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Do H, Babbush Graber K, Chernoff KA, Melnick LE. Evolving Landscape of Biologic Therapy for Pediatric Psoriasis. Dermatol Clin 2024; 42:377-386. [PMID: 38796269 DOI: 10.1016/j.det.2024.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2024]
Abstract
Pediatric psoriasis is a chronic inflammatory skin condition. Current treatment modalities include topical medications, phototherapy, and systemic drugs, including biological agents. In cases of moderate-to-severe psoriasis recalcitrant to other therapies, biological therapies are often an attractive option given their dosing schedules, safety profiles, and need for less frequent laboratory monitoring, when compared with traditional systemic therapies. This article reviews biological treatment options approved for pediatric psoriasis and identifies others actively under investigation.
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Affiliation(s)
- Huongly Do
- Weill Cornell Medical College, New York, NY, USA
| | - Kayla Babbush Graber
- Department of Dermatology, Weill Cornell Medicine, 1305 York Avenue, 9th Floor, New York, NY 10021, USA
| | - Karen A Chernoff
- Department of Dermatology, Weill Cornell Medicine, 1305 York Avenue, 9th Floor, New York, NY 10021, USA
| | - Laura E Melnick
- Department of Dermatology, Weill Cornell Medicine, 1305 York Avenue, 9th Floor, New York, NY 10021, USA.
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2
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Bagri NK, King H, Ramanan AV. Secukinumab for children and adolescents with enthesitis-related arthritis and psoriatic arthritis: lessons from treatment in adults and the way forward. Expert Rev Clin Immunol 2024; 20:435-440. [PMID: 38186357 DOI: 10.1080/1744666x.2024.2303340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Accepted: 01/05/2024] [Indexed: 01/09/2024]
Abstract
INTRODUCTION Targeting IL-17A using Secukinumab, a humanized monoclonal immunoglobulin G1 (IgG1)/κ against IL-17A is a therapeutic option for immune-mediated disorders such as psoriasis and ankylosing spondylitis. The US Food and Drug Administration and the European Medicines Agency have approved it for the treatment of moderate to severe plaque psoriasis, active psoriatic arthritis, ankylosing spondylitis, and non-radiographic axial spondylarthritis. Recently it has also been approved for use in children with severe plaque psoriasis, active psoriatic arthritis, and enthesitis-related arthritis. AREAS COVERED This review focuses on the role of Secukinumab in the management of children and adolescents with enthesitis-related arthritis and psoriatic arthritis. We discuss the salient findings of pivotal RCTs and other studies supporting the use of Secukinumab in adults and children, in particular, focusing on its safety and efficacy. EXPERT OPINION Secukinumab is a therapeutic target for psoriasis, psoriatic arthritis, and spondyloarthropathies in both adults and children. No major safety signals are observed with its use in short-term follow-up. Thus far, Secukinumab has not been found to significantly increase the risk of tuberculosis (TB).
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Affiliation(s)
- Narendra Kumar Bagri
- Division of Pediatric Rheumatology, Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
| | - Hayley King
- Department of Paediatric Rheumatology, Bristol Royal Hospital for Children, Bristol, UK
| | - A V Ramanan
- Department of Paediatric Rheumatology, Bristol Royal Hospital for Children, Bristol, UK
- Translational Health Science, University of Bristol, Bristol, UK
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3
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Hoff J, Spora L, Fang Y, Brüggen MC, Möhrenschlager M. Dramatic early improvement of psoriasis in an 11-year old boy after four doses of secukinumab following an alternative dosing scheme. J Eur Acad Dermatol Venereol 2024; 38:e399-e400. [PMID: 37909322 DOI: 10.1111/jdv.19620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Accepted: 10/27/2023] [Indexed: 11/03/2023]
Affiliation(s)
- Julia Hoff
- Department of Dermatology, Hochgebirgsklinik, Davos, Switzerland
| | - Leo Spora
- Department of Dermatology, Hochgebirgsklinik, Davos, Switzerland
- Christine Kühne Center for Allergy Research and Education, Davos, Switzerland
| | - Yongxing Fang
- Christine Kühne Center for Allergy Research and Education, Davos, Switzerland
- Department of Dermatology, University of Zurich, Zurich, Switzerland
| | - Marie-Charlotte Brüggen
- Department of Dermatology, Hochgebirgsklinik, Davos, Switzerland
- Christine Kühne Center for Allergy Research and Education, Davos, Switzerland
- Department of Dermatology, University of Zurich, Zurich, Switzerland
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Shao X, Huang K, Chen A, Liu C, Xiong J, Pan Y, Chen X, Wang P. Successful guselkumab treatment of a refractory psoriasis patient with Graves' disease: a case report. J Int Med Res 2024; 52:3000605241239856. [PMID: 38656269 PMCID: PMC11044775 DOI: 10.1177/03000605241239856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Accepted: 02/29/2024] [Indexed: 04/26/2024] Open
Abstract
Psoriasis is a chronic inflammatory skin disease. It is associated with many autoimmune diseases such as rheumatoid arthritis, Crohn's disease and thyroid diseases. Graves' disease (GD) is a common organ-specific autoimmune disease characterized by diffuse goitre and thyrotoxicosis. Management of psoriasis patients with GD is challenging. This current report presents the case of a 34-year-old female patient with refractory psoriasis with GD who was hospitalized for drug eruption and then experienced new-onset erythema and scaling following treatment with adalimumab and secukinumab. Despite the sequential move to phototherapy, tofacitinib and ustekinumab, the erythema and scaling continued unabated and exacerbated. Finally, switching to guselkumab resulted in the psoriasis lesions significantly improving. These findings suggest that guselkumab might be an effective treatment option for refractory psoriasis combined with GD.
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Affiliation(s)
- Xinyi Shao
- Department of Dermatology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Kun Huang
- Department of Dermatology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Aijun Chen
- Department of Dermatology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Chuan Liu
- Department of Dermatology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Jianxia Xiong
- Department of Dermatology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Yun Pan
- Department of Dermatology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Xiaoli Chen
- Department of Dermatology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Ping Wang
- Department of Dermatology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
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Greenzaid J, Feldman S. Clinical Pharmacokinetic and Pharmacodynamic Considerations in the Treatment of Moderate-to-Severe Psoriasis. Clin Pharmacokinet 2024; 63:137-153. [PMID: 38280146 DOI: 10.1007/s40262-023-01341-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/19/2023] [Indexed: 01/29/2024]
Abstract
Psoriasis is a common inflammatory immune disorder due to chronic activation of the adaptive and innate immune responses. Therapies for psoriasis target reducing inflammatory cytokines such as tumor necrosis factor-alpha, interleukin-17, and interleukin-22. Patients with inflammatory disorders have reduced metabolism by cytochrome P450 enzymes in the liver. The pharmacokinetic and pharmacodynamic changes due to psoriasis also have an impact on reaching therapeutic concentrations of the drug. Pharmacokinetic and pharmacodynamic data help determine the safety and clinical considerations necessary when utilizing drugs for plaque psoriasis. A literature search was performed on PubMed and Ovid MEDLINE for the pharmacokinetic and pharmacodynamic data of oral therapies and biologics utilized for moderate-to-severe plaque psoriasis. The findings from the literature search were organized into two sections: oral therapies and biologics. The pharmacokinetic and pharmacodynamic parameters in healthy patients, patients with psoriasis, and special populations are discussed in each section. The oral therapies described in this review include methotrexate, cyclosporine, apremilast, tofacitinib, and deucravacitinib. Biologics include tumor necrosis factor-alpha inhibitors, interleukin-17 inhibitors, ustekinumab, and interleukin-23 inhibitors. Clinical considerations for these therapies include drug toxicities, dosing frequency, and anti-drug antibodies. Methotrexate and cyclosporine have a risk for hepatoxicity and renal impairment, respectively. Moreover, drugs metabolized via cytochrome P450, including tofacitinib and apremilast have decreased clearance in patients with psoriasis, requiring dose adjustments. Patients treated with therapies such as adalimumab can develop anti-drug antibodies that reduce the long-term efficacy of the drug. Additionally, overweight patients benefit from more frequent dosing to achieve better psoriasis clearance.
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Affiliation(s)
- Jonathan Greenzaid
- Department of Dermatology, Center for Dermatology Research, Wake Forest University School of Medicine, 475 Vine St, Winston-Salem, NC, 27101, USA.
| | - Steven Feldman
- Department of Dermatology, Center for Dermatology Research, Wake Forest University School of Medicine, 475 Vine St, Winston-Salem, NC, 27101, USA
- Department of Pathology, Wake Forest University School of Medicine, Winston-Salem, NC, USA
- Department of Social Sciences & Health Policy, Wake Forest University School of Medicine, Winston-Salem, NC, USA
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George A, Lansang RP, Lansang P, Gooderham M. A Practical Guide to Using Biologics in Pediatric Dermatology. J Cutan Med Surg 2024; 28:59-67. [PMID: 38229411 PMCID: PMC10908204 DOI: 10.1177/12034754231222415] [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: 01/18/2024]
Abstract
Psoriasis, hidradenitis suppurativa (HS), atopic dermatitis (AD), and chronic spontaneous urticaria (CSU), are common, immune-mediated, chronic, inflammatory skin diseases that can affect the pediatric population. While there is adequate evidence supporting the use of biologics in pediatric patients, concerns regarding safety and efficacy amongst healthcare providers are not uncommon. However, new emerging evidence in this population highlights the safety of biologic therapy, making it crucial to review and establish a practical guide for their use. This article describes a methodological framework for initiating biologics in the management of pediatric psoriasis, HS, AD, and CSU, with a special focus on baseline work-up, monitoring, dosing, and considerations in this population.
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Affiliation(s)
- Annie George
- Temerty School of Medicine, University of Toronto, Toronto, ON, Canada
| | - Rafael Paolo Lansang
- Michael G. Degroote School of Medicine, McMaster University, Hamilton, ON, Canada
| | - Perla Lansang
- Temerty School of Medicine, University of Toronto, Toronto, ON, Canada
- Division of Dermatology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - Melinda Gooderham
- SKiN Centre for Dermatology, Peterborough, ON, Canada
- Probity Medical Research, Waterloo, ON, Canada
- Department of Medicine, Queen’s University, Kingston, ON, Canada
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Ruggiero A, Portarapillo A, Megna M, Patruno C, Napolitano M. Management Strategies for Pediatric Moderate-to-Severe Plaque Psoriasis: Spotlight on Biologics. Pediatric Health Med Ther 2023; 14:435-451. [PMID: 38024562 PMCID: PMC10656860 DOI: 10.2147/phmt.s389108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Accepted: 10/26/2023] [Indexed: 12/01/2023] Open
Abstract
Although psoriasis onset has been reported at any ages, in up to one-third of cases, it begins during childhood, with an estimated prevalence of about 2% in pediatric population. The management of moderate-to-severe forms of childhood psoriasis may represent a challenge for dermatologists, especially for parents' concerns about the need of systemic treatments. However, a prompt safe and effective treatment is mandatory in these patients, due to the significative impact that psoriasis may have on their quality of life, with well-known consequences on psychological health of both patients and caregivers. Due to the relatively frequent parents' refusal of systemic treatments, probably due to the fear of eventual adverse events, difficulties of oral or injective route, the management of moderate-to-severe forms still represents a challenge. Herein, we report a narrative review, aiming to resume the systemic treatments for pediatric psoriasis, focusing on the use of biologics and small molecules in the pediatric ages. The most widely used therapeutic strategies today for the pediatric population with moderate-severe psoriasis are traditional systemic therapies, while more innovative drugs such as biologics and small molecules now represent a somewhat unexplored but certainly promising field for unresponsive patients.
