Efficacy and safety of bimekizumab in real-world psoriasis management: data from patients who are biologic-naive vs. biologic-experienced.

BACKGROUND: Bimekizumab is the latest monoclonal antibody approved for the management of moderate-to-severe plaque psoriasis. Currently, data investigating its use in real-world settings are limited. OBJECTIVES: To assess the efficacy and safety of bimekizumab, also comparing patients who are biologic-naive vs. biologic-experienced. METHODS: A short-term (16 weeks) real-world monocentric prospective study was undertaken. RESULTS: Globally, 56 patients were included. At baseline, mean Psoriasis Activity Severity Index (PASI) and Dermatology Life Quality Index (DLQI) were 16.9 (SD 7.8) and 22.6 (SD 5.9), respectively. A ≥ 75%/≥ 90%/100% reduction in PASI (PASI 75/90/100) were reached by 77% (43/56)/50% (28/56)/43% (43/56) of patients at week 4 and by 88% (49/56)/82% (46/56)/70% (39/56) of patients at week 16. In our cohort of 56 people, 29 (52%) patients were biologic-naive whereas 27 (48%) were biologic-experienced. At baseline, both PASI and DLQI were significantly higher in the biologic-naive group compared with the biologic-experienced group [PASI 19.4 (SD 7.7) vs. 14.2 (SD 7.0), P < 0.05; DLQI: 25.3 (SD 4.5) vs. 19.7 (SD 6.0), P < 0.001]. Although not significant, a higher percentage of patients in the biologic-naive group compared with the biologic-experienced group reached PASI 75 (79% vs. 63%, P = 0.18), PASI 90 (62% vs. 44%, P = 0.19) and PASI 100 (48% vs. 37%, P = 0.40) at week 4. However, the percentage of PASI 75/90/100 response were similar between the two groups at week 16. Regarding safety, three candidiasis (5%) and one (2%) eczematous reaction were reported, without differences between the two groups. Finally, two (4%) bimekizumab discontinuation because of treatment failure and three (5%) for AEs were collected. CONCLUSIONS: Our study confirmed the efficacy and safety of bimekizumab, suggesting that the previous failure of biologics does not seem to affect its therapeutic effectiveness.

A Case of Erythrodermic Psoriasis Successfully Treated with Risankizumab.

Psoriasis is a chronic inflammatory cutaneous disease, affecting up to 3% of the worldwide population. Several clinical phenotypes can be distinguished. Among these, erythrodermic psoriasis (EP) is a rare and severe variant (less than 3% of cases), characterized by severe generalized erythema and scaling affecting at least 90% of the body surface area. EP is often a life-threatening condition, since several systemic symptoms (tachycardia, fever, fatigue, lymphadenopathy, dehydration, serum electrolyte disturbances) can be associated. Thus, a prompt and appropriate treatment is mandatory. Unfortunately, EP treatment is challenging. Indeed, the reduced prevalence of EP makes clinical trials feasibility difficult, leading to the absence of established guidelines. So, the treatment of EP is often derived from moderate-to-severe psoriasis management which relies on the use of conventional systemic drugs (cyclosporine, dimethyl fumarate, methotrexate, retinoids) and biologic agents. However, conventional systemic drugs are often contraindicated for patients' comorbidities, or their use is characterized by reduced efficacy and various adverse events (AEs). The recent development of biologic drugs, which showed excellent results in terms of effectiveness and safety in plaque psoriasis, made these drugs an ideal weapon in EP management, despite their use in EP is still off-label. Among these, risankizumab, a humanized immunoglobulin G1 monoclonal antibody targeting the p19 subunit of the IL23, is one of the latest biologics approved for the management of moderate-to-severe psoriasis. Herein, we reported the first case of a caucasian patient affected by EP successfully treated with risankizumab, reaching PASI100 response after 16 weeks of treatment, without experiencing AEs.

Chronic Urticaria in Older Adults: Treatment Considerations.

Chronic urticaria is characterized by recurrent wheals and/or angioedema lasting for more than 6 weeks. Chronic urticaria is an extremely disabling disease limiting daily activities, compromising patient quality of life, and frequently associated with psychiatric comorbidities (depression and/or anxiety). Unfortunately, there are still gaps in the knowledge regarding treatment in special populations, especially in older patients. Indeed, there are no specific recommendations for the management and treatment of chronic urticaria in older people; therefore, recommendations for the general population are used. However, the utilization of some medications may be complicated by potential concerns of comorbidities or polypharmacy. Currently, the diagnostic and therapeutic procedures for chronic urticaria in the older patient are the same as those indicated for other age groups. In particular, there is a limited number of blood chemistry investigations for spontaneous chronic urticaria and specific tests for inducible urticaria. With regard to therapy, second-generation anti-H1 antihistamines are used and, in recalcitrant cases, omalizumab (an anti-IgE monoclonal antibody) and possibly cyclosporine A are additional choices. Nonetheless, it should be underlined that in older patients the differential diagnosis can be more difficult, owing to the lower frequency of chronic urticaria and the likelihood of other pathologies that are peculiar for this age group and that can be included in the chronic urticaria differential diagnosis. As far as therapy is concerned, the physiological characteristics of these patients, the possible comorbidities, and the intake of other medications often require a very attentive drug selection for chronic urticaria compared with other age groups. The purpose of this narrative review is to provide an update on the epidemiology, clinical characteristics, and management of chronic urticaria in older patients.