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Marijam A, Vroom N, Bhavsar A, Posiuniene I, Lecrenier N, Vroling H. Systematic Literature Review on the Incidence of Herpes Zoster in Populations at Increased Risk of Disease in the EU/EEA, Switzerland, and the UK. Infect Dis Ther 2024; 13:1083-1104. [PMID: 38656653 PMCID: PMC11098998 DOI: 10.1007/s40121-024-00963-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2024] [Accepted: 03/15/2024] [Indexed: 04/26/2024] Open
Abstract
INTRODUCTION Older adults and patients with underlying conditions such as immunocompromised (IC) populations (e.g., due to medical conditions or immunosuppressive medication) are at increased risk for herpes zoster (HZ). The first HZ recombinant vaccine for IC patients was approved in 2020. Limited evidence exists to inform decision-makers on HZ incidence in high-risk patients in Europe. This systematic literature review (SLR) assessed HZ incidence across 14 high-risk populations in the European Union/European Economic Area, Switzerland, and the United Kingdom. METHODS An SLR (Embase, Medline, 2002-2022, observational studies) was performed to identify HZ incidence (i.e., primary outcomes: rate or cumulative; secondary: relative incidence) in type 1 and 2 diabetes mellitus (DM); chronic obstructive pulmonary disease and asthma; depression; rheumatic disorders (RD); multiple sclerosis (MS); inflammatory bowel diseases (IBD); psoriasis; lupus; human immunodeficiency virus (HIV); solid organ transplantation (SOT); solid organ malignancy (SOM); hematologic malignancy (HM); and stem cell transplantation (SCT). RESULTS Of 776 unique records screened, 59 studies were included (24 reported incidence rate per 1000 person-years; two, cumulative incidence per 1000 persons; and 33, relative incidence). The highest incidence rates were reported for SOT (12.1-78.8) and SCT (37.2-56.1); HM (2.9-32.0); RD (0.41-21.5); lupus (11.0-16.5); IC mixed population (11.3-15.5); HIV/AIDS (11.8-13.0); chronic respiratory diseases (4.7-11.4); SOM (8.8-11.0); IBD (7.0-10.8); DM (4.3-9.4); depression (7.2-7.6); MS (5.7-6.3); and psoriasis (5.3-6.1). In many high-risk populations, HZ incidence was higher for older age groups, women, and some treatments. CONCLUSIONS The HZ incidence rate in Europe increased with age and varied across high-risk populations, with high rates for solid organ and stem cell transplants, cancer, and rheumatoid arthritis. Most studies were retrospective with methodological differences affecting generalizability and comparability. Future studies should stratify data by IC population, age, sex, severity, medication, and study timeframe.
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Affiliation(s)
| | - Nikki Vroom
- Pallas Health Research & Consultancy, A P95 Company, Rotterdam, The Netherlands
| | | | | | | | - Hilde Vroling
- Pallas Health Research & Consultancy, A P95 Company, Rotterdam, The Netherlands
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Verardi F, Maul LV, Borsky K, Steinmann S, Rosset N, Pons HO, Sorbe C, Yawalkar N, Micheroli R, Egeberg A, Thyssen JP, Heidemeyer K, Boehncke WH, Conrad C, Cozzio A, Pinter A, Kündig T, Navarini AA, Maul JT. Sex differences in adverse events from systemic treatments for psoriasis: A decade of insights from the Swiss Psoriasis Registry (SDNTT). J Eur Acad Dermatol Venereol 2024; 38:719-731. [PMID: 38084852 DOI: 10.1111/jdv.19730] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Accepted: 10/26/2023] [Indexed: 03/26/2024]
Abstract
BACKGROUND Psoriasis is a disease that often requires prolonged systemic treatment. It is important to determine the safety of available therapies. There is currently little insight into sex-specific differences in the safety of systemic psoriasis therapies. OBJECTIVES To examine the real-world, long-term safety of systemic psoriasis therapies with sex stratification in drug-related adverse events (ADRs). METHODS Ten-year data from adults with moderate-to-severe psoriasis requiring systemic treatment (conventional systemic therapies [CST], biologics) were obtained from the Swiss psoriasis registry (SDNTT). ADRs were categorized according to the international terminology Medical Dictionary for Regulatory Activities (MedDRA). Safety was assessed by calculating event rates per 100 patient-years (PY). We used descriptive statistics for patient and disease characteristics, and binomial and t-tests to compare treatment groups and sex. RESULTS In total, 791 patients (290 females) were included with a mean age of 46 years. 358 (45%) received CSTs and 433 (55%) biologics; both groups had similar baseline characteristics except for more joint involvement in patients using biologics (26.86% vs. 14.8%, p < 0.0001). CSTs were associated with a 2.2-fold higher ADR rate (40.43/100 PY vs. 18.22/100 PY, p < 0.0001) and an 8.0-fold higher drug-related discontinuation rate than biologics (0.16/PY vs. 0.02/PY, p < 0.0001). Trends showed non-significant higher serious adverse event rates per 100 PY for biologics (8.19, CI 6.87-9.68) compared to CSTs (7.08, CI 5.39-9.13) (p = 0.3922). Sex stratification revealed a significantly higher overall ADR rate for all treatments in females (1.8-fold for CSTs [57.30/100 PY vs. 31.69/100 PY] and 2.0-fold for biologics [27.36/100 PY vs. 13.9/100 PY], p < 0.0001), and drug-related discontinuation rates for most CSTs in females. CONCLUSION Females were associated with a significantly higher rate of ADRs and drug-related discontinuation rates. Sex stratification should be taken into consideration when designing studies in the patient-tailored management of psoriasis.
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Affiliation(s)
- Fabio Verardi
- Department of Dermatology, University Hospital Zurich, Zurich, Switzerland
- Faculty of Medicine, University of Zurich, Zurich, Switzerland
| | - Lara Valeska Maul
- Department of Dermatology, University Hospital Zurich, Zurich, Switzerland
- Faculty of Medicine, University of Zurich, Zurich, Switzerland
- Department of Dermatology, University Hospital Basel, Basel, Switzerland
| | - Kim Borsky
- Oxford School of Surgery, Oxford Business Park, Oxford, UK
| | - Simona Steinmann
- Department of Dermatology, University Hospital Zurich, Zurich, Switzerland
- Faculty of Medicine, University of Zurich, Zurich, Switzerland
| | - Nina Rosset
- Department of Dermatology, University Hospital Zurich, Zurich, Switzerland
| | | | - Christina Sorbe
- Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Nikhil Yawalkar
- Department of Dermatology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Raphael Micheroli
- Department of Rheumatology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Alexander Egeberg
- Department of Dermato-Venereology and Wound Healing Centre, Copenhagen University Hospital Bispebjerg, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Jacob P Thyssen
- Department of Dermato-Venereology and Wound Healing Centre, Copenhagen University Hospital Bispebjerg, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Kristine Heidemeyer
- Department of Dermatology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Wolf-Henning Boehncke
- Division of Dermatology and Venereology, Geneva University Hospitals, Geneva, Switzerland
| | - Curdin Conrad
- Department of Dermatology, CHUV University Hospital and University of Lausanne (UNIL), Lausanne, Switzerland
| | - Antonio Cozzio
- Clinic of Dermatology, Venereology and Allergology, Cantonal Hospital St. Gallen, St. Gallen, Switzerland
| | - Andreas Pinter
- Department of Dermatology, Venerology and Allergology, University Hospital Frankfurt am Main, Frankfurt am Main, Germany
| | - Thomas Kündig
- Department of Dermatology, University Hospital Zurich, Zurich, Switzerland
| | | | - Julia-Tatjana Maul
- Department of Dermatology, University Hospital Zurich, Zurich, Switzerland
- Faculty of Medicine, University of Zurich, Zurich, Switzerland
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Couselo-Rodríguez C, Batalla A, Carrascosa JM, Chicharro P, González-Quesada A, de la Cueva P, Giménez-Arnau AM, Gilaberte Y, Rodríguez-Serna M, Montero-Vilchez T, Ruiz-Villaverde R, Elosua-González M, Silvestre-Salvador JF, Munera-Campos M, Sánchez-Pérez J, Carretero G, Mauleón-Fernández C, Curto-Barredo L, Ballano-Ruiz A, Botella-Estrada R, Arias-Santiago S, Navarro-Triviño FJ, Roustan-Gullón G, Betlloch I, Del Alcázar E, Abalde-Pintos MT, Suárez-Perez J, García-Doval I, Descalzo MÁ, Flórez Á. [Translated article] Drug Survival in Cyclosporine Treatment for Moderate to Severe Atopic Dermatitis: Analysis of the Spanish Atopic Dermatitis Registry (BIOBADATOP). ACTAS DERMO-SIFILIOGRAFICAS 2024; 115:T341-T346. [PMID: 38325545 DOI: 10.1016/j.ad.2023.07.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Accepted: 07/03/2023] [Indexed: 02/09/2024] Open
Abstract
BACKGROUND The past 5 years have seen a proliferation of new treatments for atopic dermatitis (AD). We analyzed recent drug survival data for cyclosporine in this setting. Because the Spanish National Healthcare system requires patients with AD to be treated with cyclosporine before they can be prescribed other systemic treatments, drug survival for cyclosporine may be shorter than in other diseases. MATERIAL AND METHOD Multicenter, observational, prospective cohort study using data from the Spanish Atopic Dermatitis Registry (BIOBADATOP). Data from the Spanish Registry of Systemic Treatments in Psoriasis (BIOBADADERM) were used to create a comparison cohort. RESULTS We analyzed data for 130 patients with AD treated with cyclosporine (median drug survival, 1 year). Median cyclosporine survival in the psoriasis comparison group (150 patients) was 0.37 years. Drug survival was significantly longer in AD than in psoriasis (P<.001). CONCLUSION Drug survival of cyclosporine in the BIOBADATOP registry is similar to that described in other series of patients with AD and longer than that observed in the BIOBADADERM psoriasis registry.