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Affiliation(s)
- Angelo Ruggiero
- Section of Dermatology, Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, 80131, Italy
| | - Antonio Portarapillo
- Section of Dermatology, Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, 80131, Italy
| | - Matteo Megna
- Section of Dermatology, Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, 80131, Italy
| | - Cataldo Patruno
- Department of Health Sciences, University Magna Graecia of Catanzaro, Catanzaro, Italy
| | - Maddalena Napolitano
- Section of Dermatology, Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, 80131, Italy
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Tada Y, Morita A, Yamanaka K, Kono M, Imafuku S, Okubo Y, Yamazaki F, Kawamura T, Itakura A, Ohtsuki M. Real-world retention rates and effectiveness of secukinumab in psoriasis: Results from a multicenter cohort study (RAILWAY). J Dermatol 2023; 50:1415-1426. [PMID: 37615243 DOI: 10.1111/1346-8138.16926] [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: 05/17/2023] [Revised: 07/10/2023] [Accepted: 08/01/2023] [Indexed: 08/25/2023]
Abstract
Psoriasis is a chronic, immune-mediated inflammatory skin disease with a high negative impact on patient's quality of life. Secukinumab, the first interleukin 17A inhibitor, has been used for the systemic treatment of psoriasis, but its long-term, real-world retention rates in Japan have not been fully investigated. In this multicenter, noninterventional, retrospective chart review study, the retention rate of secukinumab and its effectiveness among patients with psoriasis in Japan was evaluated up to 5 years. Data of patients who received secukinumab after December 26, 2014, were collected from medical charts obtained from seven sites, all certified for biologics use by the Japanese Dermatological Association. Patient characteristics, secukinumab retention, factors affecting secukinumab retention, reason for drug discontinuation, and effectiveness data were collected. The primary end point was secukinumab retention rate at week 52. A total of 123 patients were included in the analysis. Of these, 27 patients discontinued secukinumab by week 52, yielding a 78.0% (95% confidence interval, 69.6-84.4) retention rate at week 52. For patients whose Psoriasis Area and Severity Index (PASI) score was available, mean ± standard deviation PASI at baseline and at week 52 were 9.21 ± 7.37 and 1.4 ± 2.6, respectively. During the entire study period, "insufficient response" was the most common reason for discontinuation, and "history of biologics use" was a factor significantly associated with secukinumab discontinuation (hazard ratio, 1.72; p = 0.018). This study demonstrates the real-world retention rate and effectiveness of secukinumab in patients with psoriasis in Japan for up to 5 years and provides clinical insights into psoriasis treatment strategies.
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Affiliation(s)
- Yayoi Tada
- Department of Dermatology, Teikyo University School of Medicine, Tokyo, Japan
| | - Akimichi Morita
- Department of Geriatric and Environmental Dermatology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Keiichi Yamanaka
- Department of Dermatology, Mie University Graduate School of Medicine, Tsu, Japan
| | - Michihiro Kono
- Department of Dermatology and Plastic Surgery, Akita University Graduate School of Medicine, Akita, Japan
| | - Shinichi Imafuku
- Department of Dermatology, Fukuoka University Faculty of Medicine, Fukuoka, Japan
| | - Yukari Okubo
- Department of Dermatology, Tokyo Medical University, Tokyo, Japan
| | - Fumikazu Yamazaki
- Department of Dermatology, Tokai University School of Medicine, Isehara, Japan
| | - Taisuke Kawamura
- Immunology, Hepatology & Dermatology Medical Franchise Department, Medical Division, Novartis Pharma K.K., Tokyo, Japan
| | - Asako Itakura
- Immunology, Hepatology & Dermatology Medical Franchise Department, Medical Division, Novartis Pharma K.K., Tokyo, Japan
| | - Mamitaro Ohtsuki
- Department of Dermatology, Jichi Medical University, Shimotsuke, Japan
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Leung AKC, Barankin B, Lam JM, Leong KF. Childhood guttate psoriasis: an updated review. Drugs Context 2023; 12:2023-8-2. [PMID: 37908643 PMCID: PMC10615329 DOI: 10.7573/dic.2023-8-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2023] [Accepted: 09/25/2023] [Indexed: 11/02/2023] Open
Abstract
Background Guttate psoriasis is common and affects 0.5-2% of individuals in the paediatric age group. This review aims to familiarize physicians with the clinical manifestations, evaluation, diagnosis and proper management of guttate psoriasis. Methods A search was conducted in July 2023 in PubMed Clinical Queries using the key term "guttate psoriasis". The search strategy included all observational studies, clinical trials and reviews published within the past 10 years. The information retrieved from the search was used in the compilation of the present article. Results Guttate psoriasis typically presents with an abrupt onset of numerous, small, scattered, tear-drop-shaped, scaly, erythematous, pruritic papules and plaques. Sites of predilection include the trunk and proximal extremities. There may be a history of preceding streptococcal infection. Koebner phenomenon is characteristic. Guttate psoriasis may spontaneously remit within 3-4 months with no residual scarring, may intermittently recur and, in 40-50% of cases, may persist and progress to chronic plaque psoriasis. Given the possibility for spontaneous remission within several months, active treatment may not be necessary except for cosmetic purposes or because of pruritus. On the other hand, given the high rates of persistence of guttate psoriasis and progression to chronic plaque psoriasis, some authors suggest active treatment of this condition. Conclusion Various treatment options are available for guttate psoriasis. Triggering and exacerbating factors should be avoided if possible. Topical corticosteroids alone or in combination with other topical agents (e.g. tazarotene and vitamin D analogues) are the most rapid and efficient treatment for guttate psoriasis and are therefore the first-line treatment for mild cases. Other topical therapies include vitamin D analogues, calcineurin inhibitors, anthralin, coal tar and tazarotene. Ultraviolet phototherapy is the first-line therapy for moderate-to-severe guttate psoriasis, as it is more practical than topical therapy when treating widespread or numerous small lesions. Systemic immunosuppressive and immunomodulatory therapies (e.g. methotrexate, cyclosporine, retinoids, fumaric acid esters and biologics) may be considered for patients with moderate-to-severe guttate psoriasis who fail to respond to phototherapy and topical therapies.
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Affiliation(s)
- Alexander KC Leung
- Department of Pediatrics, The University of Calgary, Calgary, Alberta, Canada
- The Alberta Children’s Hospital, Calgary, Alberta, Canada
| | | | - Joseph M Lam
- Department of Pediatrics and Department of Dermatology and Skin Sciences, University of British Columbia, Vancouver, British Columbia, Canada
- BC Children’s Hospital, Vancouver, British Columbia, Canada
| | - Kin Fon Leong
- Pediatric Institute, Kuala Lumpur General Hospital, Kuala Lumpur, Malaysia
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10
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Sticherling M, Nikkels AF, Hamza AM, Kwong P, Szepietowski JC, El Sayed M, Ghislain PD, Khotko AA, Patekar M, Ortmann CE, Forrer P, Papanastasiou P, Keefe D. Secukinumab in Pediatric Patients with Plaque Psoriasis: Pooled Safety Analysis from Two Phase 3 Randomized Clinical Trials. Am J Clin Dermatol 2023; 24:821-835. [PMID: 37341961 PMCID: PMC10460311 DOI: 10.1007/s40257-023-00782-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/03/2023] [Indexed: 06/22/2023]
Abstract
BACKGROUND Plaque psoriasis affects ~ 1% of the pediatric population, negatively impacting quality of life. The efficacy and safety of secukinumab in pediatric patients with moderate to severe or severe chronic plaque psoriasis have been established in two pivotal phase 3 trials (open-label, NCT03668613; double-blind, NCT02471144). OBJECTIVES The aims were to report the pooled safety of secukinumab up to 52 weeks from two studies in subgroups of pediatric patients stratified by age and bodyweight, and to present, alongside the pediatric data, the pooled safety data from four pivotal adult secukinumab trials. METHODS The safety of secukinumab was evaluated in subgroups of pediatric patients defined by age (6 to < 12 and 12 to < 18 years) and bodyweight (< 25 kg, 25 to < 50 kg, and ≥ 50 kg) in the pooled population. Patients received secukinumab low dose (LD; 75/75/150 mg), secukinumab high dose (HD; 75/150/300 mg), placebo, or etanercept (0.8 mg/kg). For safety analyses, data were pooled from the pediatric studies NCT03668613 and NCT02471144, and presented alongside the pooled data from four adult pivotal studies (NCT01365455, NCT01636687, NCT01358578, NCT01555125). RESULTS A total of 198 pediatric patients (overall exposure: 184.6 patient-years [PY]) and 1989 adult patients (1749.5 PY) receiving secukinumab up to week 52 were included in this analysis. At week 52, the incidence of adverse events (AEs) was lower in the lower age and bodyweight subgroups. The AEs reported within these subgroups were consistent with the overall AEs reported in this analysis. Overall, exposure-adjusted incidence rates for treatment-emergent AEs were lower in the secukinumab-treated pediatric pool (198.8/100 PY) compared with the etanercept (266.3/100 PY) and adult pools (256.1/100 PY). Up to 52 weeks, the incidence rates of the AEs in the secukinumab-treated patients in the 6 to < 12 years subgroup and 12 to < 18 years subgroup were 167.7/100 PY and 214.7/100 PY, respectively. Similarly, incidence rates of the AEs in the secukinumab-treated patients in the < 25 kg, 25 kg to < 50 kg, and ≥ 50 kg subgroups were 177.3/100 PY, 192.5/100 PY, and 206.8/100 PY, respectively. Nasopharyngitis was the most frequently reported AE in secukinumab-treated pediatric patients across age (< 12 years: 11.8/100 PY; ≥ 12 years: 42.4/100 PY) and bodyweight (< 25 kg: 22.8/100 PY; 25 kg to < 50 kg: 19.0/100 PY; ≥ 50 kg: 43.0/100 PY). Of the 198 secukinumab-treated pediatric patients, one reported nail Candida, one reported skin Candida, and two reported vulvovaginal Candida. Transient and mostly mild events of neutropenia were observed with secukinumab, none leading to study treatment discontinuation. No incidence of treatment-emergent anti-drug antibodies was reported in pediatric patients treated with secukinumab. CONCLUSIONS Secukinumab was well tolerated in pediatric patients with moderate to severe and severe plaque psoriasis across age and bodyweight subgroups. The overall safety profile of secukinumab in pediatric patients was consistent with that of adult patients. CLINICALTRIALS GOV IDENTIFIER NCT03668613 (Novartis Study Code CAIN457A2311, referred to as A2311), actual study start date: August 29, 2018; actual primary completion date: September 19, 2019; estimated study completion date: September 14, 2023. NCT02471144 (Novartis Study Code CAIN457A2310, referred to as A2310), study start date: September 29, 2015; primary completion date: December 13, 2018; estimated study completion date: March 31, 2023.
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Affiliation(s)
- Michael Sticherling
- Hautklinik, Friedrich-Alexander-University of Erlangen-Nürnberg (FAU) Department of Dermatology, University Hospital Erlangen, Ulmenweg 18, 91054, Erlangen, Germany.
| | - Arjen F Nikkels
- Department of Dermatology, University Hospital Centre, CHU of Sart Tilman, University of Liège, 4000, Liège, Belgium
| | - Ashraf M Hamza
- Department of Dermatology and Andrology, Alexandria University, Alexandria, Egypt
| | - Pearl Kwong
- Solutions through Advanced Research, Jacksonville, FL, USA
| | - Jacek C Szepietowski
- Department of Dermatology, Venereology and Allergology, Medical University, Wrocław, Poland
| | | | | | - Alkes A Khotko
- GBUZ Clinical Dermatology and Venereological Dispensary, Krasnodar, Russia
| | | | | | | | | | - Deborah Keefe
- Novartis Pharmaceuticals Corporation, East Hanover, NJ, USA
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11
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Nikolaishvili M, Di Lernia V. Biological therapies for the treatment of psoriasis in pediatrics. Expert Opin Biol Ther 2023; 23:1219-1226. [PMID: 37936485 DOI: 10.1080/14712598.2023.2281496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Accepted: 11/06/2023] [Indexed: 11/09/2023]
Abstract
INTRODUCTION Psoriasis is a multifactorial, immune-mediated condition with predominant skin involvement. It may develop at any age. In one-third of patients, the first symptoms of psoriasis start during childhood or adolescence. A marked impairment of the quality of life of patients and their caregivers is often associated. AREAS COVERED Databases including PubMed and Clinicaltrials.gov were used to identify clinical studies involving pediatric patients with psoriasis. In the last few years, the implementation of therapy with drugs targeting cytokines like interleukin (IL)-12/23 and IL-17A has expanded the number of available therapeutic options in pediatric psoriasis. This review focuses on the latest evidence on the clinical efficacy and safety profile of drugs licensed for severe pediatric psoriasis. EXPERT OPINION Increasing knowledge about the pathogenetic mechanisms underlying pediatric psoriasis is leading to an improvement in disease management. Effective treatment is crucial in patients affected with moderate to severe disease to reduce the burden of the disease and avoid stigmatization. The treatment of pediatric psoriasis remains challenging for specific clinical subtypes, when difficult areas are involved, after resistance to multiple treatments, and when psoriatic arthritis is associated. A personalized approach and a thorough understanding of the disease are required to advance pediatric psoriasis care.
