Rapid and Sustained Improvement in a Patient With Plaque Psoriasis Switched to Brodalumab After Failing Treatment Clearance on Six Other Biologic Therapies

Psoriasis is a chronic, inflammatory, remitting/relapsing autoimmune condition involving a dysregulated inflammatory response of the interleukin (IL) 23/T-helper (Th)-17 pathway. Greater understanding of the immune-mediated pathology of the disease has led to the development of numerous biological therapies and biosimilars that target the various inflammatory pathways. Each biologic has a unique mechanism of action, pharmacodynamics, and pharmacokinetics resulting in different clinical efficacy and tolerability. This case describes a 64-year-old female with a nine-year history of plaque psoriasis, predominantly affecting her feet, who was successfully treated with brodalumab having previously failed multiple topical and systemic therapies including six other biologicals. To date, there are few guidelines to help physicians select the optimal biology agent and none that have looked specifically at plantar psoriasis. For this patient, finding a biologic that worked and was tolerable was a process of trial and error that took four years. The results achieved in this previously refractory patient with difficult-to-treat psoriasis may be due to the unique mechanism of action of brodalumab, though this will need to be confirmed in larger studies. J Drugs Dermatol. 2020;19(1):86-88. doi:10.36849/JDD.2020.4583