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Foley P, Gebauer K, Sullivan J, McMeniman E, Shumack S, Ng J, James A, Rawlin M, Sidhu S, Tilakaratne D, Turner M, Radulski B, Nash P, Baker C. Australian consensus: Treatment goals for moderate to severe psoriasis in the era of targeted therapies - Adult patients. Australas J Dermatol 2023; 64:476-487. [PMID: 37501636 DOI: 10.1111/ajd.14138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Accepted: 07/15/2023] [Indexed: 07/29/2023]
Abstract
BACKGROUND Over the last decade, the treatment landscape for moderate-severe psoriasis has rapidly evolved. The Australasian College of Dermatologists sought to review and update previously published treatment goals for moderate-severe psoriasis. METHODS A modified Delphi approach was used. Comprehensive literature review and guideline evaluation resulted in the development of statements and other questions to establish current clinical practices. Two rounds of anonymous voting were undertaken, with a collaborative meeting held in between to discuss areas of discordance. Overall, consensus was defined as achievement of ≥75% agreement in the range 7-9 on a 9-point scale (1 strongly disagree; 9 strongly agree). RESULTS Consensus was achieved on 26/29 statements in round 1 and a further 20 statements in round 2. There was strong agreement to expanding the classification/definition of psoriasis severity by including a choice of metrics, incorporating quality of life measures, and widening the scope of high-impact sites. Consensus was also reached on revised treatment response criteria, which were then incorporated into a new treatment algorithm. There was discordance with the current requirement to undertake a trial with established systemic agents before accessing targeted therapy. CONCLUSION The ability of new targeted treatment options to change the narrative in psoriasis patient care can only be properly realised if challenges to timely and equitable access are addressed. The proposed framework for the assessment, classification and management of moderate-severe psoriasis aligns with international recommendations. Its adoption into Australian clinical practice is hoped to improve treatment outcomes and patients' satisfaction with their care.
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Affiliation(s)
- Peter Foley
- Skin Health Institute, Carlton, Victoria, Australia
- Department of Dermatology, St Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia
- The University of Melbourne, Melbourne, Victoria, Australia
| | - Kurt Gebauer
- Fremantle Dermatology, Fremantle, Western Australia, Australia
- The University of Western Australia, Nedlands, Western Australia, Australia
| | - John Sullivan
- Kareena Private Hospital, Ramsay Surgical Centre, Miranda, New South Wales, Australia
- Kingsway Dermatology & Aesthetics, Miranda, New South Wales, Australia
| | - Erin McMeniman
- Dermatology Research Centre, Princess Alexandra Hospital Southside Clinical Unit, University of Queensland, Brisbane, Queensland, Australia
| | - Stephen Shumack
- Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
- Department of Dermatology, Royal North Shore Hospital, Sydney, New South Wales, Australia
| | - Jonathan Ng
- Hobart Medical Specialists, Hobart, Tasmania, Australia
| | - Amelia James
- Department of Dermatology, St Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia
| | - Morton Rawlin
- General Practitioner, Lower Templestowe, Victoria, Australia
| | - Shireen Sidhu
- Department of Dermatology, Royal Adelaide Hospital, Adelaide, South Australia, Australia
- Faculty of Health Sciences, School of Medicine, University of Adelaide, Adelaide, South Australia, Australia
| | - Dev Tilakaratne
- Department of Dermatology, Royal Darwin Hospital, Tiwi, Northwest Territories, Australia
- Darwin Dermatology, Tiwi, Northwest Territories, Australia
| | | | - Barbara Radulski
- CNC Dermatology, The Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - Peter Nash
- School of Medicine and Dentistry, Griffith University, Gold Coast, Queensland, Australia
- Department of Medicine, University of Queensland, Brisbane, Queensland, Australia
- Rheumatology Research Unit, Sunshine Coast, Queensland, Australia
| | - Christopher Baker
- Skin Health Institute, Carlton, Victoria, Australia
- Department of Dermatology, St Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia
- The University of Melbourne, Melbourne, Victoria, Australia
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Xia R, Liu J, Gao Y, Diao Z, Chen D, Zhou C, Zhang Z, Yin Z. Local injection of micro-dose anti-interleukin-17A antibody for palmoplantar pustulosis: A real-world study. Clin Immunol 2023:109694. [PMID: 37433424 DOI: 10.1016/j.clim.2023.109694] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Revised: 05/29/2023] [Accepted: 07/02/2023] [Indexed: 07/13/2023]
Abstract
Palmoplantar pustulosis (PPP), a chronic and stubborn skin disease, is mainly confined to the palms or/and soles, making it possible for localized use of therapeutic antibodies. In this real-world prospective cohort study, 8 patients with PPP received palms/soles injections of ixekizumab (0.8 mg in 0.1 ml) every 2 to 8 weeks due to the COVID-19 pandemic. The treatment endpoint was a 75% improvement from baseline in Palmoplantar Psoriasis Area and Severity Index (PPPASI 75). At week 8, 75%, 50% and 12.5% of 8 patients reached PPPASI 50, PPPASI 75 and PPPASI 90. At week 12, 100%, 67.5% and 25% of 8 patients reached PPPASI 50, PPPASI 75 and PPPASI 90. This is the first study to evaluate the efficacy and safety of local injection of micro-dose ixekizumab for PPP in real clinical practice. A high proportion of patients rapidly achieved PPPASI 75, and maintained long-term efficacy with satisfactory safety.
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Affiliation(s)
- RuiYuan Xia
- Department of Dermatology, First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Jian Liu
- Department of Dermatology, First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - YaMei Gao
- Department of Dermatology, First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - ZiYue Diao
- Department of Dermatology, First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - DanDan Chen
- Department of Dermatology, First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - ChaoJing Zhou
- Department of Dermatology, First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - ZhiQin Zhang
- Department of Dermatology, First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - ZhiQiang Yin
- Department of Dermatology, First Affiliated Hospital of Nanjing Medical University, Nanjing, China.
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Nicolescu AC, Ionescu MA, Constantin MM, Ancuta I, Ionescu S, Niculet E, Tatu AL, Zirpel H, Thaçi D. Psoriasis Management Challenges Regarding Difficult-to-Treat Areas: Therapeutic Decision and Effectiveness. LIFE (BASEL, SWITZERLAND) 2022; 12:life12122050. [PMID: 36556415 PMCID: PMC9785802 DOI: 10.3390/life12122050] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Revised: 11/19/2022] [Accepted: 12/05/2022] [Indexed: 12/13/2022]
Abstract
Psoriasis is not optimally controlled in spite of newly developed treatments, possibly due to the difficulty of objectively quantifying the disease's severity, considering the limitations of the clinical scores used in clinical practice. A major challenge addresses difficult-to-treat areas, especially in the absence of significant body surface involvement. It is controversial whether the severity evaluation of patients with several affected areas (having at least one difficult-to-treat area) should be done differently from current methods. Scores used for special areas (PSSI, NAPSI and ESIF) allow an accurate assessment of disease severity in difficult-to-treat areas, but the issue of whether to integrate these scores into PASI, BSA or DLQI remains. The review's purpose resides in providing an overview of the main current issues in determining psoriasis severity in patients with psoriasis in difficult-to-treat areas and suggesting possible solutions for the optimal integration of the area assessment in current scores: severity can be either established according to the highest calculated score (PASI or PSSI or NAPSI or ESIF) or by adding a correction factor in the calculation of PASI for special areas.
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Affiliation(s)
| | - Marius-Anton Ionescu
- Dermatology Department, University Hospital “Saint Louis”, University of Paris, 75014 Paris, France
| | - Maria Magdalena Constantin
- Department of Dermatology II, “Carol Davila” University of Medicine and Pharmacy, Colentina Clinical Hospital, 020125 Bucharest, Romania
| | - Ioan Ancuta
- Department of Rheumatology, “Carol Davila” University of Medicine and Pharmacy, “Dr. I. Cantacuzino” Clinical Hospital, 011437 Bucharest, Romania
- Department of Dermatology III, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania
- Correspondence: (I.A.); (E.N.); Tel.: +40-728267435 (I.A.); +40-741398895 (E.N.)
| | - Sinziana Ionescu
- General Surgery and Surgical Oncology Clinic I of the Bucharest Oncology Institute, “Carol Davila” University of Medicine and Pharmacy, 022328 Bucharest, Romania
- “Prof Dr. Al Trestioreanu” Bucharest Oncology Institute, 022328 București, Romania
| | - Elena Niculet
- Department of Morphological and Functional Sciences, Faculty of Medicine and Pharmacy, “Dunarea de Jos” University of Medicine and Pharmacy, 800008 Galati, Romania
- Pathology Department, “Sfantul Apostol Andrei” Emergency Clinical Hospital, 800578 Galati, Romania
- Correspondence: (I.A.); (E.N.); Tel.: +40-728267435 (I.A.); +40-741398895 (E.N.)
| | - Alin Laurentiu Tatu
- Clinical Medical Department, Faculty of Medicine and Pharmacy, “Dunarea de Jos” University of Medicine and Pharmacy, 800008 Galati, Romania
- Dermatology Department, “Sfanta Cuvioasa Parascheva” Hospital of Infectious Diseases, 800179 Galati, Romania
| | - Henner Zirpel
- Research Institute and Comprehensive Center for Inflammation Medicine, University of Lübeck, 23538 Lübeck, Germany
| | - Diamant Thaçi
- Comprehensive Center for Inflammation Medicine, University of Lübeck, 23538 Lübeck, Germany
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Lin CP, Merola JF, Wallace EB. Current and emerging biologic and small molecule systemic treatment options for psoriasis and psoriatic arthritis. Curr Opin Pharmacol 2022; 67:102292. [PMID: 36228472 DOI: 10.1016/j.coph.2022.102292] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Revised: 08/31/2022] [Accepted: 09/01/2022] [Indexed: 01/25/2023]
Abstract
Psoriasis and psoriatic arthritis are chronic inflammatory diseases affecting the skin and joints, respectively. Psoriasis and psoriatic arthritis are associated with a high comorbidity burden as well as negative impact on quality of life. Impact on health-related quality of life is optimized when both skin and joint manifestations are effectively treated. The identification of key cytokines involved in disease pathogenesis has led to the development of several therapeutic options for psoriatic disease. When selecting a therapy, it is important to consider disease severity, psoriasis disease subtypes or domains of psoriatic arthritis, comorbidities, patient preference for treatment, among other factors. This review summarizes current biologic and small molecule treatment options as well as emerging therapies for moderate-to-severe adult plaque psoriasis and psoriatic arthritis.
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Affiliation(s)
- Christine P Lin
- Department of Internal Medicine, University of Colorado School of Medicine, Aurora, CO, USA
| | - Joseph F Merola
- Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; Department of Medicine, Division of Rheumatology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Elizabeth B Wallace
- Department of Dermatology, University of Colorado School of Medicine, Aurora, CO, USA.
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5
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Kiltz U, Sfikakis PP, Gaffney K, Bounas A, Gullick N, Lespessailles E, Brandt-Juergens J, Rashkov R, Schulz B, Pournara E, Jagiello P. Interim 2-Year Analysis from SERENA: A Real-World Study in Patients with Psoriatic Arthritis or Ankylosing Spondylitis Treated with Secukinumab. Rheumatol Ther 2022; 9:1129-1142. [PMID: 35674938 PMCID: PMC9174439 DOI: 10.1007/s40744-022-00460-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Accepted: 04/29/2022] [Indexed: 10/28/2022] Open
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Felice S, Bressler MY, Karim R, Markowitz O. Transforming the treatment of psoriasis to the 21st century: Detecting subclinical therapeutic response to secukinumab using optical coherence tomography as a prognostic indicator. Lasers Surg Med 2022; 54:825-834. [PMID: 35598099 DOI: 10.1002/lsm.23551] [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: 12/23/2021] [Revised: 03/29/2022] [Accepted: 03/29/2022] [Indexed: 11/10/2022]
Abstract
BACKGROUND Optical coherence tomography (OCT) is a noninvasive imaging device that scans the skin up to 2 mm in depth. OCT can capture real-time epidermal thickness (ET) measurements and detect subclinical changes in inflammatory skin diseases like eczema and psoriasis. © 2022 Wiley Periodicals LLC. OBJECTIVE To determine if measuring ET with OCT can detect a subclinical therapeutic response in psoriasis treated with the biological therapy, secukinumab (an IL-17A antagonist). DESIGN Phase IV, single-center, open-label, and single-arm study. PARTICIPANTS Twenty-six consecutive patients with moderate to severe plaque psoriasis. MEASUREMENTS Clinical, dermoscopic, and OCT images were obtained at each visit. The clinician measured disease severity with the Investigator's Global Assessment (IGA) and Psoriasis Area And Severity Index (PASI). OCT was used to scan the ET at the center of lesional skin (ET-L), along the border, and normal skin (ET-N) on the same body plane; their difference was noted as ΔET. RESULTS Initially, ET-L was greater than ET-N (p < 0.0001), their differences decreased throughout the study, and there were no significant differences at Week 16 (p = 0.48). Twenty-four (92%) patients achieved a 50% reduction in PASI score (PASI50); they had lower ΔET at Weeks 0, 1, 3, 4, and 8 compared to those who did not clear (p < 0.04). Having a lower ΔET at Week 4 was associated with a shorter time to reach PASI50 (p = 0.02). CONCLUSION ET measurements using OCT can detect an early subclinical response to secukinumab compared to clinical scoring and identify nonresponders as early as 4 weeks.
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Affiliation(s)
- Skye Felice
- OptiSkin, New York, New York, USA.,Department of Dermatology, SUNY Downstate Health Sciences University, Brooklyn, New York, USA.,New York Institute of Technology College of Osteopathic Medicine, Old Westbury, New York, USA
| | - Moshe Y Bressler
- OptiSkin, New York, New York, USA.,Department of Dermatology, SUNY Downstate Health Sciences University, Brooklyn, New York, USA
| | | | - Orit Markowitz
- OptiSkin, New York, New York, USA.,Department of Dermatology, SUNY Downstate Health Sciences University, Brooklyn, New York, USA
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7
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Deucravacitinib in Moderate to Severe Psoriasis: Clinical and Quality-of-Life Outcomes in a Phase 2 Trial. Dermatol Ther (Heidelb) 2022; 12:495-510. [PMID: 35025062 PMCID: PMC8850503 DOI: 10.1007/s13555-021-00649-y] [Citation(s) in RCA: 27] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Accepted: 11/16/2021] [Indexed: 11/13/2022] Open
Abstract
Introduction Deucravacitinib is an oral, selective tyrosine kinase 2 inhibitor that demonstrated therapeutic benefit in a Phase 2 clinical trial of adults with moderate to severe plaque psoriasis. This analysis was designed to evaluate the effect of deucravacitinib on additional clinical and quality-of-life (QoL) outcomes and assess the relationship between these outcomes in adults with psoriasis. Methods Post-hoc analysis of a 12-week Phase 2 trial was conducted for the three most efficacious dosage groups (3 mg twice daily, 6 mg twice daily, 12 mg once daily) and placebo. Investigator assessments for efficacy included Psoriasis Area and Severity Index (PASI), body surface area (BSA) involvement, and static Physician's Global Assessment; QoL was assessed using the Dermatology Life Quality Index (DLQI). Treatment responses and their associations were evaluated over time. Results Deucravacitinib elicited improvement versus placebo as early as Week 4 for most efficacy measures (including changes in absolute PASI and BSA), with efficacy trends observed from Week 2 to Week 12. Improvements in QoL, assessed by achievement of a DLQI overall score of 0/1 (no effect at all on patient’s life), followed a pattern similar to deucravacitinib-related clinical outcomes over 12 weeks. Overall, patients with greater improvements in psoriasis-related clinical signs and symptoms also reported greater improvement in QoL. However, complete skin clearance was not required for achieving DLQI 0/1. Conclusion Deucravacitinib treatment produced early response and similar trends in improvements across multiple efficacy assessments and QoL in moderate to severe plaque psoriasis. Deucravacitinib has the potential to become a promising new oral therapy for this condition. Trial Registration ClinicalTrials.gov identifier; NCT02931838. Supplementary Information The online version contains supplementary material available at 10.1007/s13555-021-00649-y. Psoriasis is a skin disease that affects up to 2% of the population. In psoriasis, red, scaly lesions develop on the skin driven by an aberrant immune response. Psoriasis impacts not only physical and mental health but also quality of life (QoL). Deucravacitinib is being investigated as a treatment for psoriasis. We performed a Phase 2 dose-ranging, placebo-controlled, 12-week study of deucravacitinib in adults with moderate to severe psoriasis. Patients in the USA, Australia, Canada, Germany, Japan, Latvia, Mexico, and Poland participated. The study showed that oral treatment with deucravacitinib was effective using a disease severity score (percentage of patients with ≥ 75% reduction from baseline in Psoriasis Area and Severity Index score) at Week 12—placebo 7% and deucravacitinib 67%–75% for the three highest dosages—and was generally well tolerated. We further analyzed the association between efficacy and a QoL measure, the Dermatology Life Quality Index (DLQI), in patients who received placebo or the most effective dosages of deucravacitinib (≥ 3 mg twice daily). Deucravacitinib was effective at the three dosage levels tested. Skin improvement occurred early during treatment and was mirrored by improvements in DLQI score during the 12 weeks of treatment. Although some patients did not have complete clearance of their psoriasis, a large percentage of those patients still achieved considerable improvement in QoL as measured by achieving a DLQI score of 0/1 (i.e., no effect at all on the patient’s QoL).
