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Wride AM, Chen GF, Spaulding SL, Tkachenko E, Cohen JM. Biologics for Psoriasis. Dermatol Clin 2024; 42:339-355. [PMID: 38796266 DOI: 10.1016/j.det.2024.02.001] [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] [Indexed: 05/28/2024]
Abstract
Biologic therapies targeting tumor necrosis factor alpha (TNF-α) (infliximab, adalimumab, certolizumab, etanercept), the p40 subunit shared by IL-12 and IL-23 (ustekinumab), the p19 subunit of IL-23 (guselkumab, tildrakizumab, risankizumab), IL-17A (secukinumab, ixekizumab), IL-17-RA (brodalumab) and both IL-17A and IL-17F (bimekizumab) have revolutionized the treatment of psoriasis. In both the short and long term, risankizumab had highest Psoriasis Area and Severity Index 90 scores compared to other oral and injectable biologics. IL-23 inhibitors had lowest rates of short-term and long-term adverse events and most favorable long-term risk-benefit profile compared to IL-17, IL-12/23, and TNF-α inhibitors.
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Affiliation(s)
- Anthony Mitchel Wride
- Department of Dermatology, Yale School of Medicine, Yale University, 15 York Street, New Haven, CT 06510, USA
| | - Gloria F Chen
- Department of Dermatology, Yale School of Medicine, Yale University, 15 York Street, New Haven, CT 06510, USA
| | - Sarah L Spaulding
- Department of Dermatology, Yale School of Medicine, Yale University, 15 York Street, New Haven, CT 06510, USA
| | - Elizabeth Tkachenko
- Department of Dermatology, Yale School of Medicine, Yale University, 15 York Street, New Haven, CT 06510, USA
| | - Jeffrey M Cohen
- Department of Dermatology, Yale School of Medicine, Yale University, 15 York Street, New Haven, CT 06510, USA.
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Hwang JK, Lipner SR. Treatment of Nail Psoriasis. Dermatol Clin 2024; 42:387-398. [PMID: 38796270 DOI: 10.1016/j.det.2024.02.004] [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] [Indexed: 05/28/2024]
Abstract
Nail psoriasis is associated with significant disease burden, negative impact on quality of life, and potential progression to psoriatic arthritis. Initiating timely and appropriate treatment is of the utmost importance, especially because nail disease may be more resistant to therapies than cutaneous psoriasis. This article reviews available intralesional, topical, and systemic treatment options for nail psoriasis, and discusses efficacy and safety of studied agents. Also reviewed are consensus treatment guideline recommendations. An updated algorithm to aid physicians in selection of specific treatment options is provided.
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Affiliation(s)
- Jonathan K Hwang
- Department of Dermatology, Weill Cornell Medicine, 1305 York Avenue, New York, NY 10021, USA
| | - Shari R Lipner
- Department of Dermatology, Weill Cornell Medicine, 1305 York Avenue, New York, NY 10021, USA.
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Yu C, Geng S, Yang B, Deng Y, Li F, Kang X, Bi M, Zhang F, Zhao Y, Pan W, Tian Z, Xu J, Zhang Z, Yu N, Duan X, Guo S, Sun Q, Li W, Tao J, Liu Z, Yin Y, Wang G. Tildrakizumab for moderate-to-severe plaque psoriasis in Chinese patients: A 12-week randomized placebo-controlled phase III trial with long-term extension. Chin Med J (Engl) 2024; 137:1190-1198. [PMID: 38192233 PMCID: PMC11101224 DOI: 10.1097/cm9.0000000000002873] [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: 06/24/2023] [Indexed: 01/10/2024] Open
Abstract
BACKGROUND There is a need for effective and safe therapies for psoriasis that provide sustained benefits. The aim of this study was to assess the efficacy and safety of tildrakizumab, an anti-interleukin-23p19 monoclonal antibody, for treating moderate-to-severe plaque psoriasis in Chinese patients. METHODS In this multi-center, double-blind, phase III trial, patients with moderate-to-severe plaque psoriasis were enrolled and randomly assigned (1:1) to receive subcutaneous tildrakizumab 100 mg or placebo at weeks 0 and 4. Patients initially assigned to placebo were switched to receive tildrakizumab at weeks 12, 16, and every 12 weeks thereafter. Patients in the tildrakizumab group continued with tildrakizumab at week 16, and every 12 weeks until week 52. The primary endpoint was the Psoriasis Area and Severity Index (PASI 75) response rate at week 12. RESULTS At week 12, tildrakizumab demonstrated significantly higher PASI 75 response rates (66.4% [73/110] vs. 12.7% [14/110]; difference, 51.4% [95% confidence interval (CI), 40.72, 62.13]; P <0.001) and Physician's Global Assessment (60.9% [67/110] vs. 10.0% [11/110]; difference, 49.1% [95% CI, 38.64, 59.62]; P <0.001) compared to placebo. PASI 75 response continued to improve over time in both tildrakizumab and placebo-switching to tildrakizumab groups, reaching maximal efficacy after 28 weeks (86.8% [92/106] vs . 82.4% [89/108]) and maintained up to 52 weeks (91.3% [95/104] vs . 87.4% [90/103]). Most treatment-emergent adverse events were mild and not related to tildrakizumab. CONCLUSION Tildrakizumab demonstrated durable efficacy through week 52 and was well tolerated in Chinese patients with moderate-to-severe plaque psoriasis. TRIAL REGISTRATION ClinicalTrials.gov , NCT05108766.
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Affiliation(s)
- Chen Yu
- Department of Dermatology, Xijing Hospital, The Fourth Military Medical University, Xi'an, Shaanxi 710032, China
| | - Songmei Geng
- Department of Dermatology, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi 710004, China
| | - Bin Yang
- Department of Dermatology, Dermatology Hospital of Southern Medical University, Guangzhou, Guangdong 510091, China
| | - Yunhua Deng
- Department of Dermatology, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, Hubei 430030, China
| | - Fuqiu Li
- Department of Dermatology, The Second Hospital of Jilin University, Changchun, Jilin 130041, China
| | - Xiaojing Kang
- Department of Dermatology, People's Hospital of Xinjiang Uygur Autonomous Region, Urumqi, Xinjiang 830001, China
| | - Mingye Bi
- Department of Dermatology, Wuxi People's Hospital of Wuxi City, Wuxi, Jiangsu 214023, China
| | - Furen Zhang
- Department of Dermatology, Shandong Provincial Hospital for Skin Diseases & Shandong Provincial Institute of Dermatology and Venereology, Shandong First Medical University & Shandong Academy of Medical Sciences, Jinan, Shandong 250022, China
| | - Yi Zhao
- Department of Dermatology, Beijing Tsinghua Changgung Hospital, Beijing 102218, China
| | - Weili Pan
- Department of Dermatology, Zhejiang Provincial People's Hospital, Hangzhou, Zhejiang 310014, China
| | - Zhongwei Tian
- Department of Dermatology, The First Affiliated Hospital of Xinxiang Medical College, Xinxiang, Henan 453100, China
| | - Jinhua Xu
- Department of Dermatology, Huashan Hospital Affiliated to Fudan University, Shanghai 200040, China
| | - Zhenghua Zhang
- Department of Dermatology, Huashan Hospital Affiliated to Fudan University, Shanghai 200040, China
| | - Nan Yu
- Department of Dermatology, General Hospital of Ningxia Medical University, Yinchuan, Ningxia 750000, China
| | - Xinsuo Duan
- Department of Dermatology, Affiliated Hospital of Chengde Medical University, Chengde, Hebei 067000, China
| | - Shuping Guo
- Department of Dermatology, The First Hospital of Shanxi Medical University, Taiyuan, Shanxi 030001, China
| | - Qing Sun
- Department of Dermatology, Qilu Hospital of Shandong University, Jinan, Shandong 250012, China
| | - Weiquan Li
- Department of Dermatology, Yuebei People's Hospital, Shaoguan, Guangdong 512026, China
| | - Juan Tao
- Department of Dermatology, Union Hospital Tongji Medical Collage Huazhong University of Science and Technology, Wuhan, Hubei 430022, China
| | - Zhijun Liu
- Department of Dermatology and Venereal Diseases, The First Affiliated Hospital of University of South China, Hengyang, Hunan 421001, China
| | - Yuanyuan Yin
- Shenzhen Kangzhe Biotechnology Co., Ltd., Shenzhen, Guangdong 518052, China
| | - Gang Wang
- Department of Dermatology, Xijing Hospital, The Fourth Military Medical University, Xi'an, Shaanxi 710032, China
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Zhao N, Wang Y, Qu B, Zhu H, Yang D, Zhang X, Zhao J, Wang Y, Meng Y, Chen Z, Li P, Di T. Jianpi-Yangxue-Jiedu decoction improves the energy metabolism of psoriasis mice by regulating the electron transfer of oxidative phosphorylation. JOURNAL OF ETHNOPHARMACOLOGY 2024; 324:117714. [PMID: 38184027 DOI: 10.1016/j.jep.2024.117714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Revised: 01/02/2024] [Accepted: 01/02/2024] [Indexed: 01/08/2024]
Abstract
ETHNOPHARMACOLOGICAL RELEVANCE The inflammatory skin condition psoriasis is immune-related. The decoction of Jianpi-Yangxue-Jiiedu (JPYX) is a useful medication for psoriasis. However, the underlying mechanics of JPYX have not yet been clarified. AIM OF THE STUDY The objective of this study was to investigate the mechanism underlying the efficacy of JPYX in the treatment of psoriasis in the context of a high-fat diet. MATERIALS AND METHODS This work generated a high-fat feeding model of imiquimod (IMQ)-induced psoriasis-like lesion mice. The blood composition of JPYX was examined using ultra-performance liquid chromatography-tandem mass spectrometry (UPLC-MS/MS). The mechanism of JPYX decoction for treating psoriasis was predicted using methods of network pharmacology, metabolomics, and transcriptomics. RESULTS JPYX prevented the release of inflammatory cytokines, decreased keratinocyte proliferation, enhanced the percentage of Treg cells in the skin, lymph nodes, and thymus, and greatly alleviated psoriatic lesions. Network pharmacology predicted that IL-1β, TNF, STAT3, and EGFR may be potential targets, and KEGG results showed that PI3K-AKT-mTOR may be a potential mechanism of action. Verification of experimental data demonstrated that the JPYX decoction dramatically decreased mTOR and AKT phosphorylation. According to metabolomics analysis, amino acids and their metabolites, benzene and its substitutes, aldehyde ketone esters, heterocyclic compounds, etc. were the primary metabolites regulated by JPYX. KEGG enrichment analysis of differential metabolites was performed. Fatty acid biosynthesis, Type I polyketide structures, Steroid hormone biosynthesis, Biosynthesis of unsaturated fatty acid, etc. Transcriptomic results showed that JPYX significantly regulated skin development, keratinocyte differentiation, and oxidative phosphorylation. Further experimental data verification showed that JPYX decoction significantly reduced the mRNA levels of mt-Nd4, mt-Nd5, mt-Nd1, Ifi205, Ifi211, and mt-Atp8. CONCLUSIONS JPYX may improve psoriasis by regulating the metabolic pathways of fatty acids and electron transport of oxidative phosphorylation.
