Damsin Thomas, Absil Gilles, Libon Florence, Tassoudji Nazli, Nikkels Arjen F
Department of Dermatology and Venerology, CHU of Sart Tilman, University of Liège B-4000, Liège, Belgium.
Psoriasis (Auckl). 2025 Jan 3;15:1-8. doi: 10.2147/PTT.S502382. eCollection 2025.
Biological therapies, including TNF-alpha, IL12/23, IL17 and IL23 antagonists, adequately control a very high number of patients with moderate-to-severe psoriasis with an excellent long-term safety profile. However, on occasion, patients on biological therapy with stabilized disease or complete remission report episodes of sudden breakthrough psoriasis.
To study prospectively in a monocentric tertiary setting, the clinical characteristics of patients presenting a sudden breakthrough psoriasis although completely stabilized (PASI 90-100) under biological therapy.
Psoriasis patients treated by biological therapies achieving PASI 90-100 and with stabilized disease for at least 6 months were invited to enter the follow-up study for 5 years. The clinical features of patients presenting a breakthrough psoriasis were described as well as the rescue therapies and outcomes.
From the total cohort of 1121 patients with psoriasis receiving biologicals, 985 patients responded to the inclusion criteria. After 5 years, 10/882 cases (1,13%) of breakthrough psoriasis were identified. Two cases were induced by the Köbner phenomenon and 8 cases by severe psychological stress. Rescue therapies included topical very potent corticosteroids or additional injections of the biological. Two patients recovered spontaneously when the stressful event was resolved. In none of the cases, there was a consistency between the breakthrough event and the next scheduled injection, nor the duration of the exposure to the treatment. No biological class or agent could be systematically incriminated.
Breakthrough psoriasis is an exceptional event among patients with stabilized psoriasis using biologicals, either triggered by the Köbner phenomenon or by severe psychological stress. The pathogenesis of the breakthrough events could be linked to stress- or Köbner-related immunomodulation, permitting breakthrough psoriasis lesions to appear.
生物疗法，包括肿瘤坏死因子-α、白细胞介素12/23、白细胞介素17和白细胞介素23拮抗剂，能充分控制大量中重度银屑病患者，且长期安全性良好。然而，有时接受生物疗法且病情稳定或完全缓解的患者会出现银屑病突然复发的情况。
在单中心三级医疗机构进行前瞻性研究，探讨在生物疗法治疗下病情完全稳定（银屑病面积和严重程度指数[PASI]为90 - 100）但仍出现银屑病突然复发的患者的临床特征。
邀请接受生物疗法且PASI达到90 - 100且病情稳定至少6个月的银屑病患者进入为期5年的随访研究。描述了出现银屑病复发患者的临床特征以及挽救治疗方法和结果。
在1121例接受生物制剂治疗的银屑病患者总队列中，985例符合纳入标准。5年后，确定有10/882例（1.13%）出现银屑病复发。2例由同形反应诱发，8例由严重心理压力诱发。挽救治疗包括外用超强效糖皮质激素或额外注射生物制剂。当应激事件解决后，2例患者自行康复。在所有病例中，复发事件与下一次预定注射之间、治疗暴露持续时间之间均无一致性。没有哪一类生物制剂或药物可被系统性地认定为罪魁祸首。
对于使用生物制剂病情稳定的银屑病患者，银屑病复发是一种罕见事件，其由同形反应或严重心理压力引发。复发事件的发病机制可能与压力或同形反应相关的免疫调节有关，从而使银屑病复发皮损出现。