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You R, Weber S, Bieth B, Vandemeulebroecke M. Innovative Pediatric Development for Secukinumab in Psoriasis: Faster Patient Access, Reduction of Patients on Control. Clin Pharmacol Ther 2021; 111:697-704. [PMID: 34939180 DOI: 10.1002/cpt.2518] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Accepted: 12/15/2021] [Indexed: 11/10/2022]
Abstract
This manuscript describes the innovative pediatric development strategy of secukinumab in psoriasis. Initially, this pediatric development had been planned early during the adult development program. This is common for most development programs as it is required by law in major regions worldwide. At that time, only limited experience with secukinumab's mechanism of action was available, especially in the pediatric population for which no data had been collected yet. Pediatric extrapolation frameworks were not in use. As a result, a standard pediatric program had initially been proposed requiring two relatively large placebo-controlled pivotal trials. However, as experience with the use of secukinumab grew, so did experience with - and regulatory openness to - innovative quantitative approaches such as extrapolation. It became clear that the pediatric development of secukinumab could be substantially accelerated by these novel ideas. Here we report how these concepts were implemented in the pediatric development program of secukinumab in psoriasis, using a wide range of innovative quantitative techniques. This strategy led to the removal of the placebo arm from one trial, a substantial reduction of the overall sample size in this program, and a significantly faster approval of secukinumab for the pediatric psoriasis population.
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Affiliation(s)
- Ruquan You
- Analytics, Novartis Institutes for Biomedical Research, Shanghai, China
| | | | - Bruno Bieth
- Analytics, Novartis Pharma AG, Basel, Switzerland
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Romani M, Biela G, Farr K, Lazar R, Duval M, Trovillion V, Vlahovic TC. Plantar Psoriasis: A Review of the Literature. Clin Podiatr Med Surg 2021; 38:541-552. [PMID: 34538432 DOI: 10.1016/j.cpm.2021.06.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Plantar psoriasis negatively affects the quality of life for patients due to its weight-bearing location. Most therapeutic studies for psoriasis focus on total body surface changes and rarely report specific effects of the plantar and palmar areas. This review focuses on therapeutic options for plantar psoriasis ranging from topical therapy to phototherapy to biological therapy. Treatment should be approached as a stepwise gradient beginning with topicals and progressing to systemics. As always, review of the patient's severity of condition, health status, and impact on quality of life is needed to individualize therapy for the best patient care.
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Affiliation(s)
- Michael Romani
- Temple University School of Podiatric Medicine, 148 North 8th Street, Philadelphia, PA 19107, USA
| | - Garrett Biela
- Temple University School of Podiatric Medicine, 148 North 8th Street, Philadelphia, PA 19107, USA
| | - Kalen Farr
- Temple University School of Podiatric Medicine, 148 North 8th Street, Philadelphia, PA 19107, USA
| | - Ryan Lazar
- Temple University School of Podiatric Medicine, 148 North 8th Street, Philadelphia, PA 19107, USA
| | - Marcus Duval
- Temple University School of Podiatric Medicine, 148 North 8th Street, Philadelphia, PA 19107, USA
| | - Victoria Trovillion
- Temple University School of Podiatric Medicine, 148 North 8th Street, Philadelphia, PA 19107, USA
| | - Tracey C Vlahovic
- Temple University School of Podiatric Medicine, 148 North 8th Street, Philadelphia, PA 19107, USA.
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Pandiyan P, McCormick TS. Regulation of IL-17A-Producing Cells in Skin Inflammatory Disorders. J Invest Dermatol 2021; 142:867-875. [PMID: 34561088 DOI: 10.1016/j.jid.2021.06.036] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2021] [Revised: 06/09/2021] [Accepted: 06/22/2021] [Indexed: 12/11/2022]
Abstract
This review focuses on the IL-17A family of cytokines produced by T lymphocytes and other immune cells and how they are involved in cutaneous pathogenic responses. It will also discuss cutaneous dysbiosis and FOXP3+ regulatory T cells in the context of inflammatory conditions linked to IL-17 responses in the skin. Specifically, it will review key literature on chronic mucocutaneous candidiasis and psoriasis.
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Affiliation(s)
- Pushpa Pandiyan
- Department of Biological Sciences, School of Dental Medicine, Case Western Reserve University, Cleveland, Ohio, USA; Department of Pathology, School of Medicine, Case Western Reserve University, Cleveland, Ohio, USA.
| | - Thomas S McCormick
- Department of Dermatology, School of Medicine, Case Western Reserve University, Cleveland, Ohio, USA
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Khattab FM, Samir MA. Botulinum toxin type-A versus 5-fluorouracil in the treatment of plaque psoriasis: Comparative study. J Cosmet Dermatol 2021; 20:3128-3132. [PMID: 34146460 DOI: 10.1111/jocd.14306] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2021] [Revised: 06/05/2021] [Accepted: 05/14/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Long-term remission and total clearance in Psoriasis can only be achieved in a few patients. AIM To compare the efficacy and safety of intradermal Botulinum toxin (BTX) in the treatment of plaque psoriasis. SUBJECTS AND METHODS A comparative study conducted in thirty-five patients with chronic plaque psoriasis was treated by split-body therapy. The patients were either treated with intradermal BTX or with intralesional 5-fluorouracil (5-FU) to each of 2 bilaterally symmetrical psoriatic plaque lesions. The outcomes were assessed using the following criteria: the sum of erythema, scaling, and induration scores and the clearing percentage of the target plaque lesion assessed by 2 blinded observers. RESULTS At the end of the study, the response rate was 85% on the BTX treatment side and 90% on the 5-FU side. There was no significant difference between both sides regarding a clinical response or side effects. The recurrence rate was 15% on both sides. CONCLUSIONS Botulinum toxin was a novel, safe, single injection, and effective therapy for plaque-type psoriasis. More studies are required to further prove the efficacy of BTX in the treatment of plaque psoriasis.
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Affiliation(s)
- Fathia M Khattab
- Department of Dermatology, Venereology and Andrology, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Mai A Samir
- Department of Dermatology, Venereology and Andrology, Faculty of Medicine, Zagazig University, Zagazig, Egypt
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Costanzo A, Russo F, Galluzzo M, Stingeni L, Scuderi R, Zichichi L, Papini M, Di Costanzo L, Conti A, Burlando M, Chiricozzi A, Gaiani FM, Mugheddu C, Musumeci ML, Gisondi P, Piaserico S, Dapavo P, Venturini M, Pagnanelli G, Amerio P, Potenza C, Peris K, Cantoresi F, Trevisini S, Loconsole F, Offidani A, Mercuri SR, Lora V, Prignano F, Bartezaghi M, Oliva G, Aloisi E, Orsenigo R. Secukinumab Exhibits Sustained and Stable Response in Patients with Moderate-to-Severe Psoriasis: Results from the SUPREME Study. Acta Derm Venereol 2021; 101:adv00576. [PMID: 33903916 PMCID: PMC9425609 DOI: 10.2340/00015555-3816] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Secukinumab, a fully human monoclonal antibody, neutralizes interleukin-17A, a cornerstone cytokine driving the multiple manifestations of psoriasis. This post-hoc analysis of the SUPREME study was performed to determine the sustainability of response to secukinumab in terms of Psoriasis Area and Severity Index (PASI) 90 in patients with moderate-to-severe plaque psoriasis. Based on PASI 90 response at week 16, patients were stratified as PASI 90 responders (PASI90R, n = 337) or non-responders (PASI90NR, n = 72). At week 20, 94.2% (n = 295/313) achieved PASI 90/100 response in PASI90R, with response maintained through week 48 (89.6%, n = 189/211). An increased proportion of patients achieved PASI 90/100 response in PASI90NR (week 20: 29.9%, n = 20/67; week 48: 57.1%, n = 20/35). Overall, 64.4% patients achieved absolute PASI score = 0 at week 24 with response sustained to week 48 (66.9%). Secukinumab showed sustained and stable efficacy in maintaining PASI 90 response in patients with moderate-to-severe plaque psoriasis up to week 48.
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Affiliation(s)
- Antonio Costanzo
- Department of Biomedical Sciences, Humanitas University, IRCCS Istituto Clinico Humanitas, IT-20089 Rozzano-Milan, Italy. E-mail:
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Papp KA, Weinberg MA, Morris A, Reich K. IL17A/F nanobody sonelokimab in patients with plaque psoriasis: a multicentre, randomised, placebo-controlled, phase 2b study. Lancet 2021; 397:1564-1575. [PMID: 33894834 DOI: 10.1016/s0140-6736(21)00440-2] [Citation(s) in RCA: 60] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Revised: 01/21/2021] [Accepted: 02/12/2021] [Indexed: 12/21/2022]
Abstract
BACKGROUND Sonelokimab (also known as M1095) is a novel trivalent nanobody comprised of monovalent camelid-derived (ie, from the Camelidae family of mammals, such as camels, llamas, and alpacas) nanobodies specific to human interleukin (IL)-17A, IL-17F, and human serum albumin. Nanobodies are a novel class of proprietary therapeutic proteins based on single-domain, camelid, heavy-chain-only antibodies. We assessed the efficacy, safety, and tolerability of sonelokimab across four dosage regimens compared with placebo in patients with plaque-type psoriasis. Secukinumab served as an active control. METHODS This multicentre, randomised, placebo-controlled, phase 2b trial was done at 41 clinics and research sites in Bulgaria, Canada, Czech Republic, Germany, Hungary, Poland, and the USA. Participants (aged 18-75 years) with stable moderate to severe plaque-type psoriasis (defined as an Investigator's Global Assessment [IGA] score of ≥3, a body surface area involvement of ≥10%, and a Psoriasis Area and Severity Index score of ≥12) for more than 6 months before randomisation, who were candidates for systemic biological therapy were included. Participants previously treated with more than two biologics or any therapy targeting IL-17 were excluded. Randomisation was stratified by weight (≤90 kg or >90 kg) and previous use of biologics. Investigators, participants, and vendors remained masked for the duration of the study, with the exception of each site's study drug administrator (who did not complete any other assessments in the study) and a study monitor who only assessed drug preparation, administration, and accountability. The study sponsor remained masked until all week 24 data were clean and locked. Participants were randomly assigned (1:1:1:1:1:1) using a centralised interactive response technology system to one of six parallel treatment groups: placebo group, sonelokimab 30 mg group, sonelokimab 60 mg group, sonelokimab 120 mg normal load group, sonelokimab 120 mg augmented load group, or secukinumab 300 mg group. All participants underwent a 4-week screening period, a 12-week placebo-controlled induction period, a 12-week dose maintenance or escalation period, and a 24-week response assessment or dose-holding period. During the placebo-controlled induction period (weeks 0-12), participants received either placebo (at weeks 0, 1, 2, 3, 4, 6, 8, and 10), sonelokimab 30 mg, 60 mg, or 120 mg normal load (at weeks 0, 2, 4, and 8), sonelokimab 120 mg augmented load (at weeks 0, 2, 4, 6, 8, and 10), or secukinumab 300 mg (at weeks 0, 1, 2, 3, 4, and 8), with placebo given at weeks 1, 3, 6, and 10 in the sonelokimab 30 mg, 60 mg, and 120 mg normal load groups, at weeks 1 and 3 in the sonelokimab 120 mg augmented load group, and at weeks 6 and 10 in the secukinumab 300 mg group. During the dose maintenance or escalation period (weeks 12-24), participants assigned to the placebo group received sonelokimab 120 mg (at weeks 12, 14, 16, and then every 4 weeks); those assigned to sonelokimab 30 mg or 60 mg groups with an IGA score of more than 1 were escalated to 120 mg and then every 4 weeks, and those with an IGA score of 1 or less stayed on the assigned dose at week 12 and then every 4 weeks; those assigned to the sonelokimab 120 mg groups received sonelokimab 120 mg at week 12 and then every 8 weeks (normal load group) or every 4 weeks (augmented load); and those assigned to the secukinumab 300 mg group received secukinumab 300 mg at week 12 and then every 4 weeks. During this period, placebo was given at week 14 in all groups, except in participants who initially received placebo, and at week 16 in the sonelokimab 120 mg normal load group. In the response assessment with dose-holding period (weeks 24-48), participants in the sonelokimab 30 mg or 60 mg groups who had dose escalation to 120 mg remained on the same regimen regardless of the IGA score at week 24. Participants in the secukinumab 300 mg group also remained on the same regimen regardless of IGA score at week 24. Participants in the sonelokimab 30 mg and 60 mg groups without dose escalation, and all participants in the two sonelokimab 120 mg groups (including placebo rollover patients) were eligible to stop the study drug at week 24. Those participants with an IGA score of 0 at week 24 received placebo; these participants resumed the previous dose of sonelokimab every 4 weeks when they had an IGA score of 1 or more (assessed every 4 weeks). Participants in these groups with an IGA score of 1 or more at week 24 continued on the same dosage. All study treatments were administered as subcutaneous injections. The final dose in all groups was given at week 44. The primary outcome was the proportion of participants in the sonelokimab groups with an IGA of clear or almost clear (score 0 or 1) at week 12 compared with the placebo group. The primary outcome and safety outcomes were assessed on an intention-to-treat basis. The study was not powered for formal comparisons between sonelokimab and secukinumab groups. This trial is registered with ClinicalTrials.gov, NCT03384745. FINDINGS Between Aug 15, 2018, and March 27, 2019, 383 patients were assessed for eligibility, 313 of whom were enrolled and randomly assigned to the placebo group (n=52), the sonelokimab 30 mg group (n=52), the sonelokimab 60 mg group (n=52), the sonelokimab 120 mg normal load group (n=53), the sonelokimab 120 mg augmented load group (n=51), or the secukinumab 300 mg group (n=53). Baseline characteristics of participants were similar among the groups. At week 12, none (0·0% [95% CI 0·0-6·8]) of the 52 participants in the placebo group had an IGA score of 0 or 1 versus 25 (48·1% [34·0-62·4], p<0·0001) of 52 participants in the sonelokimab 30 mg group, 44 (84·6% [71·9-93·1], p<0·0001) of 52 participants in the sonelokimab 60 mg group, 41 (77·4% [63·8-87·7], p<0·0001) of 53 participants in the sonelokimab 120 mg normal load group, 45 (88·2% [76·1-95·6], p<0·0001) of 51 participants in the sonelokimab 120 mg augmented load group, and 41 (77·4% [63·8-87·7], p<0·0001) of 53 participants in the secukinumab 300 mg group. During the placebo-controlled induction period, 155 (49·5%) of 313 participants had one or more mostly mild to moderate adverse event; the most frequent adverse events in all participants on sonelokimab during weeks 0-12 were nasopharyngitis (28 [13·5%] of 208 participants), pruritus (14 [6·7%] participants), and upper respiratory tract infection (nine [4·3%] participants). One patient from all sonelokimab-containing groups had Crohn's disease that developed during weeks 12-52. Over 52 weeks, sonelokimab safety was similar to secukinumab, with the possible exception of manageable Candida infections (one [1·9%] of 53 participants in the secukinumab group had a Candida infection vs 19 [7·4%] of 257 participants in all sonelokimab-containing groups). INTERPRETATION Treatment with sonelokimab doses of 120 mg or less showed significant clinical benefit over placebo, with rapid onset of treatment effect, durable improvements, and an acceptable safety profile. FUNDING Avillion.
