Secukinumab for New-Onset Plaque Psoriasis in a Peritoneal Dialysis Patient

# Secukinumab for New-Onset Plaque Psoriasis in a Peritoneal Dialysis Patient: A Case Report Summary

Psoriasis presents therapeutic challenges when it arises in patients receiving peritoneal dialysis.

Standard systemic agents are often restricted, and evidence for the use of biologic therapies in this setting is sparse.

This report summarizes a published single-patient experience in which an interleukin-17A inhibitor produced sustained clinical remission without apparent dialysis-related complications over one year of follow-up.

In a single reported case, a 61-year-old man on peritoneal dialysis developed severe plaque psoriasis six years into dialysis and obtained complete lesion clearance after secukinumab 300 mg induction weekly for four doses, then 300 mg every four weeks, with no adverse events or dialysis complications at 12 months.

Psoriasis is an immune-mediated inflammatory skin condition that can be accompanied by systemic manifestations.

Epidemiologic and clinical literature link psoriasis with an increased burden of renal disease, including chronic kidney disease and progression to end-stage renal failure.

Management becomes complex when patients are already receiving renal replacement therapy by peritoneal dialysis (PD).

Many conventional systemic psoriasis treatments carry contraindications or require dose adjustments in the context of impaired renal function, and data addressing biologic therapies in PD recipients are limited.

The report under review describes severe plaque-type psoriasis that developed in a patient undergoing PD.

The timing of onset—six years after initiation of dialysis—illustrates that dialysis may interact with psoriatic disease activity in variable ways.

In some patients, dialysis can lead to improvement of cutaneous disease, while in others it precedes new-onset or worsening psoriasis.

The mechanisms responsible for these divergent effects are not established in the present source.

This is a single-case clinical report detailing diagnostic history, prior management, therapeutic decision-making, treatment regimen, and follow-up outcomes over 12 months.

Patient profile: A 61-year-old man treated with peritoneal dialysis for six years at the time of psoriasis diagnosis.

Initial management: Early in the disease course, clinicians intensified peritoneal dialysis and applied topical corticosteroids, which produced symptomatic and objective improvement.

Despite this partial response, the disease subsequently flared, progressing to extensive cutaneous involvement accompanied by severe, generalized pruritus that disrupted sleep.

Therapeutic escalation: Given persistent and disabling disease, clinicians initiated secukinumab therapy.

The regimen consisted of subcutaneous secukinumab 300 mg weekly for four weeks (induction phase), followed by maintenance dosing of 300 mg every four weeks thereafter.

Monitoring and outcomes: The case report documents clinical follow-up through 12 months after treatment initiation.

Assessment focused on skin lesion clearance, adverse events, and PD-related complications.

The report does not provide laboratory monitoring details or quantitative psoriasis severity scores in the source text.

It notes the absence of reported treatment-related adverse events and the lack of peritoneal dialysis complications attributable to the biologic agent during the observation window.

No adverse events or complications related to peritoneal dialysis were documented in this time frame.

However, whether IL-17A blockade provides any protective effect on the peritoneal membrane in dialysis patients remains unestablished and requires targeted research.

• Temporal relationship: Plaque psoriasis emerged in this patient after six years of receiving peritoneal dialysis, underscoring that psoriasis can present at variable times relative to dialysis initiation.
• Initial responsiveness to conservative measures: Increasing dialysis intensity and topical corticosteroid use led to transient clinical improvement, indicating that modifying dialysis and topical therapy may influence skin disease in some patients.
• Exacerbation and impact on quality of life: The condition worsened, becoming widespread and causing severe itch that impaired sleep, thereby prompting consideration of systemic biologic therapy.
• Secukinumab administration: The patient received an induction course (300 mg weekly × 4) followed by maintenance dosing of 300 mg every four weeks.
• Clinical outcome at 12 months: Complete clearance of psoriatic lesions was reported at one year after starting secukinumab.
• Mechanistic uncertainty: The report notes that interleukin-17A (IL-17A) has been implicated in peritoneal membrane injury associated with dialysis in other experimental or clinical contexts.

• The case illustrates that biologic therapy with an IL-17A inhibitor can be used in a patient on peritoneal dialysis and, in this instance, was associated with sustained clinical remission without observed dialysis-related complications over 12 months.
• The experience supports consideration of biologic agents in selected PD patients when disease is severe and refractory to conservative measures, but it does not establish safety or efficacy beyond a single case.
• The potential dual role of dialysis—either facilitating amelioration or provoking new or worsening psoriasis—remains a clinical variable that clinicians may encounter; the mechanisms underlying this variability are not clarified in the source.
• Given limited data, clinicians and guideline panels require larger, systematic studies to guide the use of secukinumab and similar biologic agents in PD populations, and to define monitoring strategies, risks, and potential effects on peritoneal membrane health.

• A 61-year-old male PD patient developed plaque psoriasis six years after dialysis initiation.
• Initial intensified dialysis plus topical steroids produced temporary improvement; disease later flared with widespread lesions and severe pruritus affecting sleep.
• Secukinumab was administered at 300 mg weekly for four weeks, then 300 mg every four weeks.
• At 12 months, complete clearance of psoriatic lesions was observed with no adverse events or PD complications reported.
• The role of IL-17A in dialysis-related peritoneal injury is noted, but whether IL-17A blockade benefits peritoneal membrane integrity is unknown.
• Robust evidence and formal guidelines for secukinumab use in PD patients are lacking and needed.

Q1: Is secukinumab safe for patients on peritoneal dialysis?

A1: In the reported case, secukinumab was administered without observed adverse events or PD-related complications during 12 months of follow-up.

This single observation cannot establish safety across the broader PD population.

Q2: Did dialysis interruption, modality change, or other renal interventions occur before biologic therapy in this patient?

A2: The report indicates an initial strategy of intensified peritoneal dialysis combined with topical corticosteroids led to partial improvement.

There is no indication of dialysis modality change or interruption prior to starting secukinumab.

Q3: Does IL-17A inhibition protect the peritoneal membrane in dialysis patients?

A3: The report notes IL-17A has been linked to peritoneal damage in the context of dialysis, but it explicitly states that whether IL-17A inhibitors confer protection for the peritoneal membrane has not been determined and requires dedicated research.

Q4: Can psoriasis onset be attributed to peritoneal dialysis?

A4: The report presents a temporal association—psoriasis manifested after years on PD—but does not establish causation.

It notes that dialysis may either precipitate new disease or improve existing lesions in different patients.

This single-case report documents successful treatment of severe plaque psoriasis in a peritoneal dialysis patient using secukinumab, with complete skin clearance and no observed dialysis-related adverse events over a 12-month follow-up.

The account highlights divergent interactions between dialysis and psoriatic disease activity and raises mechanistic questions about IL-17A’s role in peritoneal membrane pathology.

However, by nature of a solitary clinical observation, the report cannot define safety profiles, efficacy rates, or practice standards for secukinumab in the PD population.

Systematic clinical studies are necessary to inform evidence-based recommendations and to evaluate potential impacts of IL-17A inhibition on peritoneal membrane health.