An alternative treatment for patients with erythrodermic psoriasis (EP) unresponsive to classic therapies may be golimumab, according to case series findings published in the Annals of Medicine and Surgery. Lacking clinical trials, golimumab is not yet approved by the FDA for treatment of EP.
EP, rare yet severe, accounting for 1 in 40 psoriasis cases, is often the result of exacerbation due to poor management of less severe psoriasis, and less often, resulting from reaction to infection, stress, medication, or possible withdrawal from corticosteroids. Current accepted treatments are often ineffective or produce intolerable side effects. Biological agents may prove a more efficacious treatment. Golimumab (50mg) an anti-TNF, immunoglobulin-kappa monoclonal antibody, has been approved for use in psoriatic arthritis, ankylosing spondylitis, and rheumatoid arthritis in the US and Europe.
Researchers at Al Mouwasat Hospital in Syria conducted a case series, reporting on a woman (patient 1) (23 years of age, 5-year duration of plaque psoriasis) with skin lesion flare-up in November 2020 with a Psoriasis Area and Severity Index (PASI) score of 39.1 and a man (patient 2) (31 years of age, 8-year duration of plaque psoriasis) with a PASI score of 41.9 diagnosed with EP in January 2021. Both patients presented with severe psoriasis with lesions worsening into erythroderma, unresponsive to cyclosporine, methotrexate, ultraviolet B phototherapy, and topical agents. The PASI score of both patients improved after golimumab 50 mg was administered by subcutaneous injection. Lesions continued to improve during treatment every 4 weeks, it was reported.
The PASI score of patient 1 dropped 4 weeks after the first injection from 39.1 (baseline) to 17.1, and continued to improve 4 weeks after the second injection (11.9), and 4 weeks after the third treatment (5.4). Burning and itching remained persistent. Patient 2 experienced similar results with PASI scores of 14.8, 7.6, and 4.9 at 4 weeks following each of the first 3 treatments as well as significant relief from rash and swelling, researchers noted.
Researchers stated, “Golimumab may be an alternative treatment for erythrodermic psoriasis patients (unresponsive) to other treatments.” Traditional first-line therapies often accompanied by limited efficacy and adverse events suggest to investigators the need for alternative—perhaps biologic—treatment. Due to lack of funding, treatment with golimumab was discontinued in patient 1 after 10 months and patient 2 after 8 months, both returning to traditional treatments.
Kudsi M, Alzabibi MA, Shibani M. Two cases of erythrodermic psoriasis treated with golimumab. Ann Med Surg (Lond). Published online June 8, 2022. doi:10.1016/j.amsu.2022.103961