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Affiliation(s)
- Kim A Papp
- Probity Medical Research, Waterloo, ON, Canada.
| | | | | | - Kristian Reich
- Translational Research in Inflammatory Skin Diseases, Institute for Health Services Research in Dermatology and Nursing, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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van der Heijde D, Mease PJ, Landewé RBM, Rahman P, Tahir H, Singhal A, Boettcher E, Navarra S, Zhu X, Ligozio G, Readie A, Mpofu S, Pricop L. Secukinumab provides sustained low rates of radiographic progression in psoriatic arthritis: 52-week results from a phase 3 study, FUTURE 5. Rheumatology (Oxford) 2020; 59:1325-1334. [PMID: 31586420 PMCID: PMC7244782 DOI: 10.1093/rheumatology/kez420] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2019] [Revised: 07/17/2019] [Indexed: 01/10/2023] Open
Abstract
Objective To evaluate the effect of secukinumab on radiographic progression through 52 weeks in patients with PsA from the FUTURE 5 study. Methods Patients with active PsA, stratified by prior anti-TNF use (naïve or inadequate response), were randomized to s.c. secukinumab 300 mg load (300 mg), 150 mg load (150 mg), 150 mg no load regimens or placebo at baseline, at weeks 1, 2 and 3 and every 4 weeks starting at week 4. Radiographic progression was assessed by change in van der Heijde-modified total Sharp score (vdH-mTSS; mean of two readers). Statistical analysis used a linear mixed-effects model (random slope) at weeks 24 and 52, and observed data at week 52. Assessments at week 52 included additional efficacy endpoints (non-responders imputation and mixed-effects models for repeated measures) and safety. Results The majority (86.6%) of patients completed 52 weeks of treatment. The proportion of patients with no radiographic progression (change from baseline in vdH-mTSS ⩽0.5) was 91.8, 85.2 and 87.2% in 300, 150 and 150 mg no load groups, respectively, at week 52. The change in vdH-mTSS from baseline to week 52 using random slope [mean change (s.e.)] was –0.18 (0.17), 0.11 (0.18) and –0.20 (0.18) in 300, 150 and 150 mg no load groups, respectively; the corresponding observed data [mean change (s.d.)] was –0.09 (1.02), 0.13 (1.39) and 0.21 (1.15). Clinical efficacy endpoints were sustained, and no new or unexpected safety signals were reported through 52 weeks. Conclusion Secukinumab 300 and 150 mg with or without s.c. loading regimen provided sustained low rates of radiographic progression through 52 weeks of treatment. Trial registration ClinicalTrials.gov, http://clinicaltrials.gov, NCT02404350.
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Affiliation(s)
| | - Philip J Mease
- Swedish Medical Center/Providence St Joseph Health and University of Washington, Seattle, WA, USA
| | - Robert B M Landewé
- Department of Rheumatology, University of Amsterdam and Atrium Medical Center, Amsterdam, The Netherlands
| | - Proton Rahman
- Faculty of Medicine, Memorial University, St Johns, Newfoundland and Labrador, Canada
| | - Hasan Tahir
- Rheumatology, Whipps Cross Hospital, London, UK
| | | | | | - Sandra Navarra
- St Luke's Medical Center, University of Santo Tomas Hospital, Manila, Philippines
| | - Xuan Zhu
- Novartis Pharmaceuticals Corporation, East Hanover, NJ, USA
| | | | - Aimee Readie
- Novartis Pharmaceuticals Corporation, East Hanover, NJ, USA
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15
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Kiltz U, Sfikakis PP, Gaffney K, Sator PG, von Kiedrowski R, Bounas A, Gullick N, Conrad C, Rigopoulos D, Lespessailles E, Romanelli M, Ghislain PD, Brandt-Jürgens J, Rashkov R, Aassi M, Orsenigo R, Perella C, Pournara E, Gathmann S, Jagiello P, Veit J, Augustin M. Secukinumab Use in Patients with Moderate to Severe Psoriasis, Psoriatic Arthritis and Ankylosing Spondylitis in Real-World Setting in Europe: Baseline Data from SERENA Study. Adv Ther 2020; 37:2865-2883. [PMID: 32378070 PMCID: PMC7467439 DOI: 10.1007/s12325-020-01352-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Indexed: 12/17/2022]
Abstract
INTRODUCTION Secukinumab, a fully human monoclonal antibody that directly inhibits interleukin-17A, has demonstrated robust efficacy in the treatment of moderate to severe psoriasis (PsO), psoriatic arthritis (PsA) and ankylosing spondylitis (AS), with a rapid onset of action, sustained long-term clinical responses and a consistently favourable safety profile across phase 3 trials. Here, we report the clinical data at enrolment from SERENA, designed to investigate the real-world use of secukinumab across all three indications. METHODS SERENA is an ongoing, longitudinal, observational study conducted at 438 sites across Europe in patients with moderate to severe plaque PsO, active PsA or active AS. Patients should have received at least 16 weeks of secukinumab treatment before enrolment in the study. RESULTS Overall 2800 patients were included in the safety set; patients with PsA (N = 541) were older than patients with PsO (N = 1799) and patients with AS (N = 460); patients with PsO had a higher mean body weight than patients with PsA and patients with AS; and patients with PsO and patients with AS were predominantly male. Time since diagnosis was longer in patients with PsO compared with patients with PsA and patients with AS, and about 40% of patients were either current or former smokers. The proportion of obese patients (body mass index ≥ 30 kg/m2) was similar across indications. Patients were treated with secukinumab for a mean duration of 1 year prior to enrolment (range 0.89-1.04). The percentages of patients with prior biologics exposure were 31.5% PsO, 59.7% PsA and 55% AS. The percentages of patients prescribed secukinumab monotherapy were 75% (n = 1349) in PsO, 48.2% (n = 261) in PsA and 48.9% (n = 225) in AS groups. CONCLUSION Baseline demographics of the study population are consistent with existing literature. This large observational study across all secukinumab indications will provide valuable information on the long-term effectiveness and safety of secukinumab in the real-world setting.
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Affiliation(s)
- Uta Kiltz
- Rheumazentrum Ruhrgebiet, Herne, Germany.
- Ruhr-University Bochum, Bochum, Germany.
| | - Petros P Sfikakis
- Joint Rheumatology Programme, National and Kapodistrian University of Athens Medical School, Athens, Greece
| | - Karl Gaffney
- Norfolk and Norwich University Hospital NHS Foundation Trust, Norfolk, UK
| | | | | | | | - Nicola Gullick
- University Hospitals Coventry & Warwickshire NHS Trust, Coventry, UK
| | - Curdin Conrad
- Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Dimitris Rigopoulos
- Dermatology and Venerology, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | | | - Marco Romanelli
- Dermatology Department, University of Pisa, Lungarno Antonio Pacinotti, 43, 56126, Pisa, PI, Italy
| | | | | | - Rasho Rashkov
- Department of Internal Medicine, Medical University, Sofia, Bulgaria
| | | | | | | | | | | | | | | | - Matthias Augustin
- Institute for Health Services Research in Dermatology and Nursing, University Medical Center Hamburg, Hamburg, Germany
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16
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Interleukin-17A and Keratinocytes in Psoriasis. Int J Mol Sci 2020; 21:ijms21041275. [PMID: 32070069 PMCID: PMC7072868 DOI: 10.3390/ijms21041275] [Citation(s) in RCA: 115] [Impact Index Per Article: 28.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Revised: 02/11/2020] [Accepted: 02/11/2020] [Indexed: 02/06/2023] Open
Abstract
The excellent clinical efficacy of anti-interleukin 17A (IL-17A) biologics on psoriasis indicates a crucial pathogenic role of IL-17A in this autoinflammatory skin disease. IL-17A accelerates the proliferation of epidermal keratinocytes. Keratinocytes produce a myriad of antimicrobial peptides and chemokines, such as CXCL1, CXCL2, CXCL8, and CCL20. Antimicrobial peptides enhance skin inflammation. IL-17A is capable of upregulating the production of these chemokines and antimicrobial peptides in keratinocytes. CXCL1, CXCL2, and CXCL8 recruit neutrophils and CCL20 chemoattracts IL-17A-producing CCR6+ immune cells, which further contributes to forming an IL-17A-rich milieu. This feed-forward pathogenic process results in characteristic histopathological features, such as epidermal hyperproliferation, intraepidermal neutrophilic microabscess, and dermal CCR6+ cell infiltration. In this review, we focus on IL-17A and keratinocyte interaction regarding psoriasis pathogenesis.
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17
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Nanes BA, Zhu JL, Chong BF. Robust measurement of clinical improvement in patients with cutaneous lupus erythematosus. Lupus Sci Med 2020; 7:e000364. [PMID: 32095249 PMCID: PMC7008708 DOI: 10.1136/lupus-2019-000364] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Revised: 12/05/2019] [Accepted: 01/05/2020] [Indexed: 11/08/2022]
Abstract
Objective The severity and disease course of cutaneous lupus erythematosus (CLE) are highly variable. Consequently, outcome measures for CLE clinical improvement are heterogeneous, complicating treatment decisions and therapeutic development. This study characterises CLE outcome measures and identifies the influence of clinical improvement thresholds on strengths of associations with patient demographic and clinical factors. Methods In this pilot cohort study, multivariable models identified factors associated with CLE activity and skin damage improvement, defined as relative decreases in Cutaneous Lupus Activity and Severity Index (CLASI) activity (CLASI-A) and damage (CLASI-D) scores, over ranges of response thresholds. Results 66 patients with 119 visit-pairs were included in the CLASI-A analysis. 74 patients with 177 visit-pairs were included in the CLASI-D analysis. Factors associated with CLE activity and damage improvement depended on the response threshold. Some associations were stronger at more stringent thresholds, including subacute CLE predominance with increased likelihood of CLASI-A improvement (R2=0.73; 50% reduction: OR 1.724 (95% CI 0.537 to 5.536); 75%: 5.67 (95% CI 1.56 to 20.5)) and African-American race with decreased likelihood of CLASI-D improvement (R2=0.80; 20%: 0.40 (95% CI 0.17 to 0.93); 40%: 0.25 (95% CI 0.08 to 0.82)). Other associations were stable across multiple thresholds, including older age of CLE development with increased likelihood of CLASI-A improvement (R2=0.25; 50%: 1.05 (95% CI 1.01 to 1.09]; 75%: 1.05 (95% CI 1.00 to 1.10)) and higher initial disease activity with decreased likelihood of CLASI-D improvement (R2=0.55; 20%: 0.91 (95% CI 0.84 to 0.98); 40%: 0.88 (95% CI 0.79 to 0.97)). Conclusions Examining a range of CLASI threshold outcomes can comprehensively characterise changes in disease course in patients with CLE. Insufficiently stringent thresholds may fail to distinguish meaningful clinical change from natural fluctuation in disease activity.
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Affiliation(s)
- Benjamin A Nanes
- Department of Dermatology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Jane L Zhu
- Department of Dermatology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Benjamin F Chong
- Department of Dermatology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
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18
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Reich K, Puig L, Szepietowski J, Paul C, Lacour J, Tsianakas A, Sieder C, Rissler M, Pournara E, Orsenigo R. Secukinumab dosing optimization in patients with moderate‐to‐severe plaque psoriasis: results from the randomized, open‐label
OPTIMISE
study. Br J Dermatol 2019; 182:304-315. [DOI: 10.1111/bjd.18143] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/15/2019] [Indexed: 12/12/2022]
Affiliation(s)
- K. Reich
- Institute for Health Services Research in Dermatology and Nursing University Medical Center Hamburg‐Eppendorf Skinflammation® Center Hamburg Germany
- Dermatologikum Berlin Berlin Germany
| | - L. Puig
- Department of Dermatology Hospital de la Santa Creu i Sant Pau Universitat Autònoma de Barcelona Barcelona Spain
| | - J.C. Szepietowski
- Department of Dermatology, Venereology and Allergology Wroclaw Medical University Wroclaw Poland
| | - C. Paul
- Department of Dermatology Toulouse University and Larrey Hospital Toulouse France
| | | | | | - C. Sieder
- Novartis Pharma GmbH Nuremberg Germany
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19
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Lee MG, Huang YH, Lee JH, Lee SC, Kim TG, Aw DCW, Bao W, Dee CMA, Guana A, Tsai TF. Secukinumab demonstrates superior efficacy and a faster response in clearing skin in Asian subjects with moderate to severe plaque psoriasis compared with ustekinumab: Subgroup analysis from the CLEAR study. J Dermatol 2019; 46:752-758. [PMID: 31342560 DOI: 10.1111/1346-8138.15004] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Accepted: 06/07/2019] [Indexed: 12/22/2022]
Abstract
The 52-week results from the CLEAR (NCT02074982) study showed high and superior efficacy of secukinumab versus ustekinumab in clearing skin and improving patient-reported outcomes, with comparable safety profile in subjects with moderate to severe psoriasis. Here, we analyzed the efficacy and safety of secukinumab in Asian subjects from the CLEAR study. In this double-blind, phase IIIb study, eligible subjects with moderate to severe plaque psoriasis were randomized (1:1) to receive s.c. injection of secukinumab 300 mg or ustekinumab as per label. Of 62 subjects included in Asian subanalyses, 23 were randomized to secukinumab and 39 to ustekinumab. A significantly higher proportion of subjects achieved 90% or more improvement in Psoriasis Area and Severity Index (PASI 90) with secukinumab versus ustekinumab at week 16 (78.3% vs 35.9%, P = 0.0010) and at week 52 (60.9% vs 33.3%, P = 0.0196). Similarly, a higher proportion of subjects achieved PASI 100 with secukinumab versus ustekinumab at week 16 (43.5% vs 10.3%, P = 0.0029) and at week 52 (30.4% vs 12.8%, P = 0.0704). The median time to achieve 50% improvement in baseline PASI was 2.8 weeks in the secukinumab group versus 6.3 weeks in the ustekinumab group. The safety profile of secukinumab was in line with the known profile and no deaths occurred. Overall, 95.7% and 84.6% of subjects remained on secukinumab and ustekinumab, respectively. Similar to the core study, secukinumab showed sustained and superior efficacy with faster response versus ustekinumab, and no new or unexpected safety concerns were identified, in Asian subjects with moderate to severe plaque psoriasis.
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Affiliation(s)
- Min-Geol Lee
- Department of Dermatology, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Yu-Huei Huang
- Department of Dermatology, Chang Gung Memorial Hospital, and College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Joo-Heung Lee
- Department of Dermatology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Seung-Chul Lee
- Department of Dermatology, Chonnam National University Medical School, Gwangju, Korea
| | - Tae-Gyun Kim
- Department of Dermatology, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | | | - Weibin Bao
- Novartis Pharmaceuticals Corporation, East Hanover, New Jersey, USA
| | | | - Adriana Guana
- Novartis Pharmaceuticals Corporation, East Hanover, New Jersey, USA
| | - Tsen-Fang Tsai
- Department of Dermatology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
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Ohtsuki M, Fujita H, Watanabe M, Suzaki K, Flack M, Huang X, Kitamura S, Valdes J, Igarashi A. Efficacy and safety of risankizumab in Japanese patients with moderate to severe plaque psoriasis: Results from the SustaIMM phase 2/3 trial. J Dermatol 2019; 46:686-694. [PMID: 31237727 PMCID: PMC6771602 DOI: 10.1111/1346-8138.14941] [Citation(s) in RCA: 62] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Accepted: 05/07/2019] [Indexed: 12/18/2022]
Abstract
Risankizumab, a humanized immunoglobulin G1 monoclonal antibody, selectively inhibits interleukin‐23, a key cytokine in the pathogenesis of psoriasis, by binding to its p19 subunit. In SustaIMM (ClinicalTrials.gov/NCT03000075), a phase 2/3, double‐blinded, placebo‐controlled study, Japanese patients with moderate to severe plaque psoriasis (n = 171) were stratified by bodyweight and concomitant psoriatic arthritis and randomized 2:2:1:1 to 75 mg risankizumab, 150 mg risankizumab, placebo with cross‐over to 75 mg risankizumab and placebo with cross‐over to 150 mg risankizumab. Dosing was at weeks 0, 4, 16, 28 and 40, with placebo cross‐over to risankizumab at week 16. The primary end‐point was 90% or more improvement from baseline in Psoriasis Area and Severity Index (PASI‐90) at week 16 for risankizumab versus placebo. Missing data were imputed as non‐response. All primary and psoriasis‐related secondary end‐points were met for both risankizumab doses (P < 0.001). At week 16, PASI‐90 responses were significantly higher in patients receiving 75 mg (76%) or 150 mg (75%) risankizumab versus placebo (2%). Corresponding response rates were 86%, 93% and 10% for static Physician Global Assessment (sPGA) score of clear/almost clear; 90%, 95% and 9% for PASI‐75; and 22%, 33% and 0% for PASI‐100, with significantly higher responses for both risankizumab doses versus placebo. Through week 52, PASI and sPGA responses increased or were maintained and treatment‐emergent adverse events were comparable across treatment groups. Both doses of risankizumab were superior to placebo in treating patients with moderate to severe plaque psoriasis. The safety profile was consistent with previous risankizumab trials, with no new or unexpected safety findings.
