Vasiliki Nikolaou1, Vincent Sibaud2, Davide Fattore3, Pietro Sollena4, Ariadna Ortiz-Brugués5, Damien Giacchero6, Maria Concetta Romano7, Julia Riganti8, Konstantinos Lallas9, Ketty Peris4, Dimitra Voudouri10, Aimilios Lallas9, Gabriella Fabbrocini3, Elisabeth Lazaridou11, Cristina Carrera5, Maria Carmela Annunziata3, Ernesto Rossi12, Angela Patri3, Dimitrios Rigopoulos10, Alexander J Stratigos10, Zoe Apalla11. 1. First Department of Dermatology, "Andreas Sygros" Hospital for Skin Diseases, National and Kapodestrian University of Athens, Medical School, Athens, Greece. Electronic address: drviknik@yahoo.com. 2. Institut Universitaire du cancer, Toulouse Oncopole, Toulouse, France. 3. Section of Dermatology, Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy. 4. Department of Dermatology, Università Cattolica del Sacro Cuore, Rome, Italy; Fondazione Policlinico "A. Gemelli" Istituto di Ricerca e Cura a Carattere Scientifico, Rome, Italy. 5. Hospital Clinic Barcelona, Barcelona, Spain. 6. Centre Antoine Lacassagne, Nice, France. 7. San Camillo Forlanini Hospital, Rome, Italy. 8. Hospital Italiano of Buenos Aires, Buenos Aires, Argentina. 9. First Dermatology Department, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece. 10. First Department of Dermatology, "Andreas Sygros" Hospital for Skin Diseases, National and Kapodestrian University of Athens, Medical School, Athens, Greece. 11. Second Dermatology Department, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece. 12. Division of Medical Oncology, Fondazione Policlinico "A. Gemelli" Istituto di Ricerca e Cura a Carattere Scientifico, Rome, Italy.
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.
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.