泛发性脓疱型银屑病患者伴有对静脉注射斯贝单抗无效的杂合子低表型 MPO 变异。

Youichi Ogawa, Eri Maejima, Takuya Takeichi, Takashi Okamoto, Hiroshi Mitsui, Shinji Shimada, Masashi Akiyama, Tatsuyoshi Kawamura
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摘要

泛发性脓疱型银屑病(GPP)是一种反复发作、有时可危及生命的无菌性脓疱病。由于白细胞介素(IL)-36 是疾病形成的核心细胞因子,干扰 IL-36 受体信号转导的斯派索利单抗非常有效。在此,我们报告了一名对静脉注射司来索利单抗无效的GPP患者,该患者患有杂合子低形态MPO变异。虽然斯派索利单抗在消退原有脓疱和红斑方面显示出了极佳的临床疗效,但它并没有抑制新脓疱和红斑的出现,而这些新脓疱和红斑并没有降低外周血中性粒细胞计数,因此,在第二次输注斯派索利单抗后,又输注了一种抗IL-17A/IL-17F抗体--bimekizumab,从而消退了脓疱和红斑。我们讨论了对斯来索利单抗产生耐药机制的可能原因。
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Generalized pustular psoriasis patient with a heterozygous hypomorphic MPO variant refractory to intravenous spesolimab.

Generalized pustular psoriasis (GPP) is a recurrent and sometimes life-threatening sterile pustular disease. Because interleukin (IL)-36 is the central cytokine in disease formation, spesolimab, which interferes with IL-36 receptor signaling, is highly effective. Here, we report a patient with GPP with a heterozygous hypomorphic MPO variant refractory to intravenous spesolimab. Although spesolimab showed excellent clinical efficacy in resolving pre-existing pustules and erythema, it did not suppress the emergence of new pustules and erythema, which did not decrease the peripheral blood neutrophil count, therefore bimekizumab, an anti-IL-17A/IL-17F antibody, was administered after the second spesolimab infusion, which resolved the pustules and erythema. We discuss the possible reasons for the resistance mechanism to spesolimab.

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