Background: Immune checkpoint inhibitor (ICI)–mediated psoriasis poses significant diagnostic and therapeutic challenges. Objective: To report data on ICI-mediated psoriasis, emerging from the largest cohort to date, to our knowledge, and to propose a step-by-step management algorithm. Methods: The medical records of all patients with ICI-mediated psoriasis were retrospectively reviewed across 9 institutions. Results: We included a cohort of 115 individuals. Grade 1, 2, and 3 disease severity was reported in 60 of 105 (57.1%, 10 missing data), 34 of 105 (32.4%), and 11 of 105 (10.5%), respectively. The ratio between exacerbation and de novo cases was 1:4.3. The most common systemic therapy was acitretin (23 patients, 20.1%), followed by systemic steroids (8 patients, 7%), apremilast (7 patients, 6.1%), methotrexate (5 patients, 4.3%) and biologics (4 patients, 3.6%). Overall, 29 of 112 patients (25.9%) interrupted and 20 of 111 (18%) permanently discontinued ICIs because of psoriasis. Body surface area of greater than 10% at baseline had a 3.6 increased risk for ICI treatment modification (odds ratio, 3.64; 95% confidence interval, 1.27-10.45; P =.03) and a 6.4 increased risk for permanent discontinuation (odds ratio, 6.41; 95% confidence interval, 2.40-17.11; P <.001). Guttate psoriasis and grade 2 or 3 disease were significant positive predictors for antitumor response of ICI, whereas pruritus was a negative predictor. Limitations: Retrospective design. Conclusion: Acitretin, apremilast, and methotrexate are safe and effective modalities for ICI-mediated psoriasis. In most cases, ICI can be completed unhindered. A therapeutic algorithm is proposed.

Nikolaou, V., Sibaud, V., Fattore, D., Sollena, P., Ortiz-Brugues, A., Giacchero, D., Romano, M. C., Riganti, J., Lallas, K., Peris, K., Voudouri, D., Lallas, A., Fabbrocini, G., Lazaridou, E., Carrera, C., Annunziata, M. C., Rossi, E., Patri, A., Rigopoulos, D., Stratigos, A. J., Apalla, Z., Immune checkpoint-mediated psoriasis: A multicenter European study of 115 patients from the European Network for Cutaneous Adverse Event to Oncologic Drugs (ENCADO) group, <<JOURNAL OF THE AMERICAN ACADEMY OF DERMATOLOGY>>, 2020; (dec): N/A-N/A. [doi:10.1016/j.jaad.2020.08.137] [http://hdl.handle.net/10807/168628]

Immune checkpoint-mediated psoriasis: A multicenter European study of 115 patients from the European Network for Cutaneous Adverse Event to Oncologic Drugs (ENCADO) group

Romano, Maria Concetta;Peris, Ketty;
2021

Abstract

Background: Immune checkpoint inhibitor (ICI)–mediated psoriasis poses significant diagnostic and therapeutic challenges. Objective: To report data on ICI-mediated psoriasis, emerging from the largest cohort to date, to our knowledge, and to propose a step-by-step management algorithm. Methods: The medical records of all patients with ICI-mediated psoriasis were retrospectively reviewed across 9 institutions. Results: We included a cohort of 115 individuals. Grade 1, 2, and 3 disease severity was reported in 60 of 105 (57.1%, 10 missing data), 34 of 105 (32.4%), and 11 of 105 (10.5%), respectively. The ratio between exacerbation and de novo cases was 1:4.3. The most common systemic therapy was acitretin (23 patients, 20.1%), followed by systemic steroids (8 patients, 7%), apremilast (7 patients, 6.1%), methotrexate (5 patients, 4.3%) and biologics (4 patients, 3.6%). Overall, 29 of 112 patients (25.9%) interrupted and 20 of 111 (18%) permanently discontinued ICIs because of psoriasis. Body surface area of greater than 10% at baseline had a 3.6 increased risk for ICI treatment modification (odds ratio, 3.64; 95% confidence interval, 1.27-10.45; P =.03) and a 6.4 increased risk for permanent discontinuation (odds ratio, 6.41; 95% confidence interval, 2.40-17.11; P <.001). Guttate psoriasis and grade 2 or 3 disease were significant positive predictors for antitumor response of ICI, whereas pruritus was a negative predictor. Limitations: Retrospective design. Conclusion: Acitretin, apremilast, and methotrexate are safe and effective modalities for ICI-mediated psoriasis. In most cases, ICI can be completed unhindered. A therapeutic algorithm is proposed.
2021
Inglese
Nikolaou, V., Sibaud, V., Fattore, D., Sollena, P., Ortiz-Brugues, A., Giacchero, D., Romano, M. C., Riganti, J., Lallas, K., Peris, K., Voudouri, D., Lallas, A., Fabbrocini, G., Lazaridou, E., Carrera, C., Annunziata, M. C., Rossi, E., Patri, A., Rigopoulos, D., Stratigos, A. J., Apalla, Z., Immune checkpoint-mediated psoriasis: A multicenter European study of 115 patients from the European Network for Cutaneous Adverse Event to Oncologic Drugs (ENCADO) group, <<JOURNAL OF THE AMERICAN ACADEMY OF DERMATOLOGY>>, 2020; (dec): N/A-N/A. [doi:10.1016/j.jaad.2020.08.137] [http://hdl.handle.net/10807/168628]
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/10807/168628
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