Immune checkpoint-mediated psoriasis: a multicentric European study of 115 patients from European Network for Cutaneous ADverse Event to Oncologic drugs (ENCADO) group.

Abstract Background Immune checkpoint inhibitors (ICIs)-mediated psoriasis poses significant diagnostic and therapeutic challenges. Objective To report data on ICI-mediated psoriasis, emerging from the largest so far cohort and to propose a step-by-step management algorithm. Methods The medical records of all patients with ICI-mediated psoriasis were retrospectively reviewed across nine institutions. Results We included a cohort of 115 individuals. Grade-1, 2 and 3 disease severity was reported in 60/105 (57.1%, 10 missing data), 34/105 (32.4%) and 11/105 (10.5%), respectively. The ratio between de novo and exacerbation cases of psoriasis was 21/90 (23.3%). The most common systemic therapy was acitretin (23 patients, 20.1%), followed by systemic steroids (8 patients, 7%), apremilast (7 patients, 6.1%), methotrexate (5 patients, 4.3%) and biologics (4 patients, 3.6%). Overall, 29/112 patients (25.9%) interrupted and 20/111 (18%) permanently discontinued ICIs due to psoriasis. BSA>10% at baseline had a 3.6 increased risk for ICIs treatment modification (OR=3.64, CI 1.27-10.45, p=0.03) and a 6.4 increased risk for permanent discontinuation (OR=6.41, CI 2.40-17.11, p Limitations Retrospective design Conclusion Acitretin, apremilast and methotrexate are safe and effective modalities for ICI-mediated psoriasis. In most cases, ICI can be completed unhindered. A therapeutic algorithm is proposed.