Brodalumab may be an effective treatment for refractory psoriasis in patients with human immunodeficiency virus (HIV), suggests case study data published in Dermatologic Therapy.
Investigators described the case of a 62-year-old man with HIV who presented with worsening and persistent plaque psoriasis. His Psoriasis Area and Severity Index (PASI) score was 20.0, indicating moderate to severe disease. Erythema and scaling were observed in large areas on the scalp, trunk, and extremities. The patient was taking highly active antiretroviral therapy (HAART) for HIV and had serological evidence of past co-infection with hepatitis B and C. Thepatient had tried ultraviolet B phototherapy and cyclosporine for psoriasis. Cyclosporine was discontinued due to loss of efficacy and replaced with ustekinumab, which also became ineffective after 1 year.
The patient was started on brodalumab at the recommended dosage of 210 mg every 2 weeks. Marked improvement in plaque psoriasis was observed; a PASI score of 0 was achieved after 6 weeks of treatment. Sustained remission was observed at 6 months. Control of HIV was maintained, with no opportunistic infections or laboratory abnormalities over follow-up.
Data from this case suggest that brodalumab may be an option for patients with HIV who have exhausted other psoriasis therapies. However, administration of an IL-17 inhibitor to a patient with HIV must be done with caution, due to the role of IL-17 in preventing candidiasis. Patients with HIV are highly susceptible to Candida infection, although HAART decreases this susceptibility. The current patient did not experience candidiasis. “[A]dditional experience is required before IL-17 inhibitors can be regarded as a standard therapy in moderate to severe HIV-associated psoriasis,” investigators wrote.
Di Lernia V, Casanova DM, Ricci C. Brodalumab: another helpful option for HIV-positive psoriatic patients? [published online June 25, 2020]. Dermatol Ther. doi: 10.1111/dth.13895