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Affiliation(s)
- Mariam Nikolaishvili
- Faculty of Medicine, Ivane Javakhishvili, Tbilisi State University, Tbilisi, Georgia
| | - Vito Di Lernia
- Dermatology Unit, Arcispedale Santa Maria Nuova, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
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12
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Krajewski PK, Szepietowski JC. Secukinumab for the treatment of moderate-to-severe plaque psoriasis in pediatric patients aged six years and older. Expert Rev Clin Immunol 2023:1-6. [PMID: 37191153 DOI: 10.1080/1744666x.2023.2214365] [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: 05/17/2023]
Abstract
INTRODUCTION Psoriasis (PSO) is a chronic, recurrent, inflammatory skin disorder that significantly influences patients' quality of life. The prevalence of PSO among children varies depending on the age and ranges from 0.12% at one year to 2% at 18 years. Due to systemic inflammation, PSO is associated with obesity, hypertension, inflammatory bowel disease, and cardiovascular incidences.Secukinumab is a fully human monoclonal antibody selectively targeting IL-17A. The drug has been approved for children aged 6-18 with moderate to severe plaque psoriasis. Nevertheless, only a few reports thoroughly describe its efficacy and safety in the pediatric population. AREAS COVERED This review aims to describe the efficacy and safety of secukinumab for the treatment of moderate-to-severe plaque PSO in pediatric patients aged six years and older. EXPERT OPINION Although there are only two clinical trials assessing the efficacy and safety of secukinumab in the pediatric population with plaque PSO, this therapy seems to be a significant advancement in managing those patients. Both dose regimens (depending on the weight, low-dose, 75/75/150 mg, and high-dose 75/150/300 mg) of secukinumab were more effective in achieving significant clinical improvement (PASI 75/90 and IGA response) than placebo or active-comparator. Both regimens showed good safety and tolerability profiles, with mostly mild AEs and no SAEs observed.
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Affiliation(s)
- Piotr K Krajewski
- Department of Dermatology, Venereology and Allergology, Wroclaw Medical University, Wrocław, Poland
| | - Jacek C Szepietowski
- Department of Dermatology, Venereology and Allergology, Wroclaw Medical University, Wrocław, Poland
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Saeki H, Mabuchi T, Asahina A, Abe M, Igarashi A, Imafuku S, Okubo Y, Komine M, Sano S, Torii H, Morita A, Yotsuyanagi H, Watanabe A, Ohtsuki M. English version of Japanese guidance for use of biologics for psoriasis (the 2022 version). J Dermatol 2023; 50:e41-e68. [PMID: 36582113 DOI: 10.1111/1346-8138.16691] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Revised: 12/05/2022] [Accepted: 12/07/2022] [Indexed: 12/31/2022]
Abstract
This is the English version of Japanese guidance for use of biologics for psoriasis (the 2022 version). As the first biologics for psoriasis in Japan, infliximab and adalimumab, anti-tumor necrosis factor-α antibodies, became available in the field of dermatology in 2010, followed by ustekinumab, an anti-interleukin (IL)-12/IL-23p40 antibody, which was launched in Japan in 2011. Moreover, after 2015, three IL-17 inhibitors, the IL-17A antibody preparations secukinumab and ixekizumab, and an anti-IL-17 receptor antibody preparation brodalumab were marketed. Furthermore, after 2018, the anti-IL23p19 antibody preparations guselkumab and risankizumab, the TNF inhibitor certolizumab pegol, the IL-23 inhibitor tildrakizumab, and the anti-IL-17A/F antibody bimekizumab were marketed. It is important for physicians to select appropriate biologic therapy for each psoriatic patient after due consideration of disease factors, treatment factors, and patient background factors, sharing such information with patients. The followings can be listed as points to be considered for the selection of biologics: drug effects (e.g., strength of effectiveness, time to onset of effectiveness, effectiveness against arthritis, primary failure, secondary failure), safety (e.g., infections, administration-related reactions, and relationships with other comorbidities), convenience for patients (e.g., hospital visit intervals, self-injection, maintenance therapy at clinics, feasibility of drug discontinuation/re-administration), and payment (medical costs) borne by patients. This guidance has been prepared with the aim of allowing dermatologists experienced in the treatment of psoriasis to use biologics appropriately according to the circumstances of individual patients after consideration of the above-mentioned factors.
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Affiliation(s)
- Hidehisa Saeki
- Department of Dermatology, Nippon Medical School, Tokyo, Japan
| | - Tomotaka Mabuchi
- Department of Dermatology, Tokai University School of Medicine, Isehara, Japan
| | - Akihiko Asahina
- Department of Dermatology, The Jikei University School of Medicine, Tokyo, Japan
| | | | | | - Shinichi Imafuku
- Department of Dermatology, Faculty of Medicine, Fukuoka University, Fukuoka, Japan
| | - Yukari Okubo
- Department of Dermatology, Tokyo Medical University, Tokyo, Japan
| | - Mayumi Komine
- Department of Dermatology, Jichi Medical University, Shimotsuke, Japan
| | - Shigetoshi Sano
- Department of Dermatology, Kochi Medical School, Kochi University, Kochi, India
| | - Hideshi Torii
- Division of Dermatology, Tokyo Yamate Medical Center, Tokyo, Japan
| | - Akimichi Morita
- Department of Geriatric and Environmental Dermatology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Hiroshi Yotsuyanagi
- Division of Infectious Diseases, Advanced Clinical Research Center, Institute of Medical Science, The University of Tokyo, Tokyo, Japan
| | - Akira Watanabe
- Research Division for Development of Anti-Infective Agents, Faculty of Medical Science and Welfare, Tohoku Bunka Gakuen University, Sendai, Japan
| | - Mamitaro Ohtsuki
- Department of Dermatology, Jichi Medical University, Shimotsuke, Japan
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Miao C, Chen Y, Wang Z, Xiang X, Liu Y, Xu Z. Real-world data on the use of secukinumab and acitretin in pediatric generalized pustular psoriasis. J Dermatol 2023; 50:258-261. [PMID: 35983654 DOI: 10.1111/1346-8138.16551] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Revised: 07/12/2022] [Accepted: 07/30/2022] [Indexed: 02/04/2023]
Abstract
To evaluate the outcomes of secukinumab and acitretin use in children with generalized pustular psoriasis (GPP), we compared the efficacy and adverse events of secukinumab in 20 children and acitretin in 16 children with GPP from January 1, 2019, to January 30, 2022. Among the 20 patients treated with secukinumab, the average time for pustules to fade, temperature to normalize, and C-reactive protein (CRP) to normalize was 3.83, 2.46, and 3.91 days, respectively. All patients recovered (Japanese Dermatological Association severity index score: 0/1) in 3 weeks. The adverse events were abnormal liver enzyme (10%), atopic dermatitis-like lesions (10%), herpes simplex (5%), and neutropenia (10%). For the patients treated with acitretin, the average time for pustules to fade, temperature to normalize, and CRP to normalize was 6, 6.14, and 8.73 days, respectively. The adverse events included mucocutaneous dryness (75%), dyslipidemia (37.5%), and abnormal liver enzyme (25%). These findings demonstrate that secukinumab has more favorable outcomes than acitretin, and secukinumab was well tolerated by the pediatric patients with GPP.
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Affiliation(s)
- Chaoyang Miao
- Department of Dermatology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Yunliu Chen
- Department of Dermatology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Zhaoyang Wang
- Department of Dermatology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Xin Xiang
- Department of Dermatology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Ying Liu
- Department of Dermatology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Zigang Xu
- Department of Dermatology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
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15
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Wang WM, Jin HZ. Biologics in pediatric psoriasis. J Dermatol 2023; 50:415-421. [PMID: 36651087 DOI: 10.1111/1346-8138.16702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Revised: 11/30/2022] [Accepted: 12/17/2022] [Indexed: 01/19/2023]
Abstract
Psoriasis is a chronic inflammatory skin disorder with a chronic relapsing course. Biologics have revolutionized the treatment of adult psoriasis with higher efficacy and favorable safety profile. Recently, more studies have focused on the use of biologics in pediatric psoriasis, and several biologics have been approved for use therein. This review is divided into two sections: the first part focuses on real-world studies on the use of biologics in pediatric psoriasis and the second part summarizes the findings of other clinical trials related to biologics in pediatric psoriasis. Case reports have been excluded from this review. Several biologics were used for treating pediatric psoriasis and the efficacy is encouraging. According to the studies included in this review, anti-IL-12/23 and anti-IL-17A for treating pediatric psoriasis might have a better efficacy than anti-TNF-α, but more data are needed.
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Affiliation(s)
- Wen-Ming Wang
- Department of Dermatology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Hong-Zhong Jin
- Department of Dermatology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
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Megna M, Camela E, Battista T, Genco L, Martora F, Noto M, Picone V, Ruggiero A, Monfrecola G, Fabbrocini G, Potestio L. Efficacy and safety of biologics and small molecules for psoriasis in pediatric and geriatric populations. Part I: focus on pediatric patients. Expert Opin Drug Saf 2023; 22:25-41. [PMID: 36718762 DOI: 10.1080/14740338.2023.2173170] [Citation(s) in RCA: 35] [Impact Index Per Article: 35.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
INTRODUCTION Psoriasis management is challenging, especially in pediatric age for different factors. The introduction of biologic drugs and oral small molecules (OSM) revolutionized the armamentarium of available weapons in psoriasis treatment. Despite the use of these drugs in adult patients has been widely investigated, pediatric patients have often been unconsidered in clinical trials and real-life studies. However, the high efficacy and speed of action, the safety profile and the ease-to-use administration make these innovative drugs an invaluable therapeutic opportunity. AREAS COVERED The aim of this manuscript is to perform a review of the current literature examining data on the effectiveness and safety of biologic drugs and OSM for the management of psoriasis in pediatric patients in order to put the basis for universally shared treatment algorithm following available evidence. PRISMA (preferred reporting items for systematic reviews and meta-analyses) guidelines were used for the literature research. EXPERT OPINION/COMMENTARY Our review based on currently available evidence suggests biologics and OSM as an ideal treatment option for pediatric patients, with an excellent profile in terms of efficacy and safety as compared to traditional systemic drugs.
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Affiliation(s)
- Matteo Megna
- Section of Dermatology - Department of Clinical Medicine and Surgery, University of Naples Federico II, Napoli, Italy
| | - Elisa Camela
- Section of Dermatology - Department of Clinical Medicine and Surgery, University of Naples Federico II, Napoli, Italy
| | - Teresa Battista
- Section of Dermatology - Department of Clinical Medicine and Surgery, University of Naples Federico II, Napoli, Italy
| | - Lucia Genco
- Section of Dermatology - Department of Clinical Medicine and Surgery, University of Naples Federico II, Napoli, Italy
| | - Fabrizio Martora
- Section of Dermatology - Department of Clinical Medicine and Surgery, University of Naples Federico II, Napoli, Italy
| | - Matteo Noto
- Section of Dermatology - Department of Clinical Medicine and Surgery, University of Naples Federico II, Napoli, Italy
| | - Vincenzo Picone
- Section of Dermatology - Department of Clinical Medicine and Surgery, University of Naples Federico II, Napoli, Italy
| | - Angelo Ruggiero
- Section of Dermatology - Department of Clinical Medicine and Surgery, University of Naples Federico II, Napoli, Italy
| | - Giuseppe Monfrecola
- Section of Dermatology - Department of Clinical Medicine and Surgery, University of Naples Federico II, Napoli, Italy
| | - Gabriella Fabbrocini
- Section of Dermatology - Department of Clinical Medicine and Surgery, University of Naples Federico II, Napoli, Italy
| | - Luca Potestio
- Section of Dermatology - Department of Clinical Medicine and Surgery, University of Naples Federico II, Napoli, Italy
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Narbutt J, Niedźwiedź M, Lesiak A, Ceryn J, Skibińska M. Secukinumab for the Treatment of Psoriasis in Pediatrics: Patient Selection and Acceptability. Patient Prefer Adherence 2023; 17:421-431. [PMID: 36815128 PMCID: PMC9940655 DOI: 10.2147/ppa.s350753] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Accepted: 02/11/2023] [Indexed: 02/17/2023] Open
Abstract
Psoriasis (PsO) is a chronic, systemic, immune-mediated inflammatory skin disease affecting 1% to 5% population worldwide. In one-third of patients, the first symptoms of PsO manifest in childhood, with a mean age of nine years. Psoriasis in children under 16 years of age constitutes 4% of dermatological problems in this age group. Chronic inflammation of the skin observed in PsO is associated with a development of potentially serious comorbidities, including psoriatic arthritis, hypertension, metabolic syndrome, cardiovascular diseases, inflammatory bowel disease, depression and anxiety. It is reported that among children with psoriasis between 5 and 16 years of age health-related quality of life is reduced by 30.5%. Early diagnosis and effective treatment are crucial in pediatric psoriatic patients to avoid future complications and stigmatization. Treatment for psoriasis consists of a range of topical medications, phototherapy and non-biologic and biologic systemic therapies. Approved biologics for PsO in pediatric patients include etanercept, adalimumab, ustekinumab, ixekizumab and secukinumab. Secukinumab, a recombinant, fully human monoclonal antibody targeting IL-17A, was approved by the EMA (2020) and FDA (2021) in pediatric patients above 6 years of age for the treatment of moderate to severe plaque psoriasis who are candidates for systemic therapy. This review discusses the selection and acceptability of secukinumab in children with psoriasis.
