title: Ustekinumab for treatment of plaque psoriasis in a patient with Down syndrome.
abstract: Down syndrome (DS) is the most common chromosomal disorder and a major cause of mental retardation. Down syndrome phenotype is complex and may present a combination of dysmorphic features, congenital heart disease and immunological deficiency. Psoriasis it has been noted to be 0.5%-8% in patients with DS and numerous factors can limit the use of therapeutic options, in particular long-term organ-specific toxicity, and the risk of opportunistic infections. It is still debated whether the use of biologics in the treatment of DS-related psoriasis is safe. We have valuated the efficacy and safety of ustekinumab treatment in-patient with DS suffering from plaque type psoriasis. A 31-year-old patient suffering from plaque type psoriasis since the age of 14, showed a PASI score of 12 after the failure of anti-TNF agents. We switched the patient to ustekinumab treatment at the standard dose of 45 mg subcutaneously initially and 4 weeks later, followed by 45 mg every 12 weeks. The patient showed a significant improvement of the PASI score already after 4 weeks of treatment and further improvements were observed throughout the treatment. We report the first case of DS-correlated psoriasis patient treated for a long-term period with various biologics, showing a satisfactory safety profile undergoing treatment. In our experience, ustekinumab has demonstrated a high efficacy, relatively rapid onset of action, favorable safety profile, and can be considered a good treatment option even after failure to respond to other biologic therapies in patient with DS.
authors.affiliation: Department of Dermatology, University of Rome Tor Vergata, Rome, Italy. marinatalamonti@libero.it
authors.forename: Marina
authors.initials: M
authors.lastname: Talamonti
authors.forename: Marco
authors.initials: M
authors.lastname: Galluzzo
authors.forename: Andrea
authors.initials: A
authors.lastname: Chiricozzi
authors.forename: Miriam
authors.initials: M
authors.lastname: Teoli
authors.forename: Mauro
authors.initials: M
authors.lastname: Bavetta
authors.forename: Antonio
authors.initials: A
authors.lastname: Costanzo
authors.forename: Sergio
authors.initials: S
authors.lastname: Chimenti
mesh_terms: D000328:Adult; D000911:Antibodies, Monoclonal / Q000009:adverse effects / Q000627:therapeutic use*; D061067:Antibodies, Monoclonal, Humanized; D004314:Down Syndrome / Q000150:complications*; D006801:Humans; D007155:Immunologic Factors / Q000009:adverse effects / Q000627:therapeutic use*; D008297:Male; D011565:Psoriasis / Q000150:complications / Q000188:drug therapy*; D012720:Severity of Illness Index; D000069549:Ustekinumab
chemical_list: D000911:Antibodies, Monoclonal; D061067:Antibodies, Monoclonal, Humanized; D007155:Immunologic Factors; D000069549:Ustekinumab