Abstract Background There is a significant association between psoriasis and IBD, which share the pathogenic role of IL-23. In the dermatological field, drugs targeting the p19 subunit of IL-23, such as risankizumab, guselkumab, and tildrakizumab, have been approved for the treatment of moderate to severe psoriasis. However, there are still no real-life data on the efficacy and safety profile of IL-23 inhibitors in patients with IBD. Methods A prospective, single center observational study was conducted on patients with IBD and psoriasis from April 2021 to March 2023 at the gastroenterological-dermatological outpatient clinic at “Città della Salute e della Scienza of Turin”, Italy. Patients received a dermatological indication to start drug therapy with IL-23 inhibitors according to the dermatological dosing schedule. They were treated either with guselkumab subcutaneously at a dose of 100 mg every 8 weeks, or with risankizumab subcutaneously at a dose of 150 mg every 12 weeks, or with tildrakizumab 100 mg every 12 weeks subcutaneously. Objectives of this study included evaluating the achievement of clinical remission at 3, 6, and 12 months, defined as disease activity with Harvey-Bradshaw Index (HBI) < of 5 in CD and pMAYO < of 2 in UC. Results At 3 months after the start of drug treatment, clinical remission was achieved by 73.3% of patients (p=0.006). This number also remained almost constant at 6 (62.4%, p=0.008) and 12 months (60.3%, p=0.04). In addition, there was a statistically superior steroid-free clinical remission compared to T0 at 3 (15.3% vs 73.3%, p=0.006) and 6 months (7.1% vs 54.1%, p=0.04). No major side effects were reported. Two cases of arthralgias (11.8%) and one case of fever with chills (5.9%) were reported. IL-23 inhibitors appear to be effective in maintaining the steroid-free clinical remission. In addition, there was a reduction in fecal calprotectin values to a median value at 6 months of 81.0 (95%IC= 28.2-249.8; p=0.03) from a median value at T0 of 343.1 (95%IC= 44.8-869.7). The maintenance rate of IL-23 inhibitors therapy at the end of follow-up was 75.8%. Conclusion In this study risankizumab, guselkumab, and tildrakizumab appear to be effective in inducing clinical remission and steroid-free clinical remission in patients with IBD. In addition, they appear to be effective in maintaining steroid-free clinical remission. IL-23 inhibitors demonstrated a good safety profile in patients with IBD. Despite the limitations of the study with the need to publish further real-world data on a larger scale and with higher dosing of IL-23 inhibitors, the results obtained are promising as they, for the first time, provide real-life support for the clinical potential of these drugs as treatment for IBD in addition to psoriasis.

Dear Editor, Pustular (PP) and erythrodermic psoriasis (EP) represent two subtypes of psoriasis that need prompt treatment to prevent potentially life-threating complications. Recently, interleukin-17 inhibitors secukinumab and ixekizumab have shown remarkable results in plaque psoriasis and few studies reported good responses to biologics in PP and EP as well. However, real-life studies comparing secukinumab and ixekizumab in the treatment of PP and EP subtypes cannot be found in the literature. To compare safety and efficacy of secukinumab and ixekizumab in PP and EP patients, we conducted a real-life monocentric cohort study, collecting 20 PP and 15 EP patients from the Dermatology clinic of the University of Turin (Table 1). Retrospective enrolment took place between October 2016 and April 2020, with follow-up until March 2021. Disease severity was assessed at baseline by Psoriasis Area Severity Index (PASI). Patients were treated with secukinumab (two 150 mg-injections at weeks 0, 1, 2, 3 and 4, followed by monthly maintenance) or with ixekizumab (two 80 mg-injections, followed by bimonthly maintenance for 12 weeks and subsequent monthly injections). The primary end-point of the study was PASI at week 12, at week 24 and at week 48. In the PP group, the outcomes at 12 weeks showed that ixekizumab is faster than secukinumab in achieving PASI 90, PASI < 3 and PASI 100, yet without achieving statistically significant difference: a PASI 90 response was achieved by 29% of patients treated with secukinumab and 50% of patients treated with ixekizumab, while a PASI 100 response was achieved in the two groups by 29% and 33% of patients respectively. These results were maintained at week 24, showing a higher rate of