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Affiliation(s)
- Ning Zhao
- Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, Beijing Institute of Chinese Medicine, Beijing Key Laboratory of Clinic and Basic Research with Traditional Chinese Medicine on Psoriasis, Beijing, People's Republic of China; Capital Medical University, Beijing, 100069, People's Republic of China.
| | - YaZhuo Wang
- Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, Beijing Institute of Chinese Medicine, Beijing Key Laboratory of Clinic and Basic Research with Traditional Chinese Medicine on Psoriasis, Beijing, People's Republic of China; Capital Medical University, Beijing, 100069, People's Republic of China
| | - BaoQuan Qu
- Beijing University of Chinese Medicine, Beijing, 100029, People's Republic of China
| | - HaoYue Zhu
- Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, Beijing Institute of Chinese Medicine, Beijing Key Laboratory of Clinic and Basic Research with Traditional Chinese Medicine on Psoriasis, Beijing, People's Republic of China; Capital Medical University, Beijing, 100069, People's Republic of China
| | - DanYang Yang
- Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, Beijing Institute of Chinese Medicine, Beijing Key Laboratory of Clinic and Basic Research with Traditional Chinese Medicine on Psoriasis, Beijing, People's Republic of China; Capital Medical University, Beijing, 100069, People's Republic of China
| | - XiaWei Zhang
- Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, Beijing Institute of Chinese Medicine, Beijing Key Laboratory of Clinic and Basic Research with Traditional Chinese Medicine on Psoriasis, Beijing, People's Republic of China; Capital Medical University, Beijing, 100069, People's Republic of China
| | - JingXia Zhao
- Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, Beijing Institute of Chinese Medicine, Beijing Key Laboratory of Clinic and Basic Research with Traditional Chinese Medicine on Psoriasis, Beijing, People's Republic of China
| | - Yan Wang
- Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, Beijing Institute of Chinese Medicine, Beijing Key Laboratory of Clinic and Basic Research with Traditional Chinese Medicine on Psoriasis, Beijing, People's Republic of China
| | - YuJiao Meng
- Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, Beijing Institute of Chinese Medicine, Beijing Key Laboratory of Clinic and Basic Research with Traditional Chinese Medicine on Psoriasis, Beijing, People's Republic of China
| | - Zhaoxia Chen
- Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, Beijing Institute of Chinese Medicine, Beijing Key Laboratory of Clinic and Basic Research with Traditional Chinese Medicine on Psoriasis, Beijing, People's Republic of China
| | - Ping Li
- Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, Beijing Institute of Chinese Medicine, Beijing Key Laboratory of Clinic and Basic Research with Traditional Chinese Medicine on Psoriasis, Beijing, People's Republic of China.
| | - TingTing Di
- Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, Beijing Institute of Chinese Medicine, Beijing Key Laboratory of Clinic and Basic Research with Traditional Chinese Medicine on Psoriasis, Beijing, People's Republic of China.
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Xia C, Fu X, Wang Q, Chen X, Chen J, Kang Y, Wang B. Anti-ROS and NIR-II-Responsive Hyaluronic Acid Microneedle Loaded With Baicalin Nanoparticles for Treatment of Psoriasis. Macromol Rapid Commun 2024:e2400136. [PMID: 38593288 DOI: 10.1002/marc.202400136] [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: 03/07/2024] [Revised: 03/28/2024] [Indexed: 04/11/2024]
Abstract
In this work, a natural medicine, baicalin, is designed for the treatment of psoriasis with the aid of hyaluronic acid (HA)-based MNs patches. This is also to improve the solubility of baicalin and increase its residence time in infected part, which is made into nanoparticles by complexation with humic acid and Eu2+. The baicalin nanoparticles loaded-MNs exhibit satisfactory rigidity, minimum injury, and controlled drug delivery. The anti-reactive oxygen species (anti-ROS) and anti-inflammatory action are verified by the effective scavenging oxygen and nitrogen radicals. In addition, the loading of baicalin nanoparticles brings remarkable photothermic effect to the MNs, enabling the device to release a controlled drug under near-infrared region II (NIR-II) laser irradiation. With the aid of NIR-II laser, the baicalin-mediated treatment of psoriasis is significantly improved by expediting radical scavenging and suppressing inflammation. The design of baicalin MNs provides a new idea for the treatment of chronic disease.
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Affiliation(s)
- Chuanlan Xia
- Key Laboratory of Luminescence Analysis and Molecular Sensing, School of Materials and Energy, Southwest University, Chongqing, 400715, China
- Yibin Academy of Southwest University, Yibin, 644000, China
| | - Xinwei Fu
- Key Laboratory of Luminescence Analysis and Molecular Sensing, School of Materials and Energy, Southwest University, Chongqing, 400715, China
- Yibin Academy of Southwest University, Yibin, 644000, China
| | - Qi Wang
- Key Laboratory of Luminescence Analysis and Molecular Sensing, School of Materials and Energy, Southwest University, Chongqing, 400715, China
- Yibin Academy of Southwest University, Yibin, 644000, China
| | - Xinyue Chen
- Key Laboratory of Luminescence Analysis and Molecular Sensing, School of Materials and Energy, Southwest University, Chongqing, 400715, China
- Yibin Academy of Southwest University, Yibin, 644000, China
| | - Jiucun Chen
- Key Laboratory of Luminescence Analysis and Molecular Sensing, School of Materials and Energy, Southwest University, Chongqing, 400715, China
| | - Yuejun Kang
- Key Laboratory of Luminescence Analysis and Molecular Sensing, School of Materials and Energy, Southwest University, Chongqing, 400715, China
- Yibin Academy of Southwest University, Yibin, 644000, China
| | - Bin Wang
- Key Laboratory of Luminescence Analysis and Molecular Sensing, School of Materials and Energy, Southwest University, Chongqing, 400715, China
- Yibin Academy of Southwest University, Yibin, 644000, China
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Egilman AC, Kesselheim AS, Avorn J, Raymakers AJN, Rome BN. Use of Efficiency Frontiers to Align Prices and Clinical Benefits of Biologic Therapies for Plaque Psoriasis. JAMA Dermatol 2024; 160:409-416. [PMID: 38381418 PMCID: PMC10882509 DOI: 10.1001/jamadermatol.2023.6236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Accepted: 10/21/2023] [Indexed: 02/22/2024]
Abstract
Importance The US lacks a systematic approach for aligning drug prices with clinical benefit, and traditional cost-effectiveness analysis (CEA) faces political obstacles. The efficiency frontier (EF) method offers policymakers an alternative approach. Objective To assess how the EF approach could align prices and clinical benefits of biologic medications for plaque psoriasis and estimate price reductions in the US vs 4 peer countries: Australia, Canada, France, and Germany. Design and Setting This health economic evaluation used the EF approach to compare the prices and clinical benefits of 11 biologics and 2 biosimilars for plaque psoriasis in the US, Australia, Canada, France, and Germany. Data were collected from February to March 2023 and analyzed from March to June 2023. Main Outcome Measures EFs were constructed based on each biologic's efficacy, measured using the Psoriasis Area and Severity Index (PASI) 90 response rate, and annual treatment cost as of January 2023; US costs were net of estimated manufacturer rebates. Prices based on the EF were compared with traditional CEA-based prices calculated by the Institute for Clinical and Economic Review at a threshold of $150 000 per quality-adjusted life-year gained. Results Among 13 biologics, PASI 90 response rates ranged from 17.9% (etanercept) to 71.6% (risankizumab); US net annual treatment costs ranged from $1664 (infliximab-dyyb) to $79 277 (risankizumab). The median (IQR) net annual treatment cost was higher in the US ($34 965 [$20 493-$48 942]) than prerebate costs in Australia ($9179 [$6691-$12 688]), Canada ($15 556 [$13 017-$16 112]), France ($9478 [$6637-$11 678]), and Germany ($13 829 [$13 231-$15 837]). The US EF included infliximab-dyyb (PASI 90: 57.4%; annual cost: $1664), ixekizumab (PASI 90: 70.8%; annual cost: $33 004), and risankizumab (PASI 90: 71.6%; annual cost: $79 277). US prices for psoriasis biologics would need to be reduced by a median (IQR) of 71% (31%-95%) to align with those estimated using the EF; the same approach would yield smaller price reductions in Canada (41% [6%-57%]), Australia (36% [0%-65%]), France (19% [0%-67%]), and Germany (11% [8%-26%]). Except for risankizumab, the EF-based prices were lower than the prices based on traditional CEA. Conclusions and Relevance This economic evaluation showed that for plaque psoriasis biologics, using an EF approach to negotiate prices could lead to substantial price reductions and better align prices with clinical benefits. US policymakers might consider using EFs to achieve prices commensurate with comparative clinical benefits, particularly for drug classes with multiple therapeutic alternatives for which differences can be adequately summarized by a single outcome measurement.