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Affiliation(s)
- Joanna Narbutt
- Department of Dermatology, Pediatric Dermatology and Dermatological Oncology, Medical University of Lodz, Lodz, Poland
| | - Michał Niedźwiedź
- Department of Dermatology, Pediatric Dermatology and Dermatological Oncology, Medical University of Lodz, Lodz, Poland
- Correspondence: Michał Niedźwiedź, Department of Dermatology, Pediatric Dermatology and Oncology, Medical University of Lodz, gen. Karola Kniaziewicza 1/5, Lodz, 91-347, Poland, Tel +48 690 529 430, Email
| | - Aleksandra Lesiak
- Department of Dermatology, Pediatric Dermatology and Dermatological Oncology, Medical University of Lodz, Lodz, Poland
| | - Justyna Ceryn
- Department of Dermatology, Pediatric Dermatology and Dermatological Oncology, Medical University of Lodz, Lodz, Poland
- International Doctoral School of the Medical University of Lodz, Lodz, Poland
| | - Małgorzata Skibińska
- Department of Dermatology, Pediatric Dermatology and Dermatological Oncology, Medical University of Lodz, Lodz, Poland
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18
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Brunner HI, Foeldvari I, Alexeeva E, Ayaz NA, Calvo Penades I, Kasapcopur O, Chasnyk VG, Hufnagel M, Żuber Z, Schulert G, Ozen S, Rakhimyanova A, Ramanan A, Scott C, Sozeri B, Zholobova E, Martin R, Zhu X, Whelan S, Pricop L, Martini A, Lovell D, Ruperto N. Secukinumab in enthesitis-related arthritis and juvenile psoriatic arthritis: a randomised, double-blind, placebo-controlled, treatment withdrawal, phase 3 trial. Ann Rheum Dis 2023; 82:154-160. [PMID: 35961761 PMCID: PMC9811076 DOI: 10.1136/ard-2022-222849] [Citation(s) in RCA: 19] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Accepted: 08/03/2022] [Indexed: 02/03/2023]
Abstract
BACKGROUND Treatment options in patients with enthesitis-related arthritis (ERA) and juvenile psoriatic arthritis (JPsA) are currently limited. This trial aimed to demonstrate the efficacy and safety of secukinumab in patients with active ERA and JPsA with inadequate response to conventional therapy. METHODS In this randomised, double-blind, placebo-controlled, treatment-withdrawal, phase 3 trial, biologic-naïve patients (aged 2 to <18 years) with active disease were treated with open-label subcutaneous secukinumab (75/150 mg in patients <50/≥50 kg) in treatment period (TP) 1 up to week 12, and juvenile idiopathic arthritis (JIA) American College of Rheumatology 30 responders at week 12 were randomised 1:1 to secukinumab or placebo up to 100 weeks. Patients who flared in TP2 immediately entered open-label secukinumab TP3 that lasted up to week 104. Primary endpoint was time to disease flare in TP2. RESULTS A total of 86 patients (median age, 14 years) entered open-label secukinumab in TP1. In TP2, responders (ERA, 44/52; JPsA, 31/34) received secukinumab or placebo. The study met its primary end point and demonstrated a statistically significant longer time to disease flare in TP2 for ERA and JPsA with secukinumab versus placebo (27% vs 55%, HR, 0.28; 95% CI 0.13 to 0.63; p<0.001). Exposure-adjusted incidence rates (per 100 patient-years (PY), 95% CI) for total patients were 290.7/100 PY (230.2 to 362.3) for adverse events and 8.2/100 PY (4.1 to 14.6) for serious adverse events in the overall JIA population. CONCLUSIONS Secukinumab demonstrated significantly longer time to disease flare than placebo in children with ERA and JPsA with a consistent safety profile with the adult indications of psoriatic arthritis and axial spondyloarthritis. TRIAL REGISTRATION NUMBER NCT03031782.
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Affiliation(s)
- Hermine I Brunner
- UC Department of Pediatrics, University of Cincinnati, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Ivan Foeldvari
- Hamburger Zentrum fuer Kinder und Jugendrheumatologie, Hamburg, Germany
| | - Ekaterina Alexeeva
- National Scientific and Practical Center of Children's Health, Ministry of Health of the Russian Federation, Moscow, Russian Federation
| | - Nuray Aktay Ayaz
- Istanbul University-Cerrahpasa, Faculty of Medicine, Department of Pediatric Rheumatology, Istanbul, Turkey
| | | | - Ozgur Kasapcopur
- Pediatric Rheumatology, Istanbul Universitesi-Cerrahpasa, Istanbul, Turkey
| | - Vyacheslav G Chasnyk
- State Pediatric Medical University, Department of Pediatric Rheumatology, Saint-Petersburg, Russian Federation
| | - Markus Hufnagel
- University Medical Center, Medical Faculty University of Freiburg, Department of Pediatrics and Adolescent Medicine, Freiburg, Germany
| | - Zbigniew Żuber
- Andrzej Frycz Modrzewski Krakow University, Faculty of Medicine and Health Sciences, Department of Pediatrics, Krakow, Poland
| | - Grant Schulert
- UC Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Seza Ozen
- Department of Pediatrics, Hacettepe University, Ankara, Turkey
| | - Adelina Rakhimyanova
- Regional Children Clinical Hospital # 1, Ural State Medical University, Ministry of Healthcare of the Russian Federation, Department of Rheumatology, Yekaterinburg, Russian Federation
| | - Athimalaipet Ramanan
- University Hospitals Bristol NHS Foundation Trust, Bristol, UK
- University of Bristol, Department of Pediatric Rheumatology, Bristol, UK
| | - Christiaan Scott
- Red Cross War Memorial Children's Hospital, University of Cape Town, Department of Pediatric Rheumatology, Cape Town, South Africa
| | - Betul Sozeri
- Umraniye Training and Research Hospital, Department of Pediatric Rheumatology, Istanbul, Turkey
| | - Elena Zholobova
- First Moscow State Medical University n.a. I.M.Sechenov, Department of Rheumatology, Moscow, Russian Federation
| | - Ruvie Martin
- Novartis Pharmaceuticals Corporation, East Hanover, New Jersey, USA
| | - Xuan Zhu
- Novartis Pharmaceuticals Corporation, East Hanover, New Jersey, USA
| | | | - Luminita Pricop
- Novartis Pharmaceuticals Corporation, East Hanover, New Jersey, USA
| | | | - Daniel Lovell
- Rheumatology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Nicolino Ruperto
- IRCCS Istituto Giannina Gaslini, UOSID Centro Trial, Genova, Italy
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Chen XB, Zheng YX, Ye LR, Chen XY, Man XY. Gradually increasing the dosing interval of Secukinumab for moderate to severe plaque psoriasis: A single-center, uncontrolled, prospective study in 36 weeks. Dermatol Ther 2022; 35:e15911. [PMID: 36209377 PMCID: PMC10078391 DOI: 10.1111/dth.15911] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 09/12/2022] [Accepted: 10/06/2022] [Indexed: 11/28/2022]
Abstract
Secukinumab is a recombinant, fully human monoclonal anti-IL-17A antibody approved to treat moderate-to-severe psoriasis and psoriatic arthritis. Its effectiveness and safety have been confirmed, but a gradual increase in the secukinumab dosing interval has not been investigated. To assess the feasibility, efficacy, and safety of gradually increasing the secukinumab dosing interval; the interval duration was determined by changes in the Psoriasis Area and Severity Index scores. Patients with moderate-to-severe plaque psoriasis received secukinumab 300 mg subcutaneously at baseline and weeks 0, 1, 2, and 3. At week 4, the improvement from baseline PASI guided the next injection time until week 36. In total, 83 patients were recruited. PASI 75 was achieved by 80%, 96%, and 95% of patients at weeks 4, 12, and 36, respectively. PASI 90 was achieved by 54%, 95%, and 84% of patients at weeks 4, 12, and 36, respectively. PASI 100 was achieved by 28%, 89%, and 68% of patients at weeks 4, 12, and 36, respectively. The average PASI score (1.05 ± 1.83) was significantly lower at week 36 than at baseline. Most patients reached PASI 75 at week 36 in our modified study. This study may provide information for future biotherapies.
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Affiliation(s)
- Xi-Bei Chen
- Department of Dermatology, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Yu-Xin Zheng
- Department of Dermatology, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Li-Ran Ye
- Department of Dermatology, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Xue-Yan Chen
- Department of Dermatology, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Xiao-Yong Man
- Department of Dermatology, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
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20
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Prignano F, Pescitelli L, Trovato E, DI Cesare A, Cuccia A, Mazzatenta C, Pellegrino M, Marsili F, Castelli A, Brandini L, Niccoli MC, Taviti F, Ricceri F, Panduri S, Buggiani G, Ghilardi A, Rubegni P, Romanelli M, Pimpinelli N. Tuscany consensus for the treatment of moderate-severe psoriasis: update and focus on practical guidelines for place in therapy of anti-IL-17 and anti-IL-23 biologics. Ital J Dermatol Venerol 2022; 157:469-479. [PMID: 35785927 DOI: 10.23736/s2784-8671.22.07355-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Psoriasis is a common chronic skin disease characterized by a worldwide distribution and a natural tendency towards progression. According to the many clinical forms, the extension of the disease and the many comorbidities, almost the 20% of the patients require a systemic treatment. Biologics have greatly changed the ongoing of psoriasis and the quality of life of psoriasis patients. After the anti-TNF-alpha, which were the first biologics in use for psoriasis, the improvement in knowledge of the pathogenetic mechanisms underlying the disease has led to the development of a series of more specific therapies for psoriasis. This "second generation" of biologics includes the interleukin (IL)-12/23 inhibitor ustekinumab, IL-17 inhibitors (secukinumab and ixekizumab), the IL-17 receptor A (IL-17RA) antagonist brodalumab, and the IL-23 inhibitors guselkumab, risankizumab and tildrakizumab. This study represents an update of the Tuscany consensus focused on the use of new drugs, such as anti-IL-17 and anti-IL-23 in moderate-to-severe psoriasis and their correct place in therapy according to specific clinical requests and in full respect of the current financial restrictions.
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Affiliation(s)
- Francesca Prignano
- Section of Dermatology, Department of Health Sciences, University of Florence, Florence, Italy -
| | | | - Emanuele Trovato
- Section of Dermatology, Department of Medical, Surgical and Neurological Science, S. Maria alle Scotte Hospital, University of Siena, Siena, Italy
| | - Antonella DI Cesare
- Section of Dermatology, Department of Health Sciences, University of Florence, Florence, Italy
| | - Aldo Cuccia
- Unit of Dermatology, San Donato Hospital, Arezzo, Italy
| | | | | | - Franco Marsili
- Unit of Dermatology, Versilia Hospital, Lido di Camaiore, Lucca, Italy
| | | | - Luca Brandini
- Unit of Dermatology, San Giuseppe Hospital, Empoli, Florence, Italy
| | | | - Franca Taviti
- Unit of Dermatology, Hospital of Prato, Prato, Italy
| | | | | | - Gionata Buggiani
- Unit of Dermatology, San Giuseppe Hospital, Empoli, Florence, Italy
| | | | - Pietro Rubegni
- Section of Dermatology, Department of Medical, Surgical and Neurological Science, S. Maria alle Scotte Hospital, University of Siena, Siena, Italy
| | | | - Nicola Pimpinelli
- Section of Dermatology, Department of Health Sciences, University of Florence, Florence, Italy
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21
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Golhen K, Winskill C, Theiler M, Buettcher M, Yeh YH, Zhang N, Welzel T, Pfister M. Understanding efficacy-safety balance of biologics in moderate-to-severe pediatric psoriasis. Front Med (Lausanne) 2022; 9:944208. [PMID: 36226155 PMCID: PMC9548699 DOI: 10.3389/fmed.2022.944208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Accepted: 09/08/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundPsoriasis is a chronic immune-mediated inflammatory skin disease affecting both adults and children. To better understand the efficacy-safety profile of biologics in children with moderate-to-severe psoriasis, this study aimed to analyze efficacy and safety data of randomized controlled trials (RCTs) performed in pediatric psoriasis and to compare efficacy outcomes in children with those in adults.MethodsRCTs investigating biologics in children with moderate-to-severe psoriasis were identified in a systematic literature review. PASI75/90 treatment responses at weeks 11/12 were analyzed comparing biologics with control arms. Serious adverse events (SAEs) were analyzed at the end of each study. Efficacy data from RCTs in adults with psoriasis were selected for the same biologics. Risk ratios (RR) of selected RCTs were pooled together in a statistical random effects model using the inverse variance method.ResultsFor children, there were 1 etanercept, 2 secukinumab, 1 ixekizumab and 1 ustekinumab placebo-controlled RCTs and 1 adalimumab RCT using methotrexate as reference arm at weeks 11/12. For adults, out of 263 RCTs, 7 adalimumab and 15 etanercept (TNF inhibitors) and 4 ixekizumab and 12 ustekinumab (IL-17 and IL-12/23 inhibitors) RCTs reported PASI75/90 efficacy responses at weeks 11/12. Regarding efficacy, all biologics showed improved PASI responses over control arms. RRs ranges were 2.02–7.45 in PASI75 and 4.10–14.50 in PASI90. The highest PASI75 responses were seen for ustekinumab 0.375 mg/kg (RR = 7.25, 95% CI 2.83–18.58) and ustekinumab 0.75 mg/kg (RR = 7.45, 95% CI 2.91–19.06) in the CADMUS study. The highest PASI90 response was seen for ixekizumab (RR = 14.50, 95% CI 4.82–43.58) in the IXORA-PEDS study. SAE incidences in pediatric and adult arms with biologics were 0 to 3% except for a pediatric arm with adalimumab 0.40 mg/kg (8%). For adults, pooled RR also showed improved PASI responses over placebo for all biologics, with highest PASI75 response observed for ixekizumab (pooled RR = 16.18, 95% CI 11.83–22.14).ConclusionBoth adults and children with psoriasis show superior efficacy with biologics compared to control arms after 3 months of treatment with SAE incidences in the low percentages. Additional longer-term clinical studies are warranted to fully understand the overall efficacy-safety profile of biologics in children with moderate-to-severe psoriasis.