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Affiliation(s)
| | | | | | - Keiko Suzaki
- Nippon Boehringer Ingelheim Co., Ltd, Tokyo, Japan
| | - Mary Flack
- Boehringer Ingelheim Pharmaceuticals Inc., Ridgefield, Connecticut, USA
| | - Xin Huang
- AbbVie Inc., North Chicago, Illinois, USA
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Kiltz U, Legeler C, Maier-Peuschel M, Mann C, Tony HP. Baseline Characteristics of Patients with Ankylosing Spondylitis and Psoriatic Arthritis Treated with Secukinumab in the Real-World Setting: AQUILA, a Non-Interventional Study. Open Rheumatol J 2019. [DOI: 10.2174/1874312901913010053] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Objective:
AQUILA is an ongoing, multicenter, prospective, Non-Interventional Study (NIS) with secukinumab, designed to evaluate real-world evidence for different aspects of treatment in patients with Ankylosing Spondylitis (AS) and psoriatic arthritis (PsA) in Germany. Here we report the study design and baseline characteristics including comorbidities and prior medication of patients as well as insights into medical care in Germany.
Methods:
Patients (age ≥18 years) with active AS or PsA, who were under secukinumab treatment or just about initiating secukinumab therapy based on medical therapeutic need,
are
enrolled. Each patient
is
observed for 52 weeks.
Results:
A total of 572 patients (AS, n = 187; PsA, n = 385) have been recruited in this ongoing study. Mean age, weight, and BMI were similar between the subgroups. About 66.4% of patients had previously received biologics other than secukinumab. Depression was the most common comorbidity (AS, 9.1%; PsA, 15.6%). Plaque psoriasis was also frequently reported (AS, 9.6%; PsA, 62.3%).
Conclusion:
The Non-Interventional Study (NIS) baseline characteristics indicate that the demographics were similar to populations of previous secukinumab trials of AS and PsA patients except
to
comorbidities and exposure to biologics. A majority of the patients who received secukinumab in this setting had previously received biologics. Comorbidities relating to obesity and cardiovascular disease were particularly evident in PsA patients whereas the elevated depression prevalence was equally distributed.
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Differential efficacy of biologic treatments targeting the TNF-α/IL-23/IL-17 axis in psoriasis and psoriatic arthritis. Cytokine 2018; 111:182-188. [PMID: 30172115 DOI: 10.1016/j.cyto.2018.08.025] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2018] [Revised: 08/20/2018] [Accepted: 08/24/2018] [Indexed: 02/08/2023]
Abstract
Psoriasis and psoriatic arthritis cause significant physical and psychological burdens for afflicted individuals. An accelerated TNF-α/IL-23/IL-17 axis is their major pathomechanism; therefore, anti-TNF-α/IL-23/IL-17 biologics are very effective for the treatment of skin and joint lesions in psoriasis and psoriatic arthritis. Given that the IL-17 signature is more upregulated in the skin than in synovium in psoriatic arthritis, anti-IL-23/IL-17 agents seem to be superior to anti-TNF-α remedies in the treatment of skin lesions. In this review, we focus on the differential efficacy of anti-TNF-α/IL-23/IL-17 biologics in psoriasis and psoriatic arthritis.
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Costanzo A, Bianchi L, Flori M, Malara G, Stingeni L, Bartezaghi M, Carraro L, Castellino G. Secukinumab shows high efficacy irrespective of HLA-Cw6
status in patients with moderate-to-severe plaque-type psoriasis: SUPREME study. Br J Dermatol 2018; 179:1072-1080. [DOI: 10.1111/bjd.16705] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/06/2018] [Indexed: 12/16/2022]
Affiliation(s)
- A. Costanzo
- Dermatology Unit; Department of Biomedical Sciences; Humanitas University; Via Alessandro Manzoni 113 Rozzano-Milan 20089 Italy
- Skin Pathology Laboratory; IRCCS Istituto Clinico Humanitas; Via Alessandro Manzoni 113 Rozzano-Milan 20089 Italy
| | - L. Bianchi
- Dermatology; Department of Systems Medicine; Policlinico di Tor Vergata; University of Rome Tor Vergata; Viale Oxford 81 Rome 00133 Italy
| | - M.L. Flori
- Dermatology Section; Department of Clinical Medicine and Immunological Science; University of Siena; Hospital S. Maria alle Scotte; viale Bracci Siena Italy
| | - G. Malara
- Dermatology Department; Grande Ospedale Metrapolitano; Bianchi Melacrino Morelli; 89124 Reggio Calabria Italy
| | - L. Stingeni
- Section of Clinical, Allergological and Venereological Dermatology; Department of Medicine; University of Perugia; Piazza Menghini 1 Perugia 06129 Italy
| | - M. Bartezaghi
- Novartis Farma S.p.A.; Via Saronnino Origgio VA 21042 Italy
| | - L. Carraro
- Novartis Farma S.p.A.; Via Saronnino Origgio VA 21042 Italy
| | - G. Castellino
- Novartis Farma S.p.A.; Via Saronnino Origgio VA 21042 Italy
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24
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Armstrong A, Jarvis S, Boehncke WH, Rajagopalan M, Fernández-Peñas P, Romiti R, Bewley A, Vaid B, Huneault L, Fox T, Sodha M, Warren RB. Patient perceptions of clear/almost clear skin in moderate-to-severe plaque psoriasis: results of the Clear About Psoriasis worldwide survey. J Eur Acad Dermatol Venereol 2018; 32:2200-2207. [PMID: 29730888 DOI: 10.1111/jdv.15065] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2017] [Accepted: 04/16/2018] [Indexed: 12/20/2022]
Abstract
BACKGROUND Therapeutic advances have made the achievement of clear/almost clear skin possible for many patients with moderate-to-severe plaque psoriasis. OBJECTIVE To determine patient perceptions of the impact of psoriasis and of attaining clear/almost clear skin. METHODS Global survey of patients with moderate-to-severe psoriasis. RESULTS A total of 8338 patients from 31 countries participated. The majority (57%) had not achieved self-assessed clear/almost clear skin with their current therapy, and 56% of those who had not met this goal believed it would be impossible to do so. Among the patients who had clear/almost clear skin, 73% had not initiated their current treatment until >1 year after psoriasis diagnosis, and 28% had to wait >5 years. Eighty-four percent of all respondents experienced discrimination and/or humiliation due to psoriasis, and many reported negative effects on work, intimate relationships, sleep and mental health. Patients without clear/almost clear skin reported that such achievement would open new possibilities, such as swimming (58%), a wider choice of clothing (40%), and meeting new people (26%). A limitation of this study, as with any survey-based research, is that selection and recall bias may have been present. Additionally, respondent definitions of clear/almost clear skin were subjective and may have varied. CONCLUSION Despite the importance of clear/almost clear skin to psoriasis patients, most are still not achieving it, and many are unaware it is possible.
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Affiliation(s)
- A Armstrong
- Department of Dermatology, University of Southern California, Los Angeles, CA, USA
| | - S Jarvis
- Richford Gate Medical Practice, London, UK
| | - W-H Boehncke
- Division of Dermatology and Venerology, Department of Internal Medicine Specialties, Geneva University Hospitals, Geneva, Switzerland.,Department of Pathology and Immunology, University of Geneva, Geneva, Switzerland
| | - M Rajagopalan
- Department of Dermatology, Apollo Hospitals, Chennai, India
| | - P Fernández-Peñas
- Department of Dermatology, Westmead Hospital, The University of Sydney, Westmead, NSW, Australia
| | - R Romiti
- Department of Dermatology, Hospital das Clínicas University of São Paulo, São Paulo, Brazil
| | - A Bewley
- Whipps Cross University Hospital and the Royal London Hospital, London, UK
| | - B Vaid
- Novartis Pharma AG, Basel, Switzerland
| | | | - T Fox
- Novartis Pharma AG, Basel, Switzerland
| | | | - R B Warren
- The Dermatology Centre, Salford Royal NHS Foundation Trust, NIHR Manchester Biomedical Research Centre, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK
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25
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Kemény L, Berggren L, Dossenbach M, Dutronc Y, Paul C. Efficacy and safety of ixekizumab in patients with plaque psoriasis across different degrees of disease severity: results from UNCOVER-2 and UNCOVER-3. J DERMATOL TREAT 2018; 30:19-26. [DOI: 10.1080/09546634.2018.1473551] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Affiliation(s)
- Lajos Kemény
- MTA SZTE Dermatological Research Group, University of Szeged, Szeged, Hungary
- Department of Dermatology and Allergology, University of Szeged, Szeged, Hungary
| | | | | | | | - Carle Paul
- Department of Dermatology, Paul Sabatier University and CHU Toulouse, Toulouse, France
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26
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Augustin M, McBride D, Gilloteau I, O'Neill C, Neidhardt K, Graham CN. Cost-effectiveness of secukinumab as first biologic treatment, compared with other biologics, for moderate to severe psoriasis in Germany. J Eur Acad Dermatol Venereol 2018; 32:2191-2199. [PMID: 29729105 DOI: 10.1111/jdv.15047] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2017] [Accepted: 04/13/2018] [Indexed: 12/21/2022]
Abstract
BACKGROUND Secukinumab, a fully human monoclonal antibody that selectively neutralizes interleukin 17A, has demonstrated strong and sustained efficacy in adults with moderate to severe psoriasis in clinical trials. OBJECTIVE This analysis compared the cost per responder of secukinumab as first biologic treatment of moderate to severe psoriasis, with adalimumab, infliximab, etanercept and ustekinumab in Germany. METHODS A 52-week decision-tree model was developed. Response to treatment was assessed based on the likelihood of achieving a predefined Psoriasis Area and Severity Index (PASI) response to separate the cohort into responders (PASI ≥75), partial responders (PASI 50 to 74) and non-responders (PASI <50). Responders at week 16 continued initial treatment, whereas partial responders and non-responders were switched to standard of care, which included methotrexate, cyclosporine, phototherapy and topical corticosteroids. Sustained response was defined as 16-week response maintained at week 52. A German healthcare system perspective was adopted. Clinical efficacy data were obtained from a mixed-treatment comparison; 2016 resource unit costs from national sources; and adverse events and discontinuation rates from the literature. We calculated cost per PASI 90 responder over week 16 and week 52, as well as cost per sustained responder between weeks 16 and 52. RESULTS Secukinumab had the lowest cost per PASI 90 responder over 16 weeks (€18 026) compared with ustekinumab (€18 080), adalimumab (€23 499), infliximab (€29 599) and etanercept (€34 037). Over 52 weeks, costs per PASI 90 responder ranged from €42 409 (secukinumab) to €70 363 (etanercept). Likewise, secukinumab had the lowest cost per sustained 52-week PASI 90 responder (€22 690) compared with other biologic treatments. Sensitivity analyses, excluding patient copayments, showed similar results. CONCLUSIONS First biologic treatment with secukinumab for moderate to severe psoriasis is cost-effective, with lowest cost per responder compared with other biologic treatments in Germany.
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Affiliation(s)
- M Augustin
- Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - D McBride
- RTI Health Solutions, Manchester, UK
| | | | - C O'Neill
- Novartis Ireland Limited, Dublin, Ireland
| | | | - C N Graham
- RTI Health Solutions, Research Triangle Park, NC, USA
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27
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Stull DE, Griffiths CEM, Gilloteau I, Zhao Y, Guana A, Finlay AY, Sherif B, Houghton K, Puig L. Differential effects of secukinumab vs. ustekinumab for treatment of psoriasis on quality of life, work productivity and activity impairment: a structural equation modelling analysis. Br J Dermatol 2018; 178:1297-1307. [PMID: 29355896 DOI: 10.1111/bjd.16366] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/05/2018] [Indexed: 01/31/2023]
Abstract
BACKGROUND The appearance and lifelong, chronic nature of psoriasis result in considerable burden to patients, such as sleep impairment, depressive symptoms, negative self-esteem and reduced work productivity. OBJECTIVES To examine direct and indirect (mediated) effects of secukinumab vs. ustekinumab on quality of life, work productivity and activity impairment based on psoriasis severity and symptoms. METHODS Analyses were based on data from the CLEAR study. Structural equation modelling examined the effects of secukinumab vs. ustekinumab on the Dermatology Life Quality Index (DLQI) and on the Work Productivity and Activity Impairment (WPAI) questionnaire using Psoriasis Area and Severity Index (PASI) severity and symptoms (pain, itching and scaling) as potential mediators. Analyses were conducted primarily for patients achieving a PASI 90 response (90% or greater reduction in PASI from baseline) at week 16 (repeated at week 52) and for PASI 50, 75 and 100. RESULTS Results at weeks 16 and 52 showed that the effect of treatment on change in DLQI score was mediated by the PASI 90 response and by improvements in itching, pain, and scaling. Achieving any PASI response as early as week 16 directly resulted in significantly better WPAI scores. At week 52, both PASI response and improvement in scaling directly resulted in significantly better WPAI scores. Pain, itching and scaling were correlated (r = 0·51-0·68); improvement in any of these had a significant effect (directly or indirectly) on WPAI. All results favoured secukinumab over ustekinumab. CONCLUSIONS The results underscore the important role of both PASI response and reduction in symptoms on improvements in health-related quality of life and work and daily activity in favour of secukinumab vs. ustekinumab.
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Affiliation(s)
- D E Stull
- RTI Health Solutions, Research Triangle Park, NC, U.S.A
| | - C E M Griffiths
- Dermatology Centre, Salford Royal Hospital, University of Manchester, Manchester Academic Health Science Centre, The Dermatology Centre, Salford Royal NHS Foundation Trust, Barnes Building, Manchester, M6 8HD, U.K
| | | | - Y Zhao
- Sun Pharma, Cranbury, NJ, U.S.A
| | - A Guana
- Novartis Pharmaceuticals Corporation, East Hanover, NJ, U.S.A
| | - A Y Finlay
- Department of Dermatology, Cardiff University School of Medicine, Cardiff, U.K
| | - B Sherif
- RTI Health Solutions, Research Triangle Park, NC, U.S.A
| | - K Houghton
- RTI Health Solutions, Research Triangle Park, NC, U.S.A
| | - L Puig
- Department of Dermatology, Hospital de la Santa Creu i Sant Pau, Mas Casanovas 90, Block A, 5th floor, Module 3, 08041, Barcelona, Spain
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28
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Mease P, van der Heijde D, Landewé R, Mpofu S, Rahman P, Tahir H, Singhal A, Boettcher E, Navarra S, Meiser K, Readie A, Pricop L, Abrams K. Secukinumab improves active psoriatic arthritis symptoms and inhibits radiographic progression: primary results from the randomised, double-blind, phase III FUTURE 5 study. Ann Rheum Dis 2018; 77:890-897. [PMID: 29550766 PMCID: PMC5965348 DOI: 10.1136/annrheumdis-2017-212687] [Citation(s) in RCA: 114] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2017] [Revised: 01/30/2018] [Accepted: 02/19/2018] [Indexed: 12/14/2022]
Abstract
OBJECTIVES To evaluate the effect of subcutaneous (s.c.) secukinumab, an interleukin-17A inhibitor, on clinical signs and symptoms and radiographic progression in patients with psoriatic arthritis (PsA). METHODS Adults (n=996) with active PsA were randomised 2:2:2:3 to s.c. secukinumab 300 mg or 150 mg with loading dose (LD), 150 mg without LD or placebo. All groups received secukinumab or placebo at baseline, weeks 1, 2 and 3 and then every 4 weeks from week 4. The primary endpoint was the proportion of patients achieving an American College of Rheumatology 20 (ACR20) response at week 16. RESULTS Significantly more patients achieved an ACR20 response at week 16 with secukinumab 300 mg with LD (62.6%), 150 mg with LD (55.5%) or 150 mg without LD (59.5%) than placebo (27.4%) (p<0.0001 for all; non-responder imputation). Radiographic progression, as measured by van der Heijde-modified total Sharp score, was significantly inhibited at week 24 in all secukinumab arms versus placebo (p<0.01 for 300 mg with LD and 150 mg without LD and p<0.05 for 150 mg with LD; linear extrapolation). Adverse event rates at week 24 were similar across treatment arms: 63.1% (300 mg with LD), 62.7% (150 mg with LD), 61.1% (150 mg without LD) and 62.0% (placebo). No deaths or new safety signals were reported. CONCLUSION S.c. secukinumab 300 mg and 150 mg with and without LD significantly improved clinical signs and symptoms and inhibited radiographic structural progression versus placebo at week 24 in patients with PsA. TRIAL REGISTRATION NUMBER NCT02404350; Results.