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Affiliation(s)
- C Couselo-Rodríguez
- Servicio de Dermatología, Complejo Hospitalario Universitario de Pontevedra, Pontevedra, Spain; Grupo de Investigación DIPO, Instituto de Investigación Sanitaria Galicia Sur (IIS Galicia Sur), SERGAS-UVIGO, Spain.
| | - A Batalla
- Servicio de Dermatología, Complejo Hospitalario Universitario de Pontevedra, Pontevedra, Spain; Grupo de Investigación DIPO, Instituto de Investigación Sanitaria Galicia Sur (IIS Galicia Sur), SERGAS-UVIGO, Spain
| | - J M Carrascosa
- Servicio de Dermatología, Hospital Universitari Germans Trias i Pujol. Germans Trias I Pujol Research Institute (IGTP), Universitat Autònoma de Barcelona, Badalona, Barcelona, Spain
| | - P Chicharro
- Servicio de Dermatología, Hospital Universitario de la Princesa, Madrid, Spain
| | - A González-Quesada
- Servicio de Dermatología, Hospital Universitario de Gran Canaria Doctor Negrín, Las Palmas de Gran Canaria, Spain
| | - P de la Cueva
- Servicio de Dermatología, Hospital Universitario Infanta Leonor, Madrid, Spain
| | - A M Giménez-Arnau
- Servicio de Dermatología, Hospital del Mar, IMIM, Universitat Pompeu Fabra, Barcelona, Spain
| | - Y Gilaberte
- Servicio de Dermatología, Hospital Universitario Miguel Servet, Zaragoza, Spain
| | - M Rodríguez-Serna
- Servicio de Dermatología, Hospital Universitario y Politécnico la Fe, Valencia, Spain
| | - T Montero-Vilchez
- Servicio de Dermatología, Hospital Universitario Virgen de las Nieves, Granada. Instituto de Investigación IBS, Granada, Spain
| | - R Ruiz-Villaverde
- Servicio de Dermatología, Hospital Universitario San Cecilio, Granada, Spain
| | - M Elosua-González
- Servicio de Dermatología, Hospital Universitario Puerta del Hierro, Madrid, Spain
| | - J F Silvestre-Salvador
- Servicio de Dermatología, Hospital General Universitario Dr. Balmis, Alicante. ISABIAL, Alicante, Spain
| | - M Munera-Campos
- Servicio de Dermatología, Hospital Universitari Germans Trias i Pujol. Germans Trias I Pujol Research Institute (IGTP), Universitat Autònoma de Barcelona, Badalona, Barcelona, Spain
| | - J Sánchez-Pérez
- Servicio de Dermatología, Hospital Universitario de la Princesa, Madrid, Spain
| | - G Carretero
- Servicio de Dermatología, Hospital Universitario de Gran Canaria Doctor Negrín, Las Palmas de Gran Canaria, Spain
| | - C Mauleón-Fernández
- Servicio de Dermatología, Hospital Universitario Infanta Leonor, Madrid, Spain
| | - L Curto-Barredo
- Servicio de Dermatología, Hospital del Mar, IMIM, Universitat Pompeu Fabra, Barcelona, Spain
| | - A Ballano-Ruiz
- Servicio de Dermatología, Hospital Universitario Miguel Servet, Zaragoza, Spain
| | - R Botella-Estrada
- Servicio de Dermatología, Hospital Universitario y Politécnico la Fe, Valencia, Spain
| | - S Arias-Santiago
- Servicio de Dermatología, Hospital Universitario Virgen de las Nieves, Granada. Instituto de Investigación IBS, Granada, Spain
| | - F J Navarro-Triviño
- Servicio de Dermatología, Hospital Universitario San Cecilio, Granada, Spain
| | - G Roustan-Gullón
- Servicio de Dermatología, Hospital Universitario Puerta del Hierro, Madrid, Spain
| | - I Betlloch
- Servicio de Dermatología, Hospital General Universitario Dr. Balmis, Alicante. ISABIAL, Alicante, Spain
| | - E Del Alcázar
- Servicio de Dermatología, Hospital Universitari Germans Trias i Pujol. Germans Trias I Pujol Research Institute (IGTP), Universitat Autònoma de Barcelona, Badalona, Barcelona, Spain
| | - M T Abalde-Pintos
- Servicio de Dermatología, Complejo Hospitalario Universitario de Pontevedra, Pontevedra, Spain; Grupo de Investigación DIPO, Instituto de Investigación Sanitaria Galicia Sur (IIS Galicia Sur), SERGAS-UVIGO, Spain
| | - J Suárez-Perez
- Servicio de Dermatología, Hospital Clínico de Málaga, Málaga, Spain
| | - I García-Doval
- Unidad de Investigación, Fundación Piel Sana AEDV, Spain; Servicio de Dermatología, Complexo Hospitalario Universitario de Vigo, Vigo, Spain
| | - M Á Descalzo
- Unidad de Investigación, Fundación Piel Sana AEDV, Spain
| | - Á Flórez
- Servicio de Dermatología, Complejo Hospitalario Universitario de Pontevedra, Pontevedra, Spain; Grupo de Investigación DIPO, Instituto de Investigación Sanitaria Galicia Sur (IIS Galicia Sur), SERGAS-UVIGO, Spain
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4
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Couselo-Rodríguez C, Batalla A, Carrascosa JM, Chicharro P, González-Quesada A, de la Cueva P, Giménez-Arnau AM, Gilaberte Y, Rodríguez-Serna M, Montero-Vilchez T, Ruiz-Villaverde R, Elosua-González M, Silvestre-Salvador JF, Munera-Campos M, Sánchez-Pérez J, Carretero G, Mauleón-Fernández C, Curto-Barredo L, Ballano-Ruiz A, Botella-Estrada R, Arias-Santiago S, Navarro-Triviño FJ, Roustan-Gullón G, Betlloch I, Del Alcázar E, Abalde-Pintos MT, Suárez-Perez J, García-Doval I, Descalzo MÁ, Flórez Á. Drug Survival in Cyclosporine Treatment for Moderate to Severe Atopic Dermatitis: Analysis of the Spanish Atopic Dermatitis Registry (BIOBADATOP). ACTAS DERMO-SIFILIOGRAFICAS 2024; 115:341-346. [PMID: 37482292 DOI: 10.1016/j.ad.2023.07.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 06/04/2023] [Accepted: 07/03/2023] [Indexed: 07/25/2023] Open
Abstract
BACKGROUND The past 5 years have seen a proliferation of new treatments for atopic dermatitis (AD). We analyzed recent drug survival data for cyclosporine in this setting. Because the Spanish National Healthcare system requires patients with AD to be treated with cyclosporine before they can be prescribed other systemic treatments, drug survival for cyclosporine may be shorter than in other diseases. MATERIAL AND METHOD Multicenter, observational, prospective cohort study using data from the Spanish Atopic Dermatitis Registry (BIOBADATOP). Data from the Spanish Registry of Systemic Treatments in Psoriasis (BIOBADADERM) were used to create a comparison cohort. RESULTS We analyzed data for 130 patients with AD treated with cyclosporine (median drug survival, 1 year). Median cyclosporine survival in the psoriasis comparison group (150 patients) was 0.37 years. Drug survival was significantly longer in AD than in psoriasis (P<.001). CONCLUSION Drug survival of cyclosporine in the BIOBADATOP registry is similar to that described in other series of patients with AD and longer than that observed in the BIOBADADERM psoriasis registry.
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Affiliation(s)
- C Couselo-Rodríguez
- Servicio de Dermatología, Complejo Hospitalario Universitario de Pontevedra, Pontevedra, España; Grupo de Investigación DIPO, Instituto de Investigación Sanitaria Galicia Sur (IIS Galicia Sur), SERGAS-UVIGO, España.
| | - A Batalla
- Servicio de Dermatología, Complejo Hospitalario Universitario de Pontevedra, Pontevedra, España; Grupo de Investigación DIPO, Instituto de Investigación Sanitaria Galicia Sur (IIS Galicia Sur), SERGAS-UVIGO, España
| | - J M Carrascosa
- Servicio de Dermatología, Hospital Universitari Germans Trias i Pujol. Germans Trias I Pujol Research Institute (IGTP), Universitat Autònoma de Barcelona, Badalona, Barcelona, España
| | - P Chicharro
- Servicio de Dermatología, Hospital Universitario de la Princesa, Madrid, España
| | - A González-Quesada
- Servicio de Dermatología, Hospital Universitario de Gran Canaria Doctor Negrín, Las Palmas de Gran Canaria, España
| | - P de la Cueva
- Servicio de Dermatología, Hospital Universitario Infanta Leonor, Madrid, España
| | - A M Giménez-Arnau
- Servicio de Dermatología, Hospital del Mar, IMIM, Universitat Pompeu Fabra, Barcelona, España
| | - Y Gilaberte
- Servicio de Dermatología, Hospital Universitario Miguel Servet, Zaragoza, España
| | - M Rodríguez-Serna
- Servicio de Dermatología, Hospital Universitario y Politécnico la Fe, Valencia, España
| | - T Montero-Vilchez
- Servicio de Dermatología, Hospital Universitario Virgen de las Nieves, Granada. Instituto de Investigación IBS, Granada, España
| | - R Ruiz-Villaverde
- Servicio de Dermatología, Hospital Universitario San Cecilio, Granada, España
| | - M Elosua-González
- Servicio de Dermatología, Hospital Universitario Puerta del Hierro, Madrid, España
| | - J F Silvestre-Salvador
- Servicio de Dermatología, Hospital General Universitario Dr. Balmis, Alicante. ISABIAL, Alicante, España
| | - M Munera-Campos
- Servicio de Dermatología, Hospital Universitari Germans Trias i Pujol. Germans Trias I Pujol Research Institute (IGTP), Universitat Autònoma de Barcelona, Badalona, Barcelona, España
| | - J Sánchez-Pérez
- Servicio de Dermatología, Hospital Universitario de la Princesa, Madrid, España
| | - G Carretero
- Servicio de Dermatología, Hospital Universitario de Gran Canaria Doctor Negrín, Las Palmas de Gran Canaria, España
| | - C Mauleón-Fernández
- Servicio de Dermatología, Hospital Universitario Infanta Leonor, Madrid, España
| | - L Curto-Barredo
- Servicio de Dermatología, Hospital del Mar, IMIM, Universitat Pompeu Fabra, Barcelona, España
| | - A Ballano-Ruiz
- Servicio de Dermatología, Hospital Universitario Miguel Servet, Zaragoza, España
| | - R Botella-Estrada
- Servicio de Dermatología, Hospital Universitario y Politécnico la Fe, Valencia, España
| | - S Arias-Santiago
- Servicio de Dermatología, Hospital Universitario Virgen de las Nieves, Granada. Instituto de Investigación IBS, Granada, España
| | - F J Navarro-Triviño
- Servicio de Dermatología, Hospital Universitario San Cecilio, Granada, España
| | - G Roustan-Gullón
- Servicio de Dermatología, Hospital Universitario Puerta del Hierro, Madrid, España
| | - I Betlloch
- Servicio de Dermatología, Hospital General Universitario Dr. Balmis, Alicante. ISABIAL, Alicante, España
| | - E Del Alcázar
- Servicio de Dermatología, Hospital Universitari Germans Trias i Pujol. Germans Trias I Pujol Research Institute (IGTP), Universitat Autònoma de Barcelona, Badalona, Barcelona, España
| | - M T Abalde-Pintos
- Servicio de Dermatología, Complejo Hospitalario Universitario de Pontevedra, Pontevedra, España; Grupo de Investigación DIPO, Instituto de Investigación Sanitaria Galicia Sur (IIS Galicia Sur), SERGAS-UVIGO, España
| | - J Suárez-Perez
- Servicio de Dermatología, Hospital Clínico de Málaga, Málaga, España
| | - I García-Doval
- Unidad de Investigación, Fundación Piel Sana AEDV, España; Servicio de Dermatología, Complexo Hospitalario Universitario de Vigo, Vigo, España
| | - M Á Descalzo
- Unidad de Investigación, Fundación Piel Sana AEDV, España
| | - Á Flórez
- Servicio de Dermatología, Complejo Hospitalario Universitario de Pontevedra, Pontevedra, España; Grupo de Investigación DIPO, Instituto de Investigación Sanitaria Galicia Sur (IIS Galicia Sur), SERGAS-UVIGO, España
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5
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Lluch-Galcerá JJ, Carrascosa JM, González-Quesada A, Rivera-Díaz R, Sahuquillo-Torralba A, Llamas-Velasco M, Gómez-García FJ, Herrera-Acosta E, de la Cueva P, Baniandrés-Rodríguez O, Lopez-Estebaranz JL, Belinchón I, Ferrán M, Mateu A, Rodríguez L, Riera-Monroig J, Abalde-Pintos MT, Carretero G, García-Donoso C, Pujol-Marco C, Del Alcázar E, Santamaría-Domínguez C, Suárez-Pérez JA, Nieto-Benito LM, Ruiz-Genao DP, Salgado-Boquete L, Descalzo MÁ, García-Doval I. Safety of biologic therapy in combination with methotrexate in moderate to severe psoriasis: a cohort study from the BIOBADADERM registry. Br J Dermatol 2024; 190:355-363. [PMID: 37846976 DOI: 10.1093/bjd/ljad382] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Revised: 09/27/2023] [Accepted: 09/28/2023] [Indexed: 10/18/2023]
Abstract
BACKGROUND Safety is an important consideration in decisions on treatment for patients with moderate-to-severe psoriasis and the study of drug safety is the main purpose of the BIOBADADERM registry. The combination of a biologic agent and a conventional systemic drug [generally methotrexate (MTX)] is a common treatment in clinical practice. However, there is a paucity of evidence from real-world practice on the safety of such combination regimens in the treatment of psoriasis. OBJECTIVES The primary objective of this study was to ascertain whether the use of regimens combining biologic drugs with MTX in the management of moderate-to-severe psoriasis increases the risk of adverse events (AEs) or serious AEs (SAEs). We compared monotherapy using tumour necrosis factor (TNF), interleukin (IL)-17 and IL-23 inhibitors with the use of the same drugs in combination with MTX. METHODS Using data from the BIOBADADERM registry, we compared biologic monotherapies with therapies that were combined with MTX. We estimated adjusted incidence rate ratios (aIRR) using a random effects Poisson regression with 95% confidence intervals for all AEs, SAEs, infections and serious infections and other AEs by system organ class. RESULTS We analysed data from 2829 patients and 5441 treatment cycles, a total of 12 853 patient-years. The combination of a biologic with MTX was not associated with statistically significant increases in overall risk of AEs or SAEs in any treatment group. No increase in the total number of infections or serious infections in patients receiving combined therapy was observed for any group. However, treatment with a TNF inhibitor combined with MTX was associated with an increase in the incidence of gastrointestinal AEs (aIRR 2.50, 95% CI 1.57-3.98; P < 0.002). CONCLUSIONS The risk of AEs and SAEs was not significantly increased in patients with moderate-to-severe psoriasis receiving different classes of biologic drugs combined with MTX compared with those on biologic monotherapy.
