Successful Treatment with Secukinumab in a Psoriasis Patient on Hemodialysis

Abstract

Moderate to severe psoriasis has been reported as an independent risk factor for IgA nephropathy (IgAN). IgAN is characterized by episodic microscopic hematuria, which can progress to end-stage renal disease (ESRD). Managing therapeutic interventions for psoriasis patients requiring dialysis due to ESRD presents significant challenges. We present a case of severe plaque psoriasis in a patient concurrently diagnosed with IgAN who is dependent on hemodialysis. Over the past two months, his condition has worsened without any identifiable triggers. Physical examination revealed generalized scaly plaques on the scalp, trunk, and extremities, resulting in a Psoriasis Area Severity Index (PASI) score of 19.2. Laboratory tests confirmed end-stage renal insufficiency, with no other abnormalities detected. Consequently, the patient was prescribed subcutaneous secukinumab following a standard regimen. He achieved complete resolution of symptoms after eight weeks of treatment and experienced no recurrence during a one-year follow-up. His kidney-related parameters remained stable during secukinumab therapy. To summarize, this case report discusses a patient with severe psoriasis who also has concurrent IgAN and ESRD, successfully treated with secukinumab. It reinforces the rapid efficacy and enduring safety of secukinumab in managing psoriasis in hemodialysis-dependent patients with IgAN comorbidity. Zeno Fratton et al has reported that an interleukin (IL)-17A/F inhibitor effectively treats moderate-to-severe psoriasis in patients with chronic kidney disease (CKD). However, further studies are necessary to develop evidence-based guidelines for biologic selection within this vulnerable population.

Keywords: IgA nephropathy; end-stage renal disease; hemodialysis; psoriasis; secukinumab.

Figure 1

(A–D) Clinical presentation of the patient before treatment; (E–H) Image of the patient 8 weeks after initial treatment with secukinumab; (I–L) Photograph of the patient 12 months after secukinumab treatment.