Department of Dermatology, Traditional Chinese and Western Medicine Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China.
Department of Dermatology, Wuhan No.1 Hospital, Wuhan, 430022, China.
Sci Rep. 2024 Jul 2;14(1):15121. doi: 10.1038/s41598-024-65902-8.
Interleukin-17A therapeutic inhibitors are among the most effective treatment methods for moderate-to-severe plaque psoriasis (PP). Reflectance confocal microscopy is a non-invasive imaging technique already documented to be beneficial in evaluating the follow-up of PP under treatment with topical actives and phototherapy. This study aimed to assess the epidermal and dermal changes associated with psoriasis and its treatment with RCM during systemic secukinumab treatment in patients with moderate-to-severe PP. A pilot study was conducted to evaluate RCM as a non-invasive tool for monitoring secukinumab treatment in patients with PP. For patients receiving secukinumab treatment, lesional skin was selected for RCM imaging, which were recorded at all scheduled times. The RCM evaluation criteria were established based on the histopathological diagnostic criteria for psoriasis. The clinical severity of psoriasis was assessed utilizing the psoriasis area severity index. A total of 23 patients with PP were included in the study. Each patient received 300 mg of subcutaneous secukinumab as induction therapy at baseline and weeks 1-4, followed by maintenance therapy every four weeks. Microscopic confocal changes were observed during the treatment. The results identified early microscopic evidence of the anti-inflammatory activity of secukinumab, which was not detected during the clinical examination. RCM findings correlating with the PASI were used to observe the patient's response to treatment and were identified as follows: acanthosis and parakeratosis, presence of epidermal and dermal inflammatory cells, presence of non-edge dermal papillae, and vascularization in the papillary dermis. This study is the first to demonstrate the use of RCM as an effective tool for non-invasive monitoring of secukinumab therapeutic response at a cellular level in a clinical or research setting. Early detection of RCM parameters associated with secukinumab activity may facilitate the identification of an early treatment response. RCM appears to be capable of providing practical and helpful information regarding follow-up in patients with PP undergoing secukinumab treatment. RCM may also provide novel perspectives on the subclinical evaluation of PP's response to biological therapy.
白细胞介素-17A 治疗抑制剂是治疗中重度斑块状银屑病（PP）最有效的方法之一。反射共聚焦显微镜是一种非侵入性成像技术，已经被证明在评估局部药物和光疗治疗 PP 时具有有益的作用。本研究旨在评估在接受中重度 PP 系统性司库奇尤单抗治疗期间，RCM 观察银屑病及其治疗的表皮和真皮变化。进行了一项试点研究，以评估 RCM 作为监测 PP 患者司库奇尤单抗治疗的非侵入性工具。对于接受司库奇尤单抗治疗的患者，选择病变皮肤进行 RCM 成像，并在所有预定时间进行记录。RCM 评估标准基于银屑病的组织病理学诊断标准。使用银屑病面积严重指数评估银屑病的临床严重程度。共有 23 名 PP 患者纳入本研究。每位患者在基线和第 1-4 周接受 300mg 司库奇尤单抗皮下诱导治疗，然后每四周进行维持治疗。在治疗过程中观察到微观对比变化。结果发现司库奇尤单抗具有早期抗炎活性的微观证据，这在临床检查中未检测到。与 PASI 相关的 RCM 发现用于观察患者对治疗的反应，如下所示：棘层肥厚和角化过度，表皮和真皮炎症细胞存在，非边缘真皮乳头存在，乳头真皮血管化。本研究首次证明 RCM 可作为一种有效的工具，用于在临床或研究环境中从细胞水平无创监测司库奇尤单抗的治疗反应。早期检测与司库奇尤单抗活性相关的 RCM 参数可能有助于识别早期治疗反应。RCM 似乎能够为接受司库奇尤单抗治疗的 PP 患者的随访提供实用和有帮助的信息。RCM 还可能为评估 PP 对生物治疗的亚临床反应提供新的视角。
