10.5826/dpc.1202a49
text/xml
2160-9381
1879
en
Giuseppe Argenziano
https://creativecommons.org/licenses/by-nc/4.0
Dermatology Practical & Conceptual
psoriasis treatment
Tildrakizumab: Successful Response in Two Patients with Psoriatic Arthritis
Text.Serial.Journal
https://dpcj.org/index.php/dpc
Research Letter
2022-05-02
2021-07-12
2022-05-02
2022-05-24
e2022049
Dermatol Pract Concept
Giuseppe Argenziano
2022/05/02
10.5826/dpc.1202a49
e2022049
Dermatology Unit, Department of Mentals and Physical Health and Preventive medicine, University of Campania Luigi Vanvitelli, Naples, Italy
2160-9381
psoriasis treatment
en
e2022049
Tildrakizumab: Successful Response in Two Patients with Psoriatic Arthritis
https://dpcj.org/index.php/dpc/article/download/1879/1571
Tildrakizumab: Successful Response in Two Patients
             With Psoriatic Arthritis
             Dario Buononato1, Gaetano Licata1, Alessio Gambardella1, Alina De Rosa1,
                            Giulia Calabrese1, Giuseppe Argenziano1


1 Dermatology Unit, Department of Mentals and Physical Health and Preventive medicine, University of Campania Luigi Vanvitelli, Naples, Italy.



Key words: Psoriatic arthritis, psoriasis, tildrakizumab, treatment
Citation: Buononato D, Licata G, Gambardella A, De Rosa A, Calabrese G, Argenziano G. Tildrakizumab: successfull response in two
patients with psoriatic arthritis. Dermatol Pract Concept. 2022;12(2):e2022049. DOI: https://doi.org/10.5826/dpc.1202a49
Accepted: July 22, 2021; Published: April 2022
Copyright: ©2022 Buononato et al. This is an open-access article distributed under the terms of the Creative Commons Attribution-
NonCommercial License (BY-NC-4.0), https://creativecommons.org/licenses/by-nc/4.0/, which permits unrestricted noncommercial use,
distribution, and reproduction in any medium, provided the original authors and source are credited.
Funding: None.
Competing interests: None.
Authorship: All authors have contributed significantly to this publication.
Corresponding author: Dario Buononato, MD, Department of Dermatology University of Campania “Luigi Vanvitelli” via Sergio
Pansini, 5, 80131 Napoli, Italy. E-mail: dario.buononato@gmail.com




Introduction                                                                  In the first case a 45-year-old man came to our unit with
                                                                         a 10 years history of PsA and psoriasis. The patient presented
Psoriatic arthritis (PsA) is a chronic, immune-mediated, in-             several episodes of dactylitis with radiologically documented
flammatory arthropathy that develops in up to 30% of pa-                 damage to the distal interphalangeal joints. He had been
tients with psoriasis. Different phenotypes are recognized               treated with methotrexate (20 mg/week) for 9 months, sus-
according to the joints involved: distal interphalangeal                 pended for a significant increase in transaminases (ALT 110
predominant, asymmetric oligoarticular, symmetric polyar-                U/L, AST 121 U/L). We started treatment with secukinumab
thritis, spondylitis and arthritis mutilans. The treatment of            (300 mg sc monthly) from October 2018 to November 2019
PsA includes different therapeutic strategies: conventional              with a partial improvement of PsA and skin disease, but the
disease modifying antirheumatic drugs (DMARDs) and                       patient developed upper respiratory tract infection and the
­biologic therapies such as tumor necrosis factor (TNF) inhib-           drug was stopped. Thus, the patient received tildrakizumab
itors, interleukins-17 (IL-17) inhibitors, IL-12/23 inhibitor.           at the same dosage regimen as in psoriasis (100 mg sc every
However not all agents used for psoriasis are yet approved               12 weeks) with improvement in both diseases.
for PsA including IL-23 inhibitors: there are several cases of                In the second case a 56-year-old woman came to our unit
PsA successfully treated with IL-23 inhibitors.                          with a 15 years history of PsA and psoriasis. The patient
                                                                         suffered from peripheral asymmetric oligoarticular arthritis
                                                                         associated with bilateral uveitis, treated periodically with
Case Presentation
                                                                         methotrexate (15 mg/week) interrupted because of several
We report 2cases of patients with PsA and psoriasis (Table 1)            relapses. From October 2019 to September 2020, she began
who successfully responded to tildrakizumab, an anti-IL-23               therapy with adalimumab (40 mg sc every 2 weeks), then
antibody approved only for psoriasis.                                    stopped for the appearance of itching and skin rash. Given



Research Letter | Dermatol Pract Concept. 2022;12(2):e2022049                                                                               1
            Table 1. Patients clinical details with tildrakizumab treatment for psoriatic arthritis
                                                          Patient 1                                    Patient 2
 Gender                                    Male                                        Female
 Age, years                                45                                          56
 Psoriatic arthritis                       Distal interphalangeal joints               Asymmetric oligoarticular
 phenotype                                                                             joints
 Systemic involvement                      Psoriasis                                   Psoriasis
                                                                                       Uveitis
 Treatment before                          Methotrexate                                Methotrexate
 tildrakizumab                             Secukinumab                                 Adalimumab


the impossibility of carrying out therapy with IL-17 inhib-      with favorable response to tildrakizumab. Recent studies
itors due to a suspected concomitant ulcerative colitis, we      have been published on the approval of guselkumab in PsA
started therapy with tildrakizumab from December 2020,           [2]: considering that IL-23 is the same target, also tildraki-
getting a control of PsA.                                        zumab could be a useful therapeutic option for this affection.
                                                                      Further studies are required to evaluate the efficacy and

Conclusions                                                      safety of tildrakizumab in larger cohorts of patients to con-
                                                                 sider this IL-23 inhibitor as a new promising treatment op-
IL-23/IL-17 cytokines are important players in the patho-        tion for PsA.
genesis of PsA. In particular, IL-23 stabilizes the Th17 phe-
notype, supporting secretion of IL-17 which mediate the
epidermal hyperplasia and keratinocyte differentiation.
                                                                 References
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