Τίτλος:
Immune checkpoint-mediated psoriasis: A multicenter European study of 115 patients from the European Network for Cutaneous Adverse Event to Oncologic Drugs (ENCADO) group
Γλώσσες Τεκμηρίου:
Αγγλικά
Περίληψη:
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. © 2020
Συγγραφείς:
Nikolaou, V.
Sibaud, V.
Fattore, D.
Sollena, P.
Ortiz-Brugués, 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.
Περιοδικό:
Journal of the American Academy of Dermatology
Εκδότης:
Mosby Year Book Inc
Λέξεις-κλειδιά:
adalimumab; antineoplastic metal complex; apremilast; atezolizumab; avelumab; betamethasone; bevacizumab; cabozantinib; calcipotriol; capmatinib; corticosteroid; cyclosporine; dabrafenib; durvalumab; etretin; guselkumab; immune checkpoint inhibitor; infliximab; ipilimumab; methotrexate; nivolumab; pazopanib; pembrolizumab; prednisolone; spartalizumab; steroid; tazarotene; ustekinumab; apremilast; biological product; dermatological agent; etretin; glucocorticoid; thalidomide, adult; aged; algorithm; Article; body surface; cancer chemotherapy; cancer immunotherapy; clinical feature; cohort analysis; combination drug therapy; data analysis software; disease exacerbation; disease severity; drug dose reduction; drug withdrawal; erythrodermic psoriasis; female; guttate psoriasis; head and neck squamous cell carcinoma; Hodgkin disease; human; lichen planus; liver cell carcinoma; lung cancer; major clinical study; male; malignant neoplasm; medical record review; melanoma; merkel cell carcinoma; mesothelioma; middle aged; monotherapy; nail psoriasis; neuroendocrine tumor; non small cell lung cancer; ovary cancer; priority journal; pruritus; psoriasis; psoriasis vulgaris; pustular psoriasis; pustulosis palmoplantaris; rash; renal cell carcinoma; retrospective study; risk; skin toxicity; steroid therapy; stomach cancer; systemic disease; systemic therapy; topical treatment; transitional cell carcinoma; ultraviolet phototherapy; vitiligo; adverse event; clinical trial; Europe; follow up; immunology; multicenter study; neoplasm; procedures; psoriasis; severity of illness index; treatment outcome, Acitretin; Aged; Biological Products; Dermatologic Agents; Drug Therapy, Combination; Europe; Female; Follow-Up Studies; Glucocorticoids; Humans; Immune Checkpoint Inhibitors; Male; Methotrexate; Middle Aged; Neoplasms; Psoriasis; Retrospective Studies; Severity of Illness Index; Thalidomide; Treatment Outcome
DOI:
10.1016/j.jaad.2020.08.137
