X.2021.1961580

Supplementary files

Supplementary Files
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1. JATS XML
2. Fig. 1. Patient N., 30 years old, diagnosis of generalized pustular psoriasis Tsumbush, condition upon admission: a ― the process is acute inflammatory with lesions of the skin of the trunk and extremities in the form of partial erythroderma; b ― on the skin of the abdomen against the background of erythema, small grouped surface pustules merging with each other with the formation of typical «purulent lakes»; c ― lesions of the skin of the back, rashes in the form of «purulent lakes»; d ― pustular rashes in the form of «purulent lakes» on the lower extremities.

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3. Fig. 2. The same patient. Pathomorphological picture of neutrophil infiltrate in the papillary layer of the dermis, especially pronounced in the epidermis area, parakeratosis, hyperkeratosis, spongiosis, elongation of the dermal papillae, thinning of the granular layer and suprasochular zones of the epidermis.

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4. Fig. 3. The same patient, the condition against the background of complex treatment (after the 3rd injection of Netakimab): a ― paleness of erythema; b ― regression of pustular elements.

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Copyright (c) 2022 Olisova O.Y., Snarskaya E.S., Kochergin N.G., Teplyuk N.P., Ignatyev D.V., Tavitova A.R., Makhmudi W.

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This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
 


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