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Affiliation(s)
- Klervi Golhen
- Pediatric Pharmacology and Pharmacometrics, University Children’s Hospital Basel (UKBB), University of Basel, Basel, Switzerland
| | - Carolyn Winskill
- Integrated Drug Development, Certara LP, Princeton, NJ, United States
| | - Martin Theiler
- Pediatric Skin Center, Dermatology Department, University Children’s Hospital Zurich, Zurich, Switzerland
| | - Michael Buettcher
- Pediatric Pharmacology and Pharmacometrics, University Children’s Hospital Basel (UKBB), University of Basel, Basel, Switzerland
- Pediatric Infectious Diseases Unit, Pediatric Department, Children’s Hospital – Lucerne Cantonal Hospital, Lucerne, Switzerland
| | - Yu-Hsin Yeh
- Integrated Drug Development, Certara LP, Princeton, NJ, United States
| | - Nancy Zhang
- Integrated Drug Development, Certara LP, Princeton, NJ, United States
| | - Tatjana Welzel
- Pediatric Pharmacology and Pharmacometrics, University Children’s Hospital Basel (UKBB), University of Basel, Basel, Switzerland
- Pediatric Rheumatology, University Children’s Hospital Basel (UKBB), University of Basel, Basel, Switzerland
| | - Marc Pfister
- Pediatric Pharmacology and Pharmacometrics, University Children’s Hospital Basel (UKBB), University of Basel, Basel, Switzerland
- Integrated Drug Development, Certara LP, Princeton, NJ, United States
- *Correspondence: Marc Pfister,
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22
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Biological Treatments for Pediatric Psoriasis: State of the Art and Future Perspectives. Int J Mol Sci 2022; 23:ijms231911128. [PMID: 36232430 PMCID: PMC9569815 DOI: 10.3390/ijms231911128] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 09/13/2022] [Accepted: 09/16/2022] [Indexed: 11/17/2022] Open
Abstract
Psoriasis is a chronic systemic inflammatory disease that primarily affects the skin and is associated with multiple comorbidities with a considerable reduction in quality of life of affected patients. One-third of psoriasis cases begin in childhood and are associated with significant medical comorbidities such as obesity, metabolic syndrome, arthritis, and psychiatric disorders. In addition, because of its chronic nature and frequent relapses, psoriasis tends to require long-term treatment. Treatment of pediatric psoriasis usually involves the same methods used for adults. However, most treatments for pediatric psoriasis are used off-label, and research in this regard is still lacking. Targeted therapies involving the use of newly developed biologic drugs are also increasingly being applied to childhood psoriasis. This review summarizes the clinical features of pediatric psoriasis and focuses mainly on the updated concepts of pathogenesis and biological treatments of pediatric psoriasis.
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Mahé E, Beauchet A, Hadj‐Rabia S, Mazereeuw‐Hautier J, Mallet S, Phan A, Severino‐Freire M, Boralevi F, Aubert H, Barthélémy H, Girard C, Martin L, Piram M, Barbarot S, Balguerie X, Zitouni J, Phan C, Di Lernia V. Biologics combined with conventional systemic agents for the treatment of children with severe psoriasis. Real‐life data from the BiPe cohorts and a practice survey among French and Italian paediatric dermatologists. Dermatol Ther 2022; 35:e15828. [DOI: 10.1111/dth.15828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Revised: 09/01/2022] [Accepted: 09/13/2022] [Indexed: 11/30/2022]
Affiliation(s)
- Emmanuel Mahé
- Dermatology department Hôpital Victor Dupouy Argenteuil France
| | - Alain Beauchet
- Public Health department, Centre Hospitalier Universitaire Ambroise Paré Boulogne‐Billancourt France
| | - Smaïl Hadj‐Rabia
- Dermatology department INSERM U1163 & Institut Imagine, Centre Hospitalier Universitaire Necker‐Enfants Malades, Assistance Publique‐Hôpitaux de Paris, Université Paris Descartes ‐ Sorbonne, Paris Cité Paris France
| | - Juliette Mazereeuw‐Hautier
- Dermatology department Centre de référence des maladies rares de la peau et des muqueuses, Hôpital Larrey Toulouse France
| | - Stéphanie Mallet
- Dermatology department Hôpital de la Timone, Assistance‐publique‐Hôpitaux de Marseille Marseille France
| | - Alice Phan
- Paediatric department Hôpital Femme‐Mère‐Enfant, Hospices Civils de Lyon Bron France
| | - Maëlle Severino‐Freire
- Dermatology department Centre de référence des maladies rares de la peau et des muqueuses, Hôpital Larrey Toulouse France
| | - Franck Boralevi
- Department of Paediatric Dermatology Hôpital Pellegrin, CHU de Bordeaux Bordeaux France
| | - Hélène Aubert
- Dermatology department Centre Hospitalier Universitaire de Nantes Nantes France
| | - Hugue Barthélémy
- Dermatology department Centre Hospitalier d'Auxerre Auxerre France
| | - Céline Girard
- Dermatology department Centre Hospitalier Universitaire de Montpellier Montpellier France
| | - Ludovic Martin
- Dermatology department Centre Hospitalier Universitaire d'Angers Angers France
| | - Maryam Piram
- Service de Rhumatologie Pédiatrique, Centre Hospitalier Universitaire Bicêtre, Université Paris Sud‐Saclay, UVSQ, Assistance Publique‐Hôpitaux de Paris HP Le Kremlin Bicêtre France
| | - Sébastien Barbarot
- Dermatology department Centre Hospitalier Universitaire de Nantes Nantes France
| | - Xavier Balguerie
- Dermatology department Centre Hospitalier Universitaire Charles‐Nicolle Rouen France
| | - Jinane Zitouni
- Dermatology department Hôpital Victor Dupouy Argenteuil France
| | - Céline Phan
- Dermatology department Hôpital Victor Dupouy Argenteuil France
| | - Vito Di Lernia
- Dermatology unit, Arcispedale S. Maria Nuova IRCCS Reggio Emilia Italy
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24
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Zheng YX, Ye LR, Yan BX, Chen SQ, Cai SQ, Man XY. Biologics for psoriasis patients under 18 years of age: Real-world evidence from the Chinese psoriasis real world evidence research group. Front Med (Lausanne) 2022; 9:1009991. [PMID: 36160145 PMCID: PMC9490006 DOI: 10.3389/fmed.2022.1009991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Accepted: 08/22/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundTreatment for pediatric psoriasis is challenging because of the lack of real-world evidence, especially for biological therapies.ObjectivesThis study evaluated the efficacy and safety of biologics in children with psoriasis based on real-world evidence.MethodsPediatric psoriasis patients aged <18 years who were treated with biologics in our hospital (2020–2022) were prospectively analyzed. Patients treated with adalimumab, secukinumab, or ixekizumab were followed up for at least 16 weeks, and 22 of 38 patients completed the 52-week observation period. Dermatologist raters were blinded to ensure the reliability of the PASI, BSA, and PGA score assessments. PASI 75 or PGA 0/1 at week 12 represented an efficient indicator.ResultsThirty-eight patients (20 males and 18 females; median age, 12.6 ± 4.1 years) were enrolled, and none were lost to follow-up. All participants were diagnosed with psoriasis, including plaque psoriasis (n = 36), nail psoriasis (n = 1), and pustular psoriasis (n = 1). Within 12 weeks, all patients achieved scores above PASI 75 and PGA 0/1. The average time to reach PASI 75 was 4.3 ± 2.0, 3.2 ± 1.8, and 2.4 ± 0.4 weeks in patients using adalimumab, secukinumab, and ixekizumab, respectively, and, 27.2% (3/11), 86.4% (19/22), and 75.0% (3/4) of these patients achieved PASI 100 at week 12, respectively. Moreover, 18 of 20 patients with plaque psoriasis maintained ≥PASI 75 after 52 weeks. The most commonly reported adverse effect was upper respiratory tract infection, and no severe adverse effects were reported.ConclusionsOur real-world data demonstrated the safety and effectiveness of adalimumab, secukinumab, and ixekizumab in children with psoriasis.
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25
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Huang IH, Yu CL, Tai CC, Tu YK, Chi CC. Biologika zur Behandlung mittelschwerer bis schwerer Plaque-Psoriasis im Kindes- und Jugendalter: Systematischer Review und Netzwerk-Metaanalyse. J Dtsch Dermatol Ges 2022; 20:1201-1210. [PMID: 36162023 DOI: 10.1111/ddg.14832_g] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Accepted: 05/25/2022] [Indexed: 11/29/2022]
Affiliation(s)
- I-Hsin Huang
- Department of Dermatology, Chang Gung Memorial Hospital, Linkou, Taoyuan, Taiwan
| | - Chia-Ling Yu
- Department of Pharmacy, Chang Gung Memorial Hospital, Linkou, Taoyuan, Taiwan
| | - Cheng-Chen Tai
- Medical Library, Department of Medical Education, Chang Gung Memorial Hospital, Linkou, Taoyuan, Taiwan
| | - Yu-Kang Tu
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan.,Department of Dentistry, National Taiwan University Hospital, Taipei, Taiwan
| | - Ching-Chi Chi
- Department of Dermatology, Chang Gung Memorial Hospital, Linkou, Taoyuan, Taiwan.,School of Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan
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26
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Huang IH, Yu CL, Tai CC, Tu YK, Chi CC. Biologics for pediatric moderate-to-severe plaque psoriasis: a systematic review and network meta-analysis. J Dtsch Dermatol Ges 2022; 20:1201-1209. [PMID: 36028470 DOI: 10.1111/ddg.14832] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Accepted: 05/25/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND OBJECTIVES To compare the efficacy and safety of biologic treatments for moderate-to-severe pediatric psoriasis approved by the US Food and Drug Administration and European Medicines Agency. PATIENTS AND METHODS MEDLINE, Embase, and Cochrane Central Register of Controlled Trials for relevant randomized controlled trials (RCTs) were searched for the identification of eligible RCTs until May 7, 2021. Fixed-effect frequentist network meta-analysis (NMA) was performed with the surface under the cumulative ranking curve (SUCRA) calculated for ranking. Our primary outcomes included ≥ 90 % improvement of Psoriasis Area and Severity Index score (PASI 90) at 12-16 weeks and discontinuation owing to adverse events (DAE) through the first 12-16 weeks. RESULTS Five RCTs involving 798 pediatric psoriasis patients were included. Compared to placebo, all biologic regimens exhibited a significantly higher PASI 90 response but did not differ in the risk for DAE. Based on the SUCRA, secukinumab-low dose (SEC-L) ranked first in the achieved PASI 90 response (84.7 %), followed by ixekizumab (70.8 %). CONCLUSIONS Among all biologic treatments, SEC-L showed the best PASI 90 response without increasing the risk for DAE. More long-term studies are warranted.
