Acitretin, apremilast, methotrexate safe, effective for ICI-mediated psoriasis

Apremilast, acitretin, and methotrexate demonstrate safety and efficacy for immune checkpoint inhibitor (ICI)-mediated psoriasis, as shown in a study, noting that ICI can be completed unhindered in most cases. In addition, a therapeutic algorithm is suggested by the investigators.

This study reported data on ICI-mediated psoriasis, emerging from the largest cohort to date, and proposed a step-by-step management algorithm. The investigators retrospectively reviewed the medical records of all patients with ICI-mediated psoriasis across nine institutions.

Of the 115 individuals included, 10 had missing data. Grade 1, 2, and 3 disease severity was reported in 60 (57.1 percent), 34 (32.4 percent), and 11 (10.5 percent) of 105 participants, respectively. The ratio between exacerbation and de novo cases was 1:4:3.

Acitretin was the most common systemic therapy (n=23; 20.1 percent), followed by systemic steroids (n=8; 7 percent), apremilast (n=7; 6.1 percent), methotrexate (n=5; 4.3 percent), and biologic agents (n=4; 3.6 percent). Moreover, 29 of 112 patients (25.9 percent) interrupted and 20 of 111 (18 percent) permanently discontinued ICIs due to psoriasis.

Notably, body surface area of >10 percent at baseline was associated with a higher likelihood for ICI treatment modification (odds ratio [OR], 3.64, 95 percent confidence interval [CI], 1.27–10.45; p=0.03) and greater risk for permanent discontinuation (OR, 6.41, 95 percent CI, 2.40–17.11; p<0.001).

Additionally, guttate psoriasis and grade 2 or 3 disease were found to be significant positive predictors for antitumour response of ICI; pruritus, on the other hand, was a negative predictor.

This study was limited by its retrospective design, according to the investigators.