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Affiliation(s)
- Philip Mease
- Department of Rheumatology, Swedish Medical Center and University of Washington, Seattle, Washington, USA
| | | | - Robert Landewé
- Department of Clinical Rheumatology and Immunology, University of Amsterdam and Atrium Medical Center, Amsterdam, The Netherlands
| | | | - Proton Rahman
- Faculty of Medicine, Memorial University, St. Johns, Newfoundland, Canada
| | - Hasan Tahir
- Whipps Cross University Hospital, London, UK
| | | | | | - Sandra Navarra
- Section of Rheumatology, University of Santo Tomas Hospital, Manila, Philippines
| | | | - Aimee Readie
- Novartis Pharmaceuticals Corporation, East Hanover, New Jersey, USA
| | - Luminita Pricop
- Novartis Pharmaceuticals Corporation, East Hanover, New Jersey, USA
| | - Ken Abrams
- Novartis Pharmaceuticals Corporation, East Hanover, New Jersey, USA
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29
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Shah VV, Lee EB, Reddy S, Lin EJ, Wu JJ. Comparison of guidelines for the use of TNF inhibitors for psoriasis in the United States, Canada, Europe and the United Kingdom: a critical appraisal and comprehensive review. J DERMATOL TREAT 2018; 29:586-592. [PMID: 29334280 DOI: 10.1080/09546634.2018.1428723] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
PURPOSE To compare and contrast evidence-based CPGs from leading dermatological organizations for the use of tumor necrosis factor inhibitors (TNFi) in psoriasis. MATERIALS AND METHODS Guidelines from the British National Institute for Health and Care Excellence (NICE), the British Association of Dermatologists (BAD), the American Academy of Dermatology (AAD), the National Psoriasis Foundation (NPF), and the Canadian Dermatology Association (CDA) were reviewed and compared. RESULTS Various guidelines are similar regarding treatment initiation but have significant differences regarding topics such as continuous versus intermittent therapy, use in erythrodermic and pustular palmoplantar psoriasis and special patient populations. CONCLUSION TNF inhibitors remain valuable tools in psoriasis therapy, and guidelines for their use may help clinicians use them effectively.
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Affiliation(s)
- Vidhi V Shah
- a School of Medicine, University of Missouri-Kansas City , Kansas City , MO , USA
| | - Erica B Lee
- b John A. Burns School of Medicine , University of Hawaii , Honolulu , HI , USA
| | - Shivani Reddy
- c Kaiser Permanente Los Angeles Medical Center Department of Dermatology , Los Angeles , CA , USA
| | - Elaine J Lin
- d Department of Dermatology , University of California Davis , Sacramento , CA , USA
| | - Jashin J Wu
- c Kaiser Permanente Los Angeles Medical Center Department of Dermatology , Los Angeles , CA , USA
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30
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Puig L, Augustin M, Blauvelt A, Gottlieb AB, Vender R, Korman NJ, Thaçi D, Zhao Y, Gilloteau I, Sherif B, Williams N, Guana A, Lebwohl MG. Effect of secukinumab on quality of life and psoriasis-related symptoms: A comparative analysis versus ustekinumab from the CLEAR 52-week study. J Am Acad Dermatol 2017; 78:741-748. [PMID: 29066271 DOI: 10.1016/j.jaad.2017.10.025] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2017] [Revised: 10/12/2017] [Accepted: 10/16/2017] [Indexed: 11/18/2022]
Abstract
BACKGROUND Secukinumab has demonstrated greater sustained skin clearance than ustekinumab through week 52, greater improvement in symptoms and health-related quality of life, and comparable safety profile. OBJECTIVE To assess the impact of secukinumab versus that of ustekinumab on complete relief from psoriasis-related symptoms, time to response in terms of health-related quality of life, and cumulative benefit among patients with moderate-to-severe plaque psoriasis. METHODS Psoriasis-related pain, itching, and scaling and the Dermatology Life Quality Index (DLQI) score were compared between treatments on the basis of time to complete relief of symptoms and time to DLQI response in the CLEAR trial. Cumulative benefit over 52 weeks based on Psoriasis Area and Severity Index score, symptom relief, and DLQI response were evaluated by area under the curve analysis. RESULTS Significantly more patients treated with secukinumab achieved complete relief of pain at weeks 16 and 52 (all P < .05). Complete relief of itching and scaling occurred significantly faster with secukinumab (median, 4 weeks faster for itching and 8 weeks faster for scaling [P < .001]). Response as measured by the DLQI was 4 weeks faster with secukinumab (P < .0001). Cumulative benefits were greater with secukinumab (all P < .05). LIMITATIONS Analyses were post hoc. CONCLUSION This patient-reported outcome analysis confirms greater and sustained benefits of secukinumab versus those of ustekinumab treatment on patients' lives.
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Affiliation(s)
- Lluís Puig
- Department of Dermatology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Matthias Augustin
- Institute for Health Services Research in Dermatology and Nursing University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | | | - Alice B Gottlieb
- New York Medical College at Metropolitan Hospital, New York, New York
| | - Ron Vender
- Dermatrials Research Inc., Hamilton, Ontario, Canada
| | - Neil J Korman
- University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Diamant Thaçi
- Comprehensive Center for Inflammation Medicine, University Hospital Schleswig-Holstein, Lübeck, Germany
| | - Yang Zhao
- formerly with Novartis Pharmaceuticals Corporation, East Hanover, New Jersey
| | | | - Bintu Sherif
- RTI Health Solutions, Research Triangle Park, North Carolina.
| | - Nicole Williams
- RTI Health Solutions, Research Triangle Park, North Carolina
| | - Adriana Guana
- formerly with Novartis Pharmaceuticals Corporation, East Hanover, New Jersey
| | - Mark G Lebwohl
- Icahn School of Medicine at Mount Sinai, New York, New York
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31
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Bissonnette R, Luger T, Thaçi D, Toth D, Messina I, You R, Guana A, Fox T, Papavassilis C, Gilloteau I, Mrowietz U. Secukinumab sustains good efficacy and favourable safety in moderate-to-severe psoriasis after up to 3 years of treatment: results from a double-blind extension study. Br J Dermatol 2017; 177:1033-1042. [PMID: 28580579 DOI: 10.1111/bjd.15706] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/31/2017] [Indexed: 01/16/2023]
Abstract
BACKGROUND Secukinumab has demonstrated significant efficacy with a good safety profile through 1 year in plaque psoriasis. Given the chronic nature of this disease, long-term follow-up is needed to evaluate psoriasis therapies fully. OBJECTIVES To determine the long-term (3-year) efficacy and safety of secukinumab in moderate-to-severe psoriasis. METHODS Patients completing 52 weeks of secukinumab treatment in the SCULPTURE core study entered an extension in which they continued the same double-blind regimens. Dosing regimens included a fixed-interval schedule (FI; every 4 weeks) and retreatment as needed (RAN), in which patients were withdrawn from secukinumab and received placebo until the start of relapse, at which time secukinumab every 4 weeks was reinitiated. The study was registered with number NCT01640951. RESULTS In total 168 patients receiving secukinumab 300 mg FI and 172 receiving secukinumab 300 mg RAN entered the extension. Secukinumab 300 mg FI sustained high efficacy: at the end of year 3, the proportion of responders achieving ≥ 90% improvement in Psoriasis Area and Severity Index (PASI 90) was 63·8%, and of PASI 100 responders it was 42·6%. The mean absolute PASI remained low (2-4) from week 52 to week 152 with 300 mg FI, with approximately two-thirds of patients reporting no impact of skin disease on their lives (Dermatology Life Quality Index of 0 or 1). Improvements in overall and subscale scores on all quality-of-life instruments were well sustained. As in the core study, FI dosing was consistently more efficacious than RAN. No new safety signals were identified to year 3. CONCLUSIONS Secukinumab 300 mg FI sustained high responses and improved quality of life with no new safety concerns through 3 years.
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Affiliation(s)
| | - T Luger
- Department of Dermatology, University of Münster, Münster, Germany
| | - D Thaçi
- Comprehensive Center for Inflammation Medicine, University Hospital Schleswig-Holstein, Lübeck, Germany
| | - D Toth
- XLR8 Medical Research, Windsor, ON, Canada
| | - I Messina
- Novartis Pharmaceuticals, East Hanover, NJ, U.S.A
| | - R You
- Novartis Beijing Novartis Pharma Co. Ltd, Shanghai, China
| | - A Guana
- Novartis Pharmaceuticals, East Hanover, NJ, U.S.A
| | - T Fox
- Novartis Pharma AG, Basel, Switzerland
| | | | | | - U Mrowietz
- Psoriasis-Center, Department of Dermatology, University Medical Center Schleswig-Holstein, Kiel, Germany
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32
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Kazemi T, Farahnik B, Koo J, Beroukhim K. Emerging targeted therapies for plaque psoriasis - impact of ixekizumab. Clin Cosmet Investig Dermatol 2017; 10:133-139. [PMID: 28461763 PMCID: PMC5409192 DOI: 10.2147/ccid.s111007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Recent studies into the pathogenesis of psoriasis have identified the importance of interleukin 17 (IL-17) in disease activity and have thus provided a new target for biologic therapy. Ixekizumab, the most recent US Food and Drug Administration (FDA)-approved anti-IL-17 biologic agent, appears to be a promising medication for patients suffering from moderate-to-severe plaque psoriasis. METHODS We reviewed the results of phase III trials for ixekizumab in order to assess the efficacy, safety, and impact on quality of life of this agent in the treatment of plaque psoriasis. Additionally, we compared these results to phase II and phase III trials for other biologic psoriasis medications including the anti-IL-23 agents tildrakizumab and guselkumab, the combined anti-IL-12 and anti-IL-23 agent ustekinumab, and the anti-IL-17 agents brodalumab and secukinumab. RESULTS Pooled results from individual studies demonstrate that among the most efficacious dosing regimens of these anti-interleukin therapies, ixekizumab achieves higher Psoriasis Area and Severity Index 75 rates and similar or higher static Physician Global Assessment 0-1 rates than the other anti-IL-17 and anti-IL-23 agents. The safety profile of ixekizumab is similar to these agents, with nasopharyngitis, upper respiratory infection, headache, arthralgia, and injection-site erythema as the most commonly reported adverse events. CONCLUSION Ixekizumab is a highly efficacious, newly FDA-approved treatment for moderate-to-severe plaque psoriasis that demonstrates a robust clinical response, significant improvement in patient quality of life, and a favorable safety profile.
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Affiliation(s)
- Tiana Kazemi
- University of California - Los Angeles, David Geffen School of Medicine, Los Angeles, CA
| | | | - John Koo
- University of California - San Francisco, Department of Dermatology, Psoriasis and Skin Treatment Center, San Francisco, CA, USA
| | - Kourosh Beroukhim
- University of California - Los Angeles, David Geffen School of Medicine, Los Angeles, CA
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33
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Papp KA, Blauvelt A, Bukhalo M, Gooderham M, Krueger JG, Lacour JP, Menter A, Philipp S, Sofen H, Tyring S, Berner BR, Visvanathan S, Pamulapati C, Bennett N, Flack M, Scholl P, Padula SJ. Risankizumab versus Ustekinumab for Moderate-to-Severe Plaque Psoriasis. N Engl J Med 2017; 376:1551-1560. [PMID: 28423301 DOI: 10.1056/nejmoa1607017] [Citation(s) in RCA: 333] [Impact Index Per Article: 47.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Interleukin-23 is thought to be critical to the pathogenesis of psoriasis. We compared risankizumab (BI 655066), a humanized IgG1 monoclonal antibody that inhibits interleukin-23 by specifically targeting the p19 subunit and thus prevents interleukin-23 signaling, and ustekinumab, an interleukin-12 and interleukin-23 inhibitor, in patients with moderate-to-severe plaque psoriasis. METHODS We randomly assigned a total of 166 patients to receive subcutaneous injections of risankizumab (a single 18-mg dose at week 0 or 90-mg or 180-mg doses at weeks 0, 4, and 16) or ustekinumab (45 or 90 mg, according to body weight, at weeks 0, 4, and 16). The primary end point was a 90% or greater reduction from baseline in the Psoriasis Area and Severity Index (PASI) score at week 12. RESULTS At week 12, the percentage of patients with a 90% or greater reduction in the PASI score was 77% (64 of 83 patients) for risankizumab (90-mg and 180-mg groups, pooled), as compared with 40% (16 of 40 patients) for ustekinumab (P<0.001); the percentage of patients with a 100% reduction in the PASI score was 45% in the pooled 90-mg and 180-mg risankizumab groups, as compared with 18% in the ustekinumab group. Efficacy was generally maintained up to 20 weeks after the final dose of 90 or 180 mg of risankizumab. In the 18-mg and 90-mg risankizumab groups and the ustekinumab group, 5 patients (12%), 6 patients (15%), and 3 patients (8%), respectively, had serious adverse events, including two basal-cell carcinomas and one major cardiovascular adverse event; there were no serious adverse events in the 180-mg risankizumab group. CONCLUSIONS In this phase 2 trial, selective blockade of interleukin-23 with risankizumab was associated with clinical responses superior to those associated with ustekinumab. This trial was not large enough or of long enough duration to draw conclusions about safety. (Funded by Boehringer Ingelheim; ClinicalTrials.gov number, NCT02054481 ).
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Affiliation(s)
- Kim A Papp
- From K. Papp Clinical Research and Probity Medical Research, Waterloo, ON (K.A.P.), School of Medicine, Queen's University, Kingston, ON (M.G.), and Centre for Dermatology and Probity Medical Research, Peterborough, ON (M.G.) - all in Canada; Oregon Medical Research Center, Portland (A.B.); Altman Dermatology Associates, Arlington Heights, IL (M.B.); Rockefeller University, New York (J.K.); Hôpital de l'Archet, University of Nice-Sophia Antipolis, Nice, France (J.-P.L.); Baylor Research Institute, Dallas (A.M.); Charité Universitätsmedizin Berlin, Berlin (S.P.), Boehringer Ingelheim Pharma, Biberach (B.R.B.), and Boehringer Ingelheim Pharma, Ingelheim, (S.J.P.) - all in Germany; University of Texas Health Science Center, Houston (S.T.); University of California, Los Angeles, School of Medicine, Los Angeles (H.S.); and Boehringer Ingelheim Pharmaceuticals, Ridgefield, CT (S.V., C.P., N.B., M.F., P.S.)
| | - Andrew Blauvelt
- From K. Papp Clinical Research and Probity Medical Research, Waterloo, ON (K.A.P.), School of Medicine, Queen's University, Kingston, ON (M.G.), and Centre for Dermatology and Probity Medical Research, Peterborough, ON (M.G.) - all in Canada; Oregon Medical Research Center, Portland (A.B.); Altman Dermatology Associates, Arlington Heights, IL (M.B.); Rockefeller University, New York (J.K.); Hôpital de l'Archet, University of Nice-Sophia Antipolis, Nice, France (J.-P.L.); Baylor Research Institute, Dallas (A.M.); Charité Universitätsmedizin Berlin, Berlin (S.P.), Boehringer Ingelheim Pharma, Biberach (B.R.B.), and Boehringer Ingelheim Pharma, Ingelheim, (S.J.P.) - all in Germany; University of Texas Health Science Center, Houston (S.T.); University of California, Los Angeles, School of Medicine, Los Angeles (H.S.); and Boehringer Ingelheim Pharmaceuticals, Ridgefield, CT (S.V., C.P., N.B., M.F., P.S.)
| | - Michael Bukhalo
- From K. Papp Clinical Research and Probity Medical Research, Waterloo, ON (K.A.P.), School of Medicine, Queen's University, Kingston, ON (M.G.), and Centre for Dermatology and Probity Medical Research, Peterborough, ON (M.G.) - all in Canada; Oregon Medical Research Center, Portland (A.B.); Altman Dermatology Associates, Arlington Heights, IL (M.B.); Rockefeller University, New York (J.K.); Hôpital de l'Archet, University of Nice-Sophia Antipolis, Nice, France (J.-P.L.); Baylor Research Institute, Dallas (A.M.); Charité Universitätsmedizin Berlin, Berlin (S.P.), Boehringer Ingelheim Pharma, Biberach (B.R.B.), and Boehringer Ingelheim Pharma, Ingelheim, (S.J.P.) - all in Germany; University of Texas Health Science Center, Houston (S.T.); University of California, Los Angeles, School of Medicine, Los Angeles (H.S.); and Boehringer Ingelheim Pharmaceuticals, Ridgefield, CT (S.V., C.P., N.B., M.F., P.S.)
| | - Melinda Gooderham
- From K. Papp Clinical Research and Probity Medical Research, Waterloo, ON (K.A.P.), School of Medicine, Queen's University, Kingston, ON (M.G.), and Centre for Dermatology and Probity Medical Research, Peterborough, ON (M.G.) - all in Canada; Oregon Medical Research Center, Portland (A.B.); Altman Dermatology Associates, Arlington Heights, IL (M.B.); Rockefeller University, New York (J.K.); Hôpital de l'Archet, University of Nice-Sophia Antipolis, Nice, France (J.-P.L.); Baylor Research Institute, Dallas (A.M.); Charité Universitätsmedizin Berlin, Berlin (S.P.), Boehringer Ingelheim Pharma, Biberach (B.R.B.), and Boehringer Ingelheim Pharma, Ingelheim, (S.J.P.) - all in Germany; University of Texas Health Science Center, Houston (S.T.); University of California, Los Angeles, School of Medicine, Los Angeles (H.S.); and Boehringer Ingelheim Pharmaceuticals, Ridgefield, CT (S.V., C.P., N.B., M.F., P.S.)
