Effectiveness of resuming ustekinumab therapy in psoriasis patients with metabolic disorders. Clinical experience

Cover Page

Abstract


Psoriasis is a chronic immune-mediated inflammatory skin disease with possible damage to the musculoskeletal system, affecting 2-3 % of the adult population of the planet. To date, special attention in the treatment of psoriasis is paid to the comorbid background, since it is known that it can aggravate the course of psoriasis and affect the effectiveness of therapy. The purpose of psoriasis therapy is to achieve clean or almost clean skin, sustainable improvement of psoriatic arthritis, improving the quality of life, all this became possible with the advent of genetically engineered biological drugs. However, in the treatment of genetically engineered biological drugs there are “pain points”: primary inefficiency, “the effect of slipping”, the scheme of transition from one drug to another, the safety of the combined use of GIBP and system-based drugs, interruption of therapy.

Objective. To study the therapeutic efficacy of ustekinumab in psoriasis patients with forced interruption of treatment, taking into account metabolic disorders.

Materials and methods. 52 patients with a diagnosis of plaque psoriasis receiving ustekinumab for 3 years were under observation, which were divided into 2 groups, depending on body weight and metabolic disorders.

Results. More than 80 % of patients taking the drug at a dosage of 45 mg, and at a dosage of 90 mg, to week 12 therapy reached PASI 75. By week 24, the proportion of patients in group I who reached PASI 75 was 96.3 %, in group II — 88.0 %.

By week 48 PASI 75 reached 90.4 % patients: in group I — 100 % patients, in group II — 80.0 % patients.

At 76 weeks, patients were interrupted ustekinumab treatment in connection with the purchase of the drug. The duration of treatment interruption ranged 36 weeks. By week 112, 86.5 % patients in both groups had a relapse of psoriasis, which was assessed by the loss of the therapeutic response of PASI 75.

By week 124 (12 weeks after the resumption of therapy) 82.7 % patients reached PASI 75: in group I — 92.6 % patients, in group II — 72.0 % patients.

After 16 weeks (week 128), all patients 100 % achieved PASI 75 IN group I. In group II to week 128 PASI 75 was observed in 80 % patients.

Conclusion. With the resumption of treatment of patients with psoriasis with ustekinumab after a long interruption, there is a rapid and complete restoration of therapeutic effectiveness, however, in patients with psoriasis with metabolic disorders, there is a decrease in efficiency after the resumption of therapy in comparison with patients without abdominal obesity, which can determine the further strategy and tactics of management of such patients.


I. V. Rychkova

Clinical Dermatovenerologic Dispensary

Author for correspondence.
Email: zkissskaz@mail.ru

Russian Federation

Irina V. Rychkova — Dermatovenerologist, Clinical and Diagnostic Department.

Bratiev Spendiarovyh lane, 6, 295006, Simferopol

O. A. Prytulo

Medical Academy named after S. I. Georgievsky, Vernadsky Crimean Federal University

Email: 55550256@mail.ru

Russian Federation

Olga A. Pritulo — Head of Department, Department of Dermatovenereology with the course of cosmetology.

Lenina blvd, 5/7, 294006, Simferopol

  1. Luan L., Han S., Wang H., Liu X. Down-regulation of the Th1, Th17, and Th22 pathways due to anti-TNF-a treatment in psoriasis. Int Im-munopharmacol. 2015;29:278-284.
  2. Николашина О. Е., Бакулев А. Л. О взаимосвязи врожденного и адаптивного иммунитета при псориазе. Саратовский научно-медицинский журнал. 2015;11(3):421-423.
  3. Myers W. A. et al. Psoriasis and psoriatic arthritis: clinical features and disease mechanisms. Clin Dermatol. 2006;24(5):438-447.
  4. Молочков В. А., Бадокин В. В., Альбанова В. И., Волнухин В. А. Псориаз и псориатический артрит. Т-во научных изданий КМК; Авторская академия, 2007. С. 197-244.
  5. McLaughlin M., Ostor A. Early treatment of psoriatic arthritis improves prognosis. Practitioner. 2014;258(1777):21-24.
  6. Buckley C., Cavill C., Taylor G. et al. Mortality in psoriatic arthritis — a single-center study from the UK. J Rheumatol. 2010;37:2141-2144.
  7. Machado-Pinto J. et al. Psoriasis: new comorbidities. An Bras Dermatol. 2016;91(1):8-14.
  8. Хобейш М. М., Сысоев К. А., Соколовский Е. В., Лапин С. В. Роль адипокинов и цитокинов в патогенезе псориаза у пациентов с сопутствующими метаболическими нарушениями. Кремлевская медицина. Клинический вестник. 2018;1:26-35.
  9. Rasouli N., Kern P. A. Adipocytokines and the metabolic complications of obesity. J Clin Endocrinol Metab. 2008;93:64-73.
  10. Федеральные клинические рекомендации по ведению больных с псориатическим артритом, 2015.
  11. Федеральные клинические рекомендации по ведению больных псориазом. Российское Общество Дерматовенерологов и Косметологов. Москва, 2015.
  12. Stelara© (ustekinumab). Summary of product characteristics. FDA 2018.
  13. Schadler E. D. et al. Biologics for the primary care physician: Review and treatment of psoriasis. Dis Mon. 2018.
  14. Leonardi C. L. et al. Efficacy and safety of ustekinumab, a human interleukin-12/23 monoclonal antibody, in patients with psoriasis: 76-week results from a randomised, double-blind, placebo-controlled trial (PHOENIX 1). Lancet. 2008;371(9625):1665-1674.

Views

Abstract - 121

PDF (Russian) - 22

Refbacks

  • There are currently no refbacks.

Copyright (c)



This website uses cookies

You consent to our cookies if you continue to use our website.

About Cookies