Long term efficacy, safety, and tolerability of tildrakizumab in epileptic patient with psoriasis and eczema

Nicoletta Bernardini; Nevena Skroza; Giovanni Rossi; Alessandra Mambrin; Ersilia Tolino; Federica Marraffa; Martina Caviglia; Antonio Di Guardo; Salvatore Volpe; Ilaria Proietti; Concetta Potenza

doi:10.4081/dr.2022.9447

Authors

Nicoletta Bernardini
nicoletta.bernardini@libero.it
Department of Medico-surgical Sciences and Biotechnologies, Sapienza University of Rome, Polo Pontino, Italy. https://orcid.org/0000-0002-6295-3574
Nevena Skroza Department of Medico-surgical Sciences and Biotechnologies, Sapienza University of Rome, Polo Pontino, Italy.
Giovanni Rossi Department of Medico-surgical Sciences and Biotechnologies, Sapienza University of Rome, Polo Pontino, Italy.
Alessandra Mambrin Department of Medico-surgical Sciences and Biotechnologies, Sapienza University of Rome, Polo Pontino, Italy.
Ersilia Tolino Department of Medico-surgical Sciences and Biotechnologies, Sapienza University of Rome, Polo Pontino, Italy.
Federica Marraffa Department of Medico-surgical Sciences and Biotechnologies, Sapienza University of Rome, Polo Pontino, Italy.
Martina Caviglia Department of Medico-surgical Sciences and Biotechnologies, Sapienza University of Rome, Polo Pontino, Italy.
Antonio Di Guardo Department of Medico-surgical Sciences and Biotechnologies, Sapienza University of Rome, Polo Pontino, Italy.
Salvatore Volpe Department of Medico-surgical Sciences and Biotechnologies, Sapienza University of Rome, Polo Pontino, Italy.
Ilaria Proietti Department of Medico-surgical Sciences and Biotechnologies, Sapienza University of Rome, Polo Pontino, Italy.
Concetta Potenza Department of Medico-surgical Sciences and Biotechnologies, Sapienza University of Rome, Polo Pontino, Italy.

Psoriasis is a chronic inflammatory disease which mostly affects skin. Tildrakizumab is a specific anti-interleukin-23p19 monoclonal antibody approved for the treatment of plaque psoriasis in adults. Herein, we report about a patient who came to our attention for a moderate-to-severe plaque psoriasis, involving primarily upper limbs, elbow, abdomen and knees (PASI 18 – DLQI 22). His medical history was relevant for epilepsy controlled pharmacologically. In addition, an eczematous and edematous appearance of the tibial area was detected; the histologic findings did not contradict the diagnostic hypothesis of subacute spongiotic dermatitis. The patient was treated with Tildrakizumab. After 12 weeks the clinical lesions improved significantly, and the eczematous component disappeared in the tibial area bilaterally. The clinical improvement was maintained even after one year of therapy. Tildrakizumab showed excellent results in the control of psoriasis, with an excellent safety profile. The promising results of clinical trials have been confirmed in a real-life setting. There are no reports about its safety in epileptic patients. In our case, neurological adverse events did not verify and tildrakizumab managed to control both the psoriatic and eczematous components

AlQassimi S, AlBrashdi S, Galadari H, Hashim MJ. Global burden of psoriasis - comparison of regional and global epidemiology, 1990 to 2017. Int J Dermatol. 2020;59(5):566-571. DOI: https://doi.org/10.1111/ijd.14864

Rendon A, Schäkel K. Psoriasis Pathogenesis and Treatment. Int J Mol Sci. 2019;20(6):1475. Published 2019 Mar 23. DOI: https://doi.org/10.3390/ijms20061475

Sivamani RK, Goodarzi H, Garcia MS, et al. Biologic therapies in the treatment of psoriasis: a comprehensive evidence-based basic science and clinical review and a practical guide to tuberculosis monitoring. Clin Rev Allergy Immunol. 2013;44(2):121-140. DOI: https://doi.org/10.1007/s12016-012-8301-7

Reich K, Warren RB, Iversen L, et al. Long-term efficacy and safety of tildrakizumab for moderate-to-severe psoriasis: pooled analyses of two randomized phase III clinical trials (reSURFACE 1 and reSURFACE 2) through 148 weeks. Br J Dermatol. 2020;182(3):605-617. DOI: https://doi.org/10.1111/bjd.18232

Tildrakizumab, Summary of Product Characteristics

Kopp T, Riedl E, Bangert C, et al. Clinical improvement in psoriasis with specific targeting of interleukin-23. Nature. 2015;521(7551):222-226. DOI: https://doi.org/10.1038/nature14175

Reich K, Papp KA, Blauvelt A, et al. Tildrakizumab versus placebo or etanercept for chronic plaque psoriasis (reSURFACE 1 and reSURFACE 2): results from two randomised controlled, phase 3 trials [published correction appears in Lancet. 2017 Jul 15;390(10091):230]. Lancet. 2017;390(10091):276-288. DOI: https://doi.org/10.1016/S0140-6736(17)31279-5

Drerup KA, Seemann C, Gerdes S, Mrowietz U. Effective and Safe Treatment of Psoriatic Disease with the Anti-IL-23p19 Biologic Tildrakizumab: Results of a Real-World Prospective Cohort Study in Nonselected Patients [published online ahead of print, 2021 Nov 12]. Dermatology. 2021;1-5. DOI: https://doi.org/10.1159/000519924

Di Cesare A, Di Meglio P, Nestle FO. The IL-23/Th17 axis in the immunopathogenesis of psoriasis. J Invest Dermatol. 2009;129(6):1339-1350. DOI: https://doi.org/10.1038/jid.2009.59

Mao LY, Ding J, Peng WF, et al. Interictal interleukin-17A levels are elevated and correlate with seizure severity of epilepsy patients. Epilepsia. 2013;54(9):e142-e145. DOI: https://doi.org/10.1111/epi.12337

Barry K, Zancanaro P, Casseres R, Abdat R, Dumont N, Rosmarin D. Concomitant atopic dermatitis and psoriasis - a retrospective review. J Dermatolog Treat. 2021;32(7):716-720. DOI: https://doi.org/10.1080/09546634.2019.1702147

Husein-ElAhmed H, Steinhoff M. Effectiveness of ustekinumab in patients with atopic dermatitis: analysis of real-world evidence [published online ahead of print, 2021 Aug 25]. J Dermatolog Treat. 2021;1-6. DOI: https://doi.org/10.1080/09546634.2021.1914315

Bernardini, N., Skroza, N., Rossi, G., Mambrin, A., Tolino, E., Marraffa, F., Caviglia, M., Di Guardo, A., Volpe, S., Proietti, I., & Potenza, C. (2022). Long term efficacy, safety, and tolerability of tildrakizumab in epileptic patient with psoriasis and eczema. Dermatology Reports, 14(4). https://doi.org/10.4081/dr.2022.9447