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Affiliation(s)
- Juan José Lluch-Galcerá
- Department of Dermatology, Hospital Universitari Germans Trias i Pujol, Universitat Autònoma de Barcelona, IGTP. Badalona, Barcelona, Spain
- Departament de Medicina, Universitat Autonoma de Barcelona (UAB), Barcelona, Spain
| | - Jose Manuel Carrascosa
- Department of Dermatology, Hospital Universitari Germans Trias i Pujol, Universitat Autònoma de Barcelona, IGTP. Badalona, Barcelona, Spain
- Departament de Medicina, Universitat Autonoma de Barcelona (UAB), Barcelona, Spain
| | - Alicia González-Quesada
- Department of Dermatology, Hospital Universitario de Gran Canaria Dr. Negrín, Las Palmas de Gran Canaria, Islas Canarias, Spain
| | - Raquel Rivera-Díaz
- Department of Dermatology, Hospital Universitario 12 de Octubre, Universidad Complutense, Madrid, Spain
| | | | - Mar Llamas-Velasco
- Department of Dermatology, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria de La Princesa (IIS-LP), Madrid,Spain
| | | | | | - Pablo de la Cueva
- Department of Dermatology, Hospital Universitario Infanta Leonor, Madrid, Spain
| | | | | | - Isabel Belinchón
- Department of Dermatology, Hospital General Universitario de Alicante-ISABIAL-UMH, Alicante, Spain
| | - Marta Ferrán
- Department of Dermatology, Hospital del Mar, Parc de Salut Mar, Barcelona, Spain
| | - Almudena Mateu
- Department of Dermatology, Hospital Universitario Doctor Peset, Valencia, Spain
| | - Lourdes Rodríguez
- Department of Dermatology, Hospital Virgen del Rocío, Seville, Spain
| | - Josep Riera-Monroig
- Department of Dermatology, Hospital Clinic de Barcelona, UB, Barcelona, Spain
| | - M Teresa Abalde-Pintos
- Department of Dermatology, Complejo Hospitalario Universitario de Pontevedra, Pontevedra, Spain
| | - Gregorio Carretero
- Department of Dermatology, Hospital Universitario de Gran Canaria Dr. Negrín, Las Palmas de Gran Canaria, Islas Canarias, Spain
| | - Carmen García-Donoso
- Department of Dermatology, Hospital Universitario 12 de Octubre, Universidad Complutense, Madrid, Spain
| | - Conrad Pujol-Marco
- Department of Dermatology, Hospital Universitario y Politécnico La Fe, Valencia,Spain
| | - Elena Del Alcázar
- Department of Dermatology, Hospital Universitari Germans Trias i Pujol, Universitat Autònoma de Barcelona, IGTP. Badalona, Barcelona, Spain
- Departament de Medicina, Universitat Autonoma de Barcelona (UAB), Barcelona, Spain
| | - Cristina Santamaría-Domínguez
- Department of Dermatology, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria de La Princesa (IIS-LP), Madrid,Spain
| | | | - Lula María Nieto-Benito
- Department of Dermatology, CEIMI, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | | | - Laura Salgado-Boquete
- Department of Dermatology, Complejo Hospitalario Universitario de Pontevedra, Pontevedra, Spain
| | | | - Ignacio García-Doval
- Research Unit, Spanish Academy of Dermatology and Venereology, Madrid, Spain
- Department of Dermatology, Complexo Hospitalario Universitario de Vigo, Vigo, Pontevedra, Spain
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6
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Davis MS, Spencer RK, Johnson CE, Elhage KG, Jin JQ, Hakimi M, Bhutani T, Liao W. Risk of Cutaneous T Cell Lymphoma with Psoriasis Biologic Therapies. Dermatol Ther (Heidelb) 2024; 14:15-30. [PMID: 38043065 PMCID: PMC10828324 DOI: 10.1007/s13555-023-01074-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Accepted: 11/13/2023] [Indexed: 12/05/2023] Open
Abstract
BACKGROUND The risk of developing cutaneous T cell lymphoma (CTCL) in patients using psoriasis biologics has not been well characterized. The goals of this review were to investigate the incidence of CTCL in patients with psoriasis receiving biologic therapy in clinical trials and psoriasis registries, and to review cases of CTCL and biologic use reported in scientific publications. METHODS The US National Library of Medicine clinical trials database (clinicaltrials.gov) was queried to identify phase 3 and 4 clinical trials of the 12 biologic agents currently FDA approved for psoriatic disease. The incidence of CTCL in these trials was examined and summarized. To examine the incidence of CTCL in psoriasis registries, a Medline search was conducted. Finally, we performed a systematic review of CTCL cases reported in the literature. RESULTS Only two cases of CTCL were reported in 35,801 subjects with psoriasis receiving a biologic agent in the active arm of 108 psoriasis phase 3 clinical trials. One of these CTCL cases was determined by the investigator to be CTCL misdiagnosed as psoriasis prior to randomization. No cases of CTCL were reported in 5440 subjects with psoriasis in 34 phase 4 clinical trials. Only one case of CTCL was identified in 34,111 registry subjects. In the literature, tumor necrosis factor (TNF) inhibitors had the highest number of reported cases of CTCL (34 cases), followed by interleukin (IL)-17 inhibitors (7 cases), and IL-12/23 inhibitors (6 cases). No cases of CTCL were found to be reported with IL-23 inhibitors. CONCLUSION Our findings indicate that the development of CTCL is rare in the setting of psoriasis biologic use. Of the limited number of cases of CTCL found, most were in the setting of TNF inhibitor use and no cases of CTCL were reported in the setting of IL-23 inhibitor use.
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Affiliation(s)
- Mitchell S Davis
- Department of Dermatology, University of California San Francisco, Floor 04, Room N426, 2340 Sutter Street, Box 0808, San Francisco, CA, 94115, USA
| | - Riley K Spencer
- Department of Dermatology, University of California San Francisco, Floor 04, Room N426, 2340 Sutter Street, Box 0808, San Francisco, CA, 94115, USA
- Arizona College of Osteopathic Medicine, Midwestern University, Glendale, AZ, USA
| | - Chandler E Johnson
- Department of Dermatology, University of California San Francisco, Floor 04, Room N426, 2340 Sutter Street, Box 0808, San Francisco, CA, 94115, USA
- Medical College of Georgia, Augusta, GA, USA
| | - Kareem G Elhage
- Department of Dermatology, University of California San Francisco, Floor 04, Room N426, 2340 Sutter Street, Box 0808, San Francisco, CA, 94115, USA
| | - Joy Q Jin
- Department of Dermatology, University of California San Francisco, Floor 04, Room N426, 2340 Sutter Street, Box 0808, San Francisco, CA, 94115, USA
- School of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Marwa Hakimi
- Department of Dermatology, University of California San Francisco, Floor 04, Room N426, 2340 Sutter Street, Box 0808, San Francisco, CA, 94115, USA
| | - Tina Bhutani
- Department of Dermatology, University of California San Francisco, Floor 04, Room N426, 2340 Sutter Street, Box 0808, San Francisco, CA, 94115, USA
| | - Wilson Liao
- Department of Dermatology, University of California San Francisco, Floor 04, Room N426, 2340 Sutter Street, Box 0808, San Francisco, CA, 94115, USA.
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7
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Gu SL, Nath S, Markova A. Safety of Immunomodulatory Systemic Therapies Used in the Management of Immune-Related Cutaneous Adverse Events. Pharmaceuticals (Basel) 2023; 16:1610. [PMID: 38004475 PMCID: PMC10674388 DOI: 10.3390/ph16111610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Revised: 11/08/2023] [Accepted: 11/11/2023] [Indexed: 11/26/2023] Open
Abstract
Immune-related cutaneous adverse events (ircAEs) commonly occur in patients on treatment with immune checkpoint inhibitors and can significantly reduce patient quality of life. These are often treated with immunomodulatory agents, including glucocorticoids, immunosuppressants, and biologics. While often effective at managing symptoms, these therapies can cause several adverse events which may limit their use. In addition, immunomodulatory agents should be used with particular caution in patients receiving immunotherapy, as the efficacy of the oncologic regimen may potentially be undermined. In this review, we summarize the safety of systemic therapies that are used in the management of ircAEs, with a particular focus on the resultant risk of secondary tumor progression in patients with active cancer.
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Affiliation(s)
- Stephanie L. Gu
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - Sandy Nath
- Urgent Care Service, Memorial Sloan Kettering Cancer, New York, NY 10065, USA
| | - Alina Markova
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
- Department of Dermatology, Weill Cornell Medical College, New York, NY 10065, USA
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8
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Koh XQ, Oon HH, Chong WS, Lee B, Zhao X, Tan EST. Clinical and patient-reported outcomes from the first 4 years of a Psoriasis Biologics Registry in Singapore. Exp Dermatol 2023; 32:2023-2028. [PMID: 37583346 DOI: 10.1111/exd.14910] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2023] [Revised: 07/23/2023] [Accepted: 07/30/2023] [Indexed: 08/17/2023]
Abstract
Interim analysis of the National Skin Centre Singapore Psoriasis Biologics Registry (SINGPSOR) from August 2017 to May 2021, in which 58 patients were analysed, showing that those receiving biologic treatment had significantly more severe psoriasis based on PASI (Psoriasis Area and Severity Index), BSA (body surface area) and PGA (Physician Global Assessment) measures at baseline, demonstrated a statistically non-significant trend towards greater improvement with treatment, and had a lower percentage of adverse events compared to those receiving conventional systemic therapy. Future analyses of SINGPSOR, with larger sample size and longer follow-up, will be invaluable to further characterize these patients and their treatment outcomes.