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Affiliation(s)
- I-Hsin Huang
- Department of Dermatology, Chang Gung Memorial Hospital, Linkou, Taoyuan, Taiwan
| | - Chia-Ling Yu
- Department of Pharmacy, Chang Gung Memorial Hospital, Linkou, Taoyuan, Taiwan
| | - Cheng-Chen Tai
- Medical Library, Department of Medical Education, Chang Gung Memorial Hospital, Linkou, Taoyuan, Taiwan
| | - Yu-Kang Tu
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan.,Department of Dentistry, National Taiwan University Hospital, Taipei, Taiwan
| | - Ching-Chi Chi
- Department of Dermatology, Chang Gung Memorial Hospital, Linkou, Taoyuan, Taiwan.,School of Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan
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27
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Cai XC, Ru Y, Liu L, Sun XY, Zhou YQ, Luo Y, Chen JL, Zhang M, Wang CX, Li B, Li X. Efficacy and safety of biological agents for the treatment of pediatric patients with psoriasis: A bayesian analysis of six high-quality randomized controlled trials. Front Immunol 2022; 13:896550. [PMID: 36081503 PMCID: PMC9446895 DOI: 10.3389/fimmu.2022.896550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Accepted: 07/28/2022] [Indexed: 11/13/2022] Open
Abstract
Background Biological agents have been used with extreme caution in children because of their possible adverse effects. Objectives This study used high-quality randomized controlled trials (RCTs) to provide high-level evidence to assess the effectiveness and safety of biological agents for treating children with psoriasis. Methods We searched PubMed, Embase, Cochrane, and Web of Science databases through October 31, 2021. We included trials reporting at least one adverse event after treatment with biological agents of patients less than 18-year-old diagnosed with psoriasis. RevMan 5.3 and Stata 15.0 software were used for meta and Bayesian analyses. Results Six trials with 864 participants were included in the analysis. The results showed a 2.37-fold higher response rate in all biologics groups than in the control group for psoriasis area and severity index 75 (PASI75) (RR= 2.37, P-value < 0.01, 95% confidence interval [CI] [1.22, 4.62]). Compared with placebo, the PASI75 response rates of etanercept (RR= 2.82, 95% [CI] [1.10, 7.21]), ustekinumab low dose (RR= 7.45, 95%[CI] [1.25, 44.58]), and ustekinumab high dose (RR= 7.25, 95%[CI] [1.21, 43.41]) were superior. Additionally, the incidence of total adverse reactions was 1.05 times higher for biologics than for controls, indicating a good safety profile (RR= 1.05, P-value = 0.53, 95%[CI] [0.92, 1.19]). Overall, these six high-quality randomized controlled trials suggest that biologics are effective and safe for pediatric patients with psoriasis. Limitations Inclusion of few relevant, high-quality RCTs. Conclusion The results of this study indicate that biologics can be used to treat children with moderate-to-severe psoriasis without the risk of adverse effects. Ustekinumab showed the best efficacy and the fewest adverse effects.
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Affiliation(s)
- Xiao-ce Cai
- Department of Dermatology, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
- Institute of Dermatology, Shanghai Academy of Traditional Chinese Medicine, Shanghai, China
| | - Yi Ru
- Department of Dermatology, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
- Institute of Dermatology, Shanghai Academy of Traditional Chinese Medicine, Shanghai, China
| | - Liu Liu
- Department of Dermatology, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
- Institute of Dermatology, Shanghai Academy of Traditional Chinese Medicine, Shanghai, China
| | - Xiao-ying Sun
- Department of Dermatology, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
- Institute of Dermatology, Shanghai Academy of Traditional Chinese Medicine, Shanghai, China
| | - Ya-qiong Zhou
- Department of Dermatology, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
- Institute of Dermatology, Shanghai Academy of Traditional Chinese Medicine, Shanghai, China
| | - Ying Luo
- Department of Dermatology, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
- Institute of Dermatology, Shanghai Academy of Traditional Chinese Medicine, Shanghai, China
| | - Jia-le Chen
- Department of Dermatology, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
- Institute of Dermatology, Shanghai Academy of Traditional Chinese Medicine, Shanghai, China
| | - Miao Zhang
- Department of Dermatology, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
- Institute of Dermatology, Shanghai Academy of Traditional Chinese Medicine, Shanghai, China
| | - Chun-xiao Wang
- Department of Dermatology, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
- Institute of Dermatology, Shanghai Academy of Traditional Chinese Medicine, Shanghai, China
| | - Bin Li
- Department of Dermatology, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
- Institute of Dermatology, Shanghai Academy of Traditional Chinese Medicine, Shanghai, China
- Shanghai Skin Disease Hospital, School of Medicine, Tongji University, Shanghai, China
- *Correspondence: Xin Li, ; Bin Li,
| | - Xin Li
- Department of Dermatology, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
- Institute of Dermatology, Shanghai Academy of Traditional Chinese Medicine, Shanghai, China
- *Correspondence: Xin Li, ; Bin Li,
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28
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Sticherling M, McPherson T, de Lucas Laguna R, Costanzo A, Reed C, Artime E, Robert C, Lucas J, Schuster C, Mahé E. Patient Characteristics and Treatment Patterns in European Pediatric Patients with Psoriasis: A Real-World, Cross-Sectional Study. Dermatol Ther (Heidelb) 2022; 12:1793-1808. [PMID: 35797001 PMCID: PMC9357581 DOI: 10.1007/s13555-022-00761-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Accepted: 06/15/2022] [Indexed: 11/26/2022] Open
Abstract
Introduction This study evaluated patient characteristics and treatment patterns according to weight in pediatric patients with psoriasis in a real-world setting. Methods Primary care and specialist physicians treating pediatric patients with psoriasis aged 6–17 years in five European countries were surveyed in the 2019–2020 Adelphi Real World Pediatric Psoriasis Disease Specific Programme. At least two patients with current or previous biologic use were included per physician. Patient characteristics and treatment patterns were analyzed overall and for patients weighing 25–50 kg or more than 50 kg. Results Data from 772 patients weighing 25–50 kg and 1147 weighing more than 50 kg were analyzed. Median age at diagnosis was significantly less in lighter than heavier patients (10.0 vs. 14.0 years; p < 0.001), as was median disease duration (2.2 vs. 3.0 years; p < 0.001). Topical treatments were prescribed in 59.0% of patients overall (70.3% of lighter and 51.4% of heavier patients; p < 0.001), and were used to treat mild rather than moderate-to-severe psoriasis. Conventional systemic use was low (10.8% of patients overall) and predominantly for moderate-to-severe psoriasis. In this biologic-enriched sample, most biologics (78.2%) were prescribed in older (> 13 years) patients. Biologic use increased with line of therapy (6.6% of first-line, 18.0% of second-line, 33.7% of third-line, 44.7% of fourth-line treatments). Conclusion Biologics are predominantly prescribed in older (> 13 years) and heavier (> 50 kg) patients, with little first- or second-line use. The low use of biologics in European pediatric patients with psoriasis may represent an unmet treatment need, as topical or conventional systemic agents remain the main treatment option for moderate or severe psoriasis in these patients through the treatment pathway. Supplementary Information The online version contains supplementary material available at 10.1007/s13555-022-00761-7. This study looked into types of treatments according to body weight in children with psoriasis, since approved dosing regimens for some treatments are based on body weight. Primary care and specialist physicians treating children with psoriasis aged 6–17 years in five European countries completed a survey. Patient information for those receiving specific types of psoriasis treatments were collected. Of the children included, 772 weighed 25–50 kg and 1147 weighed more than 50 kg. Most children received treatments applied to the skin, such as creams and ointments; this occurred in 70% of lighter patients and in 51% of heavier patients. Conventional treatments taken via the mouth were prescribed in a few patients (11% [overall]), while newer biologic drugs were taken to a greater extent in heavier (30%) than lighter (16%) patients. Most biologics (78%) were prescribed in older (> 13 years) patients. Biologic use increased with the number of failed previous treatments, comprising 7%, 18%, 34%, and 45% of first, second, third, and fourth treatments, respectively. We conclude that children with psoriasis who are treated with biologic drugs are predominantly older and heavier, and have more severe psoriasis. Prescriptions for biologics are given after many other treatments have been tried.
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Affiliation(s)
- Michael Sticherling
- Department of Dermatology, Psoriasic-Center, Deutsches Zentrum Immuntherapie (DZI), University of Erlangen, Ulmenweg 18, 91054 Erlangen, Germany
| | - Tess McPherson
- Churchill Hospital, Old Road, Headington, Oxford, OX3 7LE UK
| | - Raúl de Lucas Laguna
- Servicio de Dermatología Infantil, Hospital Universitario La Paz, P.º de la Castellana, 261, 28046 Madrid, Spain
| | - Antonio Costanzo
- Dermatology, Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini, 4, 20090 Pieve Emanuele, Milan, Italy
- Dermatology, IRCCS Humanitas Research Hospital, Via Alessandro Manzoni, 56, 20089 Rozzano, Milan, Italy
| | - Catherine Reed
- Eli Lilly and Company, 8 Arlington Square West, Downshire Way, Bracknell, Berkshire, RG12 1PU UK
| | - Esther Artime
- Eli Lilly and Company, Av. de la Industria, 30, 28108 Alcobendas, Madrid, Spain
| | - Camille Robert
- Lilly France SAS, 24 Bd Vital Bouhot, 92521 Neuilly Sur Seine, France
| | - James Lucas
- Adelphi Real-World, Adelphi Mil, Grimshaw Lane, Macclesfield, SK10 5JB UK
| | | | - Emmanuel Mahé
- Service de Dermatologie, Hôpital Victor Dupouy, 69, Rue du Lieutenant-Colonel Prud’hon, 95107 Argenteuil, France
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Update on the Management of Pediatric Psoriasis: An Italian Consensus. Dermatol Ther (Heidelb) 2022; 12:1753-1775. [PMID: 35776408 PMCID: PMC9247936 DOI: 10.1007/s13555-022-00758-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Accepted: 06/08/2022] [Indexed: 12/15/2022] Open
Abstract
Introduction Psoriasis affects children with a considerable burden in early life. Treating pediatric psoriasis is challenging also because of the lack of updated specific guidelines. With the recent approval of several biologics for pediatric psoriasis and the ongoing COVID-19 pandemic, the management of young psoriatic patients is facing major changes. A revision of treatment recommendations is therefore needed. Methods In September 2021, a board of six Italian dermatologists convened to update treatment recommendations. The board issued evidence- and consensus-based statements covering relevant areas of pediatric psoriasis, namely: assessment of psoriasis severity, management of children with psoriasis, and treatment of pediatric psoriasis. To reach consensus, the statements were submitted to a panel of 24 experts in a Delphi process performed entirely via videoconference. A treatment algorithm was produced. Results There was full consensus that psoriasis severity is determined by the extension/severity of skin lesions, site of lesions, and impact on patient quality of life. Agreement was reached on the need for a multidisciplinary approach to pediatric psoriasis and the importance of patient/parents education. The relevance of vaccinations, including COVID-19 vaccination, for psoriatic children was acknowledged by all participants. Management issues that initially failed to reach consensus included the screening for psoriasis comorbidities and early treatment with biologics to prevent them and the use of telemedicine to facilitate patient follow-up. There was full consensus that topical corticosteroids are the first choice for the treatment of mild pediatric psoriasis, while phototherapy and systemic therapy are used in children with moderate-severe psoriasis. According to the proposed treatment algorithm, biologics are the first line of systemic therapy. Conclusions Targeted systemic therapies are changing the treatment of moderate-severe pediatric psoriasis, while topical corticosteroids continue to be the first choice for mild disease. Children-centered research is needed to further improve the treatment of pediatric psoriasis.
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Hebert AA, Browning J, Kwong PC, Duarte AM, Price HN, Siegfried E. Managing Pediatric Psoriasis: Update on Treatments and Challenges-A Review. J DERMATOL TREAT 2022; 33:2433-2442. [PMID: 35736804 DOI: 10.1080/09546634.2022.2059051] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
BACKGROUND Psoriasis is a chronic, immune-mediated inflammatory disease with prominent cutaneous features, although the limited number of medications approved for pediatric psoriasis makes treating this population difficult. This review provides an overview of the challenges associated with diagnosing and treating pediatric psoriasis as well as the approved and off-label treatments for children and infants with psoriasis. METHODS Articles relevant to pediatric psoriasis were identified using series of PubMed searches. Topics relevant to pediatric psoriasis were explored, including disease characteristics, epidemiology, treatment efficacy and safety, and access to care. Publications previously known to the authors were also included. RESULTS Clinical features of psoriasis can be challenging to identify clinically, and patients face challenges gaining access to treatment. Most medications that have been approved for adult psoriasis lack data and labelling to support safe and effective use in pediatric patients, and therefore access is limited. A growing number of clinical trials using biologic agents for pediatric psoriasis aim to broaden available treatment options but may also raise unique concerns associated with the use of these medications in children. CONCLUSION Pediatric psoriasis is underrecognized and often undertreated. Clinicians must balance relative risks and potential benefits when developing a treatment strategy for these patients.