Interleukin-17 (IL-17) is central in the pathogenesis of psoriasis (1). Brodalumab was approved in Europe in 2017, and its blockade of IL-17 receptor A provides, in clinical trials, quick onset of action and long-term maintenance of treatment response with a favorable safety profile (2,3). Data regarding real-life use are limited (4–6). We retrospectively assessed efficacy and safety of brodalumab in moderate to severe psoriasis patients attending the Dermatology Clinic of the Turin University Hospital for up to 48weeks. Patients received subcutaneous brodalumab 210mg every 2weeks after the administration of 210mg every week for the first 3weeks. Disease severity at baseline was measured by the Psoriasis Area Severity Index (PASI); PASI improvement of 90% (PASI90) and 100% (PASI100) was recorded at 12, 24, and 48weeks. DLQI response rates were collected at baseline and after 48weeks of treatment. Among 1635 patients on biologics attending our clinic, 202 received brodalumab (Table 1). At week 12, 125 (68%) and 97 (53%) patients achieved PASI90 and PASI100, respectively. At week 24, 93 patients (77%) and 111 (65%) achieved PASI90 and PASI100, respectively. At week 48, 32 patients (78%) achieved PASI90 response, while 39 (64%) had complete clearance. Between baseline and week 48, DLQI improved from a mean of 13.8 to 1.3 (p< .001) and PASI improved from 23.3 to 2.2 (p< .001) respectively). Obesity did not seem to reduce the efficacy or time to onset of action of brodalumab since no difference in efficacy was observed between patients with a BMI above or below 30. No significant differences in efficacy were detected at the different time points between patients with and without joint involvement (Figure 1). Bio-naïve patients improved faster than bio-experienced patients in the first weeks of treatment and at every time point. At week 12, the mean PASI in the bio-naïve population was lower than in the bio-experienced (1.56 vs 2.47; p1⁄4 .045), and more patients achieved PASI 90 and PASI <3 (76% vs 56%; p1⁄4 .004 and 86% vs 69%; p1⁄4 .005). At week 24, more bio-naïve patients than bio-experienced patients achieved PASI90 (84% vs 67%, p1⁄4 .021). Forty-nine patients reported side effects, the most frequent of which were arthralgia (15 patients) in patients without joint involvement at baseline and asthenia (10 patients). Two patients discontinued treatment due to reported side effects, one due to joint pain and one due to a major dental abscess resistant to multiple antibiotic therapies. Brodalumab rapidly improves psoriasis in the first few weeks of treatment, particularly in bio-naïve patients, which is in line with the results of registration studies and previous real-life experience (3,5,6). Performance in bio-experienced patients is also good, as previously reported (5,6). Although not approved in the treatment of psoriatic arthritis, joint involvement does not appear to affect the response to therapy.

Journal of the European Academy of Dermatology and VenereologyVolume 36, Issue 10 p. e838-e841 Letter to the Editor Risankizumab shows faster response in bio naïve than in bio-experienced psoriatic patients L. Mastorino, Corresponding Author L. Mastorino [email protected] orcid.org/0000-0001-7386-3219 Department of Medical Sciences, Section of Dermatology, University of Turin, Torino, ItalyCorrespondence: L. Mastorino. E-mail: [email protected]Search for more papers by this authorF. Castelli, F. Castelli Section of Dermatology, Koelliker Hospital, Turin, ItalySearch for more papers by this authorE. Stroppiana, E. Stroppiana Department of Medical Sciences, Section of Dermatology, University of Turin, Torino, ItalySearch for more papers by this authorA. Verrone, A. Verrone Department of Medical Sciences, Section of Dermatology, University of Turin, Torino, ItalySearch for more papers by this authorM. Ortoncelli, M. Ortoncelli Department of Medical Sciences, Section of Dermatology, University of Turin, Torino, ItalySearch for more papers by this authorS. Susca, S. Susca Department of Medical Sciences, Section of Dermatology, University of Turin, Torino, ItalySearch for more papers by this authorS. Boskovic, S. Boskovic Department of Medical Sciences, Section of Dermatology, University of Turin, Torino, ItalySearch for more papers by this authorS.G. Passerini, S.G. Passerini Department of Medical Sciences, Section of Dermatology, University of Turin, Torino, ItalySearch for more papers by this authorN. Macagno, N. Macagno orcid.org/0000-0002-0097-2139 Department