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Affiliation(s)
| | - Hazel H Oon
- National Skin Centre, Singapore, Singapore
- Skin Research Institute of Singapore, Singapore, Singapore
| | | | - Bernett Lee
- Centre for Biomedical Informatics, Nanyang Technological University, Singapore, Singapore
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9
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Membrive-Jiménez C, Pérez-Ramírez C, Arias-Santiago S, Richetta AG, Ottini L, Pineda-Lancheros LE, Ramírez-Tortosa MDC, Jiménez-Morales A. Impact of Functional Polymorphisms on Drug Survival of Biological Therapies in Patients with Moderate-to-Severe Psoriasis. Int J Mol Sci 2023; 24:ijms24108703. [PMID: 37240048 DOI: 10.3390/ijms24108703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 05/09/2023] [Accepted: 05/10/2023] [Indexed: 05/28/2023] Open
Abstract
Biological therapies (BTs) indicated for psoriasis are highly effective; however, not all patients obtain good results, and loss of effectiveness is the main reason for switching. Genetic factors may be involved. The objective of this study was to evaluate the influence of single-nucleotide polymorphisms (SNPs) on the drug survival of tumor necrosis factor inhibitors (anti-TNF) medications and ustekinumab (UTK) in patients diagnosed with moderate-to-severe psoriasis. We conducted an ambispective observational cohort study that included 379 lines of treatment with anti-TNF (n = 247) and UTK (132) in 206 white patients from southern Spain and Italy. The genotyping of the 29 functional SNPs was carried out using real-time polymerase chain reaction (PCR) with TaqMan probes. Drug survival was evaluated with Cox regression and Kaplan-Meier curves. The multivariate analysis showed that the HLA-C rs12191877-T (hazard ratio [HR] = 0.560; 95% CI = 0.40-0.78; p = 0.0006) and TNF-1031 (rs1799964-C) (HR = 0.707; 95% CI = 0.50-0.99; p = 0.048) polymorphisms are associated with anti-TNF drug survival, while TLR5 rs5744174-G (HR = 0.589; 95% CI = 0.37-0.92; p = 0.02), CD84 rs6427528-GG (HR = 0.557; 95% CI = 0.35-0.88; p = 0.013) and PDE3A rs11045392-T together with SLCO1C1 rs3794271-T (HR = 0.508; 95% CI = 0.32-0.79; p = 0.002) are related to UTK survival. The limitations are the sample size and the clustering of anti-TNF drugs; we used a homogeneous cohort of patients from 2 hospitals only. In conclusion, SNPs in the HLA-C, TNF, TLR5, CD84, PDE3A, and SLCO1C1 genes may be useful as biomarkers of drug survival of BTs indicated for psoriasis, making it possible to implement personalized medicine that will reduce financial healthcare costs, facilitate medical decision-making and improve patient quality of life. However, further pharmacogenetic studies need to be conducted to confirm these associations.
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Affiliation(s)
- Cristina Membrive-Jiménez
- Pharmacogenetics Unit, Pharmacy Service, University Hospital Virgen de las Nieves, Avenida. de las Fuerzas Armadas 2, 18004 Granada, Spain
| | - Cristina Pérez-Ramírez
- Department of Biochemistry and Molecular Biology II, Faculty of Pharmacy, Campus Universitario de Cartuja, University of Granada, 18011 Granada, Spain
| | | | - Antonio Giovanni Richetta
- Unit of Dermatology, Department of Internal Medicine and Medical Specialties Sapienza, University of Rome, 00161 Rome, Italy
| | - Laura Ottini
- Department of Molecular Medicine, Sapienza University of Rome, 00161 Rome, Italy
| | - Laura Elena Pineda-Lancheros
- Pharmacogenetics Unit, Pharmacy Service, University Hospital Virgen de las Nieves, Avenida. de las Fuerzas Armadas 2, 18004 Granada, Spain
| | - Maria Del Carmen Ramírez-Tortosa
- Department of Biochemistry and Molecular Biology II, Faculty of Pharmacy, Campus Universitario de Cartuja, University of Granada, 18011 Granada, Spain
| | - Alberto Jiménez-Morales
- Pharmacogenetics Unit, Pharmacy Service, University Hospital Virgen de las Nieves, Avenida. de las Fuerzas Armadas 2, 18004 Granada, Spain
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10
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Topaloğlu Demir F, Polat Ekinci A, Aytekin S, Topkarcı Z, Aslan Kayıran M, Özkök Akbulut T, Oğuz Topal İ, Sarıkaya Solak S, Kara Polat A, Karadağ AS. Clinical course of psoriasis patients that discontinued biologics during the COVID-19 pandemic. J Cosmet Dermatol 2023; 22:722-731. [PMID: 36630728 DOI: 10.1111/jocd.15638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Accepted: 01/03/2023] [Indexed: 01/12/2023]
Abstract
BACKGROUND Since psoriasis is a chronic disease, it is not recommended to discontinue the treatment agents used. However, in real life, the treatment of psoriasis patients may be interrupted for various reasons. During the pandemic period, the treatment of many patients was also interrupted. OBJECTIVES To evaluate relapse and clinical worsening in psoriasis patients whose biological therapy was interrupted during the pandemic and reveal associated factors. METHODS The study included patients aged ≥18 years, who were followed up with moderate and severe chronic psoriasis controlled by the last biological agent [Psoriasis Area Severity Index (PASI) 75 response achieved] but had to discontinue their treatment during the pandemic. The patients' demographic and clinical characteristics, clinical course after the discontinuation of these agents, presence of clinical worsening, and relapse were evaluated. Risk factors were analyzed with the logistic regression analysis. RESULTS The study included 169 patients, with a mean age of 47.3 ± 14.5 (18-87) years. The mean biologics-free time was 18.2 ± 12.3 (2-56) weeks. Clinical worsening was detected in 41.4% and relapse in 48.5% of the patients. The significant risk factors for clinical worsening and relapse in both univariate and multivariate analyses were alcohol use during the biologics-free period, total time off biologics, and the presence of an additional triggering factor. The use of secukinumab and ustekinumab was found to be a protective factor against clinical worsening in multivariate analyses. CONCLUSION As the biologics-free period is prolonged, the likelihood of clinical worsening and relapse increases, therefore, we do not recommend discontinuing biological agents.
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Affiliation(s)
- Filiz Topaloğlu Demir
- Department of Dermatology and Venereology, Faculty of Medicine, Istanbul Medipol University, Istanbul, Turkey
| | - Algün Polat Ekinci
- Department of Dermatology and Venereology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Sema Aytekin
- Department of Dermatology and Venereology, Faculty of Medicine, Tekirdag Namik Kemal University, Tekirdag, Turkey
| | - Zeynep Topkarcı
- Department of Dermatology and Venereology, Istanbul Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Health Sciences University, Istanbul, Turkey
| | - Melek Aslan Kayıran
- Department of Dermatology and Venereology, Goztepe Training and Research Hospital, Istanbul Medeniyet University, Istanbul, Turkey
| | - Tuğba Özkök Akbulut
- Department of Dermatology and Venereology, Haseki Training and Research Hospital, Health Sciences University, Istanbul, Turkey
| | - İlteriş Oğuz Topal
- Department of Dermatology and Venereology, Prof. Dr. Cemil Tascioglu City Hospital, Health Sciences University, Istanbul, Turkey
| | - Sezgi Sarıkaya Solak
- Department of Dermatology and Venereology, Faculty of Medicine, Trakya University, Edirne, Turkey
| | - Asude Kara Polat
- Department of Dermatology and Venereology, Istanbul Training and Research Hospital, Health Sciences University, Istanbul, Turkey
| | - Ayşe Serap Karadağ
- Department of Dermatology and Venereology, Memorial Atasehir Hospital, Istanbul Arel University, Istanbul, Turkey
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11
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Inflammation Causes Exacerbation of COVID-19: How about Skin Inflammation? Int J Mol Sci 2022; 23:ijms232012260. [PMID: 36293117 PMCID: PMC9603600 DOI: 10.3390/ijms232012260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Revised: 09/10/2022] [Accepted: 09/27/2022] [Indexed: 01/24/2023] Open
Abstract
COVID-19 is a recently emerged viral infection worldwide. SARS-CoV-2, the causative virus, is believed to have emerged from bat coronaviruses, probably through host conversion. The bat coronavirus which has the highest gene homology to SARS-CoV-2 specifically infects deep forest bats in China whose habitat extends through the Middle East to Southern Europe. Host conversion might have occurred due to the deforestation by humans exposing wild bats to the environment they had never encountered before. SARS-CoV-2 infects cells through two mechanisms: through its receptor ACE2 with the help of enzyme TMPRSS and through membrane fusion with the help of elastases in the inflammatory condition. Obesity, hypertension, diabetes mellitus, and pulmonary diseases cause poor prognosis of COVID-19. Aging is another factor promoting poor prognosis. These diseases and aging cause low-level and persistent inflammation in humans, which can promote poor prognosis of COVID-19. Psoriasis and atopic dermatitis are the major inflammatory skin diseases. These inflammatory skin conditions, however, do not seem to cause poor prognosis for COVID-19 based on the epidemiological data accumulated so far. These mechanisms need to be elucidated.
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12
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Tsentemeidou A, Sotiriou E, Sideris N, Bakirtzi K, Papadimitriou I, Lallas A, Ioannides D, Vakirlis E. Apremilast in Psoriasis Patients With Serious Comorbidities: a Case Series and Systematic Review of Literature. Dermatol Pract Concept 2022; 12:e2022179. [PMID: 36534526 PMCID: PMC9681161 DOI: 10.5826/dpc.1204a179] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/18/2022] [Indexed: 01/25/2023] Open
Abstract
INTRODUCTION Patients with serious comorbidities are traditionally excluded from clinical trials. Apremilast is not contraindicated in active infections, malignancy and serious hepatic or renal impairment, but real-life data is needed to support this recommendation. OBJECTIVES The aim of this paper is to present our personal as well as literature-sourced real-world evidenced on apremilast use in psoriasis patients with serious baseline comorbidities. METHODS A case-series and systematic literature review were performed. The psoriasis archives of a tertiary-care hospital, four electronic databases (MEDLINE, ScienceDirect, Cochrane Library, Google scholar) and other sources were searched (January 2014 - July 2021). Identified records were considered eligible, if they reported on the use of apremilast monotherapy in psoriasis patients with chronic infections, history of malignancy, serious liver, renal, psychiatric, or other disease(s). RESULTS At least 841 psoriasis patients with serious baseline diseases received apremilast. Only 3 cases of cancer progression and no infection reactivations or worsening of other diseases were documented. No increased frequency/severity of adverse events or reduced drug efficacy were noted. Main limitations of this study are the exclusion of a few reports due to inappropriately documented data and the fact that at least some patients might have been counted more than once. CONCLUSIONS Apremilast is a safe and adequately efficacious option for psoriasis that cannot be treated/is challenging to treat with classic systemic agents and/or biologics.
