Introduction: Pyoderma gangrenosum (PG) is an ulcerating disease associated with a high degree of morbidity and mortality. Currently, little is known about the pathophysiology of PG, though it has been linked to increased levels of inflammatory cytokines including TNF- alpha, interleukin-17, interleukin-12 and interleukin-23.(1)
Monoclonal antibodies (mAbs) are emerging as a novel therapeutic option in recalcitrant PG (2,3,4,5) although there are no guidelines or therapeutic standards for their use. The aim of this study was to report our clinical experience with mAbs in cases of relapsing and multiresistant PG.
Methods: In our study we included: 1 patient treated with Ixekizumab (anti IL-17 mAb) , 3 patients with Risankizumab (anti IL-23 mAb), 1 patient with Bimekizumab (anti IL-17 mAb), and 2 patients with Adalimumab (anti TNF-alpha mAb).
Each patient was evaluated after 3 and 6 months from the start of the mAb therapy, by performing a complete Wound Bed Score (WBS) assessments and Dermatology Life Quality Index (DLQI).
Results: All patients treated with these molecules showed a significant improvement in terms of DLQI and WBS (Delta DLQI 80% and Delta WBS 60%).
Each of our patients, however, could not achieve good disease control with mAbs monotherapy.
Discussion: mAbs represent an excellent therapeutic option in cases of recalcitrant PG.
Due to the complex molecular landscape of wound healing, it is not possible to identify a single target molecule and for this reason the use of mAbs should be interpreted as a translational application to limited cases of multi-resistant conditions.
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