Pediatric patients with palmoplantar plaque psoriasis suffer from ineffective biologics
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Key takeaways:
- None of the patients with palmoplantar plaque psoriasis achieved PASI 75 or PASI 90.
- 37.5% of those patients discontinued treatment due to inefficacy.
Pediatric patients with palmoplantar plaque psoriasis were more likely to use combination treatment due to the inefficacy of biologics as a primary treatment in this indication, according to a study.
“The most frequent clinical type of psoriasis occurring in childhood is the plaque form. ... It is often considered as a severe disorder because it is socially detrimental, often painful and difficult to treat,” Bochra Hanafi, MD, of the dermatology department at Hôpital Victor Dupouy in Argenteuil France, and colleagues wrote.
Pediatric patients with palmoplantar plaque psoriasis were more likely to use combination treatment due to the inefficacy of biologics as a primary treatment in this indication. Image: Adobe Stock.
Researchers, however, have found that palmoplantar plaque psoriasis is relatively unresponsive to most treatment, according to the study.
Hanafi and colleagues included 20 pediatric patients with palmoplantar plaque psoriasis (mean age, 13.9 years; 45% girls) and 116 with generalized plaque psoriasis (mean age, 15.5 years; 69% girls) in their analysis of real-life data. Patients with palmoplantar plaque psoriasis vs. those with generalized plaque psoriasis had an earlier age of disease onset (4.4 years vs. 7.2 years; P < .001) and a higher frequency of nail involvement (70% vs. 20.7%; P < .001).
After 3 months of biologic treatment, the researchers showed that those with palmoplantar plaque psoriasis did not respond as well as those with the generalized type. Patients in the palmoplantar and generalized groups were taking etanercept (45% vs. 38.8%, respectively), adalimumab (45% vs 35.3%) or ustekinumab (10% vs 25.9%).
While both groups achieved decreases in PGA and PASI after those 3 months compared with baseline, none of the children in the palmoplantar group achieved PASI 75 or PASI 90. On the other hand, 59.7% of those in the generalized group achieved PASI 75 and 34.7% achieved PASI 90.
The mean PGA score after 3 months was also higher in the palmoplantar group than the generalized group (2.4 ± 1.5 vs. 1.3 ± 1.1; P = .004). Only 40% of children achieved PGA 0/1 in the palmoplantar group compared with 62.8% in the generalized group.
In addition to being relatively unresponsive to these biologics, patients in the palmoplantar group discontinued treatment more often than those in the generalized group (80% vs 49.1%; P = .01).
The most common reason for discontinuation in the palmoplantar group was inefficacy (37.5%), whereas the least common reason was disease remission (0%). The roles were reversed for the generalized group, with 26.3% discontinuing due to disease remission and 1.5% for inefficacy.
As a result, patients with palmoplantar plaque psoriasis more often use a biologic in combination with acitretin (40%) or acitretin and methotrexate (10%) compared with patients with generalized psoriasis (5.2% and 0%, respectively).
As far as primary biologics go, the authors observed that adalimumab maintained higher continuation rates than the other biologics, implying adalimumab may be a relatively promising treatment option in this indication.
The study may have been limited to a small sample size, according to the researchers.
“These data highlight the importance of proposing therapeutic algorithms for this clinical form ... in future recommendations for pediatric psoriasis management,” Hanafi and colleagues wrote.