Adalimumab Therapy in a Patient with Psoriasis, Down Syndrome, and Concomitant Hepatitis B Virus Infection

Figures & data

Figure 1 Extensive bilateral psoriatic lesions over the knee, anterior leg, and dorsum of the foot.

Figure 2 Significant improvement in psoriatic lesions after treatment with adalimumab.

Table 1 Characteristics of Patients with Down Syndrome and Plaque Psoriasis Treated with Biologic Agents

Demographic Data	The Severity of Psoriasis Prior to Systemic/Biologic Treatment	Previous Systemic Treatment	Reason for Stopping	Biologic Treatment	The Severity of Psoriasis After Biologic Treatment
A 31-year-old^Citation4	After the failure of anti-TNF: ● PASI score: 12	Anti-TNF Agents	Failure of anti-TNF agents	Ustekinumab 45 mg S.C initially, 4 weeks later, then every 12 weeks.	Significant improvement of the PASI score
A 12-year-old girl^Citation6	At the time of admission: ● PASI score: 41 ● BSA: 78% After: cyclosporine: ● PASI score: 12.7 ● BSA: 15.5%	Cyclosporine 3.5 mg/kg/d, P.O. for 2 weeks. The dose was tapered to 1.7 mg/kg/d due to elevated liver enzymes	Massive viral warts and loss of efficacy	Etanercept 0.8 mg/kg, S.C. every week	At week 8: ● PASI score: 2.0 ● BSA: 5.5%
A 12-year-old boy^Citation3	BSA: 10%			Adalimumab 40 mg, S.C. every other week	At week 4: ● PGA: 1 ● BSA: 1%
A 20-year-old man^Citation3	BSA: 25% PGA=4	Methotrexate 15 mg weekly and etanercept 50 mg once a week for 9 months.	Etanercept was substituted for adalimumab 40 mg due to lack of efficacy	Adalimumab 40 mg every other week and methotrexate 15 mg every week	Significantly sustained improvement for the next 3 years.
A 30-year-old man^Citation8	BSA: 30% PASI score: 14			Etanercept 25 mg, S.C. twice per week	At week 12: PASI score: 4

Abbreviations: DS, Down syndrome; HBV, hepatitis B virus; HBsAg, hepatitis B surface antigen; HBeAg, hepatitis B e antigen; Anti-HBc, hepatitis B core antibody; HBsAb, hepatitis B surface antibody; HBeAb, hepatitis B e antibody; IFN, interferon; IFNGR-1, interferon gamma receptor-1; IFNGR-2, interferon gamma receptor-2; TNF, tumor necrosis factor; PASI score, Psoriasis area and severity index score; BSA, body surface area; PGA, Physician Global Assessment.

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