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Affiliation(s)
- Aikaterini Tsentemeidou
- First Department of Dermatology and Venereology, School of Medicine, Aristotle University, Thessaloniki, Greece
| | - Elena Sotiriou
- First Department of Dermatology and Venereology, School of Medicine, Aristotle University, Thessaloniki, Greece
| | - Nikolaos Sideris
- First Department of Dermatology and Venereology, School of Medicine, Aristotle University, Thessaloniki, Greece
| | - Katerina Bakirtzi
- First Department of Dermatology and Venereology, School of Medicine, Aristotle University, Thessaloniki, Greece
| | - Ilias Papadimitriou
- First Department of Dermatology and Venereology, School of Medicine, Aristotle University, Thessaloniki, Greece
| | - Aimilios Lallas
- First Department of Dermatology and Venereology, School of Medicine, Aristotle University, Thessaloniki, Greece
| | - Dimitrios Ioannides
- First Department of Dermatology and Venereology, School of Medicine, Aristotle University, Thessaloniki, Greece
| | - Efstratios Vakirlis
- First Department of Dermatology and Venereology, School of Medicine, Aristotle University, Thessaloniki, Greece
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13
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Lopez‐Trujillo E, Pesqué D, Sanchez F, Dominguez M, Gallardo F, Pujol RM, Ferran M. Active tuberculosis in a cohort of patients with psoriasis on biologic therapy: learnings from real‐life medical practice. J Eur Acad Dermatol Venereol 2022; 36:e689-e691. [DOI: 10.1111/jdv.18131] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Accepted: 04/06/2022] [Indexed: 11/26/2022]
Affiliation(s)
- E Lopez‐Trujillo
- Department of Dermatology, Hospital del Mar, Parc de Salut Mar Barcelona Spain
| | - D Pesqué
- Department of Dermatology, Hospital del Mar, Parc de Salut Mar Barcelona Spain
| | - F Sanchez
- Department of Infectious diseases, Hospital del Mar, Parc de Salut Mar Barcelona Spain
| | - M Dominguez
- Department of Pneumology, Hospital del Mar, Parc de Salut Mar Barcelona Spain
| | - F Gallardo
- Department of Dermatology, Hospital del Mar, Parc de Salut Mar Barcelona Spain
| | - RM Pujol
- Department of Dermatology, Hospital del Mar, Parc de Salut Mar Barcelona Spain
| | - M Ferran
- Department of Dermatology, Hospital del Mar, Parc de Salut Mar Barcelona Spain
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14
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Piaserico S, Messina F. Pharmacological management of severe plaque psoriasis in patients with cardiovascular disease. Expert Opin Pharmacother 2022; 23:853-864. [PMID: 35361040 DOI: 10.1080/14656566.2022.2060739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
INTRODUCTION There is compelling evidence about the independent association between psoriasis and an increased risk of cardiovascular diseases, in particular myocardial infarction, chronic heart failure and cardiac arrythmia. This is due to both the higher prevalence of traditional cardiovascular risk factors (including hypertension, diabetes, hyperlipidemia, obesity, and smoking) and an independent contribution of chronic systemic inflammation associated with psoriasis. Inflammation is not only important in atherosclerosis, but also is increasingly recognized as a contributing factor to heart failure and arrythmia through microvascular dysfunction and myocardial fibrosis. When treating a patient with severe psoriasis, it is recommended to take into consideration this enhanced cardiovascular risk. Moreover, the use of a systemic treatment in a patient with already existing cardiovascular comorbidities should always be considered with caution, assessing the pro and cons of these drugs. AREAS COVERED Herein, the authors review the pharmacological management of severe plaque psoriasis in patients with cardiovascular disease, providing their expert opinion and future perspectives on the subject. EXPERT OPINION Theoretically, anti-inflammatory drugs may not only dampen the systemic burden associated with psoriasis, but also potentially contribute to prevent long-term cardiovascular events in psoriasis. On the other hand, some treatments may also induce negative effects on the cardiovascular system. Whether findings from observational studies or ones evaluating surrogates of cardiovascular risk translate into reductions in cardiovascular events needs to be investigated by long-term clinical trials with clinically meaningful endpoints.
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Affiliation(s)
- Stefano Piaserico
- Department of Medicine, Dermatology Unit, University of Padua, Padua, Italy
| | - Francesco Messina
- Department of Medicine, Dermatology Unit, University of Padua, Padua, Italy
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15
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Li N, Qin Y, Dai D, Wang P, Shi M, Gao J, Yang J, Xiao W, Song P, Xu R. Transdermal Delivery of Therapeutic Compounds With Nanotechnological Approaches in Psoriasis. Front Bioeng Biotechnol 2022; 9:804415. [PMID: 35141215 PMCID: PMC8819148 DOI: 10.3389/fbioe.2021.804415] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Accepted: 12/20/2021] [Indexed: 12/12/2022] Open
Abstract
Psoriasis is a chronic, immune-mediated skin disorder involving hyperproliferation of the keratinocytes in the epidermis. As complex as its pathophysiology, the optimal treatment for psoriasis remains unsatisfactorily addressed. Though systemic administration of biological agents has made an impressive stride in moderate-to-severe psoriasis, a considerable portion of psoriatic conditions were left unresolved, mainly due to adverse effects from systemic drug administration or insufficient drug delivery across a highly packed stratum corneum via topical therapies. Along with the advances in nanotechnologies, the incorporation of nanomaterials as topical drug carriers opens an obvious prospect for the development of antipsoriatic topicals. Hence, this review aims to distinguish the benefits and weaknesses of individual nanostructures when applied as topical antipsoriatics in preclinical psoriatic models. In view of specific features of each nanostructure, we propose that a proper combination of distinctive nanomaterials according to the physicochemical properties of loaded drugs and clinical features of psoriatic patients is becoming a promising option that potentially drives the translation of nanomaterials from bench to bedside with improved transdermal drug delivery and consequently therapeutic effects.
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Affiliation(s)
- Ning Li
- Institute of Basic Theory for Chinese Medicine, China Academy of Chinese Medical Sciences, Beijing, China
| | - Yeping Qin
- Guang’anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Dan Dai
- Guang’anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Pengyu Wang
- Guang’anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Mingfei Shi
- Institute of Basic Theory for Chinese Medicine, China Academy of Chinese Medical Sciences, Beijing, China
| | - Junwei Gao
- Institute of Basic Theory for Chinese Medicine, China Academy of Chinese Medical Sciences, Beijing, China
| | - Jinsheng Yang
- Institute of Basic Theory for Chinese Medicine, China Academy of Chinese Medical Sciences, Beijing, China
| | - Wei Xiao
- State Key Laboratory of New-tech for Chinese Medicine Pharmaceutical Process, Jiangsu Kanion Pharmaceutical Co., Ltd, Lianyungang, China
- *Correspondence: Wei Xiao, ; Ping Song, ; Ruodan Xu,
| | - Ping Song
- Guang’anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
- *Correspondence: Wei Xiao, ; Ping Song, ; Ruodan Xu,
| | - Ruodan Xu
- Institute of Basic Theory for Chinese Medicine, China Academy of Chinese Medical Sciences, Beijing, China
- Interdisciplinary of Nanoscience Center (iNANO), Aarhus University, Aarhus, Denmark
- *Correspondence: Wei Xiao, ; Ping Song, ; Ruodan Xu,
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16
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Arora H, Boothby-Shoemaker W, Braunberger T, Lim HW, Veenstra J. Safety of conventional immunosuppressive therapies for patients with dermatological conditions and coronavirus disease 2019: A review of current evidence. J Dermatol 2021; 49:317-329. [PMID: 34962304 DOI: 10.1111/1346-8138.16182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Revised: 09/16/2021] [Accepted: 09/21/2021] [Indexed: 12/15/2022]
Abstract
The effect of coronavirus disease 2019 (COVID-19) on patients receiving conventional immunosuppressive (IS) therapy has yet to be fully determined; however, research on using IS therapy for treating COVID-19 in acutely ill patients is increasing. While some believe that IS therapy may be protective, others argue that these agents may make patients more susceptible to COVID-19 infection and morbidity and advocate for a more cautious, individualized approach to determining continuation, reduction, or discontinuation of therapy. In this review, we aim to provide an overview of COVID-19 risk in dermatological patients who are receiving conventional IS therapies, including mycophenolate mofetil, methotrexate, cyclosporine, azathioprine, apremilast, JAK inhibitors, and systemic steroids. Additionally, we provide recommendations for management of these medications for dermatological patients during the COVID-19 pandemic. Treatment of dermatological disease during the COVID-19 pandemic should involve shared decision-making between the patient and provider, with consideration of each patient's comorbidities and the severity of the patient's dermatological disease.
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Affiliation(s)
- Harleen Arora
- Department of Dermatology, Henry Ford Hospital, Detroit, Michigan, USA
| | - Wyatt Boothby-Shoemaker
- Department of Dermatology, Henry Ford Hospital, Detroit, Michigan, USA.,College of Human Medicine, Michigan State University, East Lansing, Michigan, USA
| | | | - Henry W Lim
- Department of Dermatology, Henry Ford Hospital, Detroit, Michigan, USA
| | - Jesse Veenstra
- Department of Dermatology, Henry Ford Hospital, Detroit, Michigan, USA
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17
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De Simone C, Fargnoli MC, Amerio P, Bianchi L, Esposito M, Pirro F, Potenza C, Ricceri F, Rongioletti F, Stingeni L, Prignano F. Risk of infections in psoriasis: assessment and challenges in daily management. Expert Rev Clin Immunol 2021; 17:1211-1220. [PMID: 34696673 DOI: 10.1080/1744666x.2021.1997592] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
INTRODUCTION In daily practice management of psoriasis, evaluation of risk factors for infections is having a growing influence. Indeed, in psoriatic patients, risk of infections may be due to psoriasis itself, immunomodulatory therapy, and comorbidities that may increase this risk and patient hospitalization. AREAS COVERED Given the greater understanding of psoriasis pathogenesis and the increasing number of treatment options, it is particularly important to customize therapy according to each, single patient; psoriasis features and comorbidities are also essential to tailor treatment goals. EXPERT OPINION In this perspective, the current knowledge on the infectious risk in psoriatic patient, related to comorbidities, such as diabetes mellitus, cardiovascular disease, and chronic obstructive pulmonary, to 'special populations,' to chronic infections, such as latent tuberculosis, chronic hepatitis B and C, and HIV, and to the most recent Covid-19 pandemic scenario, is reviewed and discussed in order to suggest the most appropriate approach and achieve the best available therapeutic option.