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Affiliation(s)
- Alexander C. Egilman
- Program On Regulation, Therapeutics, And Law (PORTAL), Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Aaron S. Kesselheim
- Program On Regulation, Therapeutics, And Law (PORTAL), Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
| | - Jerry Avorn
- Program On Regulation, Therapeutics, And Law (PORTAL), Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
| | - Adam J. N. Raymakers
- Program On Regulation, Therapeutics, And Law (PORTAL), Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Benjamin N. Rome
- Program On Regulation, Therapeutics, And Law (PORTAL), Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
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López E, Cabrera R, Lecaros C. Targeted therapy for immune mediated skin diseases. What should a dermatologist know? An Bras Dermatol 2024:S0365-0596(24)00036-9. [PMID: 38521706 DOI: 10.1016/j.abd.2023.10.002] [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: 08/25/2023] [Revised: 09/25/2023] [Accepted: 10/14/2023] [Indexed: 03/25/2024] Open
Abstract
BACKGROUND Molecularly targeted therapies, such as monoclonal antibodies (mAbs) and Janus Kinase inhibitors (JAKis), have emerged as essential tools in the treatment of dermatological diseases. These therapies modulate the immune system through specific signaling pathways, providing effective alternatives to traditional systemic immunosuppressive agents. This review aims to provide an updated summary of targeted immune therapies for inflammatory skin diseases, considering their pathophysiology, efficacy, dosage, and safety profiles. METHODS The review followed the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. A systematic search was conducted on PubMed over the past 10 years, focusing on randomized clinical trials, case reports, and case series related to targeted immune therapies in dermatology. Eligibility criteria were applied, and data were extracted from each study, including citation data, study design, and results. RESULTS We identified 1360 non-duplicate articles with the initial search strategy. Title and abstract review excluded 1150, while a full-text review excluded an additional 50 articles. The review included 143 studies published between 2012 and 2022, highlighting 39 drugs currently under investigation or in use for managing inflammatory skin diseases. STUDY LIMITATIONS The heterogeneity of summarized information limits this review. Some recommendations originated from data from clinical trials, while others relied on retrospective analyses and small case series. Recommendations will likely be updated as new results emerge. CONCLUSION Targeted therapies have revolutionized the treatment of chronic skin diseases, offering new options for patients unresponsive to standard treatments. Paradoxical reactions are rarely observed. Further studies are needed to fully understand the mechanisms and nature of these therapies. Overall, targeted immune therapies in dermatology represent a promising development, significantly improving the quality of life for patients with chronic inflammatory skin diseases.
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Affiliation(s)
- Edinson López
- Department of Dermatology, Facultad de Medicina Universidad del Desarrollo-Clínica Alemana de Santiago, Santiago, Chile
| | - Raúl Cabrera
- Department of Dermatology, Facultad de Medicina Universidad del Desarrollo-Clínica Alemana de Santiago, Santiago, Chile.
| | - Cristóbal Lecaros
- Department of Dermatology, Facultad de Medicina Universidad del Desarrollo-Clínica Alemana de Santiago, Santiago, Chile
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Dapavo P, Burlando M, Guarneri C, Megna M, Narcisi A, Talamonti M, Gisondi P. Tildrakizumab: the value of a personalized and flexible approach for treating moderate-to-severe plaque psoriasis in patients with high body weight or high disease burden. Expert Opin Biol Ther 2024:1-6. [PMID: 38444107 DOI: 10.1080/14712598.2024.2325547] [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: 12/20/2023] [Accepted: 02/27/2024] [Indexed: 03/07/2024]
Abstract
INTRODUCTION The introduction of biologics for the treatment of plaque psoriasis is one of the major therapeutic advances of the last decades in dermatology. The efficacy of this class of drugs can be influenced by multiple factors including obesity, being overweight, prior treatment failures, and disease severity. AREAS COVERED Most of the currently available approved biologics are limited by their lack of dosing flexibility for adapting the therapy to the complexity of real-world patients with psoriasis. Among the class of anti-interleukin-23, tildrakizumab allows a greater dosing flexibility, increasing clinical benefits of patients with high burden of the disease or body weight >90 kg. EXPERT OPINION This meta-opinion discusses the clinical data that were foundational for tildrakizumab dosage flexibility, elaborates on the definition of high burden of disease specifically linked to tildrakizumab dosage, and profiles the ideal patient that could benefit from treatment with the higher approved tildrakizumab dosage of 200 mg.
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Affiliation(s)
- Paolo Dapavo
- Department of Medical Sciences, Section of Dermatology, University of Turin, Turin, Italy
| | - Martina Burlando
- Clinica Dermatologica Ospedale Policlinico San Martino - IRCCS, Università di Genova, Genova, Italy
| | - Claudio Guarneri
- Department of Biomedical and Dental Sciences and Morpho Functional Imaging, University of Messina, Messina, Italy
| | - Matteo Megna
- Section of Dermatology, Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Alessandra Narcisi
- Dermatology Unit, IRCCS Humanitas Research Hospital, Milan, Rozzano, Italy
- Department of Biomedical sciences, Humanitas University, Milan, Pieve Emanuele, Italy
| | - Marina Talamonti
- Dermatology Unit, Fondazione Policlinico "Tor Vergata", Rome, Italy
| | - Paolo Gisondi
- Dermatology and Venereology, Department of Medicine, University of Verona, Verona, Italy
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9
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Hwang JK, Grover C, Iorizzo M, Lebwohl MG, Piraccini BM, Rigopoulos DG, Lipner SR. Nail psoriasis and nail lichen planus: Updates on diagnosis and management. J Am Acad Dermatol 2024; 90:585-596. [PMID: 38007038 DOI: 10.1016/j.jaad.2023.11.024] [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: 07/23/2023] [Revised: 10/30/2023] [Accepted: 11/17/2023] [Indexed: 11/27/2023]
Abstract
BACKGROUND Inflammatory diseases of the nail, including nail psoriasis and nail lichen planus, are associated with significant disease burden and have a negative impact on quality of life. Diagnosis is often delayed, especially when patients present without cutaneous findings. Therefore, recognizing clinical signs and symptoms of inflammatory nail diseases, and initiating timely and appropriate treatment, is of utmost importance. OBJECTIVE We review recent studies on diagnostic techniques, discuss severity grading and scoring systems, and describe consensus treatment recommendations for nail psoriasis and nail lichen planus. METHODS An updated literature review was performed using the PubMed database on studies assessing diagnostic techniques or treatment modalities for nail psoriasis and nail lichen planus. RESULTS Recent studies on diagnostic techniques for inflammatory nail disease have focused on use of dermoscopy, capillaroscopy, and ultrasound modalities. Treatment of these conditions is dichotomized into involvement of few (≤3) or many (>3) nails. Recent psoriatic therapeutics studied for nail outcomes include brodalumab, tildrakizumab, risankizumab, deucravacitinib, and bimekizumab, while emerging treatments for nail lichen planus include JAK inhibitors and intralesional platelet rich plasma injections. CONCLUSIONS We emphasize the need for increased awareness and expanded management strategies for inflammatory nail diseases to improve patient outcomes.
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Affiliation(s)
- Jonathan K Hwang
- Department of Dermatology, Weill Cornell Medicine, New York, New York
| | - Chander Grover
- Department of Dermatology, University College of Medical Sciences, New Delhi, India
| | | | - Mark G Lebwohl
- Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Bianca M Piraccini
- Dermatology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy; Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Dimitris G Rigopoulos
- 1st Department of Dermatology-Venereology, National and Kapodistrian University of Athens, Athens, Greece
| | - Shari R Lipner
- Department of Dermatology, Weill Cornell Medicine, New York, New York.
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Ouranos K, Saleem H, Vassilopoulos S, Vassilopoulos A, Mylona EK, Shehadeh F, Kalligeros M, Abraham BP, Mylonakis E. Risk of Infection in Patients With Inflammatory Bowel Disease Treated With Interleukin-Targeting Agents: A Systematic Review and Meta-Analysis. Inflamm Bowel Dis 2024:izae031. [PMID: 38427714 DOI: 10.1093/ibd/izae031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Indexed: 03/03/2024]
Abstract
BACKGROUND Patients with inflammatory bowel disease (IBD) are at increased risk of infection. The aim of this study was to assess the cumulative incidence and risk of infection in patients with IBD treated with interleukin (IL)-targeting agents. METHODS We searched PubMed, EMBASE, and Web of Science for randomized controlled trials including patients with IBD receiving IL-targeting agents compared with patients receiving placebo or treatment that only differed from the intervention arm in the absence of an IL-targeting agent. The primary outcome of interest was the relative risk (RR) of any-grade and severe infection during the induction phase. RESULTS There was no difference in risk of any-grade (RR, 0.98; 95% confidence interval [CI], 0.89-1.09) or severe (RR, 0.64; 95% CI, 0.38-1.10) infection in patients receiving any IL-targeting agent compared with the control group. During the maintenance period, the cumulative incidence of any-grade infection in patients receiving IL-12/23p40-targeting agents (mean follow-up 29 weeks) was 34.82% (95% CI, 26.78%-43.32%), while the cumulative incidence of severe infection was 3.07% (95% CI, 0.93%-6.21%). The cumulative incidence of any-grade infection in patients receiving IL-23p19-targeting agents (mean follow-up 40.9 weeks) was 32.16% (95% CI, 20.63%-44.88%), while the cumulative incidence of severe infection was 1.75% (95% CI, 0.60%-3.36%). During the maintenance phase of the included studies, the incidence of infection was 30.66% (95% CI, 22.12%-39.90%) for any-grade and 1.59% (95% CI, 0.76%-2.63%) for severe infection in patients in the control group. CONCLUSIONS There was no difference in risk of infection between patients with IBD who received IL-targeting agents compared with the control group. Case registries and randomized controlled trials reporting the safety of IL inhibitors should provide detailed information about the risk of specific infectious complications in patients with IBD receiving IL-targeting agents.
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Affiliation(s)
| | - Hira Saleem
- Department of Medicine, Houston Methodist Research Institute, Houston, TX, USA
| | - Stephanos Vassilopoulos
- Department of Medicine, Rhode Island Hospital, Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Athanasios Vassilopoulos
- Department of Medicine, Rhode Island Hospital, Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Evangelia K Mylona
- Department of Medicine, Houston Methodist Research Institute, Houston, TX, USA
| | - Fadi Shehadeh
- Department of Medicine, Houston Methodist Research Institute, Houston, TX, USA
- Department of Electrical and Computer Engineering, School of Electrical and Computer Engineering, National Technical University of Athens, Athens, Greece
| | - Markos Kalligeros
- Department of Medicine, Rhode Island Hospital, Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Bincy P Abraham
- Division of Gastroenterology and Hepatology, Department of Medicine, Lynda K. and David M. Underwood Center for Digestive Disorders, Houston Methodist Hospital, Houston, TX, USA
| | - Eleftherios Mylonakis
- Department of Medicine, Houston Methodist Research Institute, Houston, TX, USA
- Department of Medicine, Weill Cornell Medicine, New York, NY, USA
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11
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Fiorillo G, Ibba L, Gargiulo L, Narcisi A, Costanzo A, Valenti M. Effectiveness and Safety of Biological Therapies in Very Severe Plaque Psoriasis: A Real-Life Retrospective Study. J Pers Med 2024; 14:186. [PMID: 38392619 PMCID: PMC10890562 DOI: 10.3390/jpm14020186] [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: 12/17/2023] [Revised: 02/03/2024] [Accepted: 02/06/2024] [Indexed: 02/24/2024] Open
Abstract
Psoriasis can have a significant impact on quality of life and productivity, especially with increased severity. However, there is limited evidence on biologics' efficacy in highly severe cases compared to moderate-to-severe ones. This study aimed to evaluate the effectiveness and safety of novel biological therapies in very severe psoriasis. We conducted a retrospective analysis on patients ≥ 18 years old affected by very severe psoriasis who had received a biological agent for at least 16 weeks. We used PASI to assess disease severity and effectiveness at weeks 16, 52, 104, and 156. Safety was evaluated by tracking treatment discontinuation rates and adverse events. This study included 29 males and 11 females, with a mean age of 55.80 years (SD 13.82). Cardiometabolic diseases were the most common comorbidities (25.00%). Twenty-eight (70.00%) patients had psoriasis involvement in at least one difficult-to-treat area. All patients completed 16 weeks of treatment. The mean PASI was 31.60 (SD 2.57) at baseline, 3.48 (SD 4.13) at week 16, 0.58 (SD 1.70) at week 52, 0.77 (SD 1.66) at week 104, and 1.29 (SD 2.12) at week 156. PASI90 and 100 were achieved by 52.50% and 30.00% of patients at week 16, by 96.15% and 80.77% at week 52, by 93.33% and 66.67% at week 104, and by 85.71% and 42.86% at week 156. PASIs ≤ 2 were achieved by 50.00% of patients at week 16, 88.46% at week 52, 86.67% at week 104, and 85.71% at week 156. Only two patients discontinued biologics due to complete remission, and mild AEs were reported by four patients. Our findings show that biologics are effective and well tolerated for treating very severe psoriasis, maintaining long-term effectiveness.