of Medical Sciences, Section of Dermatology, University of Turin, Torino, ItalySearch for more papers by this authorC. Cariti, C. Cariti Department of Medical Sciences, Section of Dermatology, University of Turin, Torino, ItalySearch for more papers by this authorM. Licciardello, M. Licciardello Section of Dermatology, Koelliker Hospital, Turin, ItalySearch for more papers by this authorC. Solaroli, C. Solaroli Section of Dermatology, Koelliker Hospital, Turin, ItalySearch for more papers by this authorG. Pertusi, G. Pertusi Outpatient Clinic, Section of Dermatology, ASL VC, Vercelli, ItalySearch for more papers by this authorM.G. Aragone, M.G. Aragone Outpatient Clinic, Section of Dermatology, ASL AL, Alessandria, ItalySearch for more papers by this authorG. Baggini, G. Baggini Outpatient Clinic, Section of Dermatology, ASL AL, Alessandria, ItalySearch for more papers by this authorC. Addese, C. Addese Outpatient Clinic, Section of Dermatology, ASLTO4, Ivrea, ItalySearch for more papers by this authorC. Leporati, C. Leporati Outpatient Clinic, Section of Dermatology, ASLTO4, Ivrea, ItalySearch for more papers by this authorR. Peila, R. Peila Outpatient Clinic, Section of Dermatology, ASLTO4, Ivrea, ItalySearch for more papers by this authorM.T. Giura, M.T. Giura Surgery Department, Section of Dermatology, Cardinal Massaia Hospital, ASL AT, Asti, ItalySearch for more papers by this authorG. Rossotto, G. Rossotto Surgery Department, Section of Dermatology, Cardinal Massaia Hospital, ASL AT, Asti, ItalySearch for more papers by this authorP. Pella, P. Pella Oncology Department, Section of Dermatology, Degli Infermi Hospital, ASL BI, Biella, ItalySearch for more papers by this authorL. Mocci, L. Mocci Section of Dermatology, AO AL Santi Antonio e Biagio e Cesare Arrigo, Alessandria, ItalySearch for more papers by this authorG. Merlo, G. Merlo Section of Dermatology, AO AL Santi Antonio e Biagio e Cesare Arrigo, Alessandria, ItalySearch for more papers by this authorR. Tiberio, R. Tiberio Dermatologic Clinic, AOU Maggiore della Carità Hospital, Novara, ItalySearch for more papers by this authorF. Graziola, F. Graziola Dermatologic Clinic, AOU Maggiore della Carità Hospital, Novara, ItalySearch for more papers by this authorP. Quaglino, P. Quaglino orcid.org/0000-0003-4185-9586 Department of Medical Sciences, Section of Dermatology, University of Turin, Torino, Italy Share last authorship.Search for more papers by this authorP. Dapavo, P. Dapavo Department of Medical Sciences, Section of Dermatology, University of Turin, Torino, Italy Share last authorship.Search for more papers by this authorS. Ribero, S. Ribero orcid.org/0000-0002-0098-1406 Department of Medical Sciences, Section of Dermatology, University of Turin, Torino, Italy Share last authorship.Search for more papers by this author L. Mastorino, Corresponding Author L. Mastorino [email protected] orcid.org/0000-0001-7386-3219 Department of Medical Sciences, Section of Dermatology, University of Turin, Torino, ItalyCorrespondence: L. Mastorino. E-mail: [email protected]Search for more papers by this authorF. Castelli, F. Castelli Section of Dermatology, Koelliker Hospital, Turin, ItalySearch for more papers by this authorE. Stroppiana, E. Stroppiana Department of Medical Sciences, Section of Dermatology, University of Turin, Torino, ItalySearch for more papers by this authorA. Verrone, A. Verrone Department of Medical Sciences, Section of Dermatology, University of Turin, Torino, ItalySearch for more papers by this authorM. Ortoncelli, M. Ortoncelli Department of Medical Sciences, Section of Dermatology, University of Turin, Torino, ItalySearch for more papers by this authorS. Susca, S. Susca Department of Medical Sciences, Section of Dermatology, University of Turin, Torino, ItalySearch for more papers by this authorS. Boskovic, S. Boskovic Department of Medical Sciences, Section of Dermatology, University of Turin, Torino, ItalySearch for more papers by this authorS.G. Passerini, S.G. Passerini Department of Medical Sciences, Section of Dermatology, University of Turin, Torino, ItalySearch for more papers by this authorN. Macagno, N. Macagno orcid.org/0000-0002-0097-2139 Department of Medical Sciences, Section of Dermatology, University of Turin, Torino, ItalySearch for more papers by this authorC. Cariti, C. Cariti Department of Medical Sciences, Section of Dermatology, University of Turin, Torino, ItalySearch for more papers by this authorM. Licciardello, M. Licciardello Section of Dermatology, Koelliker