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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
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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