Evaluation of the effectiveness of long-term interruption and resumption of therapy with ustekinumab in psoriasis patients with metabolic disorders

Abstract

BACKGROUND:Psoriasis is a chronic immune-mediated inflammatory skin disease. The goal of psoriasis therapy is to achieve long-term stable remission and improve the patients quality of life. Continuity of therapy is the basis for successful disease control. To achieve this goal, the most effective genetic engineered biological drugs are currently used. However, in some patients the biologicals demonstrated insufficient effectiveness. The presence of comorbidities, in particular metabolic syndrome in such cases, is one of the reasons for low therapeutic response.
 AIM:This study aimed to evaluate the therapeutic effectiveness of ustekinumab in psoriasis patients with metabolic syndrome after a long interruption and resumption of therapy.
 MATERIALS AND METODS:We observed 68 patients diagnosed with advanced plaque psoriasis. They were divided into two groups according to their body mass index and metabolic disorders.
 RESULTS:By week 24, 96.8% of the patients in group 1 and 91.6% in group 2 reached PASI 75. By week 48, 100% of the patients in group 1 and 86.1% in group 2 reached PASI 75. By week 76, PASI 75 was observed in 96.8% of patients receiving 45 mg of ustekinumab and in 83.3% of patients receiving 90 mg of ustekinumab. Treatment with ustekinumab was discontinued at week 76 due to economic factors. The therapy was discontinued for 36 weeks. By week 112, 86.7% of the patients in both groups had a relapse of psoriasis, which was assessed by the loss of therapeutic response. By week 124 (12 weeks after the resumption of therapy), PASI 75 was reached in 93.7% of the patients in group 1 and 77.7% in group 2. By week 136, all patients in group 1 had achieved PASI 75, and by week 128, 83.3% of patients in group 2 had PASI 75.
 CONCLUSIONS:In patients with psoriasis on ustekinumab therapy, a long-term (36 weeks) interruption and resumption of therapy is possible. However, in patients with comorbid pathology, effectiveness is dimi-nished; thus, new methods of pathogenetic therapy to correct metabolic disorders are needed.