Acta Dermato-Venereologica Suppl 219 AbstractPsoriasis2018 | Page 42

40 5 th World Psoriasis & Psoriatic Arthritis Conference 2018 We won’t be insisting on the treatment nor the outcomes of these patients whereas the aim of this presentation is to emphasize the importance of patient’s education, prevention, but also of an early and correct treatment. Materials And Methods: Case report no.1: -Patient characteristics: 49-years-old white Caucasian male; -Clinical presentation: widespread, confluent erythema of the skin, large scales, malaise, intense joint pain, shivers, oliguria, marked onychodystrophy of fingernails and toenails with an evolution of about 1 week; -Physical examination: fever, tachycardia, generalized nontender adenopathy; -Patients history: Psoriasis vulgaris and Psoriatic arthritis since 2003 treated with 8 months Methotrexate switched (due to diges- tive symptoms) to oral Acitretinum for about 2 months prior the current presentation; -Possible cause of the flare-up: lack of compliance to treatment, but mostly because of disorderly lifestyle. Case report no.2: -Patient characteristics: 64-years-old white Caucasian male; -Clinical presentation: widespread, confluent erythema of the skin, large scales, malaise, loss of appetite, marked onychodystrophy of fingernails and toenails with an evolution of about 2 weeks; -Physical examination: fever, tachycardia; -Patients history: Psoriasis vulgaris since 1992 treated with Ada- limumb (discontinued after 2 years) and Methotrexate; -Possible cause of the flare-up: voluntarily discontinuation of the treatment (Methotrexate) 3 weeks prior to current presentation. Case report no.3: -Patient characteristics: 38-years-old white Caucasian female; -Clinical presentation: pustular lesions spread throughout an erythematous background intercalated with skin atrophies and subepidermal pseudocysts disseminated throughout the body, erythematous, scaly plaque on the scalp; -Physical examination: vital signs within normal limits; -Patients history: Pustular Psoriasis from the age of 7 treated with Prednisone, Acitretinum and topical steroids; -Possible cause of the flare-up: voluntarily discontinuation of the treatment (Acitretinum) 7 months prior to current presenta- tion (the patient wishes to conceive) and long-term use of potent topical steroids. Results: All three cases were treated considering the Psoriasis type, clinical presentation and symptoms, each of them having a positive evolution during the hospitalization and follow-up visits. P095 SUCCESSFUL SWITCHING TO BIOSIMILAR IN PSORIATIC PATIENT WITH SEVERE DRUG REACTION TO INFLIXIMAB. A CASE REPORT Maria Politou 1 , Maria Pompou 1 , Dimitrios Rigopoulos 1 , Nikolaos Fekkas 2 , Anastasios Giannoukos 1 1 Department of Dermatology-Venereology "Andreas Syggros" Hospital, UOA, 2 Department of Dermatology-venereology, 401 Military Hospital, Greece 1 st Introduction: Biosimilar medicines are drugs which are highly similar to other biological medicines already licensed and that do not have any clinically meaningful difference to the originator drug in structure, pharmacokinetics, quality, safety or efficacy. Objectives: Many clinical and observational studies involving a switch between reference infliximab and its biosimilars have been conducted or are ongoing. Switching between reference biologics and biosimilars should be performed by the prescriber for clinical reasons such as optimizing efficacy or minimizing AES. Efficacy and clinical measures of safety were similar in the switched and not switched groups at studies end. Differences in the type of AES upon switching must also be considered. Because biosimilars are www.medicaljournals.se/acta structurally distinct from innovator biologic, they may produce significantly different side effects. Although, data in the literature suggest that if a patient experience a severe allergic reaction to the originator drug it is most possible the same reaction to happen with the biosimilar this may not always be the case. Methods/Results: We present a case of a 60 years old female patient with severe plaque psoriasis from 25 years treated with infliximab every eight weeks for the last five years with great therapeutic ef- ficacy. During the last five infusions she presented mild reaction with itching and facial redness which was treated successfully with antihistamines without the need of interrupting the infusion. Patient was also administered pretreatment therapy with a three day course of corticosteroids to minimize these reactions. During the last infusion patient presented severe body rash and hypotension which led to the discontinuation of the infusion. Due to the great therapeutic response and because patient had undergone several therapies in the past which either hadn’t tolerated or hadn’t re- sponded to, she was reluctant to change therapy so we decided to switch to a biosimilar. Patient is currently through the eight month of treatment with the biosimilar with no sign of reaction and with maintenance of the therapeutic response. Conclusion: Biologics are much more complex than conventional chemical drugs because they are larger and have more complicated structures, so it is impossible to produce biosimilars that are iden- tical to the originator drug. As a result, the therapeutic efficacy and safety of a biosimilar could vary from the originator because the end product is highly dependent on a proprietary manufacturing process that differs for each manufacturer. Our case suggests that we may try a switch between reference biologic and its biosimilar even when an allergic reaction to the originator drug had occurred, especially when we have a great therapeutic efficacy. However, more data is needed. P096 SAFETY OF APREMILAST IN THE TREATMENT OF A PSORIASIS PATIENT WITH CHRONIC HEPATITIS B Christina Fotiadou, Myrto Trakatelli, Despina Papathemeli, Eli- zabeth Lazaridou Second Department of Dermatology-Venereology, Aristotle University Medical School Introduction: The treatment of patien