Evaluation of the efficacy of netakimab therapy for psoriasis involving difficult-to-treat sites: A retrospective single-centre study

Introduction. Netakimab is a humanized anti-interleukin-17 monoclonal antibody, approved for the treatment of moderate to severe psoriasis vulgaris. Available data from the literature on the use and efficacy of this drug in the treatment of psoriasis in difficult-to-treat sites are still limited. However, due to resistance of psoriasis involving difficult-to-treat sites to other drugs, netakimab can be regarded as the drug of choice for the treatment of these forms of psoriasis.

Aim. To evaluate the efficacy and safety of netakimab in the treatment of psoriasis of difficult localizations.

Materials and methods. A total of 50 patients 18 years of age and older with moderate to severe psoriasis vulgaris were included in the study. Patients were screened and randomized with a focus on lesions in difficult-to-treat sites, among which patients with vulgar psoriasis that predominantly affected the inguinal, axillary and inframammary folds (inverse psoriasis) accounted for 28% (n = 14), nails (n = 26; 52%), palms and soles (n = 10; 20%). All patients received netakimab therapy for 52 weeks.

Results. Among 14 patients with inverse psoriasis, 42.9% of patients achieved PASI 90 (n = 6), and 57.1% achieve PASI 100 (n = 8). Netakimab also allowed 34.6% patients with nail psoriasis to achieve PASI 90 (n = 9), and 65.4% to achieve PASI 100 (n = 17), and 20% and 80% patients with predominant localization on the palms and soles to achieve PASI 90 (n = 2) and 100 (n = 8) respectively.

Conclusions. The data presented in the article show that the use of netakimab allows sustained control of the disease and improvement of the quality of life in patients with psoriasis involving difficult-to-treat sites.

1. Кубанов АА, Карамова АЭ, Притуло ОА, Аршинский МИ, Знаменская ЛФ, Чикин ВВ. Псориаз: клинические рекомендации. 2023. Режим доступа: https://cr.minzdrav.gov.ru/preview-cr/234_2.

2. Petit RG, Cano A, Ortiz A, Espina M, Prat J, Muñoz M et al. Psoriasis: From Pathogenesis to Pharmacological and Nano-Technological-Based Therapeutics. Int J Mol Sci. 2021;22(9):4983. https://doi.org/10.3390/ijms22094983.

3. Di Meglio P, Villanova F, Nestle FO. Psoriasis. Cold Spring Harb Perspect Med. 2014;4(8):a015354. https://doi.org/10.1101/cshperspect.a015354.

4. Alikbaev TZ, Frolova EV, Gulordava MD, Mksimova MD, Filippova LV, Vasilieva NV, Raznatovskiy KI. Modern ideas about the pathogenesis, clinic and treatment of severe psoriasis. Problems in Medical Mycology. 2021;23(4):9–16. (In Russ.) https://doi.org/10.24412/1999-6780-2021-4-9-16.

5. Rendon A, Schäkel K. Psoriasis Pathogenesis and Treatment. Int J Mol Sci. 2019;20(6):1475. https://doi.org/10.3390/ijms20061475.

6. Matsuzaki G, Umemura M. Interleukin-17 family cytokines in protective immunity against infections: role of hematopoietic cell-derived and nonhematopoietic cell-derived interleukin-17s. Microbiol Immunol. 2018;62(1):1–13. https://doi.org/10.1111/1348-0421.12560.

7. Lo YH, Li CS, Chen HL, Chiang CY, Huang CC, Tu TJ et al. Galectin-8 Is Upregulated in Keratinocytes by IL-17A and Promotes Proliferation by Regulating Mitosis in Psoriasis. J Invest Dermatol. 2021;141(3):503–511.e9. https://doi.org/10.1016/j.jid.2020.07.021.

8. Xu X, Prens E, Florencia E, Leenen P, Boon L, Asmawidjaja P et al. Interleukin-17A Drives IL-19 and IL-24 Expression in Skin Stromal Cells Regulating Keratinocyte Proliferation. Front Immunol. 2021;12:719562. https://doi.org/10.3389/fimmu.2021.719562.

9. Butacu AI, Toma C, Negulet IE, Manole I, Banica AN, Plesea A et al. Updates on Psoriasis in Special Areas. J Clin Med. 2024;13(24):7549. https://doi.org/10.3390/jcm13247549.

10. Melnichenko ОО. Modern approaches to therapy of grave psoriasis forms. Meditsinskiy Sovet. 2017;(11):208–211. (In Russ.) https://doi.org/10.21518/2079-701X-2017-11-208-211.