| | - James G Krueger
- From K. Papp Clinical Research and Probity Medical Research, Waterloo, ON (K.A.P.), School of Medicine, Queen's University, Kingston, ON (M.G.), and Centre for Dermatology and Probity Medical Research, Peterborough, ON (M.G.) - all in Canada; Oregon Medical Research Center, Portland (A.B.); Altman Dermatology Associates, Arlington Heights, IL (M.B.); Rockefeller University, New York (J.K.); Hôpital de l'Archet, University of Nice-Sophia Antipolis, Nice, France (J.-P.L.); Baylor Research Institute, Dallas (A.M.); Charité Universitätsmedizin Berlin, Berlin (S.P.), Boehringer Ingelheim Pharma, Biberach (B.R.B.), and Boehringer Ingelheim Pharma, Ingelheim, (S.J.P.) - all in Germany; University of Texas Health Science Center, Houston (S.T.); University of California, Los Angeles, School of Medicine, Los Angeles (H.S.); and Boehringer Ingelheim Pharmaceuticals, Ridgefield, CT (S.V., C.P., N.B., M.F., P.S.)
| | - Jean-Philippe Lacour
- From K. Papp Clinical Research and Probity Medical Research, Waterloo, ON (K.A.P.), School of Medicine, Queen's University, Kingston, ON (M.G.), and Centre for Dermatology and Probity Medical Research, Peterborough, ON (M.G.) - all in Canada; Oregon Medical Research Center, Portland (A.B.); Altman Dermatology Associates, Arlington Heights, IL (M.B.); Rockefeller University, New York (J.K.); Hôpital de l'Archet, University of Nice-Sophia Antipolis, Nice, France (J.-P.L.); Baylor Research Institute, Dallas (A.M.); Charité Universitätsmedizin Berlin, Berlin (S.P.), Boehringer Ingelheim Pharma, Biberach (B.R.B.), and Boehringer Ingelheim Pharma, Ingelheim, (S.J.P.) - all in Germany; University of Texas Health Science Center, Houston (S.T.); University of California, Los Angeles, School of Medicine, Los Angeles (H.S.); and Boehringer Ingelheim Pharmaceuticals, Ridgefield, CT (S.V., C.P., N.B., M.F., P.S.)
| | - Alan Menter
- From K. Papp Clinical Research and Probity Medical Research, Waterloo, ON (K.A.P.), School of Medicine, Queen's University, Kingston, ON (M.G.), and Centre for Dermatology and Probity Medical Research, Peterborough, ON (M.G.) - all in Canada; Oregon Medical Research Center, Portland (A.B.); Altman Dermatology Associates, Arlington Heights, IL (M.B.); Rockefeller University, New York (J.K.); Hôpital de l'Archet, University of Nice-Sophia Antipolis, Nice, France (J.-P.L.); Baylor Research Institute, Dallas (A.M.); Charité Universitätsmedizin Berlin, Berlin (S.P.), Boehringer Ingelheim Pharma, Biberach (B.R.B.), and Boehringer Ingelheim Pharma, Ingelheim, (S.J.P.) - all in Germany; University of Texas Health Science Center, Houston (S.T.); University of California, Los Angeles, School of Medicine, Los Angeles (H.S.); and Boehringer Ingelheim Pharmaceuticals, Ridgefield, CT (S.V., C.P., N.B., M.F., P.S.)
| | - Sandra Philipp
- From K. Papp Clinical Research and Probity Medical Research, Waterloo, ON (K.A.P.), School of Medicine, Queen's University, Kingston, ON (M.G.), and Centre for Dermatology and Probity Medical Research, Peterborough, ON (M.G.) - all in Canada; Oregon Medical Research Center, Portland (A.B.); Altman Dermatology Associates, Arlington Heights, IL (M.B.); Rockefeller University, New York (J.K.); Hôpital de l'Archet, University of Nice-Sophia Antipolis, Nice, France (J.-P.L.); Baylor Research Institute, Dallas (A.M.); Charité Universitätsmedizin Berlin, Berlin (S.P.), Boehringer Ingelheim Pharma, Biberach (B.R.B.), and Boehringer Ingelheim Pharma, Ingelheim, (S.J.P.) - all in Germany; University of Texas Health Science Center, Houston (S.T.); University of California, Los Angeles, School of Medicine, Los Angeles (H.S.); and Boehringer Ingelheim Pharmaceuticals, Ridgefield, CT (S.V., C.P., N.B., M.F., P.S.)
| | - Howard Sofen
- From K. Papp Clinical Research and Probity Medical Research, Waterloo, ON (K.A.P.), School of Medicine, Queen's University, Kingston, ON (M.G.), and Centre for Dermatology and Probity Medical Research, Peterborough, ON (M.G.) - all in Canada; Oregon Medical Research Center, Portland (A.B.); Altman Dermatology Associates, Arlington Heights, IL (M.B.); Rockefeller University, New York (J.K.); Hôpital de l'Archet, University of Nice-Sophia Antipolis, Nice, France (J.-P.L.); Baylor Research Institute, Dallas (A.M.); Charité Universitätsmedizin Berlin, Berlin (S.P.), Boehringer Ingelheim Pharma, Biberach (B.R.B.), and Boehringer Ingelheim Pharma, Ingelheim, (S.J.P.) - all in Germany; University of Texas Health Science Center, Houston (S.T.); University of California, Los Angeles, School of Medicine, Los Angeles (H.S.); and Boehringer Ingelheim Pharmaceuticals, Ridgefield, CT (S.V., C.P., N.B., M.F., P.S.)
| | - Stephen Tyring
- From K. Papp Clinical Research and Probity Medical Research, Waterloo, ON (K.A.P.), School of Medicine, Queen's University, Kingston, ON (M.G.), and Centre for Dermatology and Probity Medical Research, Peterborough, ON (M.G.) - all in Canada; Oregon Medical Research Center, Portland (A.B.); Altman Dermatology Associates, Arlington Heights, IL (M.B.); Rockefeller University, New York (J.K.); Hôpital de l'Archet, University of Nice-Sophia Antipolis, Nice, France (J.-P.L.); Baylor Research Institute, Dallas (A.M.); Charité Universitätsmedizin Berlin, Berlin (S.P.), Boehringer Ingelheim Pharma, Biberach (B.R.B.), and Boehringer Ingelheim Pharma, Ingelheim, (S.J.P.) - all in Germany; University of Texas Health Science Center, Houston (S.T.); University of California, Los Angeles, School of Medicine, Los Angeles (H.S.); and Boehringer Ingelheim Pharmaceuticals, Ridgefield, CT (S.V., C.P., N.B., M.F., P.S.)
| | - Beate R Berner
- From K. Papp Clinical Research and Probity Medical Research, Waterloo, ON (K.A.P.), School of Medicine, Queen's University, Kingston, ON (M.G.), and Centre for Dermatology and Probity Medical Research, Peterborough, ON (M.G.) - all in Canada; Oregon Medical Research Center, Portland (A.B.); Altman Dermatology Associates, Arlington Heights, IL (M.B.); Rockefeller University, New York (J.K.); Hôpital de l'Archet, University of Nice-Sophia Antipolis, Nice, France (J.-P.L.); Baylor Research Institute, Dallas (A.M.); Charité Universitätsmedizin Berlin, Berlin (S.P.), Boehringer Ingelheim Pharma, Biberach (B.R.B.), and Boehringer Ingelheim Pharma, Ingelheim, (S.J.P.) - all in Germany; University of Texas Health Science Center, Houston (S.T.); University of California, Los Angeles, School of Medicine, Los Angeles (H.S.); and Boehringer Ingelheim Pharmaceuticals, Ridgefield, CT (S.V., C.P., N.B., M.F., P.S.)
| | - Sudha Visvanathan
- From K. Papp Clinical Research and Probity Medical Research, Waterloo, ON (K.A.P.), School of Medicine, Queen's University, Kingston, ON (M.G.), and Centre for Dermatology and Probity Medical Research, Peterborough, ON (M.G.) - all in Canada; Oregon Medical Research Center, Portland (A.B.); Altman Dermatology Associates, Arlington Heights, IL (M.B.); Rockefeller University, New York (J.K.); Hôpital de l'Archet, University of Nice-Sophia Antipolis, Nice, France (J.-P.L.); Baylor Research Institute, Dallas (A.M.); Charité Universitätsmedizin Berlin, Berlin (S.P.), Boehringer Ingelheim Pharma, Biberach (B.R.B.), and Boehringer Ingelheim Pharma, Ingelheim, (S.J.P.) - all in Germany; University of Texas Health Science Center, Houston (S.T.); University of California, Los Angeles, School of Medicine, Los Angeles (H.S.); and Boehringer Ingelheim Pharmaceuticals, Ridgefield, CT (S.V., C.P., N.B., M.F., P.S.)
| | - Chandrasena Pamulapati
- From K. Papp Clinical Research and Probity Medical Research, Waterloo, ON (K.A.P.), School of Medicine, Queen's University, Kingston, ON (M.G.), and Centre for Dermatology and Probity Medical Research, Peterborough, ON (M.G.) - all in Canada; Oregon Medical Research Center, Portland (A.B.); Altman Dermatology Associates, Arlington Heights, IL (M.B.); Rockefeller University, New York (J.K.); Hôpital de l'Archet, University of Nice-Sophia Antipolis, Nice, France (J.-P.L.); Baylor Research Institute, Dallas (A.M.); Charité Universitätsmedizin Berlin, Berlin (S.P.), Boehringer Ingelheim Pharma, Biberach (B.R.B.), and Boehringer Ingelheim Pharma, Ingelheim, (S.J.P.) - all in Germany; University of Texas Health Science Center, Houston (S.T.); University of California, Los Angeles, School of Medicine, Los Angeles (H.S.); and Boehringer Ingelheim Pharmaceuticals, Ridgefield, CT (S.V., C.P., N.B., M.F., P.S.)
| | - Nathan Bennett
- From K. Papp Clinical Research and Probity Medical Research, Waterloo, ON (K.A.P.), School of Medicine, Queen's University, Kingston, ON (M.G.), and Centre for Dermatology and Probity Medical Research, Peterborough, ON (M.G.) - all in Canada; Oregon Medical Research Center, Portland (A.B.); Altman Dermatology Associates, Arlington Heights, IL (M.B.); Rockefeller University, New York (J.K.); Hôpital de l'Archet, University of Nice-Sophia Antipolis, Nice, France (J.-P.L.); Baylor Research Institute, Dallas (A.M.); Charité Universitätsmedizin Berlin, Berlin (S.P.), Boehringer Ingelheim Pharma, Biberach (B.R.B.), and Boehringer Ingelheim Pharma, Ingelheim, (S.J.P.) - all in Germany; University of Texas Health Science Center, Houston (S.T.); University of California, Los Angeles, School of Medicine, Los Angeles (H.S.); and Boehringer Ingelheim Pharmaceuticals, Ridgefield, CT (S.V., C.P., N.B., M.F., P.S.)
| | - Mary Flack
- From K. Papp Clinical Research and Probity Medical Research, Waterloo, ON (K.A.P.), School of Medicine, Queen's University, Kingston, ON (M.G.), and Centre for Dermatology and Probity Medical Research, Peterborough, ON (M.G.) - all in Canada; Oregon Medical Research Center, Portland (A.B.); Altman Dermatology Associates, Arlington Heights, IL (M.B.); Rockefeller University, New York (J.K.); Hôpital de l'Archet, University of Nice-Sophia Antipolis, Nice, France (J.-P.L.); Baylor Research Institute, Dallas (A.M.); Charité Universitätsmedizin Berlin, Berlin (S.P.), Boehringer Ingelheim Pharma, Biberach (B.R.B.), and Boehringer Ingelheim Pharma, Ingelheim, (S.J.P.) - all in Germany; University of Texas Health Science Center, Houston (S.T.); University of California, Los Angeles, School of Medicine, Los Angeles (H.S.); and Boehringer Ingelheim Pharmaceuticals, Ridgefield, CT (S.V., C.P., N.B., M.F., P.S.)
| | - Paul Scholl
- From K. Papp Clinical Research and Probity Medical Research, Waterloo, ON (K.A.P.), School of Medicine, Queen's University, Kingston, ON (M.G.), and Centre for Dermatology and Probity Medical Research, Peterborough, ON (M.G.) - all in Canada; Oregon Medical Research Center, Portland (A.B.); Altman Dermatology Associates, Arlington Heights, IL (M.B.); Rockefeller University, New York (J.K.); Hôpital de l'Archet, University of Nice-Sophia Antipolis, Nice, France (J.-P.L.); Baylor Research Institute, Dallas (A.M.); Charité Universitätsmedizin Berlin, Berlin (S.P.), Boehringer Ingelheim Pharma, Biberach (B.R.B.), and Boehringer Ingelheim Pharma, Ingelheim, (S.J.P.) - all in Germany; University of Texas Health Science Center, Houston (S.T.); University of California, Los Angeles, School of Medicine, Los Angeles (H.S.); and Boehringer Ingelheim Pharmaceuticals, Ridgefield, CT (S.V., C.P., N.B., M.F., P.S.)
| | - Steven J Padula
- From K. Papp Clinical Research and Probity Medical Research, Waterloo, ON (K.A.P.), School of Medicine, Queen's University, Kingston, ON (M.G.), and Centre for Dermatology and Probity Medical Research, Peterborough, ON (M.G.) - all in Canada; Oregon Medical Research Center, Portland (A.B.); Altman Dermatology Associates, Arlington Heights, IL (M.B.); Rockefeller University, New York (J.K.); Hôpital de l'Archet, University of Nice-Sophia Antipolis, Nice, France (J.-P.L.); Baylor Research Institute, Dallas (A.M.); Charité Universitätsmedizin Berlin, Berlin (S.P.), Boehringer Ingelheim Pharma, Biberach (B.R.B.), and Boehringer Ingelheim Pharma, Ingelheim, (S.J.P.) - all in Germany; University of Texas Health Science Center, Houston (S.T.); University of California, Los Angeles, School of Medicine, Los Angeles (H.S.); and Boehringer Ingelheim Pharmaceuticals, Ridgefield, CT (S.V., C.P., N.B., M.F., P.S.)
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Elewski BE, Puig L, Mordin M, Gilloteau I, Sherif B, Fox T, Gnanasakthy A, Papavassilis C, Strober BE. Psoriasis patients with psoriasis Area and Severity Index (PASI) 90 response achieve greater health-related quality-of-life improvements than those with PASI 75–89 response: results from two phase 3 studies of secukinumab. J DERMATOL TREAT 2017; 28:492-499. [DOI: 10.1080/09546634.2017.1294727] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Affiliation(s)
| | - Lluís Puig
- Department of Dermatology, Hospital de la Sanat Creu i Sant Pau, Barcelona, Spain
| | | | | | - Bintu Sherif
- RTI Health Solutions, Research Triangle Park, NC, USA
| | - Todd Fox
- Novartis Pharma AG, Basel, Switzerland
| | | | | | - Bruce E. Strober
- University of Connecticut Health Center, Farmington, CT, USA
- Probity Medical Research, Waterloo, Canada
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Secukinumab shows significant efficacy in palmoplantar psoriasis: Results from GESTURE, a randomized controlled trial. J Am Acad Dermatol 2017; 76:70-80. [DOI: 10.1016/j.jaad.2016.07.058] [Citation(s) in RCA: 99] [Impact Index Per Article: 14.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2015] [Revised: 07/28/2016] [Accepted: 07/28/2016] [Indexed: 12/14/2022]
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Validation studies of outcome measures in pemphigus. Int J Womens Dermatol 2016; 2:128-139. [PMID: 28492025 PMCID: PMC5419045 DOI: 10.1016/j.ijwd.2016.10.003] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2016] [Revised: 10/28/2016] [Accepted: 10/28/2016] [Indexed: 11/22/2022] Open
Abstract
Pemphigus is a group of rare and potentially fatal autoimmune blistering diseases that are associated with auto-antibodies that target intercellular adhesion molecules. Incidence of pemphigus varies among populations, with the lowest incidence in Switzerland and Finland at 0.6–0.76 per million per year and the highest in Jewish communities at 16.1–32 per million per year. Pemphigus is associated with devastating morbidity and despite advancements in our understanding of the disease and a widening array of therapeutic options, no cure exists. The delay in the development of a cure may in part be attributed to the absence of a standardized and completely validated severity outcome measures to allow for high-quality multicenter control studies. Such a tool is necessary to define the best practice in clinical studies, allow for accurate comparisons between study results, justify drug use within the clinical setting, and reduce the cost burden that is associated with the use of ineffective therapies. Utilizing outcome measures that are not validated provides an opportunity to synthesize outcome measures with the intent to favor particular treatments and thus produce false conclusions. According to the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) group, a validation of these measurement instruments requires investigating their responsiveness, reliability, and validity. More than 116 outcome measures exist to assess pemphigus severity, of which the Pemphigus Disease Area Index (PDAI), Autoimmune Bullous Skin Disorder Intensity Score (ABSIS), and Pemphigus Vulgaris Activity Score (PVAS) are the most comprehensively corroborated measures. With regard to validity and reliability, PDAI was unsurpassed by ABSIS and PVAS. Data indicate that ABSIS is more reliable than PVAS, but PVAS seems to have greater validity although the results are not consistent. PDAI, ABSIS, and PVAS have not yet had their responsiveness analyzed, which should be the next step to completely validate the outcome measures and conclusively determine which measure is superior.