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Affiliation(s)
- Clara De Simone
- Institute of Dermatology, Catholic University, Rome, Italy.,Dermatology Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Maria Concetta Fargnoli
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Paolo Amerio
- Department of Medicine and Aging Science and Dermatologic Clinic, University "G. d'Annunzio", Chieti-Pescara, Italy
| | - Luca Bianchi
- Dermatology Unit, Department of Systems Medicine, Tor Vergata University of Rome, Italy
| | - Maria Esposito
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Federico Pirro
- Institute of Dermatology, Catholic University, Rome, Italy.,Dermatology Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Concetta Potenza
- Dermatology Unit "Daniele Innocenzi", Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Rome, Italy
| | - Federica Ricceri
- Unit of Dermatology, Department of Health Science, University of Florence, Florence, Italy
| | - Franco Rongioletti
- Dermatology Clinic, Department of Medical Sciences and Public Health, University of Cagliari, via Università 40, 09124 Cagliari, Italy, IRCCS San Raffaele Hospital, Vita Salute University, Milan, Italy
| | - Luca Stingeni
- Section of Dermatology, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - Francesca Prignano
- Unit of Dermatology, Department of Health Science, University of Florence, Florence, Italy
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18
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Membrive Jiménez C, Pérez Ramírez C, Sánchez Martín A, Vieira Maroun S, Arias Santiago S, Ramírez Tortosa MC, Jiménez Morales A. Clinical Application of Pharmacogenetic Markers in the Treatment of Dermatologic Pathologies. Pharmaceuticals (Basel) 2021; 14:ph14090905. [PMID: 34577605 PMCID: PMC8471650 DOI: 10.3390/ph14090905] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Revised: 08/25/2021] [Accepted: 09/01/2021] [Indexed: 02/07/2023] Open
Abstract
Dermatologic pathologies are the fourth most common cause of non-fatal disease worldwide; however, they produce a psychosocial, economic, and occupational impact equal to or greater than other chronic conditions. The most prevalent are actinic keratosis, followed by basal-cell carcinoma, in a lesser proportion acne vulgaris, psoriasis, and hidradenitis suppurativa, among others, and more rarely dermatitis herpetiformis. To treat actinic keratosis and basal-cell carcinoma, 5-fluorouracil (5-FU) 0.5% is administered topically with good results, although in certain patients it produces severe toxicity. On the other hand, dapsone is a drug commonly used in inflammatory skin conditions such as dermatitis herpetiformis; however, it occasionally causes hemolytic anemia. Additionally, biologic drugs indicated for the treatment of moderate-to-severe psoriasis and hidradenitis suppurativa have proved to be effective and safe; nevertheless, a small percentage of patients do not respond to treatment with biologics in the long term or they are ineffective. This interindividual variability in response may be due to alterations in genes that encode proteins involved in the pathologic environment of the disease or the mechanism of action of the medication. Pharmacogenetics studies the relationship between genetic variations and drug response, which is useful for the early identification of non-responsive patients and those with a higher risk of developing toxicity upon treatment. This review describes the pharmacogenetic recommendations with the strongest evidence at present for the treatments used in dermatology, highlighting those included in clinical practice guides. Currently, we could only find pharmacogenetic clinical guidelines for 5-FU. However, the summary of product characteristics for dapsone contains a pharmacogenetic recommendation from the United States Food and Drug Administration. Finally, there is an enormous amount of information from pharmacogenetic studies in patients with dermatologic pathologies (mainly psoriasis) treated with biologic therapies, but they need to be validated in order to be included in clinical practice guides.
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Affiliation(s)
- Cristina Membrive Jiménez
- Pharmacy Service, Pharmacogenetics Unit, University Hospital Virgen de las Nieves, 18014 Granada, Spain; (C.M.J.); (A.S.M.); (S.V.M.); (A.J.M.)
| | - Cristina Pérez Ramírez
- Pharmacy Service, Pharmacogenetics Unit, University Hospital Virgen de las Nieves, 18014 Granada, Spain; (C.M.J.); (A.S.M.); (S.V.M.); (A.J.M.)
- Center of Biomedical Research, Department of Biochemistry and Molecular Biology II, Institute of Nutrition and Food Technology “José Mataix”, University of Granada, Avda. del Conocimiento s/n., Armilla, 18016 Granada, Spain;
- Correspondence:
| | - Almudena Sánchez Martín
- Pharmacy Service, Pharmacogenetics Unit, University Hospital Virgen de las Nieves, 18014 Granada, Spain; (C.M.J.); (A.S.M.); (S.V.M.); (A.J.M.)
| | - Sayleth Vieira Maroun
- Pharmacy Service, Pharmacogenetics Unit, University Hospital Virgen de las Nieves, 18014 Granada, Spain; (C.M.J.); (A.S.M.); (S.V.M.); (A.J.M.)
| | | | - María Carmen Ramírez Tortosa
- Center of Biomedical Research, Department of Biochemistry and Molecular Biology II, Institute of Nutrition and Food Technology “José Mataix”, University of Granada, Avda. del Conocimiento s/n., Armilla, 18016 Granada, Spain;
| | - Alberto Jiménez Morales
- Pharmacy Service, Pharmacogenetics Unit, University Hospital Virgen de las Nieves, 18014 Granada, Spain; (C.M.J.); (A.S.M.); (S.V.M.); (A.J.M.)
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19
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Değirmenci MFK, Yalçındağ FN, Tugal-Tutkun İ. COVID-19 and the Use of Immunomodulatory Agents in Ophthalmology. Turk J Ophthalmol 2021; 51:231-242. [PMID: 34461710 PMCID: PMC8411289 DOI: 10.4274/tjo.galenos.2021.68252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Immunomodulatory agents are often used in the systemic treatment of non-infectious uveitis. These drugs consist of corticosteroids, conventional immunosuppressives, and biological agents. As it is known that they suppress the immune system, the most important concern associated with immunomodulatory therapy (IMT) is the increased risk of infection. The World Health Organization declared COVID-19 a pandemic on 11 March 2020. Although severe acute respiratory distress syndrome secondary to SARS-CoV-2 infection may develop in all people, patients who receive IMT may be at higher risk in terms of both the transmission of the infection and more severe disease course. Therefore, guidelines on the management of patients receiving IMT due to uveitis during the pandemic are needed. In this review, we examined the immunomodulatory drugs used in the treatment of uveitis in terms of infectious complications and the data of patients who received IMT during the COVID-19 pandemic and discussed recommendations for the use of these drugs. According to the latest information, patients who receive IMT may continue their treatment as long as there are no disruptions in regular complete blood count (especially white blood cell count >4,000/μL) and liver and kidney function tests. Patients diagnosed with COVID-19 should be managed with a multidisciplinary approach.
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Affiliation(s)
| | - F Nilüfer Yalçındağ
- Ankara University Faculty of Medicine, Department of Ophthalmology, Ankara, Turkey
| | - İlknur Tugal-Tutkun
- İstanbul University, İstanbul Faculty of Medicine, Department of Ophthalmology, İstanbul, Turkey
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20
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Woodbury MJ, Cohen JM, Merola JF, Perez-Chada LM. Leveraging behavioral economics to promote treatment adherence: A primer for the practicing dermatologist. J Am Acad Dermatol 2021; 87:1075-1080. [PMID: 34098000 DOI: 10.1016/j.jaad.2021.05.049] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Revised: 05/11/2021] [Accepted: 05/15/2021] [Indexed: 01/23/2023]
Abstract
The problem of suboptimal treatment adherence among patients with dermatologic or other diseases has not been adequately addressed in health care. Despite a wide range of efficacious therapies, nonadherence remains a primary driver of suboptimal clinical outcomes. Novel solutions to address this unmet need can be found in behavioral economics. By leveraging our understanding of human decision-making, we may better promote treatment adherence, thereby improving quality of life and decreasing economic burdens. Behavioral economics has been studied extensively in relation to topics such as health policy and health behaviors; however, there is a dearth of research applying this approach to chronic diseases and only a handful within dermatology. We conducted a scoping review in PubMed to identify articles that discuss behavioral economics and its application to treatment adherence in dermatologic patients, with a particular focus on psoriasis, followed by a summary of key ethical considerations. We found that such principles can be employed in cost-effective, scalable interventions that improve patient adherence to a range of medical therapies and lifestyle modifications.
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Affiliation(s)
| | - Jeffrey M Cohen
- Department of Dermatology, Yale School of Medicine, New Haven, Connecticut
| | - Joseph F Merola
- Division of Rheumatology, Department of Medicine, Harvard Medical School, Brigham and Women's Hospital, Boston, Massachusetts; Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
| | - Lourdes M Perez-Chada
- Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
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21
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Munera-Campos M, Vilar-Alejo J, Rivera R, Carrascosa JM, Daudén E, Herrera-Acosta E, Sahuquillo-Torralba A, Gómez-García FJ, Baniandrés-Rodríguez O, de la Cueva P, López-Estebaranz JL, Belinchón I, Ferran M, Riera-Monroig J, Rodriguez L, Carretero G, García-Donoso C, Ballescá F, Llamas-Velasco M, Herrera-Ceballos E, Pujol-Marco C, Nieto-Benito LM, Ruiz-Genao DP, Alsina M, Descalzo MA, García-Doval I. The risk of hepatic adverse events of systemic medications for psoriasis: a prospective cohort study using the BIOBADADERM registry. J DERMATOL TREAT 2021; 33:2110-2117. [PMID: 33913796 DOI: 10.1080/09546634.2021.1922572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND Limited information is available regarding the risk of incident liver disease in patients with psoriasis receiving systemic therapies. OBJECTIVES To describe the liver safety findings of conventional and modern systemic therapies for moderate-to-severe psoriasis, and to compare the relative incidence rates of hepatic adverse events (AEs) for each drug. METHODS All the patients on the BIOBADADERM registry were included. Crude and adjusted incidence rate ratios (cIRR and aIRR, respectively) of hepatic AEs, using anti-TNF drugs as reference, were determined. Outcomes of interest were hypertransaminasemia, nonalcoholic fatty liver disease (NADFLD) and a group of other, less represented, hepatic AEs. RESULTS Our study included 3,171 patients exposed to systemic drugs (6279 treatment cycles). Incident hypertransaminasemia was the most frequent hepatic AE (incidence rate of 21 per 1000 patients-years [CI 95% CI 18-23]), followed by NAFLD (8 cases per 1000 patients-years [95% CI 6-10]). Methotrexate (aIRR 3.06 [2.31-4.4]; p = 0.000) and cyclosporine (aIRR 2.37 [1.05-5.35]; p = 0.0378) were associated with an increased risk for hypertransaminasemia when compared to anti-TNF-α agents. No differences were observed between different groups of biologics. Conventional therapies were not associated with new incident NAFLD. CONCLUSIONS Comparative information of the incidence of hepatic AEs could facilitate drug selection in moderate-to-severe psoriasis.
