Ustekinumab in the Treatment of Moderate to Severe Lower Extremity Psoriasis: A case series

Abstract

People that endure moderate to severe plaque psoriasis regularly report social and personal discomforts that impair their quality of life. When topical therapy, phototherapy, and common oral medications such as methotrexate and cyclosporine have failed, targeted systemic therapies (biologics) have become increasingly more common. The purpose of this case series was to examine the use of Ustekinumab (Stelara™) for moderate to severe plaque psoriasis to the lower extremity. Four individuals (3 males, 1 female) ranging in age from 16 to 66 years with a prior history of ineffective conventional therapy for their lower extremity plaque psoriasis were selected for this study. After reviewing each patient’s medical history they received their first injections at the Temple University Foot and Ankle Institute during March-June 2010. Patient progress was based on the clinical PASI score (Psoriasis Area and Severity Index), which was calculated at each visit. After 16 weeks of treatment, clinical regression of moderate to severe lower extremity plaque psoriasis was noted in three of the four cases. At 52 weeks, it was noted in all four cases. Ustekinumab is a fully human monoclonal antibody that binds with high specificity and affinity to the shared cytokine subunit p40 found in both IL-12 and IL-23. In turn, this decreases the differentiation of T-cells, an important phase in the pathogenesis of psoriasis. This protein selective targeting allows the physician increased mechanisms to combat plaque recalcitrant palmo-plantar psoriasis. More importantly, it provides the patient a new and proven means to control their own quality of life when other psoriatic treatments have failed. In this case series, ustekinumab injections show an effective method of controlling chronic and recalcitrant plantar psoriasis.