Patrì, Angela (2024) Effectiveness of brodalumab in patients with moderate-to-severe plaque psoriasis located in difficult-to-treat areas. [Tesi di dottorato]

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Abstract

Background: Recent knowledge of psoriasis pathogenesis has led to the development of biologic drugs. They have been suggested for moderate-to-severe psoriasis, milder disease in case of active psoriatic arthritis, severe impact on quality of life, and involvement of sensitive and difficult-to-treat areas. Brodalumab is a monoclonal antibody targeting the interleukin-17-A receptor, approved for moderate-to-severe plaque psoriasis. Nowadays, psoriasis severity monitoring can be more precise than in the past. Indeed, clinical evaluation by means of specific efficacy scores may be combined with serological evaluation of inflammatory markers, the increase of which is an indirect sign of the inflammatory state in psoriasis. Besides, dermoscopy may help to diagnose psoriasis and to evaluate its clinical course. Methods: A monocentric observational prospective study was performed enrolling patients affected by moderate-to-severe plaque psoriasis, particularly in difficult-to-treat areas (scalp and palmoplantar regions), undergoing treatment with brodalumab, to evaluate its effectiveness and safety. Secondary outcomes were the assessment of inflammatory serum markers during the treatment period as well as the evaluation of dermoscopic features of the affected sites, in order to quantify disease activity and to evaluate the response to treatment. Results: Twenty-five patients were included in the study. A statistically significant reduction from baseline in PASI, PSSI, ppPASI and DLQI values as early as week 24 was observed, with further improvement up to week 52. Plasma levels of MMP-3, VEGF-A, and hs-CRP decreased during treatment from week 0 to week 52. Dermoscopy revealed a punctuated vascular pattern in most lesions and superficial scales in all lesions. After 52 weeks of treatment, regression of the vascular component and disappearance of desquamation were demonstrated. Conclusion: Our real-life experience suggests brodalumab as a valuable option for the management of psoriasis located in difficult-to-treat areas. Moreover, our study highlights the capability of brodalumab to reduce plasmatic levels of inflammatory biomarkers, showing how the drug could modulate the skin inflammatory response by reducing systemic inflammation.

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