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Affiliation(s)
- Giovanni Fiorillo
- Department of Biomedical Sciences, Humanitas University, 20072 Pieve Emanuele, Italy
- Dermatology Unit, IRCCS Humanitas Research Hospital, 20089 Rozzano, Italy
| | - Luciano Ibba
- Department of Biomedical Sciences, Humanitas University, 20072 Pieve Emanuele, Italy
- Dermatology Unit, IRCCS Humanitas Research Hospital, 20089 Rozzano, Italy
| | - Luigi Gargiulo
- Department of Biomedical Sciences, Humanitas University, 20072 Pieve Emanuele, Italy
- Dermatology Unit, IRCCS Humanitas Research Hospital, 20089 Rozzano, Italy
| | - Alessandra Narcisi
- Dermatology Unit, IRCCS Humanitas Research Hospital, 20089 Rozzano, Italy
| | - Antonio Costanzo
- Department of Biomedical Sciences, Humanitas University, 20072 Pieve Emanuele, Italy
- Dermatology Unit, IRCCS Humanitas Research Hospital, 20089 Rozzano, Italy
| | - Mario Valenti
- Department of Biomedical Sciences, Humanitas University, 20072 Pieve Emanuele, Italy
- Dermatology Unit, IRCCS Humanitas Research Hospital, 20089 Rozzano, Italy
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12
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Narbutt J, Żuber Z, Lesiak A, Bień N, Szepietowski JC. Vaccinations in Selected Immune-Related Diseases Treated with Biological Drugs and JAK Inhibitors-Literature Review and Statement of Experts from Polish Dermatological Society. Vaccines (Basel) 2024; 12:82. [PMID: 38250895 PMCID: PMC10820194 DOI: 10.3390/vaccines12010082] [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: 12/19/2023] [Revised: 01/08/2024] [Accepted: 01/09/2024] [Indexed: 01/23/2024] Open
Abstract
The growing use of biological drugs in immune-mediated chronic diseases has undoubtedly revolutionized their treatment. Yet, the topic of vaccinations in this group of patients still raises many concerns and implies many therapeutic problems that require discussion and standardization of management. The aim of this literature review is to present current knowledge regarding safety and efficacy of vaccinations in dermatological and rheumatological patients treated with biological drugs and JAK inhibitors. Additionally, this article provides recommendation from experts of the Polish Dermatological Society about proper use of vaccinations during therapy with biologics. Generally, all live attenuated vaccines are contraindicated during immunosuppressive/immunomodulatory therapy. If there is need, they should be administered long enough prior to the therapy or after cessation. Yet, inactivated vaccines mostly can be safely used, but the problem in this case is the effectiveness of the vaccination. Most studies report that the immune response in patients on biologics after administration of different inactivated vaccines is similar to or even better than in the control group. Thus, the importance of vaccination among patients on biologics must be emphasized to reduce omissions and the fear of possible side effects or insufficient post-vaccination response.
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Affiliation(s)
- Joanna Narbutt
- Department of Dermatology, Pediatric Dermatology and Oncology Clinic, Medical University of Lodz, 90-419 Lodz, Poland; (J.N.); (A.L.)
| | - Zbigniew Żuber
- Department of Pediatrics, Faculty of Medicine and Health Sciences, Andrzej Frycz Modrzewski Krakow University, 30-705 Krakow, Poland;
| | - Aleksandra Lesiak
- Department of Dermatology, Pediatric Dermatology and Oncology Clinic, Medical University of Lodz, 90-419 Lodz, Poland; (J.N.); (A.L.)
| | - Natalia Bień
- Department of Dermatology, Pediatric Dermatology and Oncology Clinic, Medical University of Lodz, 90-419 Lodz, Poland; (J.N.); (A.L.)
| | - Jacek C. Szepietowski
- Department of Dermatology, Venereology and Allergology, Wroclaw Medical University, 50-368 Wroclaw, Poland;
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13
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Gargiulo L, Ibba L, Malagoli P, Balato A, Bardazzi F, Burlando M, Carrera CG, Damiani G, Dapavo P, Dini V, Gaiani FM, Girolomoni G, Guarneri C, Lasagni C, Loconsole F, Marzano AV, Megna M, Mercuri SR, Travaglini M, Costanzo A, Narcisi A. Drug survival of IL-12/23, IL-17 and IL-23 inhibitors for moderate-to-severe plaque psoriasis: a retrospective multicenter real-world experience on 5932 treatment courses - IL PSO (Italian landscape psoriasis). Front Immunol 2024; 14:1341708. [PMID: 38274801 PMCID: PMC10808601 DOI: 10.3389/fimmu.2023.1341708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Accepted: 12/22/2023] [Indexed: 01/27/2024] Open
Abstract
Introduction The development of several effective biological drugs for moderate-to-severe plaque psoriasis has dramatically changed the lives of patients. Despite the wide use of interleukin (IL) inhibitors, limited data are available to date regarding long-term treatment persistence. Method This multicenter retrospective real-world study evaluated 5932 treatment courses across 5300 patients, all treated with interleukin inhibitors. Drug survival was expressed by using the Kaplan-Meier estimator for each biological drug at 6, 12, 24, 36 and 48 months. We also stratified by discontinuation associated with primary or secondary ineffectiveness. Results In our study, the most prescribed drugs were secukinumab (1412), ixekizumab (1183), and risankizumab (977). After four years of follow-up, risankizumab emerged as the treatment with the highest drug survival overall, as 91.6% of patients were still on treatment. The overall probability of drug survival at four years was comparable for tildrakizumab (83.5%), ixekizumab (82.6%), guselkumab (82.4%) and brodalumab (81.8%). When evaluating only patients who discontinued the treatment because of ineffectiveness, once again risankizumab was the molecule with the highest drug survival at 4 years (93.4%), this time followed by ixekizumab (87%). Our study, in which all IL inhibitors were adequately represented, confirmed a slightly better treatment persistence for IL-23 inhibitors, consistent with other real-world studies. Conclusion Our experience showed that IL-23 inhibitors, and risankizumab in particular, had a higher probability of drug survival overall during a 4-year follow-up. Risankizumab and ixekizumab were less likely to be discontinued because of ineffectiveness after four years.
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Affiliation(s)
- Luigi Gargiulo
- Dermatology Unit, IRCCS Humanitas Research Hospital, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Luciano Ibba
- Dermatology Unit, IRCCS Humanitas Research Hospital, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Piergiorgio Malagoli
- Department of Dermatology, Dermatology Unit, Azienda Ospedaliera San Donato Milanese, Milan, Italy
| | - Anna Balato
- Dermatology Unit, University of Campania L. Vanvitelli, Naples, Italy
| | - Federico Bardazzi
- Dermatology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Policlinico S. Orsola-Malpighi, Bologna, Italy
| | - Martina Burlando
- Section of Dermatology, Department of Health Sciences (DISSAL), IRCCS San Martino University Hospital, Genoa, Italy
| | - Carlo G. Carrera
- Dermatology Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Giovanni Damiani
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy
- Dermatology and Cosmetology Unit, IRCCS San Raffaele Hospital, Milan, Italy
| | - Paolo Dapavo
- Department of Biomedical Science and Human Oncology, Second Dermatologic Clinic, University of Turin, Turin, Italy
| | - Valentina Dini
- Dermatology Unit, Department of Clinical and Experimental Medicine, Ospedale Santa Chiara, Pisa, Italy
| | - Francesca M. Gaiani
- Department of Dermatology, Dermatology Unit, Azienda Ospedaliera San Donato Milanese, Milan, Italy
| | - Giampiero Girolomoni
- Department of Medicine, Section of Dermatology and Venereology, University of Verona, Verona, Italy
| | - Claudio Guarneri
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Messina, Italy
| | - Claudia Lasagni
- Dermatological Clinic, Department of Specialized Medicine, University of Modena, Modena, Italy
| | | | - Angelo V. Marzano
- Dermatology Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy
| | - Matteo Megna
- Section of Dermatology, Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Santo R. Mercuri
- Dermatology and Cosmetology Unit, IRCCS San Raffaele Hospital, Milan, Italy
- Dermatology Unit, Università Vita-Salute San Raffaele, Milan, Italy
| | - Massimo Travaglini
- U.O.S.D. Dermatologica - Centro per la Cura della Psoriasi, Ospedale Perrino, Brindisi, Italy
| | - Antonio Costanzo
- Dermatology Unit, IRCCS Humanitas Research Hospital, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
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14
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Heidemeyer K, May Lee M, Cazzaniga S, Yawalkar N, Naldi L. Palmoplantar Pustulosis: A Systematic Review of Risk Factors and Therapies. PSORIASIS (AUCKLAND, N.Z.) 2023; 13:33-58. [PMID: 37772169 PMCID: PMC10522454 DOI: 10.2147/ptt.s400402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Accepted: 09/16/2023] [Indexed: 09/30/2023]
Abstract
Palmoplantar pustulosis (PPP) is a chronic, relapsing, inflammatory disease that can occur alone or in association with arthritis. There is still controversy about whether it should be separated from psoriasis or classified as pustular psoriasis. Furthermore, drug-induced paradoxical PPP is a special variant of PPP that differs from classic PPP in several ways. Treatment of PPP is still challenging, and there are a number of treatment-resistant cases. This review summarizes the risk factors for the development of PPP and the currently available treatment modalities. Female sex, smokers or ex-smokers, obesity, thyroid dysfunction, and treatment with a tumor necrosis factor (TNF)-α inhibitor have been identified as risk factors for the disease's development, severity, and course. Topical treatments and phototherapy are effective for some patients and are used as a first-line or adjuvant treatment modality. Conventional treatments including retinoids and fumaric acid show good effects and can increase the efficacy of treatment with psoralen + ultraviolet light therapy (PUVA). Ciclosporin is fast acting, but relapse mostly occurs immediately after cessation. TNF-α inhibitors are efficient, and an even better response can be achieved with IL-17 and IL-23 blockers as well as apremilast. The effect of Janus kinase inhibitors seems to be promising according to case reports, but further investigations with larger cohorts are needed.
