Share |

A Case Series Exploring the Efficacy, Secondary Failure, Paradoxical Event & Relapse with Ustekinumab Therapy in Chronic Plaque Psoriasis

Original article

Abstrak

Ustekinumab adalah agen biologi yang berkesan untuk rawatan kulit psoriasis dengan menyasarkan molekul interleukin 12 dan 23. Namun begitu ada beberapa halangan ketika penggunaannya seperti kegagalan sekunder dan juga peristiwa paradoks. Penyakit juga didapati kembali menyerang selepas terapi dihentikan. Kajian kohort retrospektif telah dilakukan ke atas pesakit kulit kronik psoriasis yang telah menerima ustekinumab di antara tahun 2013 ke 2018 di Pusat Perubatan Universiti Kebangsaan Malaysia (PPUKM). Demografi, ciri-ciri klinikal, keberkesanan rawatan, komplikasi, kadar dan corak penyakit berulang dikaji melalui rekod-rekod pesakit. Enam (75%) pesakit adalah lelaki. Enam (75%) pesakit ini tidak pernah menerima agen biologi sebelum ini. Usia median pesakit adalah 41.5 tahun (IQR 26.8-48.3), tempoh median penyakit ialah 16.5 tahun (IQR 6.5-23.0). Tempoh median untuk mencapai kadar 75% pengurangan penyakit (PAS I75) adalah 16 minggu. PASI75 pada minggu ke 12 dicapai oleh 37.5% pesakit manakala tempoh median untuk mencapai sekurang-kurangnya PASI75 adalah 16 minggu. Tempoh median keseluruhan rawatan adalah selama 102 minggu. Semua pesakit berjaya dirawat. Dua (25%) pesakit mengalami kegagalan sekunder. Seorang (12.5%) pesakit mendapat peristiwa paradoks dengan tumbuhnya fenomena nanah dan plak di kulit semasa rawatan. Tempoh median untuk penyakit berulang adalah 40 minggu. Semua pesakit kecuali seorang memerlukan rawatan biologi untuk penyakit berulang. Ustekinumab berkesan untuk semua pesakit. Kejayaan rawatan diperolehi 4 minggu selepas piawai yang dijangkakan. Kohort ini telah merekodkan kegagalan sekunder dan fenomena paradoks yang jarang berlaku. Penyakit didapati akan berulang dan corak psoriasis yang berbeza ditemui selepas rawatan dihentikan.

 

Abstract

Ustekinumab is an anti-IL12/23 biologic agent used for treatment of psoriasis with excellent efficacy. However, there are therapeutic obstacles such as secondary failure and paradoxical event. Disease relapse upon discontinuation of therapy is common. A case series was performed on patients with chronic plaque psoriasis who received ustekinumab between 2013 to 2018 at a tertiary referral centre. Demographics, clinical characteristics, duration of therapy, efficacy, treatment complications, rate and pattern of relapses were determined from the patients’ medical records. Out of 8 patients, 6 (75%) patients were males. There were 6 (75%) biologic-naïve patients. Median age was 41.5 years (IQR26.8-48.3), median duration of psoriasis was 16.5 years (IQR6.5-23.0). Median duration to achieve Psoriasis Activity and Severity Index (PASI)75 was 16 weeks and median total duration of treatment was 102 weeks. All patients achieved treatment success. PASI75 at week 12 was achieved by 37.5%, a median of 16 weeks was required to achieve at least PASI 75 but 6 (75%) attained PASI 90 by then. One patient (12.5%) developed paradoxical event with pustular and plaques.  Secondary failure occurred in 2 (25%) patients. All patients relapsed after treatment discontinuation, relapse occurred at median of 40 weeks. Most (71%) developed plaques on relapse but 25% developed plaques and pustules. All but one patient required further biological agent for treatment of relapse. Ustekinumab was efficacious in all patients. Treatment success was achieved slightly later than standard duration. The rare occurrences of secondary failure and paradoxical were observed. Relapse was inevitable, new onset pustular eruptions featured in relapses.