gms | German Medical Science

47. Kongress der Deutschen Gesellschaft für Rheumatologie (DGRh), 33. Jahrestagung der Deutschen Gesellschaft für Orthopädische Rheumatologie (DGORh), 29. Jahrestagung der Gesellschaft für Kinder- und Jugendrheumatologie (GKJR)

04.09. - 07.09.2019, Dresden

Successful double disease control by guselkumab in a patient with Behçet’s disease and psoriasis

Meeting Abstract

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  • Theodoros Xenitidis - Universitätsklinikum Tübingen, Innere Medizin II - Onkologie, Hämatologie, klinische Immunologie, Rheumatologie und Pulmologie, Tübingen
  • Lisa Speidel - Universitätsklinikum Tübingen, Innere Medizin II - Onkologie, Hämatologie, klinische Immunologie, Rheumatologie und Pulmologie, Tübingen
  • Lothar Kanz - Universitätsklinikum Tübingen, Innere Medizin II - Onkologie, Hämatologie, klinische Immunologie, Rheumatologie und Pulmologie, Tübingen
  • Jörg Henes - Universitätsklinikum Tübingen, Innere Medizin II - Hämatologie, Onkologie, klinische Immunologie und Rheumatologie, Tübingen

Deutsche Gesellschaft für Rheumatologie. Deutsche Gesellschaft für Orthopädische Rheumatologie. Gesellschaft für Kinder- und Jugendrheumatologie. 47. Kongress der Deutschen Gesellschaft für Rheumatologie (DGRh), 33. Jahrestagung der Deutschen Gesellschaft für Orthopädische Rheumatologie (DGORh), 29. Jahrestagung der Gesellschaft für Kinder- und Jugendrheumatologie (GKJR). Dresden, 04.-07.09.2019. Düsseldorf: German Medical Science GMS Publishing House; 2019. DocFA.34

doi: 10.3205/19dgrh034, urn:nbn:de:0183-19dgrh0349

Veröffentlicht: 8. Oktober 2019

© 2019 Xenitidis et al.
Dieser Artikel ist ein Open-Access-Artikel und steht unter den Lizenzbedingungen der Creative Commons Attribution 4.0 License (Namensnennung). Lizenz-Angaben siehe http://creativecommons.org/licenses/by/4.0/.


Gliederung

Text

Introduction: Behçet’s disease (BD) is a multisystemic inflammatory disorder of unknown aetiology, characterized by recurrent oral aphthosis (OA), genital ulcers (GU), uveitis and cutaneous lesions [1]. Skin involvement regularly consists of papulopustulosis and erythema nodosum (EN). Standard treatment for mucocutaneous manifestations are colchizine, azathioprine, ciclosporin A and in resistant patients TNFa antagonists [2]. Psoriasis is an immune-mediated, genetic disease manifesting in the skin or joints or both. The interleukin-23/Th17 axis and its crucial role in the pathogenesis of the psoriasis resulted in several novel targeted therapies [3]. We present a 40-year-old Caucasian woman in whom the combination of BD and psoriasis was successfully treated with guselkumab (Anti-IL-23 mAb). Guselkumab was approved for psoriasis in 2018.

Case: At the age of 32 (two years after the appearing of the first symptoms) she was diagnosed with BD according to the guidelines of the international study group on BD based on recurrent OA, GU, papulopustulosis and EN [4]. She also suffered from multiple deep vein thrombosis (pelvic and leg veins) receiving Rivaroxaban as long term anticoagulant. At 32 she presented plaque psoriasis on the extensor surfaces of the elbows and knees. For the treatment of the BD, the patient received Ciclosporine A [CsA] 150mg per day and low-dose steroids. In March 2017 we added colchicine because of flaring OA and EN – without success. In April 2018 external colleagues tried a treatment with PDF4-inhibitor Apremilast. The attempt failed and the patient returned to her former medication (CsA 125 mg every day plus 2.5 mg prednisolone daily). On May 2018, CsA administration was ended due to ineffectiveness (up to 26 concomitant oral aphthae). Two days later the patient developed a severe flare with 25 new oral ulcers and 8 EN. We increased the dose of prednisolone to 20mg per day which led to an improvement of the oral aphthosis. On June 2018, the first guselkumab injection (100mg) was administered. The patient was asked to fill out a “patient diary”, collecting all possible manifestations of her disease. We observed a rapid decline of OA and EN followed by limited flares of both. Figure 1 [Fig. 1] highlights the disease manifestations and laboratory parameters over time. Up to now the patient received guselkumab 4 times (about every 8 weeks). Elevated inflammation markers (ESR and CRP) resolved completely. Steroids were tapered to 4mg prednisolone per day. All psoriatic plaques resolved completely. The only relevant adverse event was a hand, foot and mouth disease caused by a coxsackie-infection leading to an exacerbation of mucocutaneous BD-manifestations, which subsequently disappeared completely. To our knowledge, our case is the first BD patient reported who was effectively treated with Guselkumab. The IL-12/23, respectively IL-17, pathway seems to play an important role for the development and maintenance of uveitis in patients with BD [5]. Polymorphism of the IL23-rezeptor may also be involved in the pathophysiology of BD [6]. Therefore we decided for this new treatment option after all previous treatments including apremilast had failed. Controlled studies should confirm our findings.


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