Tildrakizumab是一种人源化IgG1/k型单克隆抗体,靶向IL23的p19蛋白亚基。尽管其有效性和安全性已被临床试验和现实生活中的经验广泛报道,关于其在先前抗IL17失败的患者中使用的数据(brodalumab,ixekizumab,bimekizumab和/或苏金单抗)很少。因此,对这一主题的进一步研究将有利于临床医生指导生物转移的选择,考虑到抗IL23、-12/23和-IL17部分共享其治疗靶点。在这种情况下,我们表演了28周,单中心,现实生活中,回顾性研究,目的是评估tildrakizumab在先前抗IL17失败的患者中的疗效和安全性,还将注意力集中在位于难以治疗区域的牛皮癣上(头皮,手掌或鞋底,手指甲,生殖器)。共有23名患者(12名男性,52.2%;平均年龄52.8±12.4岁)。其中,11(47.8%)苏金单抗失败,7(30.4%)ixekizumab,3(13.0%)Brodalumab,苏金单抗和ixekizumab均为1例(4.3%),比克单抗为1例(4.3%)。在基线,平均PASI和BSA分别为12.8±5.9和18.7±9.6。在W16时,PASI75和PASI90反应分别达到15(65.2%),和9名(39.1%)患者,分别,而在W28时,有19名(82.6%)和13名(56.6%)受试者达到了这些分数。评估了1例(4.3%)原发性无效和1例(4.3%)继发性无效。最后,未收集到严重不良事件.Tildrakizumab似乎是对抗IL17无反应的银屑病患者的有价值的选择,这表明先前接触生物疗法似乎并不直接影响其有效性。
Tildrakizumab is a humanised IgG1/k-type monoclonal antibody that targets the p19 protein subunit of IL23. Despite its effectiveness and safety have been widely reported by clinical trials and real-life experiences, data regarding its use on patients who previously failed anti-IL17 (brodalumab, ixekizumab, bimekizumab and/or secukinumab) are scant. Therefore, further studies on this topic would be beneficial for clinicians in guiding the selection of biologic shifting, considering that anti-IL23, -12/23, and -IL17 partially share their therapeutic targets. In this context, we performed a 28-week, single-center, real-life, retrospective study, with the aim of assessing the efficacy and safety of tildrakizumab in patients who previously failed anti-IL17, also focusing the attention on psoriasis located in difficult-to-treat areas (scalp, palms or soles, fingernails, genitals). A total of 23 patients (12 male, 52.2%; mean age 52.8 ± 12.4 years) were enrolled. Of these, 11 (47.8%) failed secukinumab, 7 (30.4%) ixekizumab, 3 (13.0%) brodalumab, 1 (4.3%) both secukinumab and ixekizumab and 1 (4.3%) bimekizumab. At baseline, mean PASI and BSA were 12.8 ± 5.9 and 18.7 ± 9.6, respectively. At W16 PASI75 and PASI90 response were achieved by 15 (65.2%), and 9 (39.1%) patients, respectively, whereas 19 (82.6%) and 13 (56.6%) subjects reached these scores at W28. One (4.3%) case of primary inefficacy and 1 (4.3%) case of secondary inefficacy were assessed. Finally, no severe adverse events were collected. Tildrakizumab seems to be a valuable option in selected patients with psoriasis unresponsive to anti-IL17, suggesting that prior exposure to biological therapies seem not directly affect its effectiveness.