Abstract
ObjectivesAnti-IL-17/23 biologics are increasingly used to treat psoriasis. We aimed to elucidate characteristics of drug-induced interstitial pneumonia (DIIP) caused by anti-IL-17/23 biologics.MethodsWe retrospectively analyzed the clinical data of psoriasis patients treated with anti-IL-17/23 biologics. Chest CT was performed to evaluate DIIP. Serum KL-6 levels were measured before treatment (baseline) and during treatment.ResultsA total of 603 psoriasis patients were treated with anti-IL-17/23 biologics with mean follow-up of 21.1 months. Six patients developed DIIP at mean 14 months after initiation of the therapy. Older age, higher baseline KL-6 value and more frequent pre-existing IPs were associated with development of DIIP by univariate analysis. At the onset of DIIP, elevated serum KL-6 levels with concomitantly increased ground glass opacity (GGO) in Chest CT were demonstrated. DIIP was improved by only cessation of causative agents in five patients but steroid therapy was needed in one patient.ConclusionsDIIP is a plausible complication of anti-IL-17/23 biologics. Age, baseline KL-6 level and underlying IP could be the risk factors for DIIP development. Serum KL-6 levels and chest CT are useful for not only predicting but also detecting DIIP caused by anti-IL-17/23 biologics.
Highlights
Psoriasis is a chronic inflammatory disease mainly affecting the skin [1]
drug-induced interstitial pneumonia (DIIP) is a plausible complication of anti-IL-17/23 biologics
Serum Krebs von den Lungen-6 (KL-6) levels and chest computed tomography (CT) are useful for predicting and detecting DIIP caused by anti-IL-17/23 biologics
Summary
Psoriasis is a chronic inflammatory disease mainly affecting the skin [1]. Increasing evidence suggests that IL-17/23 axis plays important roles in the pathogenesis of psoriasis [1,2,3,4,5]. Biologics inhibiting IL-17/23 axis has been developed to treat psoriasis, and currently, three anti-IL23 and three anti-IL-17 biological agents are available for psoriasis in Japan [6]. Ustekinumab (UST) is a monoclonal antibody targeting IL-12/23 p40, and Guselkumab (GUS) and Risankizumab(RIS) are monoclonal antibodies targeting IL-23 p19. Secukinumab (SEC) and ixekizumab (IXE) are monoclonal antibodies targeting IL-17A, and brodalumab (BRO) is a fully human monoclonal antibody targeting the IL-17 receptor A. All of them have demonstrated high efficacy for psoriasis in clinical settings [7]
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