Secukinumab effective for treating pityriasis rubra pilaris: Study

USA: Secukinumab is a good therapy with favorable outcomes for pityriasis rubra pilaris (PRP) and deserves more research, suggests an article published in the British Journal of Dermatology.

Pityriasis rubra pilaris is a diverse collection of uncommon papulo-squamous illnesses distinguished by folliculo-centric keratinization. The incidence of PRP is bimodal, with equal gender preference. The pathophysiology of pityriasis rubra pilaris is unknown, however, IL-17 has been proven to play an important role. There are no effective immunomodulatory drugs for the treatment of PRP. As a result, Blake W. Boudreaux and colleagues undertook this study to assess the therapeutic effectiveness of secukinumab as well as to describe the transcriptome landscape of PRP and its response to IL-17A inhibition.

Twelve PRP patients were enrolled in an open-label study with secukinumab. Secukinumab was administered to patients throughout a 24-week period. The primary goal was to reduce the Psoriatic Area Severity Index score (PASI-75) by ≥75% from baseline to week 28. PASI-90, change in Dermatology Life Quality Index (DLQI)score, and change in Physician Global Assessment (PGA) were secondary objectives. At baseline and week 2, RNA sequencing was done on lesional and non-lesional skin samples. Differential gene expression and pathway enrichment were identified by comparing sample groups.

The key findings of this study were as follows:

1. At week 28, 6 patients (55%) reached PASI-75, whereas 3 patients (27%) achieved PASI-90.

2. Treatment resulted in substantial improvements in PGA and DLQI scores.

3. There were no significant treatment-related side effects. Secukinumab treatment restored transcriptional discrepancies between lesional and nonlesional skin.

4. Transcriptomic findings from nonresponsive patients imply that secukinumab resistance may be caused by the overactivity of innate immune pathways.

In conclusion, PRP is a transcriptionally diverse illness with a varied response to treatment. Future clinical trials should include agents targeting additional IL-17 isoforms and innate immune mediators.

Reference:

Boudreaux, B.W., Pincelli, T.P., Bhullar, P.K., Patel, M.H., Brumfiel, C.M., Li, X., Heckman, M.G., Pittelkow, M.R., Mangold, A.R. and Sluzevich, J.C. (2022), Secukinumab for the Treatment of Adult-Onset Pityriasis Rubra Pilaris: A Single-Arm Clinical Trial with Transcriptomic Analysis. Br J Dermatol. Accepted Author Manuscript. https://doi.org/10.1111/bjd.21708