Canakinumab in adults with steroid-refractory pyoderma gangrenosum.
Br J Dermatol
; 173(5): 1216-23, 2015 Nov.
Article
en En
| MEDLINE
| ID: mdl-26471257
ABSTRACT
BACKGROUND:
Pyoderma gangrenosum (PG) is a rare, neutrophilic, ulcerative skin disease that is difficult to treat, especially when unresponsive to steroids.OBJECTIVES:
To determine whether canakinumab is an effective and safe treatment in PG.METHODS:
Five adult patients with clinically and histologically confirmed steroid-refractory PG were enrolled in this prospective open-label study. They received canakinumab 150 mg subcutaneously at week 0 with an optional 150 mg at week 2 in case of an inadequate response [Physician's Global Assessment (PGA) ≥ 2], and an optional 150-300 mg at week 8 depending on PGA. The primary clinical end point was clinical improvement (PGA at least -1 from baseline) and/or complete remission (PGA 0 or 1) at week 16. Real-time quantitative polymerase chain reaction was performed on skin samples to quantify cytokine mRNA levels.RESULTS:
Interleukin (IL)-1ß and its known target genes IL6, CXCL8 and IL36A were significantly increased in lesional skin of PG. Under canakinumab therapy, four of five patients showed a decrease in target-lesion size, PGA and Dermatology Life Quality Index (DLQI), and three of five achieved complete remission. The mean diameter of target lesions decreased from 4·32 ± 2·6 cm at visit 1 to 0·78 ± 1·3 cm at visit 7 (P = 0·03). Mean DLQI decreased from 15 ± 5 at visit 1 to 8 ± 4 by visit 7 (P = 0·01). Adverse effects were reported in two patients fatigue in one and worsening of disease at a nontarget lesion in the other.CONCLUSIONS:
Our data indicate that IL-1ß plays a key pathogenic role in PG and canakinumab may represent a therapeutic option for steroid-refractory PG.
Texto completo:
1
Colección:
01-internacional
Banco de datos:
MEDLINE
Asunto principal:
Piodermia Gangrenosa
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Fármacos Dermatológicos
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Anticuerpos Monoclonales
Tipo de estudio:
Observational_studies
Límite:
Adult
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Aged
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Humans
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Middle aged
Idioma:
En
Revista:
Br J Dermatol
Año:
2015
Tipo del documento:
Article
País de afiliación:
Suiza