11. Marek-Jozefowicz L, Czajkowski R, Borkowska A, Nedoszytko B, Żmijewski MA, Cubała WJ, Slominski AT. The Brain-Skin Axis in Psoriasis-Psychological, Psychiatric, Hormonal, and Dermatological Aspects. Int J Mol Sci. 2022;23(2):669. https://doi.org/10.3390/ijms23020669.

12. Merola JF, Qureshi A, Husni ME. Underdiagnosed and undertreated psoriasis: Nuances of treating psoriasis affecting the scalp, face, intertriginous areas, genitals, hands, feet, and nails. Dermatol Ther. 2018;31(3):e12589. https://doi.org/10.1111/dth.12589.

13. Radaschin DS, Iancu AV, Ionescu AM, Gurau G, Niculet E, Bujoreanu FC et al. Comparative Analysis of the Cutaneous Microbiome in Psoriasis Patients and Healthy Individuals – Insights into Microbial Dysbiosis: Final Results. Int J Mol Sci. 2024;25:10583. https://doi.org/10.3390/ijms251910583.

14. Radaschin DS, Tatu A, Iancu AV, Beiu C, Popa LG. The Contribution of the Skin Microbiome to Psoriasis Pathogenesis and Its Implications for Therapeutic Strategies. Medicina. 2024;60:1619. https://doi.org/10.3390/medicina60101619.

15. Lupulescu AM, Savu AP, Bucur Ş, Şerban ED, Popescu S, Constantin MM. Hard-to-Treat Areas in Psoriasis: An Underevaluated Part of the Disease. Life. 2025;15(3):425. https://doi.org/10.3390/life15030425.

16. Dopytalska K, Sobolewski P, Błaszczak A, Szymańska E, Walecka I. Psoriasis in special localizations. Rheumatology. 2018;56(6):392–398. https://doi.org/10.5114/reum.2018.80718.

17. Адаскевич ВП, Козин ВМ. Кожные и венерические болезни. М.: Мед. лит.; 2006. 672 с.

18. Khandpur S, Singhal V, Sharma VK. Palmoplantar involvement in psoriasis: a clinical study. Indian J Dermatol Venereol Leprol. 2011;77(5):625. https://doi.org/10.4103/0378-6323.84071.

19. Hong JJ, Mosca ML, Hadeler EK, Brownstone ND, Bhutani T, Liao WJ. Genital and Inverse/Intertriginous Psoriasis: An Updated Review of Therapies and Recommendations for Practical Management. Dermatol Ther. 2021;11(3):833–844. https://doi.org/10.1007/s13555-021-00536-6.

20. Radtke MA, Beikert FC, Augustin M. Nail psoriasis – a treatment challenge. J Dtsch Dermatol Ges. 2013;11(3):203–219. https://doi.org/10.1111/ddg.12054.

21. Micali G, Verzì AE, Giuffrida G, Panebianco E, Musumeci ML, Lacarrubba F. Inverse Psoriasis: From Diagnosis to Current Treatment Options. Clin Cosmet Investig Dermatol. 2019;12:953–959. https://doi.org/10.2147/CCID.S189000.

22. Bakulev AL, Samtsov AV, Kubanov AA, Khairutdinov VR, Kokhan MM, Artemyeva AV et al. Long-term efficacy and safety of netakimab in patients with moderate-to-severe psoriasis. Results of phase II open-label extension clinical study BCD-085-2-ext. Vestnik Dermatologii i Venerologii. 2019;95(3):54–64. (In Russ.) https://doi.org/10.25208/0042-4609-2019-95-3-54-64.

23. Abdulganieva DI, Bakulev AL, Belousova EА, Znamenskaya LF, Korotaeva TV, Kruglova LS et al. Draft interdisciplinary guidelines for diagnosis, methods for estimation of the degree of activity, for evaluation of therapeutic efficacy, and for use of biological agents in patients with concomitant immunoinflammatory diseases (psoriasis, psoriatic arthritis, Crohn’s disease). Sovremennaya Revmatologiya. 2018;12(3):4–18. (In Russ.) https://doi.org/10.14412/1996-7012-2018-3-4-18.

24. Kruglova LS, Rudneva NS, Bakulev AL, Khotko AA. Inverse psoriasis and psoriasis of ‘difficult’ localizations: Effectiveness of netakimab. Medical Alphabet. 2022;(27):14–20. (In Russ.) https://doi.org/10.33667/2078-5631-2022-27-14-20.

25. Hotko AA, Kruglova LS, Pomazanova MYu, Hotko RA. Effectiveness of netakimab in real clinical practice in patients with severe forms of psoriasis. Medical Alphabet. 2020;(6):28–33. (In Russ.) https://doi.org/10.33667/2078-56312020-6-28-33.