Psoriasis is a chronic inflammatory disease, immune - mediated, with multisystemic implications and genetic predisposition, characterized by the development of erythematous, scaling plaques on the skin. The current therapy with biologic agents induces long term remissions in patients with moderate or severe psoriasis vulgaris, who are not responding to the conventional systemic therapy. Risankizumab is a humanised immunoglobulin G1 monoclonal antibody selective to the interleukin (IL)-23. We are presenting the case of a 71-year-old male patient, smoker, known with generalized psoriasis vulgaris, multiple bio-experienced who was referred to our Clinic for the occurrence of an eruption constituted by well-defined erythematous-squamous plaques and placards, pruritic, disseminated at the level of the whole body, occured in the context of discontinuation of biologic treatment for a period of 5 months due to the pandemic. Psoriasis Area Severity Index (PASI) upon hospitalization was 24,2. The treatment with risankizumab was initiated and we observed a very fast response, the evolution after 4 weeks was favorable, achieving PASI 2 and DLQI 0, with improving skin lesions and pruritus resolution. Being in front of a multiple bio “failure” patient (adalimumab, etanercept, ixekizumab, ustekinumab) we expected a modest response to therapy. However, the evolution was spectacular with PASI 2 four weeks after initiating the therapy with risankizumab. We also observed that treatment with IL-23 inhibitor was superior to both TNF-alpha blockers and IL-17 inhibitors to which the patient did not react, as well as ustekinumab, a monoclonal antibody that blocks the p40 subunit, common IL-12/23 to which he partially reacted and lost the response. In conclusion, although the patient was being treated with ustekinumab, a drug similar in structure and effect to risankizumab, the IL-23 inhibitor acting specifically on the p19 subunit had a very good and rapid response.

ESDR095 - Therapeutic conduct in multiple bio-experienced psoriatic patient

50th Annual Meeting of the European Society for Dermatological Research. VIRTUAL MEETING