Acitretin, apremilast, methotrexate effective in treating ICI-mediated psoriasis

Acitretin, apremilast and methotrexate can be used to treat immune checkpoint inhibitors-mediated psoriasis, according to a study published in Journal of the American Academy of Dermatology.

“Immune checkpoint inhibitors (ICIs) are monoclonal antibodies targeting cytotoxic T121 lymphocyte-associated antigen-4, programmed cell death protein-1 (PD-1) 122 or programmed death ligand-1,” Vasiliki Nikolaou, MD, and colleagues wrote. “Their addition in our armamentarium has radically transformed the therapeutic arena in oncology, providing the potential of high-level and durable responses in a large number of diverse malignancies.”

However, patients treated with ICIs often develop adverse skin reactions, including psoriasis.

The multicenter retrospective study used nine oncodermatology databases from Greece, France, Italy, Spain and Argentina to search for patients with anti-PD-1/PD-1-induced psoriasis, of which 115 were identified.

Grade 1 severity was reported in 60 patients (57.1%), while grades 2 and 3 were reported in 34 patients (32.4%) and 11 patients (10.5%), respectively. Ten patients were missing disease severity data.

A personal history of psoriasis was recorded in 33 patients (28.7%), with 20 of those having active disease when starting ICI treatment.

Psoriasis treatment included topical agents, mostly steroids, for 68 patients (59.1%). Four used narrow-band UVB phototherapy combined with topical steroids, calcipotriol plus betamethasone or topical retinoids. A combination of systemic and topical agents was used in 47 patients (40.9%).

Acitretin was prescribed to 23 patients (20.1%), while systemic steroids were given to eight (7%), seven (6.1%) received apremilast, five (4.3%) were on methotrexate, and biologics were given to four patients (3.6%).

Of the 23 treated with acitretin, complete clearance was reported in six (26%) and partial response was recorded in 12 (52.1%). All patients treated with apremilast and systemic steroids had a complete or partial positive response.

The biologics cohort showed one patient treated with infliximab and one with ustekinumab showing partial responses, and two treated with adalimumab and guselkumab did not have responses.

ICI treatment was interrupted in 29 of 112 patients due to psoriasis, while 20 patients permanently discontinued immunotherapy.

“Acitretin, apremilast and methotrexate are safe and effective modalities for ICI-mediated psoriasis,” the authors wrote. “In most cases, ICI can be completed, as long as strict dermatological surveillance is present throughout treatment.”