The Effectiveness of Risankizumab Following Guselkumab Failure in Moderate-to-Severe Psoriasis Patients: A Retrospective Study.

BACKGROUND: Psoriasis is a chronic inflammatory skin disease with a strong genetic predisposition and autoimmune component that is often treated with immunomodulators such as biologic therapy. Guselkumab is a biologic treatment option that selectively targets the p19 subunit of interleukin (IL)-23; risankizumab is a more recently developed monoclonal antibody of the same class that targets IL-23p19. There is limited research around effective treatment response with intra class switching within IL-23-targeted therapies for the treatment of moderate-to-severe plaque psoriasis. OBJECTIVES: The purpose is to assess patient response to risankizumab after guselkumab failure for the treatment of plaque psoriasis. METHODS: A retrospective chart review was conducted for 13 patients meeting inclusion criteria. Physical examination findings were converted to a 5-point static physicians' global assessment (sPGA) score. Baseline, 4-month, and 12-month sPGA scores were assigned from visits immediately prior to and during their course of risankizumab treatment. sPGA scores were analyzed to compare changes between baseline and 4 months and 12 months of therapy. RESULTS: Patients treated with risankizumab had lower sPGA scores after both 4 and 12 months compared to their baseline sPGA score. 46% of patients met the primary outcome of an sPGA score of 0 or 1 at 4 months of risankizumab, increasing to 90% of patients at 12 months. CONCLUSIONS: Our findings reflect an improvement in sPGA scores when patients are treated with risankizumab following guselkumab failure. This highlights the benefit of in-class switch to risankizumab when patients with moderate-to-severe plaque psoriasis have failed multiple treatments including guselkumab.

Off-Label High-Dose Secukinumab for the Treatment of Moderate-to-Severe Psoriasis.

BACKGROUND: Secukinumab is an anti-IL-17A monoclonal antibody approved for the treatment of moderate-to-severe psoriasis in adult patients. Despite its favourable safety and efficacy profile in clinical trials, some patients in clinical practice fail to respond adequately to the approved maintenance regimen of 300 mg subcutaneous monthly. Some clinicians manage these patients by using off-label high-dose secukinumab regimens, which include shortening the dosing interval to 300 mg every 2 or 3 weeks instead of monthly, or increasing the monthly dose to 450 mg. OBJECTIVE: This study aims to investigate the safety and efficacy of high-dose secukinumab regimens for the treatment of psoriasis to inform real-world clinical practice. METHODS: We performed a retrospective chart review at 5 dermatology clinics for adult patients diagnosed with moderate-to-severe psoriasis treated with an off-label high-dose secukinumab regimen. Efficacy was measured using the Psoriasis Area and Severity Index or a Physician Global Assessment score of 0 or 1 after dose escalation. Adverse events were recorded to assess safety outcomes. RESULTS: Twenty-five patients were included in this case series, and 14 of them achieved efficacy from dose escalation with secukinumab based on our study endpoints. There was 1 case of the common cold and 1 upper respiratory tract infection reported after dose escalation. CONCLUSION: Our study provides evidence that dose escalation with secukinumab results in clinical benefit and is well tolerated among patients with moderate-to-severe psoriasis who failed to respond adequately to the approved regimen. This work necessitates larger studies to fully characterize the efficacy and long-term safety profile of secukinumab dose escalation.

Complete Genome Sequences of a Diverse Group of 13 Propionibacterium acnes Bacteriophages Isolated from Urban Raw Sewage.

We present complete genome sequences of 13 Propionibacterium acnes phages isolated from urban raw sewage. They belong to the family Siphoviridae, have genome sizes of 29,450.6 ± 256.5 nucleotides and G+C contents of 54.14% ± 0.22% and contain 42 to 45 coding DNA sequences (CDS). Genomic sequences of 9 of 13 phages were divergent by 6 to 10%, distinguishing them as species.

A Suspected Case of Silodosin-Induced Erythroderma.

An 86-year-old man developed a suspected severe erythroderma during treatment with silodosin (dosage unknown) for benign prostatic enlargement. Two weeks after starting silodosin, he developed a total-body scaling dermatitis. A biopsy was planned but the patient improved at his subsequent visit and it was not taken. Silodosin was discontinued and the patient received UVB phototherapy, clobetasol ointment, and several bland and protective skin-care measures. One week after the initial presentation, the patient demonstrated improvement in his total-body scaling. Based on these findings, the patient was diagnosed with a suspected silodosin-induced erythroderma. Due to limitations in the patient's clinical history and investigations, a Naranjo assessment score was not obtainable.

Combined therapeutic use of oral alitretinoin and narrowband ultraviolet-B therapy in the treatment of hailey-hailey disease.

Hailey-Hailey disease (HHD) is a chronic familial bullous disease characterized by recurrent blisters and erosions typically at friction-prone areas of the body accompanied by acantholysis upon histologic examination. There are a number of therapies used in the management of HHD. Its symptoms have been effectively treated with antimicrobial therapies, corticosteroids and other agents such as cyclosporine and prednisone. However, such treatments are not always effective. Therefore, there is a need for new treatments for the management of HHD. In this report, a patient with long-standing HHD responsive only to high levels of prednisone is described. After the successful tapering and cessation of oral prednisone the patient began a new combination therapy of complementary doses of oral alitretinoin, and narrowband UVB therapy, which yielded a favorable response within 2-3 weeks. After 6 weeks, a mono-therapy of daily (30 mg) oral alitretinoin was sufficient to maintain successful near-complete remission of the disease.

Contact dermatitis to incontinency pads in a (meth)acrylate allergic patient.

BACKGROUND: The authors report a case of a 47-year-old woman who suffered a severe allergic contact dermatitis (ACD) in the vulvar area after using Poise thin incontinency pads. She had a past history of ACD after the use of sculptured acrylic nails and after the installation of a dental crown. OBJECTIVE: The aim of this report is to show the spectrum of (meth)acrylate allergy in one individual. METHODS: Patch testing of moistened inner and outer aspect of the pad was performed. We also patch tested with the North American Contact Dermatitis Group series of 50 allergens, the dentistry series, various catalysts and inhibitors used in acrylic resin systems, and some epoxy acrylates. RESULTS: Positive ACD reaction occurred to both sides of the pad, with the inner aspect being stronger than the outer aspect. There were also multiple (meth)acrylate allergies. CONCLUSION: This case shows a new potential source of allergy to (meth)acrylates.