Cannizzaro Maria Vittoria, Coscarella Giulia, Chiricozzi Andrea
Dermatologia, Dipartimento Universitario di Medicina e Chirurgia Traslazionale, Università Cattolica del Sacro Cuore, Rome, Italy.
Dermatologia, Dipartimento Scienze Mediche e Chirurgiche, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.
Dermatol Pract Concept. 2023 Jul 1;13(3):e2023245. doi: 10.5826/dpc.1303a245.
Psoriasis is a common chronic, immune-mediated, inflammatory skin disease that in certain localization results difficult to treat. Psoriatic lesions in difficult-to-treat areas might be hardly managed as no standardized therapeutic approach and the application of topical treatments might have great limitations. Systemic agents, including biologic therapies, have been proven effective in treating this subgroup of patients. In particular, current evidence has shown beneficial effects with the use of brodalumab, a fully human IgG2 monoclonal antibody antagonizing the IL-17 receptor A subunit (IL-17RA).
The aim of this narrative review was to collect published data about efficacy and safety of brodalumab in the treatment of psoriasis occurring in difficult-to-treat areas.
Data on brodalumab effectiveness and safety deriving from both trials and real-world setting that had been published in the last 15 years were collected for this review, together with clinical findings issued during international meetings.
In phase 3 trials, brodalumab demonstrated to be effective in promoting a rapid response in scalp psoriasis as well as in generalized pustular psoriasis and erythrodermic psoriasis. Nail psoriasis demonstrated marked clinical improvement after treatment with brodalumab. Amelioration of palmoplantar psoriasis was also described in brodalumab-treated patients. Various retrospective real-world studies reported a complete clearance of psoriatic lesions in difficult-to-treat areas, including genitalia, through short-term brodalumab treatment.
Brodalumab, combining rapid and sustained efficacy with a favorable safety profile, may be a valid therapeutic option for severe variants of psoriasis as well as for psoriasis localized in difficult-to-treat areas.
银屑病是一种常见的慢性、免疫介导的炎症性皮肤病，在某些部位难以治疗。由于缺乏标准化的治疗方法，难治疗部位的银屑病皮损可能难以处理，局部治疗的应用可能有很大局限性。全身用药，包括生物疗法，已被证明对治疗这一亚组患者有效。特别是，目前的证据表明，使用完全人源化IgG2单克隆抗体布罗达单抗拮抗白细胞介素-17受体A亚基（IL-17RA）具有有益效果。
本叙述性综述的目的是收集已发表的关于布罗达单抗治疗难治疗部位银屑病的疗效和安全性的数据。
本综述收集了过去15年发表的来自试验和真实世界的数据，以及国际会议期间发布的临床研究结果，这些数据涉及布罗达单抗的有效性和安全性。
在3期试验中，布罗达单抗在促进头皮银屑病、泛发性脓疱型银屑病和红皮病型银屑病的快速反应方面显示出有效性。布罗达单抗治疗后甲银屑病显示出明显的临床改善。接受布罗达单抗治疗的患者中也描述了掌跖银屑病的改善情况。各种回顾性真实世界研究报告称，通过短期布罗达单抗治疗，难治疗部位（包括生殖器）的银屑病皮损完全清除。
布罗达单抗兼具快速和持续的疗效以及良好的安全性，可能是严重银屑病变体以及难治疗部位银屑病的有效治疗选择。