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Secukinumab is superior to ustekinumab in clearing skin of subjects with moderate-to-severe plaque psoriasis up to 1 year: Results from the CLEAR study. J Am Acad Dermatol 2016; 76:60-69.e9. [PMID: 27663079 DOI: 10.1016/j.jaad.2016.08.008] [Citation(s) in RCA: 212] [Impact Index Per Article: 26.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2016] [Revised: 08/01/2016] [Accepted: 08/02/2016] [Indexed: 01/01/2023]
Abstract
BACKGROUND Secukinumab demonstrated superior efficacy to ustekinumab at week 4 and week 16 of the CLEAR study, with comparable safety, in subjects with moderate-to-severe plaque psoriasis. OBJECTIVE To compare the efficacy and safety of secukinumab and ustekinumab use over 52 weeks. METHODS Analysis of 52-week data from CLEAR, a randomized, double-blind, phase 3b study. RESULTS Among 676 randomized subjects, secukinumab demonstrated superiority to ustekinumab at week 52 in the proportion of subjects with ≥90% improvement in Psoriasis Area and Severity Index (PASI 90) (76% vs 61% [P < .0001]); PASI 100 responses were 46% versus 36% (P = .0103) and Investigator's Global Assessment responses of clear/almost clear skin were 80% versus 65% (P < .0001). Subjects on secukinumab reported greater reductions in psoriasis-related pain, itching, and scaling, and greater improvement across all quality-of-life measures evaluated (Dermatology Life Quality Index [DLQI], EuroQoL 5-Dimension Health Questionnaire, Work Productivity and Activity Impairment Questionnaire-Psoriasis, and Health Assessment Questionnaire-Disability Index). At week 52, 72% of subjects on secukinumab versus 59% on ustekinumab (P = .0008) reported no impact of skin disease on their lives (DLQI 0/1 response). Safety and tolerability was comparable. LIMITATIONS There was no placebo arm. CONCLUSION In this head-to-head, double-blind study, secukinumab demonstrated sustained superior efficacy in comparison with ustekinumab in clearing skin through week 52, greater improvement in quality of life, and a favorable and comparable safety profile.
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Finlay AY, Ortonne JP. Patient Satisfaction with Psoriasis Therapies: An Update and Introduction to Biologic Therapy. J Cutan Med Surg 2016. [DOI: 10.1177/120347540400800502] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background: Psoriasis is a chronic, immune-mediated skin condition that often requires lifelong treatment. Many patients report dissatisfaction with traditional nonbiologic therapies because they are ineffective for their psoriasis, are associated with side effects, or impact negatively on quality of life. Objectives: The aim of this article is to review the effect on patient quality of life of traditional nonbiologic psoriasis therapies and to discuss the impact of biologic psoriasis therapies on patient satisfaction. Methods: A review of the literature is presented. Results: Traditional nonbiologic psoriasis therapies can negatively impact quality of life due to a variety of factors including inconvenience and toxicity. Biologic agents have been developed that target the immunopathogenesis of psoriasis. Based on favorable efficacy and safety results in clinical trials, some of these agents are now approved for clinical use. Evidence suggests that patients receiving biologic therapies experience significant improvements in health-related quality of life. Conclusion: Biologic agents offer new hope for patients with psoriasis that their chronic condition can be controlled in a manner that improves their quality of life and may lead to high levels of satisfaction with their treatment.
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Affiliation(s)
- Andrew Y. Finlay
- Department of Dermatology, Wales College of Medicine, Cardiff University, CF14 4XN, Cardiff, Wales, U.K
| | - Jean-Paul Ortonne
- Department of Dermatology, Wales College of Medicine, Cardiff University, CF14 4XN, Cardiff, Wales, U.K
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Gupta AK, Langley R, Poulin Y, Lui H, Searles G, Carey W, Toole J, Inniss K. Pathogenesis of Psoriasis and Current Challenges. J Cutan Med Surg 2016. [DOI: 10.1177/12034754040080s102] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
| | | | - Yves Poulin
- Mediprobe Research Inc., London, Ontario, Canada
| | - Harvey Lui
- Mediprobe Research Inc., London, Ontario, Canada
| | | | - Wayne Carey
- Mediprobe Research Inc., London, Ontario, Canada
| | - John Toole
- Mediprobe Research Inc., London, Ontario, Canada
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Mease PJ, van der Heijde D, Ritchlin CT, Okada M, Cuchacovich RS, Shuler CL, Lin CY, Braun DK, Lee CH, Gladman DD. Ixekizumab, an interleukin-17A specific monoclonal antibody, for the treatment of biologic-naive patients with active psoriatic arthritis: results from the 24-week randomised, double-blind, placebo-controlled and active (adalimumab)-controlled period of the phase III trial SPIRIT-P1. Ann Rheum Dis 2016; 76:79-87. [PMID: 27553214 PMCID: PMC5264219 DOI: 10.1136/annrheumdis-2016-209709] [Citation(s) in RCA: 370] [Impact Index Per Article: 46.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2016] [Revised: 07/21/2016] [Accepted: 07/25/2016] [Indexed: 01/29/2023]
Abstract
OBJECTIVE To assess the safety and efficacy of ixekizumab, a monoclonal antibody that inhibits interleukin-17A, in a double-blind phase III trial enrolling patients with active psoriatic arthritis (PsA). METHODS Patients naive to biologic therapy with active PsA were randomised to subcutaneous injections of placebo (N=106), adalimumab 40 mg once every 2 weeks (active reference; N=101), ixekizumab 80 mg once every 2 weeks (IXEQ2W) (N=103), or ixekizumab 80 mg once every 4 weeks (IXEQ4W) (N=107). Both ixekizumab regimens included a 160-mg starting dose. The primary objective was to assess the superiority of IXEQ2W or IXEQ4W versus placebo as measured by the proportion of patients achieving an American College of Rheumatology 20 (ACR20) response at week 24. RESULTS Significantly more patients treated with ixekizumab achieved an ACR20 response with IXEQ2W (62.1%) or IXEQ4W (57.9%) than placebo (30.2%) (p≤0.001; non-responder imputation method). Disease activity and functional disability were significantly improved with both ixekizumab doses versus placebo at weeks 12 and 24, and there was significantly less progression of structural damage at week 24 (p≤0.01). Clearance of plaque psoriasis was greater with ixekizumab than placebo (p≤0.001). Efficacy results with adalimumab, the active reference arm, showed significant improvements versus placebo. Treatment-emergent adverse events were more frequent with ixekizumab (65.7-66.4%) and adalimumab (64.4%) than placebo (47.2%) (p<0.05). CONCLUSIONS In biologic-naive patients with active PsA, ixekizumab treatment resulted in improvements in disease activity and physical function, as well as in the inhibition of structural damage progression. Overall, adverse events were more frequent in all active groups compared with placebo. TRIAL REGISTRATION NUMBER NCT01695239; EudraCT2011-002326-49; Results.
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Affiliation(s)
- Philip J Mease
- Department of Rheumatology, Swedish Medical Center, and University of Washington, Seattle, Washington, USA
| | | | - Christopher T Ritchlin
- Allergy, Immunology, & Rheumatology Division, University of Rochester Medical Center, Rochester, New York, USA
| | - Masato Okada
- Immuno-Rheumatology Center, St. Luke's International Hospital, Tokyo, Japan
| | - Raquel S Cuchacovich
- Eli Lilly and Company, Indianapolis, Indiana, USA.,Rheumatology Division, Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | | | - Chen-Yen Lin
- Eli Lilly and Company, Indianapolis, Indiana, USA
| | | | - Chin H Lee
- Eli Lilly and Company, Indianapolis, Indiana, USA
| | - Dafna D Gladman
- Division of Rheumatology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
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Landells I, Searles G, Bissonnette R, Shear NH, Vender R, Lui H. Efficacy Outcomes in Patients Using Alefacept in the AWARE Study. J Cutan Med Surg 2016; 13 Suppl 3:S122-30. [DOI: 10.2310/7750.2009.00030] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Background: Alefacept has demonstrated efficacy in clinical trials of patients with chronic plaque psoriasis, either as monotherapy or combined with other treatment modalities such as phototherapy. Objective: AWARE (Amevive Wisdom Acquired from Real-World Evidence) is a multicenter, observational, phase IV Canadian registry of psoriasis patients treated with alefacept. Methods: Patients with chronic plaque psoriasis were treated with at least one course of alefacept, either alone or added on to their existing antipsoriatic treatment regimen. Each course of alefacept was followed by a period of at least 12 weeks off treatment. Efficacy outcomes included physicians' and patients' assessments of response at week 18, as well as change in percent body surface area (BSA) involvement with psoriasis. The time to retreatment was assessed in patients receiving a second course of alefacept during at least 60 weeks of prospective follow-up. Results: The majority of patients received alefacept in combination with other antipsoriatic therapies. Physicians' and patients' assessments of response at 18 weeks showed that 42% and 41% of patients, respectively, had a “cleared to marked response” and a further 42% had a “moderate to some response.” Among those patients whose psoriasis was moderately controlled or not controlled at baseline, 49 to 51% and 33 to 36%, respectively, improved to “cleared to marked response” at 18 weeks. A substantial shift in percent BSA involvement with psoriasis was observed at 18 weeks, with 55% of patients having a BSA involvement of < 10% at week 18 compared to only 20% having this level of BSA involvement at baseline. The mean time to retreatment among the 60% of patients who received a second course of alefacept was 19.3 weeks (range 2–47 weeks). Conclusion: A single course of alefacept therapy improved outcomes in this broad population of real-world chronic plaque psoriasis patients. Study Limitations: The limitations of this study include its nonrandomized, noncontrolled, noncomparative design, which allowed multiple different treatment approaches across all patients. The rating scales used in this study have not been previously validated, and ranges were assigned to baseline control and response data that are not specifically defined. Clinicians did not receive specific training in using these scales; therefore, interrater variability could not be assessed.
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Affiliation(s)
- Ian Landells
- From Nexus Clinical Research, St. John's, NL; University of Alberta, Edmonton, AB; Innovaderm Research, Montreal, QC; the Department of Medicine, Division of Dermatology, University of Toronto, Toronto, ON; Dermatrials Research, Hamilton, ON; Department of Dermatology and Skin Science, University of British Columbia, Vancouver, BC; Vancouver Coastal Health Research Institute, Vancouver, BC
| | - Gordon Searles
- From Nexus Clinical Research, St. John's, NL; University of Alberta, Edmonton, AB; Innovaderm Research, Montreal, QC; the Department of Medicine, Division of Dermatology, University of Toronto, Toronto, ON; Dermatrials Research, Hamilton, ON; Department of Dermatology and Skin Science, University of British Columbia, Vancouver, BC; Vancouver Coastal Health Research Institute, Vancouver, BC
| | - Robert Bissonnette
- From Nexus Clinical Research, St. John's, NL; University of Alberta, Edmonton, AB; Innovaderm Research, Montreal, QC; the Department of Medicine, Division of Dermatology, University of Toronto, Toronto, ON; Dermatrials Research, Hamilton, ON; Department of Dermatology and Skin Science, University of British Columbia, Vancouver, BC; Vancouver Coastal Health Research Institute, Vancouver, BC
| | - Neil H. Shear
- From Nexus Clinical Research, St. John's, NL; University of Alberta, Edmonton, AB; Innovaderm Research, Montreal, QC; the Department of Medicine, Division of Dermatology, University of Toronto, Toronto, ON; Dermatrials Research, Hamilton, ON; Department of Dermatology and Skin Science, University of British Columbia, Vancouver, BC; Vancouver Coastal Health Research Institute, Vancouver, BC
| | - Ronald Vender
- From Nexus Clinical Research, St. John's, NL; University of Alberta, Edmonton, AB; Innovaderm Research, Montreal, QC; the Department of Medicine, Division of Dermatology, University of Toronto, Toronto, ON; Dermatrials Research, Hamilton, ON; Department of Dermatology and Skin Science, University of British Columbia, Vancouver, BC; Vancouver Coastal Health Research Institute, Vancouver, BC
| | - Harvey Lui
- From Nexus Clinical Research, St. John's, NL; University of Alberta, Edmonton, AB; Innovaderm Research, Montreal, QC; the Department of Medicine, Division of Dermatology, University of Toronto, Toronto, ON; Dermatrials Research, Hamilton, ON; Department of Dermatology and Skin Science, University of British Columbia, Vancouver, BC; Vancouver Coastal Health Research Institute, Vancouver, BC
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Kwon HH, Kim MW, Park GH, Bae YI, Kuk SK, Suh DH, Youn JI, Kwon IH. Facial Psoriasis Log-based Area and Severity Index: A valid and reliable severity measurement method detecting improvement of facial psoriasis in clinical practice settings. J Dermatol 2016; 43:894-9. [PMID: 26992293 DOI: 10.1111/1346-8138.13283] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2015] [Accepted: 12/01/2015] [Indexed: 01/10/2023]
Abstract
Facial psoriasis is often observed in moderate to severe degrees of psoriasis. While we previously demonstrated construct validity of the facial Psoriasis Log-based Area and Severity Index (fPLASI) system for the cross-sectional evaluation of facial psoriasis, its reliability and accuracy to detect clinical improvement has not been confirmed yet. The aim of this study is to analyze whether the fPLASI properly represents the range of improvement for facial psoriasis compared with the existing facial Psoriasis Area and Severity Index (fPASI) after receiving systemic treatments in clinical practice settings. The changing severity of facial psoriasis for 118 patients was calculated by the scales of fPASI and fPLASI between two time points after systemic treatments. Then, percentage changes (ΔfPASI and ΔfPLASI) were analyzed from the perspective of both the Physician's Global Assessment of effectiveness (PGA) and patients' Subjective Global Assessment (SGA). As a result, the distribution of the fPASI was more heavily clustered around the low score range compared with the fPLASI at both first and second visits. Linear regression analysis between ΔfPASI and ΔfPLASI shows that the correlation coefficient was 0.94, and ΔfPLASI represented greater percentage changes than ΔfPASI. Remarkably, degrees of clinical improvement measured by the PGA matched better with ΔfPLASI, while ΔfPASI underestimated clinical improvements compared with ΔfPLASI from treatment-responding groups by the PGA and SGA. In conclusion, the fPLASI represented clinical improvement of facial psoriasis with more sensitivity and reliability compared with the fPASI. Therefore, the PLASI system would be a viable severity measurement method for facial psoriasis in clinical practice.
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Affiliation(s)
- Hyuck Hoon Kwon
- Department of Dermatology, Seoul National University College of Medicine, Seoul, Korea
| | - Min-Woo Kim
- Department of Dermatology, Seoul National University College of Medicine, Seoul, Korea
| | - Gyeong-Hun Park
- Department of Dermatology, Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Hwaseong, Korea
| | - You In Bae
- Department of Dermatology, Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Hwaseong, Korea
| | - Su Kyung Kuk
- Department of Oral Pathology, School of Dentistry and Dental Research Institute, Seoul National University, Seoul, Korea
| | - Dae Hun Suh
- Department of Dermatology, Seoul National University College of Medicine, Seoul, Korea
| | - Jai Il Youn
- Department of Dermatology, National Medical Center, Seoul, Korea
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Mease PJ, McInnes IB, Kirkham B, Kavanaugh A, Rahman P, van der Heijde D, Landewé R, Nash P, Pricop L, Yuan J, Richards HB, Mpofu S. Secukinumab Inhibition of Interleukin-17A in Patients with Psoriatic Arthritis. N Engl J Med 2015; 373:1329-39. [PMID: 26422723 DOI: 10.1056/nejmoa1412679] [Citation(s) in RCA: 547] [Impact Index Per Article: 60.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND In a phase 2 study, the inhibition of the interleukin-17A receptor improved signs and symptoms of psoriatic arthritis. We sought to evaluate the efficacy and safety of secukinumab, an anti-interleukin-17A monoclonal antibody, in such patients. METHODS In this double-blind, phase 3 study, 606 patients with psoriatic arthritis were randomly assigned in a 1:1:1 ratio to receive intravenous secukinumab (at a dose of 10 mg per kilogram) at weeks 0, 2, and 4, followed by subcutaneous secukinumab at a dose of either 150 mg or 75 mg every 4 weeks, or placebo. Patients in the placebo group were switched to subcutaneous secukinumab at a dose of 150 mg or 75 mg at week 16 or 24, depending on clinical response. The primary end point was the proportion of patients with an American College of Rheumatology 20 (ACR20) response at week 24, defined as a 20% improvement from baseline in the number of tender and swollen joints and at least three other important domains. RESULTS ACR20 response rates at week 24 were significantly higher in the group receiving secukinumab at doses of 150 mg (50.0%) and 75 mg (50.5%) than in those receiving placebo (17.3%) (P<0.001 for both comparisons with placebo). Secondary end points, including the ACR50 response and joint structural damage, were significantly better in the secukinumab groups than in the placebo group. Improvements were sustained through 52 weeks. Infections, including candida, were more common in the secukinumab groups. Throughout the study (mean secukinumab exposure, 438.5 days; mean placebo exposure, 128.5 days), four patients in the secukinumab groups had a stroke (0.6 per 100 patient-years; 95% confidence interval [CI], 0.2 to 1.5), and two had a myocardial infarction (0.3 per 100 patient-years; 95% CI, 0.0 to 1.0), as compared with no patients in the placebo group. CONCLUSIONS Secukinumab was more effective than placebo in patients with psoriatic arthritis, which validates interleukin-17A as a therapeutic target. Infections were more common in the secukinumab groups than in the placebo group. The study was neither large enough nor long enough to evaluate uncommon serious adverse events or the risks associated with long-term use. (Funded by Novartis Pharma; ClinicalTrials.gov number, NCT01392326.).
