Patient With Plaque Psoriasis and Accompanying End-Stage Renal Disease Treated With Adalimumab

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A recent case report published in the journal Clinical, Cosmetic and Investigational Dermatology revealed that therapy with adalimumab led to the successful treatment of a patient with severe plaque psoriasis and psoriatic end-stage renal disease.

Investigators Xu et al sought to explore connections between psoriasis and renal complications, noting that the literature has described associations between psoriatic disease and several other comorbidities. These include cardiometabolic disorders, stroke, and mood disorders, among them.

Xu et al describe a case of a 40-year-old male patient with severe plaque psoriasis. The patient presented with a 10-year history of psoriasis. Despite receiving intermittent and irregular treatment with various oral and topical treatments, the patient's psoriasis recurred without regular management or follow-up.

The patient was examined and given a Psoriasis Area and Severity Index (PASI) score of 62 and a Physician Global Assessment (PGA) score of 4 with over 87% of body surface area impacted by psoriasis lesions, leaning toward erythrodermic psoriasis.

When admitted to a local hospital, an exam determined the patient also had severe comorbid end-stage renal disease (ESRD).

"Considering the patient’s high severity of psoriasis, previous lack of significant improvement by traditional medications and the possible burden on the kidneys by traditional oral medications because of his comorbid ESRD, we concluded that biologic therapy was safe and effective, and the patient was advised to complete procalcitonin, interleukin assays and other related tests," study authors wrote.

On the 7th day of the patient's hospitalization, treatment with adalimumab 80 mg was administered. The patient was also advised to lower the dose of adalimumab to 40 mg due to renal dysfunction upon examination with a laboratory exam.

At discharge, the patient achieved PASI 75 and a PGA score of 3. In total, the patient's overall affected body surface area reduced to 15%.

"We suggest that patients with psoriasis are more likely to develop CKD and ESRD and that biologics may also play a role in therapy for psoriasis-related kidney damage," study authors wrote. "Because host defenses are often compromised in patients with CKD/ESRD, careful monitoring and follow-up of infection is also required when administering biologic therapies. Further research into biologic therapies for patients with CKD/ESRD would provide useful treatment options for patients with psoriasis suffering from renal failure."

Reference

Xu J, Chen A, Peng Y, Wen Z, Huang K, Wang P. A case report of adalimumab successfully treated a severe plaque psoriasis patient with psoriatic end-stage renal disease. Clin Cosmet Investig Dermatol. 2023;16:2841-2846. Published 2023 Oct 12. doi:10.2147/CCID.S420900