Hospital, Turin, ItalySearch for more papers by this authorC. Solaroli, C. Solaroli Section of Dermatology, Koelliker Hospital, Turin, ItalySearch for more papers by this authorG. Pertusi, G. Pertusi Outpatient Clinic, Section of Dermatology, ASL VC, Vercelli, ItalySearch for more papers by this authorM.G. Aragone, M.G. Aragone Outpatient Clinic, Section of Dermatology, ASL AL, Alessandria, ItalySearch for more papers by this authorG. Baggini, G. Baggini Outpatient Clinic, Section of Dermatology, ASL AL, Alessandria, ItalySearch for more papers by this authorC. Addese, C. Addese Outpatient Clinic, Section of Dermatology, ASLTO4, Ivrea, ItalySearch for more papers by this authorC. Leporati, C. Leporati Outpatient Clinic, Section of Dermatology, ASLTO4, Ivrea, ItalySearch for more papers by this authorR. Peila, R. Peila Outpatient Clinic, Section of Dermatology, ASLTO4, Ivrea, ItalySearch for more papers by this authorM.T. Giura, M.T. Giura Surgery Department, Section of Dermatology, Cardinal Massaia Hospital, ASL AT, Asti, ItalySearch for more papers by this authorG. Rossotto, G. Rossotto Surgery Department, Section of Dermatology, Cardinal Massaia Hospital, ASL AT, Asti, ItalySearch for more papers by this authorP. Pella, P. Pella Oncology Department, Section of Dermatology, Degli Infermi Hospital, ASL BI, Biella, ItalySearch for more papers by this authorL. Mocci, L. Mocci Section of Dermatology, AO AL Santi Antonio e Biagio e Cesare Arrigo, Alessandria, ItalySearch for more papers by this authorG. Merlo, G. Merlo Section of Dermatology, AO AL Santi Antonio e Biagio e Cesare Arrigo, Alessandria, ItalySearch for more papers by this authorR. Tiberio, R. Tiberio Dermatologic Clinic, AOU Maggiore della Carità Hospital, Novara, ItalySearch for more papers by this authorF. Graziola, F. Graziola Dermatologic Clinic, AOU Maggiore della Carità Hospital, Novara, ItalySearch for more papers by this authorP. Quaglino, P. Quaglino orcid.org/0000-0003-4185-9586 Department of Medical Sciences, Section of Dermatology, University of Turin, Torino, Italy Share last authorship.Search for more papers by this authorP. Dapavo, P. Dapavo Department of Medical Sciences, Section of Dermatology, University of Turin, Torino, Italy Share last authorship.Search for more papers by this authorS. Ribero, S. Ribero orcid.org/0000-0002-0098-1406 Department of Medical Sciences, Section of Dermatology, University of Turin, Torino, Italy Share last authorship.Search for more papers by this author First published: 10 June 2022 https://doi.org/10.1111/jdv.18314Citations: 5 Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onEmailFacebookTwitterLinkedInRedditWechat References 1Mastorino L, Sara S, Megna M et al. Risankizumab shows high efficacy and Maintenance in improvement of response until week 52. Dermatol Ther 2022; 14: e15378. 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Lymphogranuloma venereum (LGV) is a sexually transmitted infection endemic in parts of Africa, Asia, South America, and the Caribbean, but once was rarely observed in Western countries, where most cases were considered to be imported. However, recent outbreaks have been reported in Europe, Australia, New Zealand, the United States and Canada, mainly among HIV positive men who have sex with men, signaling LGV re-emergence. The etiological agent of LGV is Chlamydia trachomatis serotypes L1, L2 and L3, and current outbreaks are mostly sustained by L2b type. The clinical course can be classically divided into three stages: an initial papule, which may ulcerate at the site of inoculation, followed by regional lymphoadenopathy (second stage, generally unilateral). In the tertiary stage, lymphatic obstruction, with elephantiasis of genitalia, and rectal involvement can lead to the formation of strictures and fistulae that may require surgical treatment. Recent cases are observed mainly among HIV positive people, often co-infected with HCV and others STIs, engaging in high-risk sexual practices. The main clinical picture is a relative new entity characterized by progressive ulcerative proctitis, the so called anorectal syndrome. Diagnosis is often delayed, requires a high index of clinical suspicion and must rely on the use of nucleic acid amplification tests. The differential diagnosis of proctitis should include LGV infection. Gastroenterologists, coloproctologists, dermatologists and other specialists need to be aware of LGV proctitis to avoid diagnostic delay and progression of disease to the tertiary stage.