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Affiliation(s)
- A A Hebert
- UTHealth McGovern Medical School, Houston, TX, USA
| | - J Browning
- UT Health San Antonio, San Antonio, TX, USA
| | - P C Kwong
- Wolfson Children's Hospital, Jacksonville, FL, USA
| | - A M Duarte
- The Children's Skin Center, Nicklaus Children's Hospital, Miami, FL, USA
| | - H N Price
- Phoenix Children's Hospital, Phoenix, AZ, USA
| | - E Siegfried
- Saint Louis University School of Medicine, St. Louis, MO, USA
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Actualización práctica de las recomendaciones del Grupo de Psoriasis de la Academia Española de Dermatología y Venereología (GPS) para el tratamiento de la psoriasis con terapia biológica. Parte 2 «Manejo de poblaciones especiales, pacientes con comorbilidad y gestión del riesgo». ACTAS DERMO-SIFILIOGRAFICAS 2022; 113:583-609. [DOI: 10.1016/j.ad.2022.01.024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Accepted: 01/26/2022] [Indexed: 12/19/2022] Open
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Carrascosa JM, Puig L, Romero IB, Salgado-Boquete L, Del Alcázar E, Lencina JJA, Moreno D, de la Cueva P. [Translated article] Practical Update of the Guidelines Published by the Psoriasis Group of the Spanish Academy of Dermatology and Venereology (GPs) on the Treatment of Psoriasis With Biologic Agents: Part 2-Management of Special Populations, Patients With Comorbid Conditions, and Risk. ACTAS DERMO-SIFILIOGRAFICAS 2022; 113:T583-T609. [PMID: 35748004 DOI: 10.1016/j.ad.2022.01.040] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Accepted: 01/26/2022] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Since its inception, the Psoriasis Group (GPs) of the Spanish Academy of Dermatology and Venereology (AEDV) has worked to continuously update recommendations for the treatment of psoriasis based on the best available evidence and incorporating proposals arising from and aimed at clinical practice. An updated GPs consensus document on the treatment of moderate to severe psoriasis was needed because of changes in the treatment paradigm and the approval in recent years of a large number of new biologic agents. METHODOLOGY The consensus document was developed using the nominal group technique complemented by a scoping review. First, a designated coordinator selected a group of GPs members for the panel based on their experience and knowledge of psoriasis. The coordinator defined the objectives and key points for the document and, with the help of a documentalist, conducted a scoping review of articles in Medline, Embase, and the Cochrane Library up to January 2021. The review included systematic reviews and meta-analyses as well as clinical trials not included in those studies and high-quality real-world studies. National and international clinical practice guidelines and consensus documents on the management of moderate to severe psoriasis were also reviewed. The coordinator then drew up a set of proposed recommendations, which were discussed and modified in a nominal group meeting. After several review processes, including external review by other GPs members, the final document was drafted. RESULTS The present guidelines include updated recommendations on assessing the severity of psoriasis and criteria for the indication of systemic treatment. They also include general principles for the treatment of patients with moderate to severe psoriasis and define treatment goals for these patients as well as criteria for the indication and selection of initial and subsequent therapies Practical issues, such as treatment failure and maintenance of response, are also addressed.
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Affiliation(s)
- J M Carrascosa
- Departamento de Dermatología, Hospital Universitari Germans Trias I Pujol, Badalona, Universitat Autònoma de Barcelona, IGTP, Barcelona, Spain.
| | - L Puig
- Departamento de Dermatología, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - I B Romero
- Departamento de Dermatología, Hospital General Universitario de Alicante-ISABIAL - Universidad Miguel Hernández de Elche, Alicante, Spain
| | - L Salgado-Boquete
- Departamento de Dermatología, Complejo Hospitalario Universitario de Pontevedra, Pontevedra, Spain
| | - E Del Alcázar
- Departamento de Dermatología, Hospital Universitari Germans Trias I Pujol, Badalona, Universitat Autònoma de Barcelona, IGTP, Barcelona, Spain
| | - J J A Lencina
- Servicio de Dermatología, Hospital Universitario Vega Baja, Alicante, Spain
| | - D Moreno
- Departamento de Dermatología, Hospital Universitario Virgen Macarena, Universidad de Sevilla, Sevilla, Spain
| | - P de la Cueva
- Servicio de Dermatología, Hospital Universitario Infanta Leonor, Universidad Complutense de Madrid, Madrid, Spain
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Adverse Effect in Patients with Psoriasis Treated with Interleukin 17A Inhibitor- Secukinumab. SERBIAN JOURNAL OF EXPERIMENTAL AND CLINICAL RESEARCH 2022. [DOI: 10.2478/sjecr-2022-0013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Abstract
Secukinumab is fully human monoclonal antibody, IgG-1κ, which selectively attaches to IL-17A and inhibits its effects, which subsequently leads to a decrease of local inflammatory markers. In 2015 it was approved for treatment of patients suffering from psoriasis. We can say that in comparison with other biologic medicine, such as IL-12/23 inhibitors and TNF-α inhibitors, the incidence rate of serious adverse effects related to use of secukinumab is notably lower. Serious adverse effects reported in relation to use of secukinumab were development of mucocutaneous candidiasis, neutropenia and development or aggravation of the inflammatory bowel disease conditions.
In this review study we focused on frequent adverse effects and adverse effects of special interest during the secukinumab therapy in treating psoriasis patients.
Available data on long-term safety and effects on comorbidities are relatively few. A more extensive and longer term research is needed, as well as critical reevaluation of the criteria for participation in clinical trials in order to obtain data which would be of relevance in clinical practice. A better understanding of adverse effects leads to an improved individual therapeutic approach, increases patient’s satisfaction and results in minimizing these effects.
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Bardowska K, Krajewski PK, Tyczyńska K, Szepietowski JC. Safety evaluation of secukinumab in paediatric patients with plaque psoriasis. Expert Opin Drug Saf 2022; 21:867-872. [PMID: 35502692 DOI: 10.1080/14740338.2022.2073349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
INTRODUCTION : Psoriasis (Ps) is a common chronic, recurrent, immune-mediated, inflammatory skin disease affecting up to 2% children. It has well-established impact on patients' quality of life. Moreover, patients with psoriasis exhibit a higher prevalence of comorbidities, including hypertension, diabetes, and inflammatory bowel disease. Secukinumab is a fully human monoclonal IL-17A antibody, which has been approved in use for children with psoriasis. Nevertheless, there is very little data on the safety of this therapy in paediatric population. AREAS COVERED : The aim of this article was to perform an extensive review of available data concerning secukinumab safety and efficiency in pediatric population used for the treatment of plaque psoriasis. Moreover, special attention was put to underline the adverse effects of secukinumab. EXPERT OPINION : Although there is very little evidence on the long-term safety of secukinumab use in pediatric population, this therapy may be a promising modality in children with moderate to severe psoriasis. The available data confirms its favorable safety profile with no serious adverse events and unexpected events. Moreover, the clinical trials revealed sustained efficiency in respect of reaching PASI 75 and decreasing impact of the disease on quality of life.
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Affiliation(s)
- Klaudia Bardowska
- Department of Dermatology, Venereology and Allergology, Wroclaw Medical University, Chalubinskiego Street 1, Wrocław 50-368, Poland
| | - Piotr K Krajewski
- Department of Dermatology, Venereology and Allergology, Wroclaw Medical University, Chalubinskiego Street 1, Wrocław 50-368, Poland
| | - Kinga Tyczyńska
- Department of Dermatology, Venereology and Allergology, Wroclaw Medical University, Chalubinskiego Street 1, Wrocław 50-368, Poland
| | - Jacek C Szepietowski
- Department of Dermatology, Venereology and Allergology, Wroclaw Medical University, Chalubinskiego Street 1, Wrocław 50-368, Poland
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Zitouni J, Beauchet A, Curmin R, Di Lernia V, Bursztejn AC, Mazereeuw-Hautier J, Gottlieb J, Lasek A, Aubert H, Droitcourt C, Bulai-Livideanu C, Fortina AB, Caroppo F, Quiles-Tsimaratos N, Mallet S, Barthélémy H, Puzenat E, Bouilly-Auvray D, Neri I, Phan C, Mahé E. Effectiveness and Safety of Adalimumab, Etanercept and Ustekinumab for Severe Psoriasis in Children Under 12 Years of Age: A French-Italian Daily Practice Cohort (BiPe Jr). Paediatr Drugs 2022; 24:281-292. [PMID: 35397731 DOI: 10.1007/s40272-022-00501-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/13/2022] [Indexed: 12/19/2022]
Abstract
INTRODUCTION Biological therapies are valuable treatments for severe psoriasis. Children aged under 12 years are underrepresented in therapeutic trials for these drugs. The objective of the 'BiPe Jr' cohort study was to evaluate the drug survival, effectiveness, tolerance and switching patterns of biological therapies in children under 12 years of age with psoriasis. METHODS We conducted a multicentre retrospective study of children with psoriasis who received at least one injection of a biological agent, even off-licence, before the age of 12 years in France and Italy, collecting the data between April and August 2021. The data collected were from March 2012 up to August 2021. RESULTS In total, 82 children (mean age: 9.1 years; females: 61.0%) received 106 treatments. The drugs administered were adalimumab (n = 49), etanercept (n = 37), ustekinumab (n = 15), anakinra (n = 2), infliximab (n = 2) and secukinumab (n = 1). The most common form of psoriasis was plaque psoriasis (62.9%). The Physician Global Assessment and the Psoriasis Area Severity Index (PASI) scores decreased significantly from baseline to 3 months after treatment initiation for the three main biological drugs; PASI went from 14.1 ± 9.4 to 4.1 ± 11.3 for adalimumab (p = 0.001), 14.9 ± 9.3 to 5.1 ± 4.0 for etanercept (p = 0.002) and 11.6 ± 8.3 to 2.6 ± 2.2 for ustekinumab (p = 0.007). A trend towards higher 2-year maintenance rates was observed for ustekinumab and adalimumab, compared with etanercept (p = 0.06). 52 children discontinued their biological therapy, most frequently due to inefficacy (n = 28) and remission (n = 14). Seven serious adverse events (SAEs) were reported, including four severe infections. DISCUSSION Our analyses of drug survival and treatment patterns, combined with those of previous studies conducted in older children, indicate that there is a trend towards higher 2-year survival rates of ustekinumab and adalimumab. The SAEs identified were rare, but highlight the need for increased vigilance concerning infections. Overall, the biological therapies showed good effectiveness and safety profiles when used in daily practice for the treatment of young children with psoriasis.
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Affiliation(s)
- Jinane Zitouni
- Dermatology Department, Hôpital Victor Dupouy, Argenteuil, France
| | - Alain Beauchet
- Public Health Department, Centre Hospitalier Universitaire Ambroise Paré, Boulogne-Billancourt, France
| | - Raphaëlle Curmin
- Sorbonne University, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Paris, France
| | - Vito Di Lernia
- Dermatology unit, Arcispedale S. Maria Nuova IRCCS, Reggio Emilia, Italy
| | - Anne-Claire Bursztejn
- Dermatology Department, Hôpitaux de Brabois, Centre Hospitalier Universitaire de Nancy, Vandoeuvre-lès-Nancy, France
| | - Juliette Mazereeuw-Hautier
- Dermatology Department, Centre de référence des maladies rares de la peau et des muqueuses, Hôpital Larrey, Toulouse, France
| | - Jérémy Gottlieb
- Immunology and Dermatology Department, Hôpital Bicêtre, CHU de Bicêtre, Assistance Publique-Hôpitaux de Paris, Université Paris-Saclay, Le Kremlin Bicêtre, France
| | - Audrey Lasek
- Dermatology Department,, Hôpital Saint Vincent de Paul, Université Catholique de Lille, Lille, France
| | - Hélène Aubert
- Dermatology Department, Centre Hospitalier Universitaire de Nantes, Nantes, France
| | - Catherine Droitcourt
- Dermatology Department, Centre Hospitalier Universitaire Pontchaillou, Rennes, France
| | | | - Anna Belloni Fortina
- Pediatric Dermatology Unit, Department of Medicine DIMED, University of Padova, Padua, Italy
| | - Francesca Caroppo
- Pediatric Dermatology Unit, Department of Medicine DIMED, University of Padova, Padua, Italy
| | | | - Stéphanie Mallet
- Dermatology Department, Hôpital de la Timone, Assistance-publique-Hôpitaux de Marseille, Marseille, France
| | - Hugues Barthélémy
- Dermatology Department, Centre Hospitalier d'Auxerre, Auxerre, France
| | - Eve Puzenat
- Dermatology Department, Centre Hospitalier Universitaire Saint-Jacques, Besançon, France
| | | | - Iria Neri
- Dermatology, Department of Experimental, Diagnostic, and Specialty Medicine, Sant'Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Céline Phan
- Dermatology Department, Hôpital Victor Dupouy, Argenteuil, France
| | - Emmanuel Mahé
- Dermatology Department, Hôpital Victor Dupouy, Argenteuil, France.
