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Bang AS, Hakimi M, Tahir P, Bhutani T, Leslie KS. Biologic Therapies in HIV/AIDS Patients with Inflammatory Diseases: A Systematic Review of the Literature. AIDS Patient Care STDS 2023; 37:215-242. [PMID: 37083445 DOI: 10.1089/apc.2022.0197] [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: 04/22/2023] Open
Abstract
Biologic therapies have been increasingly developed and used for the treatment of severe inflammatory diseases. However, the safety and efficacy profile of biologic drugs in patients with HIV is not well established as this patient population is historically excluded from clinical trials. We review the available evidence of biologic use in people with HIV. We conducted a systematic review of the literature up to June 29, 2022 and included studies that treated patients with HIV who have inflammatory disease using biologic drugs. Clinical data regarding safety and efficacy were abstracted into tables. One hundred twelve studies were included, and 179 patients were included in our study. Nearly all classes of biologics drugs had a favorable safety profile with minimal or minor adverse events. Anti-CD-20 inhibitors and TNF-alpha inhibitors were associated with opportunistic infections. Transient increase in HIV viral load was noted with use of some agents such as TNF-alpha inhibitors. The quality of evidence is low, restricted to case reports and retrospective reviews. However, the safety profile of biologics observed in these patients with HIV was overall favorable.
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Affiliation(s)
- Alexander S Bang
- Department of Dermatology, Weill Cornell Medicine, New York, New York, USA
- Dermatology Service, Memorial Sloan Kettering Cancer Center, New York, New York, USA
- Department of Dermatology, Stanford Medicine, Redwood City, California, USA
| | - Marwa Hakimi
- Department of Dermatology and University of California San Francisco, San Francisco, California, USA
| | - Peggy Tahir
- UCSF Library, University of California San Francisco, San Francisco, California, USA
| | - Tina Bhutani
- Department of Dermatology and University of California San Francisco, San Francisco, California, USA
| | - Kieron S Leslie
- Department of Dermatology and University of California San Francisco, San Francisco, California, USA
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Qian F, Yan Y, Huang J, Xu W, Zhu Y, Liu J, Wu X, Chen F. Use of ixekizumab in an HIV-positive patient with psoriatic arthritis. Int J STD AIDS 2022; 33:519-521. [PMID: 35220812 DOI: 10.1177/09564624221076289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Psoriasis is a chronic immune-mediated disease of the skin. The incidence of psoriasis among people living with HIV (PLHIV) is higher than that in the general population. The mechanism is complex, the manifestations are varied, and the treatment is difficult. Biotherapy has greatly alleviated psoriasis, but clinical trials often exclude PLHIV, and evidence is limited to case reports. Here, we report a man living with psoriatic arthritis who had poor response to traditional treatments. After receiving the anti-interleukin (IL)-17 monoclonal antibody (ixekizumab), the arthritis symptoms were significantly relieved, while CD4+ T cell count increased and the viral load of HIV-1 remained undetectable in combination with antiretroviral therapy (ART). In conclusion, anti-IL-17 monoclonal antibody is a promising and safe treatment for psoriatic arthritis in HIV-positive patients.
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Affiliation(s)
- Feng Qian
- Department of Infectious Diseases, 590441Affiliated Infectious Diseases Hospital of Soochow University, Suzhou, China
| | - Yujuan Yan
- Department of Infectious Diseases, 590441Affiliated Infectious Diseases Hospital of Soochow University, Suzhou, China
| | - Jinlong Huang
- Department of Infectious Diseases, 590441Affiliated Infectious Diseases Hospital of Soochow University, Suzhou, China
| | - Weilu Xu
- Department of Infectious Diseases, 590441Affiliated Infectious Diseases Hospital of Soochow University, Suzhou, China
| | - Yueping Zhu
- Department of Infectious Diseases, 590441Affiliated Infectious Diseases Hospital of Soochow University, Suzhou, China
| | - Jin Liu
- Department of Infectious Diseases, 590441Affiliated Infectious Diseases Hospital of Soochow University, Suzhou, China
| | - Xuehua Wu
- Department of Infectious Diseases, 590441Affiliated Infectious Diseases Hospital of Soochow University, Suzhou, China
| | - Fan Chen
- Department of Infectious Diseases, 590441Affiliated Infectious Diseases Hospital of Soochow University, Suzhou, China
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Hong JJ, Hadeler EK, Mosca ML, Brownstone ND, Bhutani T, Liao WJ. TNF-alpha inhibitors and ustekinumab for the treatment of psoriasis: therapeutic utility in the era of IL-17 and IL-23 inhibitors. JOURNAL OF PSORIASIS AND PSORIATIC ARTHRITIS 2022; 7:79-92. [PMID: 35757187 PMCID: PMC9229820 DOI: 10.1177/24755303211047479] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Psoriasis is a chronic inflammatory condition for which eleven FDA-approved biologic therapies are approved. Over the past decade, studies have documented the higher efficacy of IL-17 and IL-23 inhibitors for the treatment of psoriasis compared to the TNF-alpha inhibitors and ustekinumab, an IL-12/23 inhibitor. Despite this, there remains an important role for the use of TNF-alpha inhibitors and ustekinumab in the treatment of psoriasis. Here, we review how considerations of infection and malignancy risk, patient demographics, treatment resistance, and co-morbidities may make certain TNF-alpha inhibitors or ustekinumab an excellent choice for therapy in particular patient subgroups.
