Service de Médecine interne, Hôpital d'Instruction des Armées Bégin, 69 avenue de Paris, Saint-Mandé, 94160, France.
Service de Rhumatologie, HIA Bégin, Saint-Mandé, France.
Rheumatol Int. 2024 Oct;44(10):2205-2212. doi: 10.1007/s00296-024-05663-9. Epub 2024 Jul 16.
Cases of psoriasis associated with Tocilizumab (TCZ) are scarce.
To describe a new case of TCZ-associated psoriasis and to perform a case-based review of similar cases.
We searched Medline/Pubmed, Embase, Scopus, Web of Science, and Directory of Open Access Journals databases using the terms « Tocilizumab » and « Psoriasis » in the French and English literature.
We report a 70-year-old woman with a history of Rheumatoid Arthritis who developed Infliximab-induced plaque psoriatic eruption of the soles and palms, that resolved after Infliximab interruption, then relapsed after TCZ relay, and eventually resolved after TCZ interruption. Including our case, we identified 16 cases of TCZ-induced psoriatic eruption. Three (21%) out of 14 patients had a history of cutaneous psoriasis - data were not available for 2 patients. Eight (50%) patients had previously received TNFα antagonists. TCZ was stopped for 10 patients and continued for 4 patients. For the 2 remaining patients, the interval between two injections of TCZ was shortened. All the patients with available follow-up data had an improvement of the eruption within 4 weeks.
To conclude, in case of TCZ-induced psoriatic eruption and in light of the published cases, we suggest using topical steroids and reassessing the patient 4 weeks later. If no healing is obtained, we suggest stopping TCZ, and treating the underlying disease with another drug. When no other drug is available, while waiting for more data regarding the value of IL-6 levels, it can be discussed to increase TCZ regimen, as it has been successful for 2 authors. Efficacy assessment of the chosen attitude should not take place before 4 weeks.
与托珠单抗（TCZ）相关的银屑病病例很少见。
描述一例新的 TCZ 相关银屑病病例，并进行类似病例的基于病例的回顾。
我们在法国和英语文献中使用“Tocilizumab”和“Psoriasis”术语在 Medline/Pubmed、Embase、Scopus、Web of Science 和开放获取期刊目录数据库中进行了搜索。
我们报告了一位 70 岁女性，患有类风湿关节炎，她在 Infliximab 诱导的足底和手掌斑块银屑病发作后，在 Infliximab 中断后得到缓解，然后在 TCZ 转接后复发，最终在 TCZ 中断后缓解。包括我们的病例在内，我们共发现 16 例 TCZ 诱导的银屑病发作。14 名患者中有 3 名（21%）有皮肤银屑病病史-2 名患者的数据不可用。8 名（50%）患者以前接受过 TNFα 拮抗剂治疗。10 名患者停止了 TCZ 治疗，4 名患者继续治疗。对于其余 2 名患者，TCZ 两次注射之间的间隔缩短。所有可获得随访数据的患者在 4 周内皮疹均得到改善。
总之，在 TCZ 诱导的银屑病发作的情况下，根据已发表的病例，我们建议使用局部类固醇，并在 4 周后重新评估患者。如果没有愈合，我们建议停止 TCZ，并使用另一种药物治疗潜在疾病。当没有其他药物可用时，在等待有关 IL-6 水平价值的更多数据期间，可以考虑增加 TCZ 方案，因为它对 2 位作者有效。在 4 周之前，不应对所选态度的疗效进行评估。
