Adalimumab for severe psoriasis in Chilean paediatric patients

Juvenile psoriasis is a chronic inflammatory skin disease affecting the 0.6--1.4% of paediatric patients. It is associated with several comorbidities including: psoriatic arthritis, psychiatric disorders, diabetes mellitus 1 and 2, hypertension, obesity, hyperlipidaemia and Crohn disease; therefore, it is essential to establish an early and adequate treatment. Systemic therapeutic options in children are limited because of the adverse events, and approved biologic therapies in severe psoriasis at the moment are few. Adalimumab has been approved by the European Medicines Agency (EMA) for the treatment of severe plaque psoriasis in patients from 4 years of age, and recently a randomized, double-blind clinical trial has shown its safety and superiority compared to methotrexate. In Chile, there’s no economic reimbursement for biological therapies and patients must pay on their own the full treatment, so the access to these therapies is limited due to the costs. The aim of our research is to present our experience with the use of adalimumab in paediatric patients with severe psoriasis. Patients < 18 years old with severe psoriasis and lack of response to topical and/or systemic-non-biological therapies were selected to receive adalimumab 0.8 mg/kg subcutaneously at week 0, then every other week since week 1. They were followed-up for at least 40 weeks. Monthly clinical evaluations were performed; Psoriasis Area and Severity Index (PASI) and Physician Global Assessment 6 point scale (PGA) were assessed at all visits. Four patients were selected, three were female. The median age at diagnosis of psoriasis was 11 years old and the mean duration of the disease before the use of adalimumab was 4.2 years. Two had positive family history of psoriasis but none of them were first-degree relatives. All of them had severe plaque psoriasis. Patient 4, presented severe genital psoriasis and HLA B27+ psoriatic arthritis with involvement