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Affiliation(s)
- Kristine Heidemeyer
- Department of Dermatology, Inselspital University Hospital of Bern, Bern, Switzerland
- Centro Studi GISED, Bergamo, Italy
| | - Marco May Lee
- Section of Dermatology, Department of Clinical and Experimental Medicine, University of Parma, Parma, Italy
| | - Simone Cazzaniga
- Department of Dermatology, Inselspital University Hospital of Bern, Bern, Switzerland
- Centro Studi GISED, Bergamo, Italy
| | - Nikhil Yawalkar
- Department of Dermatology, Inselspital University Hospital of Bern, Bern, Switzerland
| | - Luigi Naldi
- Centro Studi GISED, Bergamo, Italy
- Dermatology Department, S. Bortolo Hospital, Vicenza, Italy
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15
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Arcuri D, Kaouache M, Lagacé F, Sasseville D, Litvinov I. A case-control pharmacovigilance study of TNF-alpha inhibitors and interleukin inhibitors on tuberculosis, Candida, lymphoma and suicidality using the FAERS database (2014-2020). J Am Acad Dermatol 2023; 89:619-621. [PMID: 37245836 DOI: 10.1016/j.jaad.2023.05.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Revised: 05/09/2023] [Accepted: 05/18/2023] [Indexed: 05/30/2023]
Affiliation(s)
- Domenico Arcuri
- McGill University - Faculty of Medicine and Health Sciences, Montreal, Quebec, Canada.
| | - Mohammed Kaouache
- McGill University - Faculty of Medicine and Health Sciences, Montreal, Quebec, Canada
| | - François Lagacé
- McGill University - Faculty of Medicine and Health Sciences, Montreal, Quebec, Canada
| | - Denis Sasseville
- McGill University - Faculty of Medicine and Health Sciences, Montreal, Quebec, Canada
| | - Ivan Litvinov
- McGill University - Faculty of Medicine and Health Sciences, Montreal, Quebec, Canada
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16
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Lam Hoai XL, Simonart T. Comparing Meta-Analyses with ChatGPT in the Evaluation of the Effectiveness and Tolerance of Systemic Therapies in Moderate-to-Severe Plaque Psoriasis. J Clin Med 2023; 12:5410. [PMID: 37629452 PMCID: PMC10455399 DOI: 10.3390/jcm12165410] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Revised: 08/16/2023] [Accepted: 08/17/2023] [Indexed: 08/27/2023] Open
Abstract
BACKGROUND Meta-analyses (MAs) and network meta-analyses (NMAs) are high-quality studies for assessing drug efficacy, but they are time-consuming and may be affected by biases. The capacity of artificial intelligence to aggregate huge amounts of information is emerging as particularly interesting for processing the volume of information needed to generate MAs. In this study, we analyzed whether the chatbot ChatGPT is able to summarize information in a useful fashion for providers and patients in a way that matches up with the results of MAs/NMAs. METHODS We included 16 studies (13 NMAs and 3 MAs) that evaluate biologics (n = 6) and both biologic and systemic treatment (n = 10) for moderate-to-severe psoriasis, published between January 2021 and May 2023. RESULTS The conclusions of the MAs/NMAs were compared to ChatGPT's answers to queries about the molecules evaluated in the selected MAs/NMAs. The reproducibility between the results of ChatGPT and the MAs/NMAs was random regarding drug safety. Regarding efficacy, ChatGPT reached the same conclusion as 5 out of the 16 studies (four out of four studies when three molecules were compared), gave acceptable answers in 7 out of 16 studies, and was inconclusive in 4 out of 16 studies. CONCLUSIONS ChatGPT can generate conclusions that are similar to MAs when the efficacy of fewer drugs is compared but is still unable to summarize information in a way that matches up to the results of MAs/NMAs when more than three molecules are compared.
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Affiliation(s)
- Xuân-Lan Lam Hoai
- Department of Dermatology, St Pierre—Brugmann—HUDERF University Hospitals, Université Libre de Bruxelles, 1050 Brussels, Belgium;
| | - Thierry Simonart
- Department of Dermatology, Delta Hospital, CHIREC, Université Libre de Bruxelles, 1050 Brussels, Belgium
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17
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Shu Y, Chen J, Ding Y, Zhang Q. Adverse events with risankizumab in the real world: postmarketing pharmacovigilance assessment of the FDA adverse event reporting system. Front Immunol 2023; 14:1169735. [PMID: 37256136 PMCID: PMC10225532 DOI: 10.3389/fimmu.2023.1169735] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Accepted: 04/28/2023] [Indexed: 06/01/2023] Open
Abstract
Background Risankizumab, a humanized IgG1 monoclonal antibody that selectively inhibits IL-23, is currently approved for the treatment of moderate-to-severe plaque psoriasis and Crohn's disease. The real-world safety study of risankizumab in a large- sample population is currently lacking. The aim of this study was to evaluate risankizumab-associated adverse events (AEs) and characterize the clinical priority through the data mining of the Food and Drug Administration (FDA) Adverse Event Reporting System (FAERS). Methods Disproportionality analyses were performed by calculating the reporting odds ratios (RORs), deemed significant when the lower limit of the 95% confidence interval was greater than 1, to quantify the signals of risankizumab-related AEs from the second quarter (Q2) of 2019 to 2022 Q3. Serious and non-serious cases were compared, and signals were prioritized using a rating scale. Results Risankizumab was recorded in 10,235 reports, with 161 AEs associated with significant disproportionality. Of note, 37 PTs in at least 30 cases were classified as unexpected AEs, which were uncovered in the drug label, such as myocardial infarction, cataract, pancreatitis, diabetes mellitus, stress, and nephrolithiasis. 74.68%, 25.32%, and 0% PTs were graded as weak, moderate, and strong clinical priorities, respectively. A total of 48 risankizumab-related AEs such as pneumonia, cerebrovascular accident, cataract, loss of consciousness, cardiac disorder, hepatic cirrhosis, and thrombosis, were more likely to be reported as serious AEs. The median TTO of moderate and weak signals related to risankizumab was 115 (IQR 16.75-305) and 124 (IQR 29-301) days, respectively. All of the disproportionality signals had early failure type features, indicating that risankizumab-associated AEs gradually decreased over time. Conclusion Our study found potential new AE signals and provided valuable evidence for clinicians to mitigate the risk of risankizumab-associated AEs based on an extensive analysis of a large-scale postmarketing international safety database.
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Affiliation(s)
- Yamin Shu
- Department of Pharmacy, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jing Chen
- Department of Pharmacy, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yiling Ding
- Graduate School of Pharmaceutical Sciences, University of Tokyo, Tokyo, Japan
| | - Qilin Zhang
- Department of Pharmacy, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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18
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Hamm H, Höger PH. [Psoriasis in children and adolescents : Short update and guideline-based treatment]. DERMATOLOGIE (HEIDELBERG, GERMANY) 2023; 74:340-349. [PMID: 36976302 PMCID: PMC10043838 DOI: 10.1007/s00105-023-05132-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Accepted: 02/14/2023] [Indexed: 03/29/2023]
Abstract
Psoriasis is nowadays regarded as a multifactorial, inflammatory, immune-mediated systemic condition with predominant involvement of the skin. It starts in about one third of cases in childhood and adolescence and is often accompanied by marked impairment of the quality of life of sufferers and their parents. Aside from genetic disposition, trigger factors such as streptococcal infections are notably involved in manifestation and in exacerbations. The harmful role of comorbidities even in the young, particularly of obesity, has been well documented. Treatment options have considerably improved following the approval of five biologic agents in childhood but are still insufficiently used. The present article gives a short overview of current knowledge and the recommendations of the updated German guideline. Besides frequent types, unusual presentations such as pustular psoriasis, psoriasis dermatitis, and paradoxical psoriasis induced by tumor necrosis factor alpha (TNF-α) inhibitors are addressed.
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Affiliation(s)
- Henning Hamm
- Klinik und Poliklinik für Dermatologie, Venerologie und Allergologie, Universitätsklinikum Würzburg, Josef-Schneider-Str. 2, 97080, Würzburg, Deutschland.
| | - Peter H Höger
- Abteilungen für Pädiatrie und Pädiatrische Dermatologie/Allergologie, Katholisches Kinderkrankenhaus Wilhelmstift, Hamburg, Deutschland
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19
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Hamm H, Höger PH. [Psoriasis in children and adolescents]. Monatsschr Kinderheilkd 2023; 171:420-429. [PMID: 37143470 PMCID: PMC10090738 DOI: 10.1007/s00112-023-01764-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
Psoriasis is nowadays regarded as a multifactorial, inflammatory, immune-mediated systemic condition with predominant involvement of the skin. It starts in about one third of cases in childhood and adolescence and is often accompanied by marked impairment of the quality of life of sufferers and their parents. Aside from genetic disposition, trigger factors such as streptococcal infections are notably involved in manifestation and in exacerbations. The harmful role of comorbidities even in the young, particularly of obesity, has been well documented. Treatment options have considerably improved following the approval of five biologic agents in childhood but are still insufficiently used. The present article gives a short overview of current knowledge and the recommendations of the updated German guideline. Besides frequent types, unusual presentations such as pustular psoriasis, psoriasis dermatitis, and paradoxical psoriasis induced by tumor necrosis factor alpha (TNF-α) inhibitors are addressed.
