P60 Safe application of Guselkumab in a psoriasis patient combined with coronary heart disease after percutaneous coronary intervention for acute myocardial infarction

Abstract Aim Recent studies indicated psoriasis leads to an increase of inflammatory cytokine levels in the skin lesions, the resulting asymptomatic chronic subclinical inflammation can also progress to a variety of complications, including cardiovascular diseases, arthritis, metabolic syndrome, inflammatory bowel disease and so on. Patients combined with acute myocardial infarction (MI) need to be treated by percutaneous coronary intervention (PCI); there is a lack of evidence indicating how to select a safe biologic after PCI. Methods Here, we report a long disease duration psoriasis patient who underwent PCI and then treated with Guselkumab, maybe can bring some experience for the treatment of a similar situation. A 49-year-old male came to our department with severe plaque psoriasis [psoriasis area and severity index (PASI) 15.2, body surface area (BSA) 12%, sPGA 4] in August 2022. The first plaque of psoriasis appeared 25 years ago and did not relapse after treatment with traditional drugs. He was diagnosed with hypertension in March 2011 but did not receive formal treatment. Results On 14 February 2021, the patient experienced a burst of acute MI and was treated with PCI. It was learned that the patient had a history of hypertension for 10 years and a history of psoriasis for 25 years. After discharge, he regularly returned to the outpatient departments of cardiology and rheumatology for follow-up visits, and his current physical condition remains good. In August 2022, he came to our department with a relapse of skin lesion. According to suggestions provided by multiple disciplinary team, for the treatment of psoriasis, he was treated with Guselkumab with recommended dosage (subcutaneous 100 mg at Weeks 0, 4 and then every 8 weeks) in our department after routine screenings of blood tests and chest CT before biologic treatment. After two injections of 100 mg Guselkumab, he achieved 100% percentage improvement of skin lesions (PASI 0, BSA 0%, sPGA 0) at Week 12, which significantly improved his quality of life. After 12-month follow-up, the patient did not appear any abnormality of examination for cardiovascular disease. Also, the skin lesion of psoriasis was controlled well without relapse or exacerbation. No safety issues appeared during the follow-up too. Conclusion We first report a long-term plaque psoriasis patient combined with hypertension and cardiovascular disease and treated with Guselkumab after PCI. Application of Guselkumab after PCI was proved to be safe and maintain stable skin lesion clearance efficacy.