Management of Systemic Anti-psoriatic Drugs in Psoriasis Patients with Concurrent Paraplegia or Tetraplegia: Insights From a 6-Year Multicenter, Retrospective Observational Study
Abstract Introduction Patients with psoriasis (PsO) and permanent spinal cord injuries (SCI) resulting in paraplegia and tetraplegia may experience a higher rate of infections compared to patients with PsO without SCI. It can result in further challenges for therapeutic management with immunosuppres...
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Adis, Springer Healthcare
2025-01-01
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| Series: | Dermatology and Therapy |
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| Online Access: | https://doi.org/10.1007/s13555-025-01338-w |
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| author | Giovanni Damiani Alessia Pacifico Stefano Ricciardi Valeria Corazza David Trigos Marco Fiore Claudio Guarneri |
| author_facet | Giovanni Damiani Alessia Pacifico Stefano Ricciardi Valeria Corazza David Trigos Marco Fiore Claudio Guarneri |
| author_sort | Giovanni Damiani |
| collection | DOAJ |
| description | Abstract Introduction Patients with psoriasis (PsO) and permanent spinal cord injuries (SCI) resulting in paraplegia and tetraplegia may experience a higher rate of infections compared to patients with PsO without SCI. It can result in further challenges for therapeutic management with immunosuppressants (biological and non-biological treatments). Thus, we aimed to evaluate the rate of infections in patients with PsO and SCI treated with systemic immunosuppressants. Methods This multicenter, retrospective observational study enrolled patients with PsO and traumatic SCI undergoing systemic immunosuppressive treatments for at least 5 years. All patients were evaluated by experienced, board-certified dermatologists and neurologists. Demographic and clinical data were collected. Results We enrolled 23 patients with SCI (16 with paraplegia and 7 with tetraplegia) treated with methotrexate (MTX) and different biologics (tumor necrosis factor (TNF) inhibitors (i) and interleukin (IL)-17i/IL-23i). Globally, patients with SCI treated with MTX displayed higher rates of infection compared to those treated with biologics. Patients with paraplegia had lower rates of infection compared to patients with tetraplegia during anti-psoriatic therapies (p < 0.05). Those treated with TNFi had greater rates of infection than those treated with IL-17i/IL-23i (p < 0.001). Patients with psoriatic arthritis (PsA) experienced a significant diagnostic delay and clinical monitoring of PsA severity was challenging. Conclusion In patients with moderate-to-severe PsO and concurrent traumatic SCI, dermatologists should consider using IL-17i/IL-23i as first-line therapy. |
| format | Article |
| id | doaj-art-8be1e6d2abdf4be39c850e0e23e73c1b |
| institution | OA Journals |
| issn | 2193-8210 2190-9172 |
| language | English |
| publishDate | 2025-01-01 |
| publisher | Adis, Springer Healthcare |
| record_format | Article |
| series | Dermatology and Therapy |
| spelling | doaj-art-8be1e6d2abdf4be39c850e0e23e73c1b2025-08-20T02:15:17ZengAdis, Springer HealthcareDermatology and Therapy2193-82102190-91722025-01-0115242743610.1007/s13555-025-01338-wManagement of Systemic Anti-psoriatic Drugs in Psoriasis Patients with Concurrent Paraplegia or Tetraplegia: Insights From a 6-Year Multicenter, Retrospective Observational StudyGiovanni Damiani0Alessia Pacifico1Stefano Ricciardi2Valeria Corazza3David Trigos4Marco Fiore5Claudio Guarneri6Department of Biomedical, Surgical and Dental Sciences, University of MilanClinical Dermatology Department, IRCCS Saint Gallicano Dermatological InstituteAssociazione Paraplegici Lombardia (APL) OnlusFondazione Natalino Corazza Onlus Psoriasis & Co.European Federation of Psoriasis Patient Associations (EUROPSO)Department of Women, Child and General and Specialized Surgery, University of Campania “Luigi Vanvitelli”Department of Biomedical and Dental Sciences and Morphofunctional Imaging, Section of Dermatology, University of MessinaAbstract Introduction Patients with psoriasis (PsO) and permanent spinal cord injuries (SCI) resulting in paraplegia and tetraplegia may experience a higher rate of infections compared to patients with PsO without SCI. It can result in further challenges for therapeutic management with immunosuppressants (biological and non-biological treatments). Thus, we aimed to evaluate the rate of infections in patients with PsO and SCI treated with systemic immunosuppressants. Methods This multicenter, retrospective observational study enrolled patients with PsO and traumatic SCI undergoing systemic immunosuppressive treatments for at least 5 years. All patients were evaluated by experienced, board-certified dermatologists and neurologists. Demographic and clinical data were collected. Results We enrolled 23 patients with SCI (16 with paraplegia and 7 with tetraplegia) treated with methotrexate (MTX) and different biologics (tumor necrosis factor (TNF) inhibitors (i) and interleukin (IL)-17i/IL-23i). Globally, patients with SCI treated with MTX displayed higher rates of infection compared to those treated with biologics. Patients with paraplegia had lower rates of infection compared to patients with tetraplegia during anti-psoriatic therapies (p < 0.05). Those treated with TNFi had greater rates of infection than those treated with IL-17i/IL-23i (p < 0.001). Patients with psoriatic arthritis (PsA) experienced a significant diagnostic delay and clinical monitoring of PsA severity was challenging. Conclusion In patients with moderate-to-severe PsO and concurrent traumatic SCI, dermatologists should consider using IL-17i/IL-23i as first-line therapy.https://doi.org/10.1007/s13555-025-01338-wPsoriasisMethotrexateSCIIL-17/IL-23 inhibitorsInfectionParaplegia |
| spellingShingle | Giovanni Damiani Alessia Pacifico Stefano Ricciardi Valeria Corazza David Trigos Marco Fiore Claudio Guarneri Management of Systemic Anti-psoriatic Drugs in Psoriasis Patients with Concurrent Paraplegia or Tetraplegia: Insights From a 6-Year Multicenter, Retrospective Observational Study Dermatology and Therapy Psoriasis Methotrexate SCI IL-17/IL-23 inhibitors Infection Paraplegia |
| title | Management of Systemic Anti-psoriatic Drugs in Psoriasis Patients with Concurrent Paraplegia or Tetraplegia: Insights From a 6-Year Multicenter, Retrospective Observational Study |
| title_full | Management of Systemic Anti-psoriatic Drugs in Psoriasis Patients with Concurrent Paraplegia or Tetraplegia: Insights From a 6-Year Multicenter, Retrospective Observational Study |
| title_fullStr | Management of Systemic Anti-psoriatic Drugs in Psoriasis Patients with Concurrent Paraplegia or Tetraplegia: Insights From a 6-Year Multicenter, Retrospective Observational Study |
| title_full_unstemmed | Management of Systemic Anti-psoriatic Drugs in Psoriasis Patients with Concurrent Paraplegia or Tetraplegia: Insights From a 6-Year Multicenter, Retrospective Observational Study |
| title_short | Management of Systemic Anti-psoriatic Drugs in Psoriasis Patients with Concurrent Paraplegia or Tetraplegia: Insights From a 6-Year Multicenter, Retrospective Observational Study |
| title_sort | management of systemic anti psoriatic drugs in psoriasis patients with concurrent paraplegia or tetraplegia insights from a 6 year multicenter retrospective observational study |
| topic | Psoriasis Methotrexate SCI IL-17/IL-23 inhibitors Infection Paraplegia |
| url | https://doi.org/10.1007/s13555-025-01338-w |
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