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Affiliation(s)
- Julie J Hong
- University of California San Francisco, Department of Dermatology, Psoriasis and Skin Treatment Center
| | - Edward K Hadeler
- University of California San Francisco, Department of Dermatology, Psoriasis and Skin Treatment Center
| | - Megan L Mosca
- University of California San Francisco, Department of Dermatology, Psoriasis and Skin Treatment Center
| | - Nicholas D Brownstone
- University of California San Francisco, Department of Dermatology, Psoriasis and Skin Treatment Center
| | - Tina Bhutani
- University of California San Francisco, Department of Dermatology, Psoriasis and Skin Treatment Center
| | - Wilson J Liao
- University of California San Francisco, Department of Dermatology, Psoriasis and Skin Treatment Center
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Motolese A, Ceccarelli M, Macca L, Li Pomi F, Ingrasciotta Y, Nunnari G, Guarneri C. Novel Therapeutic Approaches to Psoriasis and Risk of Infectious Disease. Biomedicines 2022; 10:biomedicines10020228. [PMID: 35203438 PMCID: PMC8869084 DOI: 10.3390/biomedicines10020228] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2022] [Revised: 01/12/2022] [Accepted: 01/18/2022] [Indexed: 01/22/2023] Open
Abstract
Psoriasis is a chronic immune-mediated skin and joint disease, with a plethora of comorbidities, characterized by a certain genetic predisposition, and a complex pathogenesis based on the IL-23/IL-17 pathway. There is no doubt that the patients affected by psoriasis are more susceptible to infections as well as that the risk of infection is higher in psoriatic subjects than in the general population. The advent of biotechnological agents on the therapeutic arsenal actually available for the treatment of moderate-to-severe patients, given the fact that the severity of the disease is a predictor of the level of infectious risk, has raised the question of whether these ‘new’ drugs could be considered a safer option and how they can be used in selected cases. Old and newer strategies in cases of chronic infectious conditions are reviewed under the light of clinical trials and other studies present in literature.
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Affiliation(s)
- Alfonso Motolese
- Department of Clinical and Experimental Medicine, Section of Dermatology, University of Messina, Messina, Italy C/O A.O.U.P. “Gaetano Martino”, via Consolare Valeria, 1, 98125 Messina, Italy; (A.M.); (L.M.); (F.L.P.)
| | - Manuela Ceccarelli
- Department of Clinical and Experimental Medicine, Unit of Infectious Diseases, University of Catania, Catania, Italy C/O ARNAS “Garibaldi”, “Nesima” Hospital, via Palermo 636, 95122 Catania, Italy;
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, Unit of Infectious Diseases, University of Messina, Messina, Italy C/O A.O.U.P. “Gaetano Martino”, via Consolare Valeria, 1, 98125 Messina, Italy
| | - Laura Macca
- Department of Clinical and Experimental Medicine, Section of Dermatology, University of Messina, Messina, Italy C/O A.O.U.P. “Gaetano Martino”, via Consolare Valeria, 1, 98125 Messina, Italy; (A.M.); (L.M.); (F.L.P.)
| | - Federica Li Pomi
- Department of Clinical and Experimental Medicine, Section of Dermatology, University of Messina, Messina, Italy C/O A.O.U.P. “Gaetano Martino”, via Consolare Valeria, 1, 98125 Messina, Italy; (A.M.); (L.M.); (F.L.P.)
| | - Ylenia Ingrasciotta
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, Section of Pharmacology, University of Messina, Messina, Italy C/O A.O.U.P. “Gaetano Martino”, via Consolare Valeria, 1, 98125 Messina, Italy;
| | - Giuseppe Nunnari
- Department of Clinical and Experimental Medicine, Unit of Infectious Diseases, University of Messina, Messina, Italy C/O A.O.U.P. “Gaetano Martino”, via Consolare Valeria, 1, 98124 Messina, Italy;
| | - Claudio Guarneri
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, Section of Dermatology, University of Messina, Messina, Italy C/O A.O.U.P. “Gaetano Martino”, via Consolare Valeria, 1, 98125 Messina, Italy
- Correspondence: ; Tel.: +39-090-2212-894; Fax: +39-09-029-27691
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The use of secukinumab in an HIV-positive patient with axial spondyloarthritis: a case-based review. Clin Rheumatol 2021; 40:5111-5114. [PMID: 34529181 DOI: 10.1007/s10067-021-05922-1] [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: 08/10/2021] [Revised: 09/08/2021] [Accepted: 09/09/2021] [Indexed: 02/06/2023]
Abstract
Axial spondyloarthritis in HIV-positive patients raises specific treatment challenges as immunosuppressant and immunomodulating agents may adversely affect the course of the HIV infection and could increase the risk of opportunistic infections. The efficacy and safety of secukinumab in patients with HIV is unknown due to HIV patients were largely excluded from clinical trials and nowadays, the clinical evidence for the treatment with biological disease-modifying antirheumatic drugs (DMARDs) is provided from scarce case reports and case series. We hereby discuss a case of a male patient with concomitant axial spondyloarthritis and HIV infection successfully treated with secukinumab, achieving disease remission and without any associated complications. Nevertheless, the potential long-term effects in the use of monoclonal antibodies with a special emphasis on opportunistic infections, malignancies, and loss of HIV control clearly need to be determined more thoroughly, and continued research efforts are necessary before a clear recommendation can be made.
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