Biologic therapy may be safe for hemodialysis patients with psoriasis

A small sample of patients with psoriasis who were also undergoing hemodialysis for kidney failure showed improvement in psoriasis symptoms following treatment with biologic therapy, according to findings published recently in the Journal of Dermatology.

Psoriasis treatments have been thought by experts to be too dangerous for use in patients with kidney disease because of the elevated risk for infection. However, researchers from Tokyo treated three patients with ustekinumab (Stelara, Janssen). All patients had positive results in psoriasis symptoms; most patients tolerated the treatment. The patients were previously treated unsuccessfully with conventional therapies such as cyclosporine, retinoids, and methotrexate.

The three patients were treated with ustekinumab for 12 months while undergoing hemodialysis, after which all three reported “rapid and maintained improvement in psoriasis,” Yoshinori Umezawa, PhD, MD, and colleagues wrote. “These findings suggest ustekinumab may be an appropriate treatment for patients with psoriasis who also require hemodialysis.”

One patient, however, discontinued treatment because of a rise in the inflammatory marker C-reactive protein, indicating possible infection. The remaining two patients reported no adverse events during their first year of treatment.

“Recently, biologic treatments have been recognized as having sufficient efficacy for severe psoriasis with low incidence of organ toxicities,” the authors concluded. “For this reason, biologic treatments may be more preferable for patients on hemodialysis; however, there is not sufficient evidence.”