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Affiliation(s)
- M Munera-Campos
- Department of Dermatology, Hospital Universitari Germans Trias i Pujol, Badalona, Universidad Autónoma de Barcelona, Barcelona, Spain
| | - J Vilar-Alejo
- Department of Dermatology, Hospital Universitario de Gran Canaria Dr. Negrín, Las Palmas de Gran Canaria, Spain
| | - R Rivera
- Department of Dermatology, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - J M Carrascosa
- Department of Dermatology, Hospital Universitari Germans Trias i Pujol, Badalona, Universidad Autónoma de Barcelona, Barcelona, Spain
| | - E Daudén
- Department of Dermatology. Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria de La Princesa (IIS-IP), Madrid, Spain
| | - E Herrera-Acosta
- Department of Dermatology, Hospital Universitario Virgen de la Victoria, Málaga, Spain
| | - A Sahuquillo-Torralba
- Department of Dermatology, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - F J Gómez-García
- Department of Dermatology, Hospital Universitario Reina Sofía, Cordoba, Spain
| | - O Baniandrés-Rodríguez
- Department of Dermatology, CEIMI Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - P de la Cueva
- Department of Dermatology, Hospital Universitario Infanta Leonor, Madrid, Spain
| | - J L López-Estebaranz
- Department of Dermatology, Hospital Universitario Fundación Alcorcón, Madrid, Spain
| | - I Belinchón
- Department of Dermatology, Hospital General Universitario de Alicante-ISABIAL, Alicante, Spain
| | - M Ferran
- Department of Dermatology, Hospital del Mar, Parc de Salut Mar, Barcelona, Spain
| | - J Riera-Monroig
- Department of Dermatology, Hospital Clínic de Barcelona, UB, Barcelona, Spain
| | - L Rodriguez
- Department of Dermatology, Hospital Virgen del Rocío, Sevilla, Spain
| | - G Carretero
- Department of Dermatology, Hospital Universitario de Gran Canaria Dr. Negrín, Las Palmas de Gran Canaria, Spain
| | - C García-Donoso
- Department of Dermatology, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - F Ballescá
- Department of Dermatology, Hospital Universitari Germans Trias i Pujol, Badalona, Universidad Autónoma de Barcelona, Barcelona, Spain
| | - M Llamas-Velasco
- Department of Dermatology. Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria de La Princesa (IIS-IP), Madrid, Spain
| | - E Herrera-Ceballos
- Department of Dermatology, Hospital Universitario Virgen de la Victoria, Málaga, Spain
| | - C Pujol-Marco
- Department of Dermatology, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - L M Nieto-Benito
- Department of Dermatology, CEIMI Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - D P Ruiz-Genao
- Department of Dermatology, Hospital Universitario Fundación Alcorcón, Madrid, Spain
| | - M Alsina
- Department of Dermatology, Hospital Clínic de Barcelona, UB, Barcelona, Spain
| | - M A Descalzo
- Research Unit. Fundación Piel Sana AEDV, Madrid, Spain
| | - I García-Doval
- Research Unit. Fundación Piel Sana AEDV, Madrid, Spain.,Department of Dermatology, Complexo Hospitalario Universitario de Vigo, Vigo, Spain
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22
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Membrive Jiménez C, Pérez Ramírez C, Sánchez Martín A, Vieira Maroun S, Arias Santiago SA, Ramírez Tortosa MDC, Jiménez Morales A. Influence of Genetic Polymorphisms on Response to Biologics in Moderate-to-Severe Psoriasis. J Pers Med 2021; 11:jpm11040293. [PMID: 33921427 PMCID: PMC8069496 DOI: 10.3390/jpm11040293] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Revised: 03/29/2021] [Accepted: 04/02/2021] [Indexed: 12/12/2022] Open
Abstract
Psoriasis is a chronic inflammatory skin pathology of autoimmune origin and unknown etiology. There are various therapies for treating it, including a wide range of biopharmaceuticals indicated in moderate-to-severe psoriasis. Depending on their therapeutic target, they are classified as tumor necrosis factor inhibitors (anti-TNF) or cytokine inhibitors (interleukin-12, 23, and 17 antagonists). Although they have proved effective and safe, in clinical practice, many patients show a short- and long-term suboptimal response and even varying degrees of toxicity. This variability in response may be influenced by genetic factors, such as polymorphisms in the genes involved in the pathological environment, metabolism or mechanism of action of the drug that could affect the effectiveness and toxicity of biological therapies. This review assesses pharmacogenetic studies of the impact of genetic factors on response to biopharmaceuticals and toxicity in patients diagnosed with moderate-to-severe psoriasis. The results suggest that polymorphisms detected in the HLA genes, in genes that encode cytokines (TNF, IL genes, TNFAIP3), transporters (PDE3A-SLCO1C1, SLC12A8), receptors (TNFRSF1B, CD84, FCGR2A and FCGR3A, IL17RA, IL23R, TLR genes, PGLYRP4) and associated proteins (TNFAIP3, LY96, TIRAP, FBXL19), as well as other genes implicated in the pathogenesis of psoriasis (CDKAL1, CARD14, PTTG1, MAP3K1, ZNF816A, GBP6, CTNNA2, HTR2A, CTLA4, TAP1) can be used in the future as predictive markers of treatment response and/or toxicity with biological therapies in patients diagnosed with moderate-to-severe psoriasis, tailoring treatment to the individual patient.
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Affiliation(s)
- Cristina Membrive Jiménez
- Pharmacogenetics Unit, Pharmacy Service, University Hospital Virgen de las Nieves, 18014 Granada, Spain; (C.M.J.); (A.S.M.); (S.V.M.); (A.J.M.)
| | - Cristina Pérez Ramírez
- Pharmacogenetics Unit, Pharmacy Service, University Hospital Virgen de las Nieves, 18014 Granada, Spain; (C.M.J.); (A.S.M.); (S.V.M.); (A.J.M.)
- Department of Biochemistry, Faculty of Pharmacy, Campus Universitario de Cartuja, University of Granada, 18071 Granada, Spain;
- Correspondence:
| | - Almudena Sánchez Martín
- Pharmacogenetics Unit, Pharmacy Service, University Hospital Virgen de las Nieves, 18014 Granada, Spain; (C.M.J.); (A.S.M.); (S.V.M.); (A.J.M.)
| | - Sayleth Vieira Maroun
- Pharmacogenetics Unit, Pharmacy Service, University Hospital Virgen de las Nieves, 18014 Granada, Spain; (C.M.J.); (A.S.M.); (S.V.M.); (A.J.M.)
| | | | | | - Alberto Jiménez Morales
- Pharmacogenetics Unit, Pharmacy Service, University Hospital Virgen de las Nieves, 18014 Granada, Spain; (C.M.J.); (A.S.M.); (S.V.M.); (A.J.M.)
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23
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Beecker J, Papp K, Dutz J, Vender R, Gniadecki R, Cooper C, Gisondi P, Gooderham M, Hong C, Kirchhof M, Lynde C, Maari C, Poulin Y, Puig L. Position statement for a pragmatic approach to immunotherapeutics in patients with inflammatory skin diseases during the coronavirus disease 2019 pandemic and beyond. J Eur Acad Dermatol Venereol 2021; 35:797-806. [PMID: 33533553 PMCID: PMC8014810 DOI: 10.1111/jdv.17075] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Revised: 10/27/2020] [Accepted: 11/12/2020] [Indexed: 12/14/2022]
Abstract
Coronavirus disease 2019 (COVID-19) is caused by SARS-CoV-2, a novel RNA virus that was declared a global pandemic on 11 March 2020. The efficiency of infection with SARS-CoV-2 is reflected by its rapid global spread. The SARS-CoV-2 pandemic has implications for patients with inflammatory skin diseases on systemic immunotherapy who may be at increased risk of infection or more severe infection. This position paper is a focused examination of current evidence considering the mechanisms of action of immunotherapeutic drugs in relation to immune response to SARS-CoV-2. We aim to provide practical guidance for dermatologists managing patients with inflammatory skin conditions on systemic therapies during the current pandemic and beyond. Considering the limited and rapidly evolving evidence, mechanisms of action of therapies, and current knowledge of SARS-CoV-2 infection, we propose that systemic immunotherapy can be continued, with special considerations for at risk patients or those presenting with symptoms.
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Affiliation(s)
- J. Beecker
- University of OttawaOttawaONCanada
- Division of DermatologyThe Ottawa HospitalOttawaONCanada
- Ottawa Hospital Research InstituteOttawaONCanada
- Probity Medical Research Inc.WaterlooONCanada
| | - K.A. Papp
- Probity Medical Research Inc.WaterlooONCanada
- K Papp Clinical ResearchWaterlooONCanada
| | - J. Dutz
- Skin Care CenterVancouverBCCanada
- Department of Dermatology and Skin ScienceUniversity of British ColumbiaVancouverBCCanada
- Skin ScienceBC Children's Hospital Research InstituteVancouverBCCanada
| | - R.B. Vender
- Dermatrials Research Inc.HamiltonONCanada
- Department of MedicineMcMaster UniversityHamiltonONCanada
| | - R. Gniadecki
- Probity Medical Research Inc.WaterlooONCanada
- Division of DermatologyDepartment of MedicineFaculty of Medicine and DentistryUniversity of AlbertaEdmontonABCanada
| | - C. Cooper
- University of OttawaOttawaONCanada
- Ottawa Hospital Research InstituteOttawaONCanada
- The Ottawa Hospital and Regional Hepatitis ProgramOttawaONCanada
| | - P. Gisondi
- Department of MedicineSection of Dermatology and VenereologyUniversity of VeronaVeronaItaly
| | - M. Gooderham
- Probity Medical Research Inc.WaterlooONCanada
- SKiN Centre for DermatologyPeterboroughONCanada
| | - C.H. Hong
- Probity Medical Research Inc.WaterlooONCanada
- Department of Dermatology and Skin ScienceUniversity of British ColumbiaVancouverBCCanada
- Dr. Chih‐ho Hong Medical Inc.SurreyBCCanada
| | - M.G. Kirchhof
- University of OttawaOttawaONCanada
- Division of DermatologyThe Ottawa HospitalOttawaONCanada
| | - C.W. Lynde
- Probity Medical Research Inc.WaterlooONCanada
- Lynde Institute for DermatologyMarkhamONCanada
| | - C. Maari
- Innovaderm Research IncMontrealQCCanada
| | - Y. Poulin
- Centre de Recherche Dermatologique du Québec MétropolitainQuébecQCCanada
- Department of MedicineUniversité LavalHôpital Hôtel‐Dieu de QuébecQuebécQCCanada
| | - L. Puig
- Department of DermatologyHospital de la Santa Creu i Sant PauBarcelonaSpain
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24
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Quoi de neuf en thérapeutique dermatologique ? Ann Dermatol Venereol 2020; 147:12S43-12S50. [DOI: 10.1016/s0151-9638(20)31107-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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25
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Sadeghinia A, Daneshpazhooh M. Immunosuppressive drugs for patients with psoriasis during the COVID-19 pandemic era. A review. Dermatol Ther 2020; 34:e14498. [PMID: 33141519 DOI: 10.1111/dth.14498] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Revised: 10/23/2020] [Accepted: 10/27/2020] [Indexed: 12/15/2022]
Abstract
The COVID-19 has been spreading around the world. Concerns about the safety of administration of immunosuppressive drugs have been raised for treatment of psoriasis (PSO), and there is insufficient evidence for the risk of COVID-19 infection for psoriatic patients using these drugs, so we did a review, focusing on the risk of overall infection associated with the most commonly used immunosuppressive drugs, such as methotrexate, biologics, cyclosporin, Janus kinase inhibitors for the treatment of PSO. The data on the effect of immunosuppressive drugs on this virus may be ever-changing and remains to be clear. We recommend the initiation and continuation of low-risk immunomodulating drugs, such as Interleukin (IL)-17, IL-12/23, and IL-23 inhibitors, for treatment of PSO during COVID-19 era. For psoriatic patients with comorbidities switching to safer modalities such as systemic retinoids, apremilast, and home phototherapy is recommended. Immunosuppressive drugs should be withheld in psoriatic patients with the COVID-19 infection.
