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Letter | Dermatol Pract Concept 2020;10(4):2020102 1
Dermatology
Practical & Conceptual
Introduction
Several guidelines recommend phototherapy, systemic agents,
or biologic therapy for the treatment of moderate-to-severe
psoriasis. Sequential use of more than 1 biologic has become
more common due to primary or secondary failure with this
type of treatment and an increase in the number of drugs
available. However, the order of usage of these drugs is still
speculative. We report about a patient with severe psoria-
sis with primary failure to respond after treatment with
ustekinumab and adalimumab who achieved psoriasis area
and severity index (PASI) 100 score with secukinumab in 8
weeks.
Case Presentation
A 47-year-old woman presented with a 30-year history of
psoriasis vulgaris without psoriatic arthritis or other comor-
bidities. She was previously treated with methotrexate and
PUVA but had hepatotoxicity and minimal response with
UVB narrowband.
At first visit, the patient revealed PASI 23.7, dermatol-
ogy life quality index (DLQI) 30, body surface area (BSA)
30, and body weight 80 kg (Figure 1) and was subsequently
Secukinumab: Rapid Efficacy in Psoriasis After
Primary Failure With Ustekinumab and Adalimumab
Aline Lissa Okita1, Tatiane Benini1, Denise Reis Longhi1
1 Department of Dermatology, Universidade de Mogi das Cruzes, São Paulo, Brazil
Key words: severe psoriasis, biologics, secukinumab, adalimumab, ustekinumab
Citation: Okita AL, Benini T, Reis Longhi D. Secukinumab: rapid efficacy in psoriasis after primary failure with ustekinumab and
adalimumab. Dermatol Pract Concept. 2020;10(4):e2020102. DOI: https://doi.org/10.5826/dpc.1004a102
Accepted: May 28, 2020; Published: October 26, 2020
Copyright: ©2020 Okita et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License BY-
NC-4.0, which permits unrestricted noncommercial use, distribution, and reproduction in any medium, provided the original author and
source are credited.
Funding: None.
Competing interests: The authors have no conflicts of interest to disclose.
Authorship: All authors have contributed significantly to this publication.
Corresponding author: Aline Lissa Okita, MD, Department of Dermatology from Universidade de Mogi das Cruzes, Ave Dr Cândido X de
Almeida e Souza, 200, São Paulo, Brazil. Email: alinelissaokita@gmail.com
Figure 1. Clinical presentation prior to ustekinumab treatment.
2 Letter | Dermatol Pract Concept 2020;10(4):2020102
300 or 150 mg. The 3 groups were: patients with primary
failure to anti-TNFα; patients with secondary failure to an-
ti-TNFα; and patients who failed with more than one an-
ti-TNFα. The patients in the 3 groups achieved statistically
significant rates of PASI 75 using secukinumab 300 mg [2].
Magnano et al reported on 16 psoriatic patients previ-
ously treated with more than 1 systemic or biologic agent,
without control of skin lesions. These patients were treated
with secukinumab, and 8 of them obtained a complete clear-
ance (PASI 100), 6 patients presented PASI 90, and 2 patients
showed PASI 75. All patients presented improvement in the
DLQI [3]. In addition, a case of successful treatment with
secukinumab in recalcitrant psoriatic arthritis treated previ-
ously with 2 anti-TNF drugs was reported [4].
The case reported here was exposed to multiple systemic
treatments resulting in inadequate disease control and adverse
events that led to discontinuation of therapies. She failed to re-
spond to both anti-TNFα and anti-IL12/23 drugs but reached
PASI 100 in 8 weeks with secukinumab without any adverse
effects. This indicates that each patient may have a specific
behavior in the disease pathway and might respond better to
certain drugs. Further studies are needed to determine which
factors are essential to define the biologic of choice.
treated with ustekinumab 45 mg for 6 months with no re-
sponse. Then she received adalimumab, but symptoms wors-
ened with an increased number of lesions and intense itching
(PASI 33.6, DLQI 30, BSA 78) (Figures 2A and 3A). After
that, she received secukinumab 300 mg at weeks 0, 1, 2 and
3, 4 achieving PASI 75 at week 5 (Figures 2B and 3B) and
PASI 100 and DLQI 0 at week 8.
Conclusions
Studies on secukinumab have demonstrated rapid and high
efficacy in the treatment of psoriasis, and bio-naïve patients
achieved higher scores, PASI 90, than those previously ex-
posed to treatment with biologics.
However, many authors reported successful treatment
with secukinumab after biological exposure. In one series
of 6 patients, patients exhibited efficacy with secukinumab
after failure with ustekinumab. Four patients had primary
failure with ustekinumab and 2 patients experienced second-
ary failure. After 12 weeks, 4 patients achieved PASI 90 with
secukinumab [1].
Another study of 235 patients randomized 3 groups of
anti-TNF nonresponders to treatment with secukinumab at
Figure 2. Clinical presentation. (A) After adalimumab treatment.
(B) After 5 weeks of secukinumab treatment.
A B
Figure 3. Clinical presentation. (A) After adalimumab treatment.
(B) After 5 weeks of secukinumab treatment.
A B
Letter | Dermatol Pract Concept 2020;10(4):2020102 3
Acad Dermatol. 2018;79(3 Suppl 1): AB256. Poster Abstract.
DOI: 10.1016/j.jaad.2018.05.1018.
3. Magnano M, Loi C, Patrizi A, et al. Secukinumab in multi-
failure psoriatic patients: the last hope? J Dermatolog, Treat.
2018;29(6):583–585. DOI: 10.1080/09546634.2018.1427206.
PMID: 29334270.
4. Pelechas E, Memi T, Voulgari PV, Drosos AA. A case of recal-
citrant psoriatic arthritis to tnf inhibitors improved after ad-
ministration of secukinumab, an IL-17A inhibitor. Rheumatol
Ther. 2017;4(2):509–513. DOI: 10.1007/s40744-017-0084-0.
PMID: 29022197.
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