Chang Shurong, Chambers Cindy J, Liu Fu-Tong, Armstrong April W
Keck School of Medicine at USC.
Dermatol Online J. 2015 Jul 15;21(7):13030/qt3bs971cr.
Psoriasis is a chronic inflammatory disease, evolving from a complex interplay of genetic and environmental factors. In the recent years, we have seen much progress in understanding the immunopathogenesis of psoriasis, paving the way for new therapies with biologics. Currently, the most commonly used biologics in psoriasis are TNF inhibitors etanercept, infliximab and adalimumab, and the IL-12/23 inhibitor ustekinumab. As TNF inhibitors are contraindicated in patients with multiple sclerosis, ustekinumab remained the only biologic available for these patient before the recent approval of Secukinumab, an IL-17A inhibitor. Herein we report two patients with multiple sclerosis and comorbid psoriasis successfully treated with ustekinumab without progression of their multiple sclerosis. Our cases demonstrate that ustekinumab is a reasonably safe choice in this patient population. We also briefly reviewed new therapies currently under investigation, which will undoubtedly further expand our armamentarium for the treatment of psoriasis in patients with neuromuscular diseases.
银屑病是一种慢性炎症性疾病，由遗传和环境因素的复杂相互作用演变而来。近年来，我们在理解银屑病的免疫发病机制方面取得了很大进展，为生物制剂的新疗法铺平了道路。目前，银屑病中最常用的生物制剂是肿瘤坏死因子（TNF）抑制剂依那西普、英夫利昔单抗和阿达木单抗，以及白细胞介素（IL）-12/23抑制剂乌司奴单抗。由于TNF抑制剂在多发性硬化症患者中禁用，在IL-17A抑制剂司库奇尤单抗最近获批之前，乌司奴单抗仍然是这些患者唯一可用的生物制剂。在此，我们报告两例患有多发性硬化症合并银屑病的患者，使用乌司奴单抗成功治疗且多发性硬化症未进展。我们的病例表明，乌司奴单抗在这一患者群体中是一个相当安全的选择。我们还简要回顾了目前正在研究的新疗法，这些疗法无疑将进一步扩大我们治疗神经肌肉疾病患者银屑病的手段。
