A biologic agent currently approved to treat rheumatoid arthritis improved cutaneous psoriasis and psoriatic arthritis symptoms in a patient who developed adverse drug reactions to standard treatments, results of a case review indicate.
Activated T-cells are present in inflamed joints of patients with psoriasis. Abatacept (Orencia, Bristol-Myers Squibb), a new biologic agent indicated for use as a first-line treatment for rheumatoid arthritis, effectively inhibits T-cell co-stimulation by blocking the interaction of lymphocyte function-associated antigen 3 (LFA-3) with CD2.
This process improved the skin lesions present with psoriasis as well as the signs and symptoms of arthritis in patients with active psoriatic arthritis, according to findings published in the Journal of Pharmacology and Pharmacotherapeutics.
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The 56-year-old white female described in the case study was diagnosed with vulgar psoriasis in 2004 and developed knee and ankle joint arthritis after five years. She was eventually diagnosed with psoriatic arthritis.
Because of her medical history of drug hypersensitivity, the patient was treated with methotrexate 15 mg/weekly with a moderate response after three months, and use of this drug was eventually discontinued because of elevated liver enzymes.
After similar treatment failures and adverse drug reactions with infliximab and adalimumab, treatment with abatacept was initiated with premedication with metilprednisolone and chlorphenamine before each infusion.
After three months of treatment with adatacept, disease activity was significantly reduced (DAS28:3.84), and the response was maintained for this patient at the subsequent six-month follow-up visit, according to Francesco Ursini, MD, PhD, from the University of Catanzaro, Catanzaro, Italy, and colleagues.
Although separate studies by Mease and Abrams and colleagues showed some evidence that indicates abatacept could be an alternative treatment for psoriasis and psoriatic arthritis in a specific type of patient, the researchers wrote, data suggests it could also induce paradoxical development of cutaneous psoriasis.
“In this article, we reviewed the scientific evidences, although limited, supporting a moderate efficacy of abatacept in cutaneous psoriasis and psoriatic arthritis. According to these data, the degree of improvement observed with abatacept and the number of patients achieving a significant response is substantially lower when compared to anti-tumor necrosis factor (TNF) alpha agents,” Ursini and colleagues concluded. “However, taking into account the good safety profile of abatacept, this molecule could be considered in patients with psoriatic arthritis and multiple anti-TNF-alpha failures.”
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