Immune checkpoint-mediated psoriasis: A multicenter European study of 115 patients from the European Network for Cutaneous Adverse Event to Oncologic Drugs (ENCADO) group - 10/04/21
, Vincent Sibaud, MD b, Davide Fattore, MD c, Pietro Sollena, MD d, e, Ariadna Ortiz-Brugués, MD f, Damien Giacchero, MD g, Maria Concetta Romano, MD h, Julia Riganti, MD i, Konstantinos Lallas, MD j, Ketty Peris, MD d, e, Dimitra Voudouri, MD a, Aimilios Lallas, MD j, Gabriella Fabbrocini, MD c, Elisabeth Lazaridou, MD k, Cristina Carrera, MD f, Maria Carmela Annunziata, MD c, Ernesto Rossi, MD l, Angela Patri, MD c, Dimitrios Rigopoulos, MD a, Alexander J. Stratigos, MD a, Zoe Apalla, MD kAbstract |
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.
Le texte complet de cet article est disponible en PDF.Key words : adverse events, immune checkpoint inhibitors, immunotherapy, nivolumab, pembrolizumab, psoriasis, skin toxicity
Abbreviations used : BSA, CI, ICI, irAE, OR, PD-1, PD-L1, SD, TNF-α
Plan
| Funding sources: None. |
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| IRB approval status: Not applicable. |
Vol 84 - N° 5
P. 1310-1320 - mai 2021 Retour au numéro
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