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Di Lernia V, Macca L, Peterle L, Ingrasciotta Y, Trifirò G, Guarneri C. Efficacy of Systemic Biologic Drugs in Pediatric Psoriasis: Evidence From Five Selected Randomized Clinical Trials. Front Pharmacol 2022; 13:847308. [PMID: 35450044 PMCID: PMC9017712 DOI: 10.3389/fphar.2022.847308] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2022] [Accepted: 03/18/2022] [Indexed: 12/14/2022] Open
Abstract
Background: Psoriasis is a chronic, immune-mediated skin disease that may occur at any age. Prevalence in children ranges between 0.5 and 1.0% across Europe. Approximately 10–20% of paediatric psoriasis patients are moderate-to-severe in severity and may require the use of systemic therapy. Objective: Recently, newer targeted, systemic therapies have been licensed for treatment of moderate-to-severe paediatric psoriasis. The objective of this study was to evaluate the short-term efficacy of available antipsoriatic systemic drugs in children with a narrative synthesis of key efficacy from randomized clinical trials. Methods: A systematic review of literature was performed on Medline and embase databases and the Cochrane Central Register of Controlled Trials. Randomized clinical trials investigating the efficacy of treatments licensed by the US Food and Drug Administration and/or the European Medicines Agency for paediatric and adolescent psoriatic population were retrieved and analyzed. Data from this literature review was assessed in line with GRADE (grading of recommendations, assessment, development and evaluations). The short-term (12-16 weeks) clinical efficacy from baseline was evaluated according to the Psoriasis Area and Severity Index (PASI) 75 and 90 compared to baseline. Illustrative comparative risks, relative risk (RR) and the number needed to treat (NNT) for response on PASI 75 and PASI 90 were extracted. Results: A total of five relevant studies were identified on two TNF-alpha blockers (etanercept and adalimumab), the IL12/23 inhibitor ustekinumab and two IL-17 inhibitors (ixekizumab, secukinumab). Comparators were placebo (3 studies), placebo and etanercept (1 study) methotrexate (1 study). All examined drugs resulted efficacious. The probability to achieve PASI 75 and PASI 90 was higher for the IL-12/23 and IL-17 inhibitors. Overall, the anti-IL17s and the anti-IL12/23 antibodies showed a more favourable NNT for PASI 75, whereas IL-17 inhibitors for PASI 90. Conclusion: The approved biological therapies may be beneficial for the treatment of moderate to severe plaque psoriasis in children and adolescents. Since psoriasis is a chronic and often challenging condition with no definitive solution, systematic evaluations of long-term efficacy, drug survival and adverse effects may help careful, individualized, patient-centered clinical decision making.
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Affiliation(s)
- Vito Di Lernia
- Dermatology Unit, Arcispedale S. Maria Nuova, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Laura Macca
- Department of Clinical and Experimental Medicine, Section of Dermatology, University of Messina, Messina, Italy
| | - Lucia Peterle
- Department of Clinical and Experimental Medicine, Section of Dermatology, University of Messina, Messina, Italy
| | - Ylenia Ingrasciotta
- Department of Biomedical and Dental Sciences and Morpho-functional Imaging, Section of Pharmacology, University of Messina, Messina, Italy
| | - Gianluca Trifirò
- Department of Diagnostics and Public Health, Section of Pharmacology, University of Verona, Verona, Italy
| | - Claudio Guarneri
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, Section of Dermatology, University of Messina, Messina, Italy
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Nieto Benito L, Carretero G, Rivera-Díaz R, Carrascosa J, Daudén E, de la Cueva P, Sahuquillo-Torralba A, Herrera-Acosta E, Baniandrés-Rodríguez O, Lopez-Estebaranz J, Belinchón I, Riera-Monroig J, Ferrán M, Gómez-García F, Mateu A, Rodríguez L, Vilar-Alejo J, García-Donoso C, Ballescá F, Velasco LM, Botella-Estrada R, Herrera-Ceballos E, Ruiz-Genao D, Descalzo M, García-Doval I. Psoriasis moderada-grave en pacientes pediátricos y jóvenes: experiencia en el registro BIOBADADERM. ACTAS DERMO-SIFILIOGRAFICAS 2022; 113:401-406. [DOI: 10.1016/j.ad.2021.05.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Accepted: 05/23/2021] [Indexed: 10/20/2022] Open
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Ornelas J, Cordoro KM. Clinical Decisions in Pediatric Psoriasis. Dermatol Clin 2022; 40:145-166. [DOI: 10.1016/j.det.2021.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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[Translated article] Moderate to Severe Psoriasis in Pediatric and Young Patients: The BIOBADADERM Registry Experience. ACTAS DERMO-SIFILIOGRAFICAS 2022. [DOI: 10.1016/j.ad.2021.05.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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40
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Neema S, Mannu A, Vasudevan B, Bhatt S, Krishnan L, A W K. Successful treatment of nevoid psoriasis with Secukinumab in a pediatric patient. Dermatol Ther 2022; 35:e15456. [PMID: 35302696 DOI: 10.1111/dth.15456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Revised: 03/03/2022] [Accepted: 03/11/2022] [Indexed: 11/28/2022]
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Kim ES, Lee A. Several approved biologic agents are now available to treat paediatric plaque psoriasis. DRUGS & THERAPY PERSPECTIVES 2022. [DOI: 10.1007/s40267-022-00896-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Magnolo N, Kingo K, Laquer V, Browning J, Reich A, Szepietowski JC, Keefe D, Papanastasiou P, Bao W, Forrer P, Patekar M. Efficacy of Secukinumab Across Subgroups and Overall Safety in Pediatric Patients with Moderate to Severe Plaque Psoriasis: Week 52 Results from a Phase III Randomized Study. Paediatr Drugs 2022; 24:377-387. [PMID: 35698000 PMCID: PMC9205811 DOI: 10.1007/s40272-022-00507-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/03/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND The efficacy and safety of biologic treatments for children and adolescents with moderate to severe psoriasis should be examined over a considerable time period and in different subgroups. OBJECTIVE We report the efficacy and safety of secukinumab low dose (LD) and high dose (HD) regimens in pediatric patients with moderate to severe psoriasis for up to Week 52. METHODS This was a randomized, open-label, parallel-group, multicenter study in patients aged 6 to < 18 years. Patients were randomized in a 1:1 ratio to receive LD (75/75/150 mg; N = 42) or HD (75/150/300 mg; N = 42) subcutaneous secukinumab. At randomization, patients were stratified by weight (< 25, 25 to < 50, ≥ 50 kg) and disease severity (moderate/severe). The study is ongoing; the present analysis included data up to Week 52 collected from August 29, 2018 (first patient first visit) to May 28, 2020 (last patient last visit for Week 52). Efficacy was measured using Investigator's Global Assessment modified 2011 0/1 (IGA 0/1) and Psoriasis Area Severity Index (PASI) 75/90/100 response. Safety outcomes included assessment of adverse events. RESULTS Of the 84 enrolled patients, 78 (92.9%) completed 52 weeks of treatment. Overall, response rates for PASI 75 and IGA 0/1 were similar between the LD (92.8/88.9%) and HD (93.3/84.7%) groups at Week 52. In the LD and HD groups, PASI 90/100 responses at Week 52 were 78.7/53.5% and 84.7/70.0%, respectively. The proportions of IGA 0/1 and PASI 75/90 responders were comparable for the age, body weight, and disease severity subgroups in the secukinumab LD and HD groups. Mean absolute PASI change from baseline at week 52 was - 17.3 ± standard deviation 5.0 and - 18.2 ± 7.0, a percentage change of - 94.3 and - 94.5% for the LD and HD groups, respectively. More than 70% of evaluable patients achieved Children's Dermatology Life Quality Index 0/1 at Week 52 (LD 70.7%; HD 70.3%). The safety profile was consistent with that in adults, with no new safety signals for either secukinumab dosing regimen. CONCLUSION A high proportion of pediatric patients with psoriasis responded to both dosing regimens of secukinumab and maintained clinical responses through 52 weeks of treatment. No clinical difference was observed in the efficacy of secukinumab across the pediatric subgroups. Safety events were consistent with the established safety profile of secukinumab. TRIAL REGISTRATION ClinicalTrials.gov: NCT03668613.
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Affiliation(s)
| | - Külli Kingo
- grid.412269.a0000 0001 0585 7044Tartu University Hospital and University of Tartu, Tartu, Estonia
| | - Vivian Laquer
- grid.453842.c0000 0004 5900 2617First OC Dermatology, Fountain Valley, CA USA
| | - John Browning
- grid.267309.90000 0001 0629 5880University of Texas Health Science Center San Antonio, San Antonio, TX USA
| | - Adam Reich
- grid.13856.390000 0001 2154 3176Department of Dermatology, Institute of Medical Science, Medical College of Rzeszów University, Rzeszów, Poland
| | - Jacek C. Szepietowski
- grid.4495.c0000 0001 1090 049XDepartment of Dermatology, Venereology and Allergology, Wroclaw Medical University, Wrocław, Poland
| | - Deborah Keefe
- grid.418424.f0000 0004 0439 2056Novartis Pharmaceuticals Corporation, East Hanover, NJ USA
| | | | - Weibin Bao
- grid.418424.f0000 0004 0439 2056Novartis Pharmaceuticals Corporation, East Hanover, NJ USA
| | - Pascal Forrer
- grid.419481.10000 0001 1515 9979Novartis Pharma AG, Basel, Switzerland
| | - Manmath Patekar
- grid.419481.10000 0001 1515 9979Novartis Pharma AG, Basel, Switzerland
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Sun HY, Phan K, Paller AS, Sebaratnam DF. Biologics for pediatric psoriasis: A systematic review and meta-analysis. Pediatr Dermatol 2022; 39:42-48. [PMID: 34888919 DOI: 10.1111/pde.14870] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Revised: 10/10/2021] [Accepted: 11/07/2021] [Indexed: 01/14/2023]
Abstract
BACKGROUND Biologics represent a promising treatment for children with moderate-to-severe psoriasis. Randomized control trials (RCTs) have been published evaluating different biologics in children with psoriasis, but no summative review exists. OBJECTIVE To summarize data from existing RCTs to assess the efficacy and safety of biologics in the management of pediatric psoriasis. METHODS A systematic review and meta-analysis of RCTs was performed from Medline, Embase, PubMed, the Cochrane Central Register of Controlled Trials, and the American College of Physicians Journal Club from inception to November 2020. Random-effects models were used to estimate the pooled effect size. RESULTS Five RCTs assessing adalimumab, etanercept, ixekizumab, secukinumab, and ustekinumab were included (768 patients). The odds ratio of achieving a 75% improvement in Psoriasis Area and Severity index score was 12.37 (95% CI: 6.23-24.55) at initial follow-up, defined as 12-16 weeks of treatment. The odds ratio of any adverse event was 0.95 (95% CI: 0.51-1.80) at initial follow-up, in patients treated with biologics when compared to placebo or a non-biologic agent. Limitations of this study include heterogeneity in both the study design and the biologics investigated between the RCTs included in the meta-analysis. CONCLUSION Biologic therapy for pediatric patients with moderate-to-severe psoriasis has high efficacy and a favorable side effect profile.
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Affiliation(s)
- Helen Y Sun
- Faculty of Medicine and Health, University of New South Wales, Randwick, New South Wales, Australia.,Department of Dermatology, Liverpool Hospital, Liverpool, New South Wales, Australia
| | - Kevin Phan
- Faculty of Medicine and Health, University of New South Wales, Randwick, New South Wales, Australia.,Department of Dermatology, Liverpool Hospital, Liverpool, New South Wales, Australia
| | - Amy S Paller
- Departments of Dermatology and Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Deshan F Sebaratnam
- Faculty of Medicine and Health, University of New South Wales, Randwick, New South Wales, Australia.,Department of Dermatology, Liverpool Hospital, Liverpool, New South Wales, Australia
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Seyger MMB, Augustin M, Sticherling M, Bachhuber T, Fang J, Hetherington J, Lucas J, Meakin S, Richardson C, Paller AS. Physician-reported Clinical Unmet Needs, Burden and Treatment Patterns of Paediatric Psoriasis Patients: a US and EU Real-world Evidence Study. Acta Derm Venereol 2021; 102:adv00660. [PMID: 34935993 PMCID: PMC9631255 DOI: 10.2340/actadv.v101.981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
This study is a retrospective analysis using data collected from the Adelphi Paediatric Psoriasis Disease-Specific Programme cross-sectional survey. Despite being treated for their psoriasis, a substantial proportion of paediatric patients presented with moderate (18.3%) or severe (1.3%) disease at sampling; 42.9% and 92.0% had a body surface area (BSA) of >10%, and 38.8% and 100.0% had a Psoriasis Area Severity Index (PASI) score >10, respectively. Overall, 69.9% of patients had only ever been treated with a topical therapy for their psoriasis. For patients with moderate or severe disease at sampling, 16.3% and 14.4% were currently receiving conventional systemics or biologic therapy, respectively. There is a clinical unmet need in this paediatric population; a considerable percentage of patients still experienced moderate or severe disease and persistent psoriasis symptoms, with numerous body areas affected. A significant proportion of patients were undertreated, which may explain the high burden of disease observed.
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Affiliation(s)
- Marieke M B Seyger
- Department of Dermatology, Radboud University Nijmegen Medical Centre, NL-6500 HB Nijmegen, the Netherlands.
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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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Magnolo N, Kingo K, Laquer V, Browning J, Reich A, Szepietowski JC, Keefe D, Mazur R, Ghelani P, