Upadacitinib for the treatment of concomitant psoriasis and atopic dermatitis: a case series

Purpose: The overlap of psoriasis and atopic dermatitis (AD) is rare and treating moderate-to-severe cases can be challenging. Conventional immune-suppressive drugs cannot be used long-term, and no biological drugs are currently approved for treating both conditions.Method: We report the cases of four patients with overlapping features of both psoriasis and AD.Result: After being treated with several systemic drugs, including gold-standard treatments for both psoriasis and AD, they received upadacitinib 15 or 30 mg, achieving complete remission. Upadacitinib is an inhibitor of Janus Kinase 1, currently approved for treating moderate-to-severe AD.Conclusion: To date, very limited data are available regarding the efficacy of upadacitinib in psoriasis. In a phase-3 trial on the efficacy of upadacitinib 15 mg in patients affected by psoriatic arthritis, 52.3% of patients achieved a 75% improvement in Psoriasis Area and Severity Index (PASI75) after one year. Currently, no clinical trials are evaluating the efficacy of upadacitinib in plaque psoriasis.

The impact of biologic therapy for moderate-to-severe psoriasis on the immune responses to SARS-CoV-2 infection and vaccination

Biologic therapy for moderate-to-severe psoriasis with anti-IL-23 and anti-IL-17 does not reduce the humoral and T-cell-mediated immune responses after COVID infection or vaccination; on the contrary, anti-IL-23 treatment was associated with a higher level of specific IgG following vaccination. In contrast, conventional therapies and TNF-α blockade reduce the production of specific antibodies.

New-onset and flares of psoriasis after COVID-19 infection or vaccination successfully treated with biologics: a case series

Since the worldwide spreading COVID-19 pandemic from early 2020 onwards, several cutaneous manifestations of SARS-CoV2 infection have been described. Similarly, with the start of the global vaccination campaign, reports of new onset or exacerbation of inflammatory dermatoses have been reported. In particular, numerous case reports of psoriasis flares after COVID-19 infection and/or vaccination have recently been published.Our study aimed to evaluate the effectiveness and safety of anti-interleukin (IL) biologic drugs for the treatment of severe flares of psoriasis following COVID-19 infection or vaccination.Twenty-eight patients with a diagnosis of moderate-to-severe psoriasis following COVID-19 infection or vaccination or patients with a severe flare of previously untreated mild plaque psoriasis, all treated with biologics, were enrolled in this study.After 16 weeks of treatment, the mean Psoriasis Area and Severity Index decreased from 13.65 to 0.77, with 16 patients (57.14%) achieving complete skin clearance.In our study, we underline a high-effectiveness profile of different biological drugs in treating psoriasis flares induced by COVID-19 vaccination and/or infection. Our data support the role of biologics in preventing severe flares of psoriasis despite possible concomitant inflammatory triggers, such as infections or vaccines.

Real-Life Effectiveness and Safety of Upadacitinib in Adults and Adolescents with Moderate-to-Severe Atopic Dermatitis: A Single-Center 16-Week Study

INTRODUCTION

The treatment of severe atopic dermatitis (AD) includes cyclosporine and recently approved biologics and small molecules. Among these, upadacitinib is a selective inhibitor of Janus kinase 1, approved for the treatment of severe AD in adolescents/adults. Upadacitinib has shown efficacy and safety in several phase 3 clinical trials, but data on real-life patients are still lacking.

METHODS

We conducted a retrospective real-life observational study to evaluate the effectiveness and safety of upadacitinib up to week 16 in a cohort of both bio-naïve and bio-experienced patients. This study was carried out by analyzing the AD database records of an Italian referral hospital. Thirty-eight patients were included in this study, and 35 completed 16 weeks of treatment.

RESULTS

At week 16, out of 35 patients, the percentages of Eczema Area and Severity Index (EASI) 50, EASI 75, EASI 90 and EASI 100 responses were 94.29, 91.43, 74.29, and 60%, respectively. A decrease of at least 4 points from baseline of itch-NRS was reported by 94.74 and 91.43% of patients at weeks 8 and 16. Regarding the safety of upadacitinib, 26.32% of patients experienced at least one adverse event (AE), and a total of 13 AEs were recorded, including blood test abnormalities and papulopustular acne. None of our patients interrupted the drug because of an AE.

CONCLUSIONS

We observed higher rates of EASI75/EASI90/EASI100 responses at week 16, compared with data from clinical trials. The safety profile of upadacitinib was favorable, as no AEs leading to discontinuation were experienced by our patients up to week 16.

Real-Life Effectiveness and Safety of Risankizumab in 131 Patients Affected by Moderate-to-Severe Plaque Psoriasis: A 52-Week Retrospective Study

Introduction

Risankizumab is a humanized monoclonal antibody that selectively targets interleukin-23. It is approved for treatment of moderate-to-severe plaque psoriasis. We conducted a 52-week monocentric retrospective study to evaluate the effectiveness and safety of risankizumab in a real-life setting.

Methods

Our study included 131 adults with moderate-to-severe plaque psoriasis all treated with risankizumab for at least 52 weeks. Patient characteristics and PASI (Psoriasis Area and Severity Index) at each visit were recorded. The percentages of patients achieving 75%/90%/100% (PASI 75/90/100) improvement in PASI with respect to baseline were registered.

Results

At week 52, 93.9%, 78.6%, and 61.1% of patients achieved PASI 75/90/100, respectively. An absolute PASI ≤ 2 was reached by 90.8% at week 52. The higher body mass index and the presence of cardio-metabolic comorbidities did not interfere with the odds of reaching PASI 75/90/100 at each time-point. At week 52, comparable percentages of patients achieved PASI 100, regardless of the involvement of difficult-to-treat-areas. No significant safety findings were recorded and none of the patients had to interrupt the treatment because of adverse events.

Conclusions

Our findings confirmed that risankizumab is a safe and effective therapeutic option for the treatment of a wide “real-life” cohort of patients with psoriasis.