PMID- 30076588
OWN - NLM
STAT- MEDLINE
DCOM- 20190204
LR  - 20190215
IS  - 1179-2000 (Electronic)
IS  - 1177-1062 (Linking)
VI  - 22
IP  - 6
DP  - 2018 Dec
TI  - Treating a Multidrug-Resistant Psoriatic HLA-C*18:01 Allele Carrier with 
      Combination Ustekinumab Apremilast Therapy.
PG  - 717-721
LID - 10.1007/s40291-018-0354-8 [doi]
AB  - BACKGROUND: Nowadays, even though several biologic therapies are available to 
      treat psoriasis, multidrug-resistant disease continues to be a therapeutic 
      challenge. Combination therapy has therefore become increasingly important. In 
      this context, apremilast, according to its safety profile, could easily be 
      combined with biologics in patients with comorbidities and/or recalcitrant 
      multidrug-resistant psoriasis. OBJECTIVE: Our goal is to share experience from 
      our institution in the observation of a patient with severe chronic plaque 
      psoriasis that was unresponsive to all anti-tumor necrosis factor-alpha treatment and 
      to an anti-interleukin (IL)-17A drug and only partially responsive to 
      ustekinumab, even in combination with apremilast. The patient carried a rare 
      allele infrequently found in Caucasian people: human leukocyte antigen 
      (HLA)-C*18:01. This allele has been found to be positively associated with 
      psoriasis in Brazilian patients. METHODS: The patient was typed for the HLA-C 
      locus at high resolution via polymerase chain reaction sequence-specific 
      oligonucleotide probes (PCR-SSOP) using a commercial kit (LAB((R))Type, One Lambda 
      Inc., Canoga Park, CA, USA). RESULTS: Our patient, previously described as having 
      multidrug-resistant psoriasis, commenced ustekinumab and apremilast combination 
      therapy. After 12 weeks, the Psoriasis Area Severity Index score had worsened, 
      and we suspended combination therapy because the patient reported an absence of 
      any benefit and was experiencing side effects from the induction therapy with 
      apremilast. CONCLUSIONS: Expanding on the previously reported experience with 
      this patient, we conclude that HLA-C*18:01 probably indicates a severe, 
      recalcitrant, multidrug-resistant psoriasis phenotype for which proper therapy 
      remains to be identified.
FAU - Galluzzo, Marco
AU  - Galluzzo M
AUID- ORCID: 0000-0002-3424-5175
AD  - Dermatology, Department of "Medicina dei Sistemi", University of Rome "Tor 
      Vergata", Viale Oxford, 81, 00133, Rome, Italy. marco.galluzzo83@gmail.com.
FAU - D'Adamio, Simone
AU  - D'Adamio S
AD  - Dermatology, Department of "Medicina dei Sistemi", University of Rome "Tor 
      Vergata", Viale Oxford, 81, 00133, Rome, Italy.
FAU - Campione, Elena
AU  - Campione E
AD  - Dermatology, Department of "Medicina dei Sistemi", University of Rome "Tor 
      Vergata", Viale Oxford, 81, 00133, Rome, Italy.
FAU - Bianchi, Luca
AU  - Bianchi L
AD  - Dermatology, Department of "Medicina dei Sistemi", University of Rome "Tor 
      Vergata", Viale Oxford, 81, 00133, Rome, Italy.
FAU - Talamonti, Marina
AU  - Talamonti M
AD  - Dermatology, Department of "Medicina dei Sistemi", University of Rome "Tor 
      Vergata", Viale Oxford, 81, 00133, Rome, Italy.
LA  - eng
PT  - Case Reports
PT  - Journal Article
PL  - New Zealand
TA  - Mol Diagn Ther
JT  - Molecular diagnosis & therapy
JID - 101264260
RN  - 0 (Dermatologic Agents)
RN  - 0 (HLA-C Antigens)
RN  - FU77B4U5Z0 (Ustekinumab)
SB  - IM
MH  - Alleles
MH  - Combined Modality Therapy
MH  - Dermatologic Agents/*therapeutic use
MH  - Drug Resistance, Multiple/*genetics
MH  - Female
MH  - HLA-C Antigens/*genetics
MH  - Humans
MH  - Middle Aged
MH  - Psoriasis/*drug therapy
MH  - Ustekinumab/*therapeutic use
EDAT- 2018/08/05 06:00
MHDA- 2019/02/05 06:00
CRDT- 2018/08/05 06:00
PHST- 2018/08/05 06:00 [pubmed]
PHST- 2019/02/05 06:00 [medline]
PHST- 2018/08/05 06:00 [entrez]
AID - 10.1007/s40291-018-0354-8 [pii]
AID - 10.1007/s40291-018-0354-8 [doi]
PST - ppublish
SO  - Mol Diagn Ther. 2018 Dec;22(6):717-721. doi: 10.1007/s40291-018-0354-8.