ustekinumab therapy efficacy in psoriasis patients previously treated with biologic drugs

Ustekinumab therapy

efficacy in psoriasis

patients previously treated

with biologic drugs

Wojciech Francuzik,

Aleksandra Skłodowska

Tutor: Prof. Zygmunt Adamski

Dermatology Interest Group,

Student Scientific Society of

Poznan University of Medical Sciences

USTEKINUMAB

Human IgG1 IL-12/23

antibody

Trade name: STELARA

Cytokines IL-12 and IL-23 activate T cells

3

Cytokins

including

IFN-g

TNF-a

Th17

Naïve

T cell

IL-23

DC

Th1

Naïve

T cell

IL-12

DC

Cytokines

including

TNF-a

IL-17

IL-22

1. Gately MK, et al. Annu Rev Immunol. 1998;16:495-521. 2. Wilson NJ, et al. Nat Immunol. 2007;8(9):950-7. 3. Nickoloff BJ, Nestle FO. J Clin Invest. 2004;113(12):1664-75.

Vasodilation, infiltration, plaque formation

Inflammation, increase in WBC

Cytokine IL-12 and IL-23 structure

IL-12

IL-23

p35

p40

p40

Anti-p40 mAb

Material and methods

39 patients

(6 women i 33 men)

Qualification to treatment with

ustekinumab

Lab tests before initiation of

the therapy

Results:

Value

Mean disese duration time (years) 18,69

Mean BSA value (%) 26.7

PASI value (range: 0-72) 12,19

Mean DLQI value (range: 0-30) 9,8

Number of patients previously exposed to

biologic drugs 19 (48,7%)

Comorbid conditions

Condition Patient count

Internal organs diseases 9 (23 %)

Hipertension 8 (20,5 %)

Coronary artery disease 4 (10,3 %)

Diabetes 3 (7,7 %)

Obesity 12 (30,8 %)

Nicotine addiction 10 (25%)

Weight and age of patients

Age Weight

Histogram of PASI values at weeks

0 – 4 – 16 – 52

Reduction of PASI value compared

to initial values (in %)

Number of patients who achieved

therapeutic goals

0

2

4

6

8

10

12

14

16

18

20

PASI 75 PASI 90

after 4 wks

after 16 wks

after 52 wks

Patient

count

Effectiveness of PASI reduction in patients with

psoriatic arthritis

Effectiveness of PASI reduction in patiens

previously exposed to biologic drugs.

Patients who were shifting from another biologic drug

had lower reduction of PASI during first 4 weeks

Adverse events

Event Patient count %

Streptococal infections 2 5 %

M. tuberculosis infection suspected

(QF-TB test positive) 2 5 %

Non- satisfactory response or

worsening 5 12,8%

Safety of ustekinumab treatment

• The therapy was well tolerated.

• Most common adverse events were: erythema

in injection site, headache, fatigue. Infections of

upper respiratory tract were most frequently

observed.

• No serious adverse events were noted.

Tips to therapeutic success:

• Patients should always undergo

qualification protocol

• Discontinue drug when no benefit is seen

only after 16-32 weeks.

• Do not be afraid of using when shifting

from different biologic agents

• Use of classical psoriasis drugs (MTX) is

often times beneficial and may be adequate

in tough cases.