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Affiliation(s)
- Henning Hamm
- Klinik und Poliklinik für Dermatologie, Venerologie und Allergologie, Universitätsklinikum Würzburg, Josef-Schneider-Str. 2, 97080 Würzburg, Deutschland
| | - Peter H. Höger
- Abteilungen für Pädiatrie und Pädiatrische Dermatologie/Allergologie, Katholisches Kinderkrankenhaus Wilhelmstift, Hamburg, Deutschland
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20
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Hwang JK, Lipner SR. Safety of current systemic therapies for nail psoriasis. Expert Opin Drug Saf 2023; 22:391-406. [PMID: 37329288 DOI: 10.1080/14740338.2023.2227560] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Accepted: 06/16/2023] [Indexed: 06/19/2023]
Abstract
INTRODUCTION A discussion of safety of systemic treatments for nail psoriasis is lacking, particularly in reference to approval of new therapies assessed for nail outcomes. A review of safety profiles for agents commonly utilized for treatment of nail psoriasis is warranted to help inform treatment choices. The PubMed database was searched on 5 April 20235 April 2023, with articles discussing safety of nail psoriasis systemic therapies identified and reviewed. AREAS COVERED Systemic treatments for nail psoriasis include biologic therapies (tumor necrosis factor-alpha inhibitors, interleukin-17 inhibitors, interleukin-23 inhibitors, interleukin-12/23 inhibitors), small molecule inhibitors (apremilast, tofacitinib), and oral systemic immunomodulators (methotrexate, cyclosporine, acitretin), each with unique safety profiles and considerations. Herein, we discuss adverse events, contraindications, drug-drug interactions, screening/monitoring guidelines, as well as utilization for special populations, including pregnant, older, and pediatric patients. EXPERT OPINION The advent of targeted therapies, including biologic treatments and small molecule inhibitors, has revolutionized outcomes for nail psoriasis patients, but warrant review and monitoring for potential adverse events. Oral systemic immunomodulators have demonstrated moderate efficacy for nail psoriasis treatment, but are notable for frequent contraindications and drug-drug interactions. Further study of these agents and their use in special populations is needed to elucidate safety profiles for long-term use.
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Affiliation(s)
- Jonathan K Hwang
- Weill Cornell Medicine, Department of Dermatology, New York, NY, USA
| | - Shari R Lipner
- Weill Cornell Medicine, Department of Dermatology, New York, NY, USA
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Prignano F, Pescitelli L, Trovato E, DI Cesare A, Cuccia A, Mazzatenta C, Pellegrino M, Marsili F, Castelli A, Brandini L, Niccoli MC, Taviti F, Ricceri F, Panduri S, Buggiani G, Ghilardi A, Rubegni P, Romanelli M, Pimpinelli N. Tuscany consensus for the treatment of moderate-severe psoriasis: update and focus on practical guidelines for place in therapy of anti-IL-17 and anti-IL-23 biologics. Ital J Dermatol Venerol 2022; 157:469-479. [PMID: 35785927 DOI: 10.23736/s2784-8671.22.07355-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Psoriasis is a common chronic skin disease characterized by a worldwide distribution and a natural tendency towards progression. According to the many clinical forms, the extension of the disease and the many comorbidities, almost the 20% of the patients require a systemic treatment. Biologics have greatly changed the ongoing of psoriasis and the quality of life of psoriasis patients. After the anti-TNF-alpha, which were the first biologics in use for psoriasis, the improvement in knowledge of the pathogenetic mechanisms underlying the disease has led to the development of a series of more specific therapies for psoriasis. This "second generation" of biologics includes the interleukin (IL)-12/23 inhibitor ustekinumab, IL-17 inhibitors (secukinumab and ixekizumab), the IL-17 receptor A (IL-17RA) antagonist brodalumab, and the IL-23 inhibitors guselkumab, risankizumab and tildrakizumab. This study represents an update of the Tuscany consensus focused on the use of new drugs, such as anti-IL-17 and anti-IL-23 in moderate-to-severe psoriasis and their correct place in therapy according to specific clinical requests and in full respect of the current financial restrictions.
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Affiliation(s)
- Francesca Prignano
- Section of Dermatology, Department of Health Sciences, University of Florence, Florence, Italy -
| | | | - Emanuele Trovato
- Section of Dermatology, Department of Medical, Surgical and Neurological Science, S. Maria alle Scotte Hospital, University of Siena, Siena, Italy
| | - Antonella DI Cesare
- Section of Dermatology, Department of Health Sciences, University of Florence, Florence, Italy
| | - Aldo Cuccia
- Unit of Dermatology, San Donato Hospital, Arezzo, Italy
| | | | | | - Franco Marsili
- Unit of Dermatology, Versilia Hospital, Lido di Camaiore, Lucca, Italy
| | | | - Luca Brandini
- Unit of Dermatology, San Giuseppe Hospital, Empoli, Florence, Italy
| | | | - Franca Taviti
- Unit of Dermatology, Hospital of Prato, Prato, Italy
| | | | | | - Gionata Buggiani
- Unit of Dermatology, San Giuseppe Hospital, Empoli, Florence, Italy
| | | | - Pietro Rubegni
- Section of Dermatology, Department of Medical, Surgical and Neurological Science, S. Maria alle Scotte Hospital, University of Siena, Siena, Italy
| | | | - Nicola Pimpinelli
- Section of Dermatology, Department of Health Sciences, University of Florence, Florence, Italy
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Armstrong AW, Soliman AM, Betts KA, Wang Y, Gao Y, Stakias V, Puig L. A Response to: Letter to the Editor Regarding Long-Term Benefit-Risk Profiles of Treatments for Moderate-to-Severe Plaque Psoriasis: A Network Meta-analysis. Dermatol Ther (Heidelb) 2022; 12:2867-2870. [PMID: 36271222 DOI: 10.1007/s13555-022-00812-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Accepted: 09/05/2022] [Indexed: 11/25/2022] Open
Affiliation(s)
- April W Armstrong
- Department of Dermatology, Keck School of Medicine, University of Southern California, Health Sciences Campus, HC4 2000 1450 San Pablo, Los Angeles, CA, 90033, USA.
| | - Ahmed M Soliman
- AbbVie, Inc., 1 N. Waukegan Road, North Chicago, IL, 60064, USA
| | - Keith A Betts
- Analysis Group, Inc., 333 South Hope Street 27th Floor, Los Angeles, CA, 90071, USA
| | - Yan Wang
- Analysis Group, Inc., 333 South Hope Street 27th Floor, Los Angeles, CA, 90071, USA
| | - Yawen Gao
- Analysis Group, Inc., 333 South Hope Street 27th Floor, Los Angeles, CA, 90071, USA
| | | | - Luis Puig
- Department of Dermatology, IIB SANTPAU, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Carrer de Sant Quintí, 89, 08041, Barcelona, Spain
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Pettitt D, Plotnick M, Gagne J. Letter to the Editor Regarding Long-Term Benefit-Risk Profiles of Treatments for Moderate-to-Severe Plaque Psoriasis: A Network Meta-analysis. Dermatol Ther (Heidelb) 2022; 12:2863-2866. [PMID: 36271223 PMCID: PMC9674805 DOI: 10.1007/s13555-022-00809-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Accepted: 09/05/2022] [Indexed: 12/02/2022] Open
Affiliation(s)
- Dan Pettitt
- Immunology Global Market Access and Health Economics, Janssen Pharmaceutical Companies of Johnson & Johnson, Horsham, PA, USA.
| | - Michael Plotnick
- Immunology Global Medical Affairs, Janssen Pharmaceutical Companies of Johnson & Johnson, Horsham, PA, USA
| | - Joshua Gagne
- Johnson & Johnson, Epidemiology, Cambridge, MA, USA
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Hu X, Qi C, Feng F, Wang Y, Di T, Meng Y, Wang Y, Zhao N, Zhang X, Li P, Zhao J. Combining network pharmacology, RNA-seq, and metabolomics strategies to reveal the mechanism of Cimicifugae Rhizoma - Smilax glabra Roxb herb pair for the treatment of psoriasis. PHYTOMEDICINE : INTERNATIONAL JOURNAL OF PHYTOTHERAPY AND PHYTOPHARMACOLOGY 2022; 105:154384. [PMID: 35963195 DOI: 10.1016/j.phymed.2022.154384] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 07/14/2022] [Accepted: 08/04/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Psoriasis is a prevalent chronic inflammatory skin condition marked by immune cell infiltration and keratinocyte abnormal proliferation. Cimicifugae Rhizoma - Smilax glabra Roxb (CS) herb pair, the main component of Shengma Detoxification Decoction, has been proven effective for the treatment of psoriasis. However, the mechanism is yet to be deciphered. PURPOSE To explore the mechanism of CS for the treatment of psoriasis. METHODS The imiquimod-induced psoriasis-like lesion mouse model was used to identify the targets and the molecular mechanisms of CS. Network pharmacology combined with RNA-seq strategy was employed to predict the targets and mechanisms of CS for psoriasis. Metabolomics approaches were used to demonstrate the complexity of CS for the treatment of psoriasis. Finally, a compound-response-enzyme-gene network was constructed based on the multi-omics results to elucidate potential connections. RESULTS The CS herb pair could significantly improve psoriatic lesions and reduce the inflammatory cell infiltration and proliferation of keratinocytes in skin lesions. Network pharmacology predicted that TNF, JNK, IL-6, and IL-1β could be potential targets. RNA-seq data revealed that CS could significantly regulate genes and signaling pathways associated with Th17 responses, such as IL-36, IL-1β, CCl2, CXCL16, keratin 14, keratin 5, and antimicrobial peptides S100A8 and S100A9 well as MAPK, mTOR, and other signaling pathways. Further experimental data validated that CS treatment remarkably reduced the expression of inflammatory cytokines and factors, such as CCL2, CCL7, IL1F6, IL-17, IL-23, IL-1β, TNF-α, and IL-6, and inhibited the phosphorylation of p38 and ERK1/2. This indicated that CS exerts its therapeutic effect by inhibiting the MAPK signaling pathways. In addition, metabolomic analyses demonstrated that CS treatment improved seven metabolic pathways, these included phenylalanine, tyrosine, pyruvate metabolism, carnitine metabolism, etc. Four key metabolites (L-Arginine, L-Phenylalanine, L-Carnitine, O-Acetylcarnitine) and nine differential genes (CMA1, PCBD2, TPSAB1, TPSB2, etc.) were identified that affected amino acid metabolism, carnitine metabolism, and other pathways contributing to the infiltration of Th17 cells in psoriatic lesions. CONCLUSION CS could alleviate IMQ-induced psoriasis-like dermatitis by reducing the expression of cytokines and chemokines mediated by the MAPK pathway, and improved amino acid and carnitine metabolism in vivo. Our study is the first to demonstrate the complex mechanism of CS for the treatment of psoriasis and provides a new paradigm to elucidate the pharmacological effects of Traditional Chinese Medicine (TCM) drugs for psoriasis from multiple perspectives.