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Affiliation(s)
- Philip J Mease
- From the Swedish Medical Center and the University of Washington - both in Seattle (P.J.M.); University of Glasgow, Glasgow (I.B.M.), and Guy's and St. Thomas' NHS Foundation Trust, London (B.K.) - both in the United Kingdom; University of California, San Diego, School of Medicine, San Diego (A.K.); Memorial University, St. John's, NL, Canada (P.R.); Leiden University Medical Center, Leiden (D.H.), and University of Amsterdam and Atrium Medical Center, Amsterdam (R.L.) - all in the Netherlands; University of Queensland, Brisbane, Australia (P.N.); Novartis Pharmaceuticals, East Hanover, NJ (L.P., J.Y.); and Novartis Pharma, Basel, Switzerland (H.B.R., S.M.)
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McInnes IB, Mease PJ, Kirkham B, Kavanaugh A, Ritchlin CT, Rahman P, van der Heijde D, Landewé R, Conaghan PG, Gottlieb AB, Richards H, Pricop L, Ligozio G, Patekar M, Mpofu S. Secukinumab, a human anti-interleukin-17A monoclonal antibody, in patients with psoriatic arthritis (FUTURE 2): a randomised, double-blind, placebo-controlled, phase 3 trial. Lancet 2015; 386:1137-46. [PMID: 26135703 DOI: 10.1016/s0140-6736(15)61134-5] [Citation(s) in RCA: 604] [Impact Index Per Article: 67.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
BACKGROUND Interleukin 17A is a proinflammatory cytokine that is implicated in the pathogenesis of psoriatic arthritis. We assessed the efficacy and safety of subcutaneous secukinumab, a human anti-interleukin-17A monoclonal antibody, in patients with psoriatic arthritis. METHODS In this phase 3, double-blind, placebo-controlled study undertaken at 76 centres in Asia, Australia, Canada, Europe, and the USA, adults (aged ≥18 years old) with active psoriatic arthritis were randomly allocated in a 1:1:1:1 ratio with computer-generated blocks to receive subcutaneous placebo or secukinumab 300 mg, 150 mg, or 75 mg once a week from baseline and then every 4 weeks from week 4. Patients and investigators were masked to treatment assignment. The primary endpoint was the proportion of patients achieving at least 20% improvement in the American College of Rheumatology response criteria (ACR20) at week 24. Analysis was by intention to treat. This study is registered with ClinicalTrials.gov, number NCT01752634. FINDINGS Between April 14, and Nov 25, 2013, 397 patients were randomly assigned to receive secukinumab 300 mg (n=100), 150 mg (n=100), 75 mg (n=99), or placebo (n=98). A significantly higher proportion of patients achieved an ACR20 at week 24 with secukinumab 300 mg (54 [54%] patients; odds ratio versus placebo 6·81, 95% CI 3·42-13·56; p<0·0001), 150 mg (51 [51%] patients; 6·52, 3·25-13·08; p<0·0001), and 75 mg (29 [29%] patients; 2·32, 1·14-4·73; p=0·0399) versus placebo (15 [15%] patients). Up to week 16, the most common adverse events were upper respiratory tract infections (four [4%], eight [8%], ten [10%], and seven [7%] with secukinumab 300 mg, 150 mg, 75 mg, and placebo, respectively) and nasopharyngitis (six [6%], four [4%], six [6%], and eight [8%], respectively). Serious adverse events were reported by five (5%), one (1%), and four (4%) patients in the secukinumab 300 mg, 150 mg, and 75 mg groups, respectively, compared with two (2%) in the placebo group. No deaths were reported. INTERPRETATION Subcutaneous secukinumab 300 mg and 150 mg improved the signs and symptoms of psoriatic arthritis, suggesting that secukinumab is a potential future treatment option for patients with this disorder. FUNDING Novartis.
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Affiliation(s)
- Iain B McInnes
- Institute of Infection, Immunity and Inflammation, University of Glasgow, Glasgow, UK.
| | - Philip J Mease
- Swedish Medical Center and University of Washington, Seattle, WA, USA
| | - Bruce Kirkham
- Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Arthur Kavanaugh
- Department of Internal Medicine, Division of Rheumatology, Allergy and Immunology, San Diego School of Medicine, San Diego, CA, USA
| | - Christopher T Ritchlin
- Allergy/Immunology and Rheumatology Division, University of Rochester, Rochester, NY, USA
| | | | | | - Robert Landewé
- Amsterdam Rheumatology and Immunology Center, Amsterdam, and Atrium Medical Center, Heerlen, Netherlands
| | - Philip G Conaghan
- NIHR Leeds Musculoskeletal Biomedical Research Unit and University of Leeds, Leeds, UK
| | - Alice B Gottlieb
- Department of Dermatology, Tufts Medical Center, Boston, MA, USA
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Chaptini C, Quinn S, Marshman G. Durable dermatology life quality index improvements in patients on biologics associated with psoriasis areas and severity index: a longitudinal study. Australas J Dermatol 2015; 57:e72-5. [DOI: 10.1111/ajd.12353] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2014] [Accepted: 04/23/2015] [Indexed: 11/30/2022]
Affiliation(s)
- Cassandra Chaptini
- Department of Dermatology; Flinders Medical Centre; Adelaide South Australia Australia
| | - Steve Quinn
- School of Medicine; Flinders University; Adelaide South Australia Australia
| | - Gillian Marshman
- Department of Dermatology; Flinders Medical Centre; Adelaide South Australia Australia
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Ohtsuki M, Morita A, Abe M, Takahashi H, Seko N, Karpov A, Shima T, Papavassilis C, Nakagawa H. Secukinumab efficacy and safety in Japanese patients with moderate-to-severe plaque psoriasis: subanalysis from ERASURE, a randomized, placebo-controlled, phase 3 study. J Dermatol 2014; 41:1039-46. [PMID: 25354738 DOI: 10.1111/1346-8138.12668] [Citation(s) in RCA: 67] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2014] [Accepted: 09/09/2014] [Indexed: 12/14/2022]
Abstract
Secukinumab, a fully human anti-IL-17A monoclonal antibody, neutralizes IL-17A, a key cytokine in the pathogenesis of psoriasis. Efficacy and safety of secukinumab was evaluated in Japanese patients with moderate-to-severe plaque psoriasis as part of a large Phase 3 global study (ERASURE). In this 52-week, double-blind study (ClinicalTrials.gov Identifier: NCT01365455, JapicCTI-111529), 87 patients from Japan (11.8% of 738 patients randomized in the overall study population) were equally randomized to receive secukinumab 300 mg or 150 mg, or placebo once weekly at baseline and at Weeks 1, 2, 3 and 4, then every 4 weeks. Co-primary endpoints (Week 12) were ≥75% improvement in psoriasis area-and-severity index (PASI 75) from baseline and a score of 0 (clear) or 1 (almost clear) on a 5-point Investigator's Global Assessment scale (IGA mod 2011 0/1) versus placebo. PASI 75 and IGA mod 2011 0/1 responses at Week 12 were superior with secukinumab 300 mg (82.8% and 55.2%, respectively) or 150 mg (86.2% and 55.2%, respectively) versus placebo (6.9% and 3.4%, respectively; P < 0.0001 for all). Greater than 90% improvement in PASI (PASI 90) was also superior with secukinumab 300 mg (62.1%) or 150 mg (55.2%) versus placebo (0.0%) at Week 12 (P < 0.0001 for both). Clinical responses were sustained up to Week 52 in the majority of patients. During a 12-week induction period, adverse event incidences were 48.3% with secukinumab 300 mg, 55.2% with 150 mg, and 41.4% with placebo. Secukinumab showed robust and sustainable efficacy in symptom reduction for moderate-to-severe plaque psoriasis in the Japanese patients.
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Langley RG, Elewski BE, Lebwohl M, Reich K, Griffiths CEM, Papp K, Puig L, Nakagawa H, Spelman L, Sigurgeirsson B, Rivas E, Tsai TF, Wasel N, Tyring S, Salko T, Hampele I, Notter M, Karpov A, Helou S, Papavassilis C. Secukinumab in plaque psoriasis--results of two phase 3 trials. N Engl J Med 2014; 371:326-38. [PMID: 25007392 DOI: 10.1056/nejmoa1314258] [Citation(s) in RCA: 1412] [Impact Index Per Article: 141.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
BACKGROUND Interleukin-17A is considered to be central to the pathogenesis of psoriasis. We evaluated secukinumab, a fully human anti-interleukin-17A monoclonal antibody, in patients with moderate-to-severe plaque psoriasis. METHODS In two phase 3, double-blind, 52-week trials, ERASURE (Efficacy of Response and Safety of Two Fixed Secukinumab Regimens in Psoriasis) and FIXTURE (Full Year Investigative Examination of Secukinumab vs. Etanercept Using Two Dosing Regimens to Determine Efficacy in Psoriasis), we randomly assigned 738 patients (in the ERASURE study) and 1306 patients (in the FIXTURE study) to subcutaneous secukinumab at a dose of 300 mg or 150 mg (administered once weekly for 5 weeks, then every 4 weeks), placebo, or (in the FIXTURE study only) etanercept at a dose of 50 mg (administered twice weekly for 12 weeks, then once weekly). The objective of each study was to show the superiority of secukinumab over placebo at week 12 with respect to the proportion of patients who had a reduction of 75% or more from baseline in the psoriasis area-and-severity index score (PASI 75) and a score of 0 (clear) or 1 (almost clear) on a 5-point modified investigator's global assessment (coprimary end points). RESULTS The proportion of patients who met the criterion for PASI 75 at week 12 was higher with each secukinumab dose than with placebo or etanercept: in the ERASURE study, the rates were 81.6% with 300 mg of secukinumab, 71.6% with 150 mg of secukinumab, and 4.5% with placebo; in the FIXTURE study, the rates were 77.1% with 300 mg of secukinumab, 67.0% with 150 mg of secukinumab, 44.0% with etanercept, and 4.9% with placebo (P<0.001 for each secukinumab dose vs. comparators). The proportion of patients with a response of 0 or 1 on the modified investigator's global assessment at week 12 was higher with each secukinumab dose than with placebo or etanercept: in the ERASURE study, the rates were 65.3% with 300 mg of secukinumab, 51.2% with 150 mg of secukinumab, and 2.4% with placebo; in the FIXTURE study, the rates were 62.5% with 300 mg of secukinumab, 51.1% with 150 mg of secukinumab, 27.2% with etanercept, and 2.8% with placebo (P<0.001 for each secukinumab dose vs. comparators). The rates of infection were higher with secukinumab than with placebo in both studies and were similar to those with etanercept. CONCLUSIONS Secukinumab was effective for psoriasis in two randomized trials, validating interleukin-17A as a therapeutic target. (Funded by Novartis Pharmaceuticals; ERASURE and FIXTURE ClinicalTrials.gov numbers, NCT01365455 and NCT01358578, respectively.).
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Affiliation(s)
- Richard G Langley
- From Dalhousie University, Halifax, NS (R.G.L.), Clinical Research (K.P.) and Probity Medical Research (K.P., L.S.), Waterloo, ON, and Stratica Medical and Probity Medical Research, Edmonton, AB (N.W.) - all in Canada; University of Alabama, Birmingham (B.E.E.); Mount Sinai Hospital, New York (M.L.); Dermatologikum Hamburg and Georg-August-Universität, Göttingen, Germany (K.R.); Dermatology Centre, Salford Royal Hospital, University of Manchester, Manchester Academic Health Science Centre, Manchester, United Kingdom (C.E.M.G.); Hospital de Sant Pau, Barcelona (L.P.); Jikei University School of Medicine, Tokyo (H.N.); Veracity Clinical Research, Woolloongabba, QLD, Australia (L.S.); Faculty of Medicine, Department of Dermatology, University of Iceland, Reykjavik (B.S.); Dermos, Guatemala City, Guatemala (E.R.); Department of Dermatology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei (T.-F.T.); University of Texas Health Science Center and Center for Clinical Studies, Houston (S.T.); and Novartis Pharma, Basel, Switzerland (T.S., I.H., M.N., A.K., S.H., C.P.)
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Why Statistics Matter: Limited Inter-Rater Agreement Prevents Using the Psoriasis Area and Severity Index as a Unique Determinant of Therapeutic Decision in Psoriasis. J Invest Dermatol 2012; 132:2171-5. [DOI: 10.1038/jid.2012.124] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Staidle JP, Dabade TS, Feldman SR. A pharmacoeconomic analysis of severe psoriasis therapy: a review of treatment choices and cost efficiency. Expert Opin Pharmacother 2011; 12:2041-54. [PMID: 21736530 DOI: 10.1517/14656566.2011.590475] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
INTRODUCTION Psoriasis is a chronic, inflammatory disease afflicting 2% of the US population; it results in significant morbidity. The annual healthcare costs related to psoriasis are an estimated $11.3 billion and, with an expanding biologic market, an updated costs analysis is needed. AREAS COVERED Current treatments, including systemic agents (acitretin, cyclosporine, methotrexate), phototherapies and all available biologics (adalimumab, etanercept, infliximab, alefacept, ustekinumab) appropriate for severe psoriasis are described mechanistically and with regard to their efficacy, quality-of-life improvements and side effects. A cost-efficacy model considering US health-system-based annual costs, clinical and quality-of-life improvements was created. Reported Psoriasis Area and Severity Index improvement of 75% from baseline (PASI-75) scores, Dermatology Life Quality Index (DLQI) improvements and estimated costs of medications are described. Annual costs ranged from $1330 for methotrexate to $48,731 for high-dose etanercept. The lowest cost per achieving DLQI minimally important difference was from phototherapy; the highest was from alefacept. The lowest costs per patient achieving PASI-75 was from methotrexate and the highest was from alefacept. EXPERT OPINION Phototherapies and methotrexate offer high efficacy for their costs. Therapeutic approaches must be individualized for each patient given all considerations described.
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Affiliation(s)
- Jonathan P Staidle
- Wake Forest University School of Medicine, Medical Center Boulevard, Department of Dermatology, Winston-Salem, NC 27157-1071, USA
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Abstract
BACKGROUND The first Canadian Guidelines for the Management of Plaque Psoriasis were recently published, reflecting an evidence-based analysis of psoriasis therapies available in Canada. The guidelines advocate patient-centered psoriasis care in which physicians explore appropriate options to find safe therapies that patients will adhere to and be satisfied with over the long term. OBJECTIVE To update the discussion in the guidelines regarding new and emerging therapies and trends in psoriasis clinical research. METHODS Searches of Medline and clinicaltrials.gov were undertaken to identify new and emerging psoriasis therapies as of March 2009. RESULTS Since May 2008, when published evidence was evaluated for the guidelines, one new drug, ustekinumab, has been approved for moderate to severe psoriasis. New formulations and combinations of existing drugs are expected to reach the Canadian market shortly. Novel agents continue to move through clinical development. CONCLUSION With the introduction and removal of antipsoriatic therapies from the Canadian market, the therapeutic landscape continues to shift. An increasing number of head-to-head comparisons and the reporting of ambitious treatment outcomes will simplify physicians' evaluation of treatment options. Recognition of quality of life as a key goal of psoriasis treatment is another hopeful trend, consistent with the principles of patient-centered care.
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