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Affiliation(s)
- Ali Sadeghinia
- Department of Dermatology, Razi Dermatology Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Maryam Daneshpazhooh
- Department of Dermatology, Razi Dermatology Hospital, Tehran University of Medical Sciences, Tehran, Iran
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26
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Doolan BJ, Koye D, Ling J, Cains GD, Baker C, Foley P, Dolianitis C. Treatment modalities and risk of adverse events associated with biologic therapy: A 10-year observational review of the Australasian Psoriasis Registry. Australas J Dermatol 2020; 62:e47-e54. [PMID: 32885846 DOI: 10.1111/ajd.13450] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Accepted: 08/02/2020] [Indexed: 12/01/2022]
Abstract
BACKGROUND Psoriasis is a chronic inflammatory disease affecting ~2-3% of the Australasian population. Therapeutic options include topical agents, phototherapy, systemic immunomodulators and biologic agents. Biologics present an acceptable short- and medium-term safety profile, derived mainly from randomised controlled trials (RCTs) and, however, may not represent real-world rates of adverse events (AEs). METHODS A retrospective, observational study of patients enrolled in The Australasian Psoriasis Registry from April 2008 to October 2018 was conducted. Data were collected from 104 sites in Australia and New Zealand. Patient characteristics, treatments and AE data were collected. AEs were classified by MedDRA System events. RESULTS 2094 patients were included (3765 patient-treatments), comprising; 1110 phototherapy, 1280 systemic and 1375 biologic therapy patient-treatments. Treatment arms were not mutually exclusive. The mean ± SD from date of diagnosis of psoriasis to commencement of biologic therapy was 8.9 ± 12.3 years. Methotrexate had the longest exposure time (3740.3 patient-years), and ustekinumab had the longest median (95% CI) time on treatment, 4.3 years (2.2, 6.6). AE differences on biologic treatment were present between patients who would have been eligible or ineligible for RCTs. Approximately 29% of registry patients would have been excluded from clinical trials enrolment. Patients ineligible for RCTs had increased adjusted hazard ratios (95% CI) of: infections and infestations (2.3, 1.7-3.1; P < 0.001), cardiac (8.2, 3.5-25.6; P < 0.001), gastrointestinal (3.5, 1.52-8.0; P < 0.001), hepatobiliary (5.6 1.7-19.1; P < 0.001), psychiatric (4.7, 1.5-14.1; P = 0.006) and eye disorders (4.8 1.5-15.6; P = 0.008), compared to those eligible for RCTs. Incidence rates in the trial eligible patients were similar to those reported from RCT rates. CONCLUSIONS This study establishes treatment modalities in use for severe psoriasis and the clinical rates of AEs associated with biologic therapy.
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Affiliation(s)
- Brent J Doolan
- Department of Dermatology, The Royal Melbourne Hospital, Melbourne, Victoria, Australia.,Skin Health Institute, Carlton, Victoria, Australia.,The Skin Hospital, Sydney, New South Wales, Australia
| | - Digsu Koye
- The Melbourne EpiCentre, University of Melbourne and Melbourne Health, Melbourne, Victoria, Australia
| | - Joanna Ling
- The Melbourne EpiCentre, University of Melbourne and Melbourne Health, Melbourne, Victoria, Australia
| | - Geoffrey D Cains
- Department of Dermatology, Liverpool Hospital, Sydney, New South Wales, Australia.,School of Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Christopher Baker
- Skin Health Institute, Carlton, Victoria, Australia.,Department of Dermatology and Medicine, St Vincent's Hospital, Melbourne, The University of Melbourne, Fitzroy, Victoria, Australia
| | - Peter Foley
- Skin Health Institute, Carlton, Victoria, Australia.,Department of Dermatology and Medicine, St Vincent's Hospital, Melbourne, The University of Melbourne, Fitzroy, Victoria, Australia
| | - Con Dolianitis
- Department of Dermatology, The Royal Melbourne Hospital, Melbourne, Victoria, Australia.,Department of Medicine, The University of Melbourne, Melbourne, Victoria, Australia
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27
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Topaloğlu Demir F, Özkök Akbulut T, Kıvanç Altunay İ, Aytekin S, Oğuz Topal İ, Kara Polat A, Özkur E, Karadağ AS. Evaluation of the adverse effects of biological agents used in the treatment of psoriasis: A multicenter retrospective cohort study. Dermatol Ther 2020; 33:e14216. [PMID: 32827159 DOI: 10.1111/dth.14216] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2020] [Revised: 08/09/2020] [Accepted: 08/13/2020] [Indexed: 01/25/2023]
Abstract
The objective was to reveal and compare the adverse effects of infliximab, etanercept, adalimumab, ustekinumab and secukinumab, and determine possible risk factors. The follow-up files and computer-based records of patients with psoriasis were retrospectively screened between January 2007 and September 2019. The five biological agents were compared in terms of their adverse effects, and factors that might be related to these effects were explored. While there was no statistically significant difference between the agents in terms of the rate of serious adverse effects, when all the adverse effects were evaluated together, the highest rate was seen in the use of infliximab and the lowest in secukinumab (P = .001). The rates of adverse effects and related drug discontinuation were higher in the use of anti-TNF agents compared to interleukin inhibitors (P = .004 and P = .012, respectively). The agent with the highest drug discontinuation rate due to adverse effects was infliximab while the least discontinued agent was ustekinumab (P = .036). There were more side effects with anti-TNF than interleukin inhibitors, but the serious adverse effect rate was similar in both groups. The incidence of certain adverse effects increases depending on age, number of comorbidities, biological agent and its group, concomitant systemic therapy, and use of multiple agents.
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Affiliation(s)
- Filiz Topaloğlu Demir
- Department of Dermatology and Venereology, Istanbul Medipol University, Faculty of Medicine, Istanbul, Turkey
| | - Tuğba Özkök Akbulut
- Department of Dermatology and Venereology, University of Health Sciences, Haseki Training and Research Hospital, Istanbul, Turkey
| | - İlknur Kıvanç Altunay
- Department of Dermatology and Venereology, University of Health Sciences, Şişli Hamidiye Etfal Training and Research Hospital, Istanbul, Turkey
| | - Sema Aytekin
- Department of Dermatology and Venereology, University of Health Sciences, Haydarpaşa Numune Training and Research Hospital, Istanbul, Turkey
| | - İlteriş Oğuz Topal
- Department of Dermatology and Venereology, University of Health Sciences, Okmeydanı Training and Research Hospital, Istanbul, Turkey
| | - Asude Kara Polat
- Department of Dermatology and Venereology, University of Health Sciences, Istanbul Training and Research Hospital, Istanbul, Turkey
| | - Ezgi Özkur
- Department of Dermatology and Venereology, University of Health Sciences, Şişli Hamidiye Etfal Training and Research Hospital, Istanbul, Turkey
| | - Ayşe Serap Karadağ
- Department of Dermatology and Venereology, Istanbul Medeniyet University, School of Medicine, Göztepe Training and Research Hospital, Istanbul, Turkey
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28
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Queiro Silva R, Armesto S, González Vela C, Naharro Fernández C, González-Gay MA. COVID-19 patients with psoriasis and psoriatic arthritis on biologic immunosuppressant therapy vs apremilast in North Spain. Dermatol Ther 2020; 33:e13961. [PMID: 32618402 PMCID: PMC7361149 DOI: 10.1111/dth.13961] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 06/29/2020] [Accepted: 07/01/2020] [Indexed: 12/13/2022]
Abstract
Immunosuppressive and immunomodulatory treatments are critical for the management of inflammatory and autoimmune conditions such as psoriasis or psoriatic arthritis. Similar to those illnesses, the lung injury and acute respiratory distress shown in coronavirus disease 2019 (COVID‐19) patients are the result of a disruption in the balance of pro‐ and anti‐inflammatory cytokines. This hyperinflammatory response to severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2), associated with the severity of the coronavirus disease, is called the cytokine storm. There is a growing concern regarding how patients on immunosuppressant biologic therapies might be at higher risk of being infected and whether they need to discontinue their treatment preemptively. Clinical data on COVID‐19‐infected patients with psoriasis or psoriatic arthritis are still scarce. Here, we presented seven cases of these type of patients. The patient infected with COVID‐19 on apremilast and the one on apremilast with infected spouse showed the best safety profile and mildest symptoms. One of the secukinumab patients also presented a relatively good outcome. Infliximab patients and the one with serious comorbidities showed the worst outcome. Even though more clinical data are yet needed to draw strong conclusions, apremilast could be a safer alternative for dermatology and rheumatology patients in case of clinically important active infection.
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Affiliation(s)
- Rubén Queiro Silva
- Rheumatology Division, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - Susana Armesto
- Department of Dermatology, Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | - Carmen González Vela
- Department of Pathology, Hospital Universitario Marqués de Valdecilla, Santander, Spain
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29
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Dai D, Wu H, He C, Wang X, Luo Y, Song P. Evidence and potential mechanisms of traditional Chinese medicine for the treatment of psoriasis vulgaris: a systematic review and meta-analysis. J DERMATOL TREAT 2020; 33:671-681. [PMID: 32610023 DOI: 10.1080/09546634.2020.1789048] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Affiliation(s)
- Dan Dai
- Department of Dermatology, Guang’anmen Hospital, China Academy of Chinese Medical Sciences, Beijing China
- Graduate College, Beijing University of Chinese Medicine, Beijing, China
| | - Haoran Wu
- Graduate College, Beijing University of Chinese Medicine, Beijing, China
- Department of Endocrinology, Guang’anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Chunyan He
- Department of Dermatology, Guang’anmen Hospital, China Academy of Chinese Medical Sciences, Beijing China
- Graduate College, Beijing University of Chinese Medicine, Beijing, China
| | - Xinmiao Wang
- Department of Endocrinology, Guang’anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Yiqi Luo
- Graduate College, Beijing University of Chinese Medicine, Beijing, China
| | - Ping Song
- Department of Dermatology, Guang’anmen Hospital, China Academy of Chinese Medical Sciences, Beijing China
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30
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Ghazawi FM, Lim M, Dutz JP, Kirchhof MG. Infection risk of dermatologic therapeutics during the COVID-19 pandemic: an evidence-based recalibration. Int J Dermatol 2020; 59:1043-1056. [PMID: 32621284 PMCID: PMC7361427 DOI: 10.1111/ijd.15028] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2020] [Revised: 05/25/2020] [Accepted: 06/04/2020] [Indexed: 12/20/2022]
Abstract
Recommendations were made recently to limit or stop the use of oral and systemic immunotherapies for skin diseases due to potential risks to the patients during the current severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) COVID-19 pandemic. Herein, we attempt to identify potentially safe immunotherapies that may be used in the treatment of cutaneous diseases during the current COVID-19 pandemic. We performed a literature review to approximate the risk of SARS-CoV-2 infection, including available data on the roles of relevant cytokines, cell subsets, and their mediators in eliciting an optimal immune response against respiratory viruses in murine gene deletion models and humans with congenital deficiencies were reviewed for viral infections risk and if possible coronaviruses specifically. Furthermore, reported risk of infections of biologic and non-biologic therapeutics for skin diseases from clinical trials and drug data registries were evaluated. Many of the immunotherapies used in dermatology have data to support their safe use during the COVID-19 pandemic including the biologics that target IgE, IL-4/13, TNF-α, IL-17, IL-12, and IL-23. Furthermore, we provide evidence to show that oral immunosuppressive medications such as methotrexate and cyclosporine do not significantly increase the risk to patients. Most biologic and conventional immunotherapies, based on doses and indications in dermatology, do not appear to increase risk of viral susceptibility and are most likely safe for use during the COVID-19 pandemic. The limitation of this study is availability of data on COVID-19.
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Affiliation(s)
- Feras M Ghazawi
- Division of Dermatology, University of Ottawa, Ottawa, ON, Canada
| | - Megan Lim
- Division of Dermatology, University of Ottawa, Ottawa, ON, Canada
| | - Jan P Dutz
- Department of Dermatology and Skin Sciences, University of British Columbia, Vancouver, BC, Canada.,BC Children's Hospital Research Institute, Vancouver, BC, Canada
| | - Mark G Kirchhof
- Division of Dermatology, University of Ottawa, Ottawa, ON, Canada
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