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Affiliation(s)
- XueQing Hu
- Beijing University of Chinese Medicine, Beijing 100105, China; Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, Beijing Institute of Traditional Chinese Medicine, No. 23rd Art Museum Back Street, Dongcheng District, Beijing 100010, China
| | - Cong Qi
- Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, Beijing Institute of Traditional Chinese Medicine, No. 23rd Art Museum Back Street, Dongcheng District, Beijing 100010, China
| | - Fang Feng
- Beijing University of Chinese Medicine, Beijing 100105, China; Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, Beijing Institute of Traditional Chinese Medicine, No. 23rd Art Museum Back Street, Dongcheng District, Beijing 100010, China
| | - Yan Wang
- Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, Beijing Institute of Traditional Chinese Medicine, No. 23rd Art Museum Back Street, Dongcheng District, Beijing 100010, China
| | - TingTing Di
- Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, Beijing Institute of Traditional Chinese Medicine, No. 23rd Art Museum Back Street, Dongcheng District, Beijing 100010, China
| | - YuJiao Meng
- Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, Beijing Institute of Traditional Chinese Medicine, No. 23rd Art Museum Back Street, Dongcheng District, Beijing 100010, China
| | - Yazhuo Wang
- Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, Beijing Institute of Traditional Chinese Medicine, No. 23rd Art Museum Back Street, Dongcheng District, Beijing 100010, China
| | - Ning Zhao
- Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, Beijing Institute of Traditional Chinese Medicine, No. 23rd Art Museum Back Street, Dongcheng District, Beijing 100010, China
| | - XiaWei Zhang
- Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, Beijing Institute of Traditional Chinese Medicine, No. 23rd Art Museum Back Street, Dongcheng District, Beijing 100010, China
| | - Ping Li
- Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, Beijing Institute of Traditional Chinese Medicine, No. 23rd Art Museum Back Street, Dongcheng District, Beijing 100010, China.
| | - Jingxia Zhao
- Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, Beijing Institute of Traditional Chinese Medicine, No. 23rd Art Museum Back Street, Dongcheng District, Beijing 100010, China.
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Armstrong A, Fahrbach K, Leonardi C, Augustin M, Neupane B, Kazmierska P, Betts M, Freitag A, Kiri S, Taieb V, Slim M, Gomez NN, Warren RB. Efficacy of Bimekizumab and Other Biologics in Moderate to Severe Plaque Psoriasis: A Systematic Literature Review and a Network Meta-Analysis. Dermatol Ther (Heidelb) 2022; 12:1777-1792. [PMID: 35798920 PMCID: PMC9357587 DOI: 10.1007/s13555-022-00760-8] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Accepted: 06/08/2022] [Indexed: 01/11/2023] Open
Abstract
INTRODUCTION Biologic treatments are increasingly being used in the management of moderate to severe plaque psoriasis (PSO). Bimekizumab is a selective inhibitor of both interleukin (IL)-17A and IL-17F approved for the treatment of moderate to severe PSO. Although bimekizumab trials provide comparisons to secukinumab, adalimumab and ustekinumab, there are no further head-to-head comparisons of bimekizumab to other biologics. This network meta-analysis (NMA) aimed to compare the short-term efficacy of bimekizumab versus other biologic systemic therapies for moderate to severe PSO. METHODS A systematic literature review was conducted to identify randomised controlled trials (RCTs) in patients with moderate to severe PSO. MEDLINE, Embase, the Cochrane Central Register of Controlled Trials and the Database of Systematic Reviews and PsycINFO were searched on July 1, 2020. An enhanced multinomial Bayesian NMA model was used to evaluate the comparative efficacy in 50%, 75%, 90% and 100% improvement from baseline Psoriasis Area and Severity Index (PASI 50/75/90/100) at 10-16 weeks. The model was also adjusted for baseline risk, given the variable placebo responses across the trials. RESULTS Eighty-six RCTs (including 34,476 patients) were included in the NMA. IL-17 and IL-23 inhibitors were the most effective treatments across all PASI levels. At 10-16 weeks, bimekizumab had the highest probability of achieving PASI 75 (92.3%), PASI 90 (84.0%) and PASI 100 (57.8%). Bimekizumab demonstrated statistical superiority over all biologics in achieving PASI 90 and PASI 100 thresholds. For PASI 75, the benefit of bimekizumab was statistically significant compared to all other treatments except risankizumab and ixekizumab. CONCLUSION This analysis demonstrated that IL-17 and IL-23 inhibitors were highly effective in achieving short-term improvement among patients with moderate to severe PSO. Patients receiving bimekizumab were significantly more likely to achieve PASI 90 or PASI 100 within 10-16 weeks of the first injection than all other biologics.
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Affiliation(s)
- April Armstrong
- Keck School of Medicine of USC, Dermatology, Los Angeles, CA, USA
| | - Kyle Fahrbach
- Evidera, Inc, 140 Kendrick St, 3rd Floor, Needham, MA, 02494, USA.
| | - Craig Leonardi
- Central Dermatology and Saint Louis University School of Medicine, St. Louis, MO, USA
| | - Matthias Augustin
- Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | | | | | - Marissa Betts
- Evidera, Inc, 140 Kendrick St, 3rd Floor, Needham, MA, 02494, USA
| | | | | | | | - Mahmoud Slim
- Evidera (Evidence Synthesis), St-Laurent, Canada
| | | | - Richard B Warren
- Dermatology Centre, Salford Royal NHS Foundation Trust, Manchester NIHR Biomedical Research Centre, The University of Manchester, Manchester, UK
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Sbidian E, Chaimani A, Garcia-Doval I, Doney L, Dressler C, Hua C, Hughes C, Naldi L, Afach S, Le Cleach L. Systemic pharmacological treatments for chronic plaque psoriasis: a network meta-analysis. Cochrane Database Syst Rev 2022; 5:CD011535. [PMID: 35603936 PMCID: PMC9125768 DOI: 10.1002/14651858.cd011535.pub5] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND Psoriasis is an immune-mediated disease with either skin or joints manifestations, or both, and it has a major impact on quality of life. Although there is currently no cure for psoriasis, various treatment strategies allow sustained control of disease signs and symptoms. The relative benefit of these treatments remains unclear due to the limited number of trials comparing them directly head-to-head, which is why we chose to conduct a network meta-analysis. OBJECTIVES To compare the efficacy and safety of non-biological systemic agents, small molecules, and biologics for people with moderate-to-severe psoriasis using a network meta-analysis, and to provide a ranking of these treatments according to their efficacy and safety. SEARCH METHODS For this update of the living systematic review, we updated our searches of the following databases monthly to October 2021: the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, and Embase. SELECTION CRITERIA Randomised controlled trials (RCTs) of systemic treatments in adults over 18 years with moderate-to-severe plaque psoriasis, at any stage of treatment, compared to placebo or another active agent. The primary outcomes were: proportion of participants who achieved clear or almost clear skin, that is, at least Psoriasis Area and Severity Index (PASI) 90; proportion of participants with serious adverse events (SAEs) at induction phase (8 to 24 weeks after randomisation). DATA COLLECTION AND ANALYSIS We conducted duplicate study selection, data extraction, risk of bias assessment and analyses. We synthesised data using pairwise and network meta-analysis (NMA) to compare treatments and rank them according to effectiveness (PASI 90 score) and acceptability (inverse of SAEs). We assessed the certainty of NMA evidence for the two primary outcomes and all comparisons using CINeMA, as very low, low, moderate, or high. We contacted study authors when data were unclear or missing. We used the surface under the cumulative ranking curve (SUCRA) to infer treatment hierarchy, from 0% (worst for effectiveness or safety) to 100% (best for effectiveness or safety). MAIN RESULTS This update includes an additional 19 studies, taking the total number of included studies to 167, and randomised participants to 58,912, 67.2% men, mainly recruited from hospitals. Average age was 44.5 years, mean PASI score at baseline was 20.4 (range: 9.5 to 39). Most studies were placebo-controlled (57%). We assessed a total of 20 treatments. Most (140) trials were multicentric (two to 231 centres). One-third of the studies (57/167) had high risk of bias; 23 unclear risk, and most (87) low risk. Most studies (127/167) declared funding by a pharmaceutical company, and 24 studies did not report a funding source. Network meta-analysis at class level showed that all interventions (non-biological systemic agents, small molecules, and biological treatments) showed a higher proportion of patients reaching PASI 90 than placebo. Anti-IL17 treatment showed a higher proportion of patients reaching PASI 90 compared to all the interventions, except anti-IL23. Biologic treatments anti-IL17, anti-IL12/23, anti-IL23 and anti-TNF alpha showed a higher proportion of patients reaching PASI 90 than the non-biological systemic agents. For reaching PASI 90, the most effective drugs when compared to placebo were (SUCRA rank order, all high-certainty evidence): infliximab (risk ratio (RR) 50.19, 95% CI 20.92 to 120.45), bimekizumab (RR 30.27, 95% CI 25.45 to 36.01), ixekizumab (RR 30.19, 95% CI 25.38 to 35.93), risankizumab (RR 28.75, 95% CI 24.03 to 34.39). Clinical effectiveness of these drugs was similar when compared against each other. Bimekizumab, ixekizumab and risankizumab showed a higher proportion of patients reaching PASI 90 than other anti-IL17 drugs (secukinumab and brodalumab) and guselkumab. Infliximab, anti-IL17 drugs (bimekizumab, ixekizumab, secukinumab and brodalumab) and anti-IL23 drugs (risankizumab and guselkumab) except tildrakizumab showed a higher proportion of patients reaching PASI 90 than ustekinumab and three anti-TNF alpha agents (adalimumab, certolizumab and etanercept). Ustekinumab was superior to certolizumab; adalimumab and ustekinumab were superior to etanercept. No significant difference was shown between apremilast and two non-biological drugs: ciclosporin and methotrexate. We found no significant difference between any of the interventions and the placebo for the risk of SAEs. The risk of SAEs was significantly lower for participants on methotrexate compared with most of the interventions. Nevertheless, the SAE analyses were based on a very low number of events with low- to moderate-certainty for all the comparisons (except methotrexate versus placebo, which was high-certainty). The findings therefore have to be viewed with caution. For other efficacy outcomes (PASI 75 and Physician Global Assessment (PGA) 0/1), the results were similar to the results for PASI 90. Information on quality of life was often poorly reported and was absent for several of the interventions. AUTHORS' CONCLUSIONS Our review shows that, compared to placebo, the biologics infliximab, bimekizumab, ixekizumab, and risankizumab were the most effective treatments for achieving PASI 90 in people with moderate-to-severe psoriasis on the basis of high-certainty evidence. This NMA evidence is limited to induction therapy (outcomes measured from 8 to 24 weeks after randomisation), and is not sufficient for evaluating longer-term outcomes in this chronic disease. Moreover, we found low numbers of studies for some of the interventions, and the young age (mean 44.5 years) and high level of disease severity (PASI 20.4 at baseline) may not be typical of patients seen in daily clinical practice. We found no significant difference in the assessed interventions and placebo in terms of SAEs, and the safety evidence for most interventions was low to moderate quality. More randomised trials directly comparing active agents are needed, and these should include systematic subgroup analyses (sex, age, ethnicity, comorbidities, psoriatic arthritis). To provide long-term information on the safety of treatments included in this review, an evaluation of non-randomised studies and postmarketing reports from regulatory agencies is needed. Editorial note: This is a living systematic review. Living systematic reviews offer a new approach to review updating, in which the review is continually updated, incorporating relevant new evidence as it becomes available. Please refer to the Cochrane Database of Systematic Reviews for the current status of this review.
