With recent advances in the understanding of psoriatic disease, it is increasingly considered a systemic inflammatory condition rather than limited to the skin and joints. A variety of biologics are available today for the treatment of psoriasis, but with them, characteristics such as rapidity of onset, long-term efficacy, safety profile, and effects on comorbidities differ. We designed an observational, non-interventional, retrospective study of patients with severe psoriasis receiving biologic treatment with IL-17 inhibitors and aimed to investigate the correlations between etiopathogenic factors and the efficacy and persistence of these therapies in a group of psoriasis patients from Romania. Study results show that patients treated with ixekizumab had better persistence and high adherence compared to those treated with secukinumab. In this study, ixekizumab demonstrated lower risks of non-persistence, discontinuation, and switching and a higher likelihood of high adherence compared with secukinumab. This study contributes to the understanding of the persistence of anti-IL17 biologic therapies in psoriasis and the factors that may influence it.
Psoriasis is a chronic inflammatory disease, with multisystemic implications and genetic predisposition, characterized by the development of erythematous, scaling plaques on the skin. Management of moderate to severe psoriasis vulgaris may involve a biological treatment that suppresses the immune system. Because of this, the patients with psoriasis on an immunosuppressive treatment are theoretically at an increased risk of infections, including SARS-CoV- 2 infection. SARS-CoV-2 (Severe Acute Respiratory Syndrome Coronavirus 2) is responsible for the current pandemic. In Romania, COVID-19 (Coronavirus Disease 19) was first reported on February 26, 2020, by confirming the first patient with SARS-CoV-2 by RT-PCR method. COVID-19 progression was divided into three phases: early infection, pulmonary phase, and hyperinflammatory phase. Although the inhibition of pro-inflammatory cytokines by biologic therapy is detrimental in the viral phase, it seems to be beneficial in the hyperinflammatory phase, by protecting the patients with psoriasis in progressing towards extra-pulmonary manifestations and death. Analyzing the evolution of the 8 cases of patients from our dermatology department – Colentina Clinical Hospital, with generalized psoriasis vulgaris on biologic immunosuppressive treatment and SARS-CoV-2 infection, we observed that they did not develop a more severe form of COVID-19 than the general population. Patients on biologic immunosuppressive treatment are more susceptible to the development of infections, including by SARS-CoV-2, but it was found that the biologic therapy can protect against a more severe type of COVID-19.
