Successful treatment of adalimumab-resistant palmoplantar pustulosis with secukinumab: a case report.
Successful treatment of adalimumab-resistant palmoplantar pustulosis with secukinumab: a case report.
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苏金单抗成功治疗阿达木单抗耐药性掌跖脓疱病：病例报告
DOI：
10.1097/cm9.0000000000001246
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发表时间：
2020-11-20
影响因子：
6.1
通讯作者：
Wang G
中科院分区：
文献类型：
--
作者：
Li QY;Wang G
致编辑：掌跖脓疱病（PPP）是一种慢性顽固性疾病。各种生物制剂已成功用于治疗斑块型银屑病，但其用于治疗PPP是有限的。尽管肿瘤坏死因子-α (TNF-α)抑制剂等生物制剂具有良好的疗效，但它们可能加重或诱发PPP。在此，我们报告了一例对TNF-α抑制剂阿达木单抗难治性PPP患者，但通过白细胞介素- 17a （IL-17A）抑制剂secukinumab成功治疗。2019年，一名25岁，体重65公斤的中国女性，手掌和脚底出现红斑和干脓疱，指甲增厚，临床诊断为PPP[图1 a]。脓疱出现于2018年，并逐渐加重。无牛皮癣家族史。真菌测试呈阴性她以前的医生给她开了局部钙化三醇，但效果有限。因此，她同意接受生物治疗，期望康复。我们给她用阿达木单抗治疗第一天80毫克，第8天40毫克，然后每周40毫克。在阿达木单抗治疗的前5周，患者反应良好，脓疱减轻[图1b]。然而，在阿达木单抗治疗9周后，她的病变复发并加重[图1c]，大腿出现红斑和鳞屑病变。因此，我们停用阿达木单抗，并在第1、8、15、22和29天开始使用secukinumab 300 mg，然后每月一次。在5次剂量的secukinumab治疗后，患者手部和大腿的病变完全清除，没有间歇性耀斑，持续时间超过5个月[图1 D]。
To the Editor: Palmoplantar pustulosis (PPP) is a chronic recalcitrant disease. Various biologics have been used to successfully treat plaque psoriasis, but their use to treat PPP is limited. Despite their promising effects, biologics such as tumor necrosis factor-α (TNF-α) inhibitors may aggravate or induce PPP. Herein, we report a patient with PPP refractory to the TNF-α inhibitor adalimumab, but successfully treated with the interleukin-17A (IL-17A) inhibitor secukinumab.In 2019, a 25-year-old, 65 kg Chinese woman with erythema and dried pustules in palms and soles, and nail thickening was clinically diagnosed with PPP [Figure 1 A]. The pustules occurred in 2018 and gradually exacerbated. There was no family history of psoriasis. Fungal tests were negative. Her previous doctors prescribed her topical calcipotriol but with limited response. Therefore, she consented for biotherapy with the expectation of recovery. We treated her with adalimumab 80 mg on day 1, and 40 mg on day 8, and then 40 mg every week. She responded well for the first 5 weeks of adalimumab treatment, with alleviated pustules [Figure 1 B]. However, after 9 weeks of adalimumab treatment, her lesions relapsed and aggravated [Figure 1 C], and erythematous and scaling lesions appeared on her thighs. Therefore, we discontinued adalimumab and started secukinumab 300 mg on days 1, 8, 15, 22, and 29, and then once every month. After five doses of secukinumab, the lesions on her hands and thighs were completely cleared without intermittent flares for more than 5 months [Figure 1 D].