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Affiliation(s)
- Emilie Sbidian
- Department of Dermatology, Hôpital Henri Mondor, Créteil, France
- Clinical Investigation Centre, Hôpital Henri Mondor, Créteil, France
- Epidemiology in Dermatology and Evaluation of Therapeutics (EpiDermE) - EA 7379, Université Paris Est Créteil (UPEC), Créteil, France
| | - Anna Chaimani
- Université de Paris, Centre of Research in Epidemiology and Statistics (CRESS), INSERM, F-75004, Paris, France
- Cochrane France, Paris, France
| | - Ignacio Garcia-Doval
- Department of Dermatology, Complexo Hospitalario Universitario de Vigo, Vigo, Spain
| | - Liz Doney
- Cochrane Skin, Centre of Evidence Based Dermatology, University of Nottingham, Nottingham, UK
| | - Corinna Dressler
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Camille Hua
- Department of Dermatology, Hôpital Henri Mondor, Créteil, France
- Epidemiology in Dermatology and Evaluation of Therapeutics (EpiDermE) - EA 7379, Université Paris Est Créteil (UPEC), Créteil, France
| | - Carolyn Hughes
- c/o Cochrane Skin Group, The University of Nottingham, Nottingham, UK
| | - Luigi Naldi
- Centro Studi GISED (Italian Group for Epidemiologic Research in Dermatology) - FROM (Research Foundation of Ospedale Maggiore Bergamo), Padiglione Mazzoleni - Presidio Ospedaliero Matteo Rota, Bergamo, Italy
| | - Sivem Afach
- Epidemiology in Dermatology and Evaluation of Therapeutics (EpiDermE) - EA 7379, Université Paris Est Créteil (UPEC), Créteil, France
| | - Laurence Le Cleach
- Department of Dermatology, Hôpital Henri Mondor, Créteil, France
- Epidemiology in Dermatology and Evaluation of Therapeutics (EpiDermE) - EA 7379, Université Paris Est Créteil (UPEC), Créteil, France
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Fernández-Ruiz M. Interleukin-12 and -23 Targeted Agents. INFECTIOUS COMPLICATIONS IN BIOLOGIC AND TARGETED THERAPIES 2022:199-217. [DOI: 10.1007/978-3-031-11363-5_11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
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Long-Term Benefit-Risk Profiles of Treatments for Moderate-to-Severe Plaque Psoriasis: A Network Meta-Analysis. Dermatol Ther (Heidelb) 2021; 12:167-184. [PMID: 34862951 PMCID: PMC8776931 DOI: 10.1007/s13555-021-00647-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Accepted: 11/12/2021] [Indexed: 01/16/2023] Open
Abstract
INTRODUCTION The long-term benefit-risk profiles of licensed and investigational treatments for moderate-to-severe plaque psoriasis have not been fully characterized. METHODS Randomized controlled trials (RCTs) of licensed and investigational treatments for moderate-to-severe plaque psoriasis were identified through a systematic literature review through 2 May 2021. Bayesian network meta-analyses (NMAs) were conducted to compare the efficacy (Psoriasis Area and Severity Index [PASI] 75/90/100 [at least a 75/90/100% reduction in PASI score from baseline] response) and safety outcomes (any adverse event [AE], any serious AE [SAE], and AEs leading to treatment discontinuation) of each treatment evaluated between weeks 48 and 56 after baseline. Surfaces under the cumulative ranking curves (SUCRAs) were calculated to evaluate the relative ranking of treatments. The benefit-risk profiles of treatments were assessed by bidimensional plots of the NMA-estimated efficacy and safety outcomes. RESULTS In the efficacy NMA (N = 14 RCTs), the relative rankings for PASI 75/90/100 responses by weeks 48-56 were the highest for risankizumab (SUCRA: 98.5%) and bimekizumab (83.8% for dosing every 4 weeks [Q4W], 72.7% for dosing Q4W then every 8 weeks). The PASI response rates did not differ significantly between risankizumab and the two bimekizumab regimens. Additionally, risankizumab was associated with significantly higher PASI response rates than brodalumab, guselkumab, ixekizumab, secukinumab, ustekinumab, adalimumab, and etanercept. In the safety NMAs (N = 8 RCTs), risankizumab had the highest relative rankings for all three outcomes (SUCRA: 92.1%, 82.0%, and 91.0% for any AE, any SAE, and AEs leading to treatment discontinuation, respectively). Risankizumab had a significantly lower rate of any AE than bimekizumab, ustekinumab, and secukinumab. CONCLUSIONS Risankizumab was associated with the most favorable long-term benefit-risk profile for the treatment of moderate-to-severe plaque psoriasis. Although ixekizumab and bimekizumab had favorable efficacy profiles, both treatments had lower rankings for safety outcomes.
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Guelimi R, Afach S, Régnaux JP, Bettuzzi T, Chaby G, Sbidian E, Naudet F, Le Cleach L. Overlapping network meta-analyses on psoriasis systemic treatments: an overview, quantity does not make quality. Br J Dermatol 2021; 187:29-41. [PMID: 34854074 DOI: 10.1111/bjd.20908] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Revised: 11/27/2021] [Accepted: 11/28/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Network Meta-analyses (NMAs) have become successful in addressing gaps in the comparative effectiveness of systemic treatments in moderate-to-severe psoriasis. However, their increasing number carries both a risk of overlap and reproducibility issues that can hamper clinical decision-making. In this overview, we aimed to assess redundancy across these NMAs and to describe their characteristics. METHODS We considered all systematic reviews with NMAs of randomized controlled trials that included adult patients with moderate-to-severe psoriasis and that evaluated the efficacy and/or safety of systemic treatments compared with placebo or with an active comparator. PubMed/MEDLINE, Epistemonikos, PROSPERO and the Evidence Update of the Centre of Evidence-Based Dermatology of the University of Nottingham were searched up to 25 February 2021. Our main outcome was the number per year of redundant NMAs and the extent of their overlap. We also described their features, especially, the confidence in the results of the reviews, the studies' funding and the presence of spin (a description that overstates efficacy and/or understates harm), reporting issues and methodological characteristics. RESULTS In total, 47 redundant NMAs were included. Only 2/47 (4%) included all available treatments. Both efficacy and safety were evaluated in 14/47 (30%) NMAs and both short and long-term evaluations were assessed in 5/47 (11 %). Confidence in the results was critically low for 39/47 (83%) NMAs and only 10/47 (23 %) registered a protocol. 26/47 NMAs (55%) received pharmaceutical funding. CROs were involved in 19/47 (40%) NMAs. Reporting was poor across most of the NMAs' abstracts and spin was present in all of the abstracts. Almost half of the NMA failed to consider important limitations such as heterogeneity (32%) or consistency (66%). DISCUSSION In addition to a duplication of efforts, our overview showed heterogeneous methods and poor confidence in the results in a majority of the included NMAs, further distorted by reporting issues and spin. Clinicians need to interpret NMAs with caution when looking for the most reliable and comprehensive evidence.
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Affiliation(s)
- R Guelimi
- EpiDermE EA 7379, Université Paris Est Créteil, F-94010, Créteil, France
| | - S Afach
- EpiDermE EA 7379, Université Paris Est Créteil, F-94010, Créteil, France
| | - J-P Régnaux
- EpiDermE EA 7379, Université Paris Est Créteil, F-94010, Créteil, France.,Ecole des Hautes Etudes en Santé Publique (EHESP), F-35000, Rennes, France
| | - T Bettuzzi
- EpiDermE EA 7379, Université Paris Est Créteil, F-94010, Créteil, France.,Department of Dermatology, Assistance Publique-Hôpitaux de Paris, Henri Mondor Hospital, F-94010, Créteil, France
| | - G Chaby
- Dermatology Department, Amiens-Picardie University Hospital Center, Amiens, F-80000, France
| | - E Sbidian
- EpiDermE EA 7379, Université Paris Est Créteil, F-94010, Créteil, France.,Department of Dermatology, Assistance Publique-Hôpitaux de Paris, Henri Mondor Hospital, F-94010, Créteil, France
| | - F Naudet
- CHU Rennes, INSERM CIC 1414 (Centre d'Investigation Clinique de Rennes), University Rennes, Rennes, F-35000, France
| | - L Le Cleach
- EpiDermE EA 7379, Université Paris Est Créteil, F-94010, Créteil, France.,Department of Dermatology, Assistance Publique-Hôpitaux de Paris, Henri Mondor Hospital, F-94010, Créteil, France
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Pettitt D, Plotnick M, Miller LS, Berlin JA. Letter to the editor concerning the article: "Comparative safety and benefit-risk profile of biologics and oral treatments for moderate-to-severe plaque psoriasis: A network meta-analysis of clinical trial data". J Am Acad Dermatol 2021; 85:e305-e306. [PMID: 34311042 DOI: 10.1016/j.jaad.2021.05.068] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Accepted: 05/31/2021] [Indexed: 11/25/2022]
Affiliation(s)
- Dan Pettitt
- Immunology Global Market Access and Health Economics, Janssen Pharmaceutical Companies of Johnson & Johnson, Horsham, Pennsylvania.
| | - Michael Plotnick
- Immunology Global Medical Affairs, Janssen Pharmaceutical Companies of Johnson & Johnson, Horsham, Pennsylvania
| | - Lloyd S Miller
- Janssen Research & Development, Spring House, Pennsylvania
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