P20 A case of erythrodermic psoriasis successfully treated with ixekizumab combined with low-dose methotrexate to ensure sustained clearance: a case report
Year: 2024
Type: article
Study design: Case Report
Abstract: Erythrodermic psoriasis (EP) is a severe type of psoriasis that requires immediate and effective treatment. Although recommended as first-line treatment, systemic immunomodulators such as methotrexate and/or cyclosporine can sometimes be ineffective or undesirable, hence the use of biologics. However, in cases of refractory disease, biologics may be combined with methotrexate to boost efficacy and optimize outcomes without compromising safety and tolerability. A 16-year-old Filipino male was seen at a tertiary hospital for generalized erythema with scaling. He had chronic plaque psoriasis since age 11 and was previously treated with methotrexate 10 mg weekly, folic acid supplementation, and alternate courses of topical clobetasol and calcipotriol every 2 weeks until near remission was achieved. He was then lost to follow-up and never went through phototherapy. The patient was diagnosed with EP and was treated simultaneously with methotrexate at a maximum of 17.5 mg/week and cyclosporine at 2.75 mg/kg/day. After 6 months of continuous treatment with no reported adverse effects, the patient still exhibited minimal improvement. The patient was then started with ixekizumab 80 mg subcutaneous injections every 4 weeks in an off-label indication and dose for his age in the Philippines. The biologic was given alongside low-dose methotrexate at 7.5 mg/week; cyclosporine was discontinued. After 12 weeks of ixekizumab in combination with low-dose methotrexate, the patient achieved PASI75. The patient received his last dose of ixekizumab at Week 20 in combination with methotrexate of the same dose with good response at PASI100, achieving complete skin clearance. Since discontinuation of ixekizumab, the patient remains lesion-free with low-dose methotrexate at Week 32, with no reported adverse effects. In a resource-constrained setting such as the Philippines, payments for treatment are largely out-of-pocket. Government subsidies for effective but expensive treatments such as biologics are limited, forcing physicians to revert to a more affordable but not necessarily more effective treatment. Methotrexate has been found to have moderate to good efficacy in the treatment of psoriasis. Its acceptable safety profile and affordable cost make it a favourable treatment option for patients with psoriasis in the Philippines. Due to its nature of being a slow starter, the concomitant use of low-dose methotrexate for at least 12 weeks provides a treatment reserve that will allow continuous efficacy once the biologic drug is discontinued. This case illustrates the effective and safe use of ixekizumab combined with methotrexate in the treatment of EP, a strategy employed to overcome limitations in management secondary to finances in a resource-constrained setting such as the Philippines.
Source: British Journal of Dermatology
Language: English
Subfield: Immunology
Field: Immunology and Microbiology
Domain: Life Sciences
Open Access status: bronze
OpenAlex ID: W4405229395