Ustekinumab is effective and safe in the long-term treatment of erythrodermic psoriasis: Multicenter study in daily practice

BackgroundThe treatment of erythrodermic psoriasis (EP) is challenging. Biological therapies have shown promising results in the long-term management of this clinical variant, but most of the current available evidence is based on single case reports and short case series.ObjectivesTo determine the effectiveness and safety of ustekinumab (UST) in the treatment of EP under daily practice conditions.MethodsWe conducted a retrospective, observational, nationwide, multicenter cohort study of patients diagnosed with EP treated with UST under daily practice conditions with up to 3 years of follow-up. Outcomes, such as the psoriasis area and severity index (PASI) and safety, were assessed at months 1, 4, 7, 13, 19, 25, 31 and 37 during treatment. "As observed" and "intention-to-treat last observation carried forward (ITT-LOCF)" analyses were performed.ResultsTwenty-eight patients were enroled in the study. Baseline mean PASI was 43.1. A sharp decrease in mean PASI was observed during the first 7 months, reaching a plateau that was maintained until the end of the 37-month follow-up. At 7 months, 61% and 43% of the patients achieved PASI <= 2 and PASI 0, respectively. At 25 months, 48 (39%) ("as observed"/ITT-LOCF) of the patients achieved complete clearance. At 31 months, PASI 75, PASI 90 and PASI 100 were achieved in 95, 80 and 45 (79%, 64% and 39%) ("as observed"/ITT-LOCF) of the patients, respectively. Eleven patients required treatment intensification by reducing the interval between doses. Treatment minimisation was performed in four patients. During the follow-up, nine patients (32%) received systemic combination therapy at some point. Eight patients discontinued treatment mainly due to lack of effectiveness. UST presented a good safety profile. With a follow-up of 69.25 patient/years, only three patients exhibited serious nondrug-related adverse events.ConclusionsUstekinumab can be a fast, effective and safe alternative for the long-term treatment of erythrodermic psoriasis. We conducted a retrospective, observational, multicenter study, including twenty-eight erythrodermic psoriasis patients to determine the effectiveness and safety of ustekinumab in their treatment. Baseline mean PASI was 43.1. At 31 months, PASI 75, PASI 90 and PASI 100 were achieved in 95/79%, 80/64% and 45/39% ("AO"/ITT -LOCF) of the patients. Eight patients discontinued treatment due to lack of effectiveness. Three patients exhibited serious non-drug-related adverse events. Ustekinumab is a fast, effective and safe erythrodermic treatment. image