Safe use of Interleukin-17 Inhibitors for Psoriasis and Psoriatic Arthritis in Two Patients with a History of Lymphoproliferative Disease

Main Article Content

Stephen Sansone
Yasmin Amir
Mark Lebwohl

Keywords

psoriasis, psoriatic arthritis, IL-17, lymphoma, biologic

Abstract

Psoriasis and psoriatic arthritis are chronic, inflammatory, immune-mediated diseases that affect the skin and joints, respectively. The older systemic agents that have been used to treat these conditions are associated with many side effects, including an increased risk of malignancies, specifically lymphoma. In the last few years, there has been a wave of development of novel systemic biologic therapies to target psoriasis and psoriatic arthritis. While long-term safety data is lacking, the newer therapies targeting interleukins 12, 23, and 17 reveal a much more favorable side effect profile, specifically with regards to lymphoma. Here we report two cases of patients with psoriasis and psoriatic arthritis who had histories of lymphoma, both successfully treated with an interleukin-17 inhibitor without any recurrence or worsening of lymphoproliferative disease.

References

1. Remicade (infliximab) [package insert]. Horsham, PA; Janssen Biotech, Inc;. 1998.

2. Enbrel (etanercept) [package insert]. Thousand Oaks, CA; Amgen;. 1998.

3. Humira (adalimumab) [package insert]. North Chicago, Abbvie Lab. 2002.

4. Patel RV, Clark LN, Lebwohl M, Weinberg JM. Treatments for psoriasis and the risk of malignancy. J Am Acad Dermatol. 2009 Jun:60(6):1001-17.

5. Leonardi CL, Kimball AB, Papp KA et al. Effi cacy and safety of ustekinumab , a human interleukin-12 / 23 monoclonal antibody , in patients with psoriasis : 76-week results from a randomised , double-blind , placebo-controlled trial ( PHOENIX 1 ). Lancet. 2008;371(9625):1665-1674. doi:10.1016/S0140-6736(08)60726-6.

6. Langley RG, Elewski BE, Lebwohl M, et al. Secukinumab in plaque psoriasis--results of two phase 3 trials. N Engl J Med. 2014;371(4):326-338. doi:10.1056/NEJMoa1314258.

7. Griffiths CEM, Reich K, Lebwohl M, et al. Comparison of ixekizumab with etanercept or placebo in moderate-to-severe psoriasis (UNCOVER-2 and UNCOVER-3): Results from two phase 3 randomised trials. Lancet. 2015;386(9993):541-551. doi:10.1016/S0140-6736(15)60125-8

8. Lebwohl M, Strober B, Menter A, et al. Phase 3 Studies Comparing Brodalumab with Ustekinumab in Psoriasis. N Engl J Med. 2015;373(14):1318-1328. doi:10.1056/NEJMoa1503824.

9. Gelfand JM, Berlin J, Van Voorhees A, Margolis DJ. Lymphoma rates are low but increased in patients with psoriasis. Arch Dermatol, 139 (2003); 1425-1429.

10. Fiorentino D, Ho V, Lebwohl MG, Leite L, Hopkins L, Galindo C, et al. Risk of malignancy with systemic psoriasis treatment in the Psoriasis Longitudinal Assessment Registry. J Am Acad Dermatol. 2017;77(5):845-854.

11. Geller S, Xu H, Lebwohl M, Nardone B, Lacouture ME, Kheterpal M. Malignancy Risk and Recurrence with Psoriasis and its Treatments: A Concise Update. Am J Clin Dermatol. 2018 Jun:19(3):363-375

12. Nam JS, Terabe M, Kang MJ, Chae H, Voong N, et al. Transforming Growth Factor Beta Subverts the Immune System into Directly Promoting Tumor Growth through Interleukin-17. Cancer Res. 2008 May; 68(10).