Immune checkpoint-mediated psoriasis: A multicenter European study of 115 patients from the European Network for Cutaneous Adverse Event to Oncologic Drugs (ENCADO) group.

Acitretin / therapeutic use Aged Biological Products / therapeutic use Dermatologic Agents / therapeutic use Drug Therapy, Combination / methods Europe / epidemiology Female Follow-Up Studies Glucocorticoids / therapeutic use Humans Immune Checkpoint Inhibitors / adverse effects Male Methotrexate / therapeutic use Middle Aged Neoplasms / drug therapy Psoriasis / chemically induced Retrospective Studies Severity of Illness Index Thalidomide / analogs & derivatives Treatment Outcome

adverse events immune checkpoint inhibitors immunotherapy nivolumab pembrolizumab psoriasis skin toxicity

Journal

Journal of the American Academy of Dermatology

ISSN: 1097-6787

Titre abrégé: J Am Acad Dermatol

Pays: United States

ID NLM: 7907132

Informations de publication

Date de publication:
May 2021

Historique:

received: 26 03 2020

revised: 27 07 2020

accepted: 20 08 2020

pubmed: 7 12 2020

medline: 28 8 2021

entrez: 6 12 2020

Statut: ppublish

Résumé

Immune checkpoint inhibitor (ICI)-mediated psoriasis poses significant diagnostic and therapeutic challenges. 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. The medical records of all patients with ICI-mediated psoriasis were retrospectively reviewed across 9 institutions. 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. Retrospective design. 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.

Sections du résumé

BACKGROUND BACKGROUND

Immune checkpoint inhibitor (ICI)-mediated psoriasis poses significant diagnostic and therapeutic challenges.

OBJECTIVE 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 METHODS

The medical records of all patients with ICI-mediated psoriasis were retrospectively reviewed across 9 institutions.

RESULTS 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 CONCLUSIONS

Retrospective design.

CONCLUSION CONCLUSIONS

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.

Identifiants

DOI: 10.1016/j.jaad.2020.08.137 PMID: 33279646

pubmed: 33279646

pii: S0190-9622(20)33115-7

doi: 10.1016/j.jaad.2020.08.137

pii:

doi:

Substances chimiques

Biological Products 0

Dermatologic Agents 0

Glucocorticoids 0

Immune Checkpoint Inhibitors 0

Thalidomide 4Z8R6ORS6L

Acitretin LCH760E9T7

apremilast UP7QBP99PN

Methotrexate YL5FZ2Y5U1

Types de publication

Journal Article Multicenter Study

Langues

eng

Sous-ensembles de citation

Pagination

1310-1320

Informations de copyright

Déclaration de conflit d'intérêts

Conflicts of interest None disclosed.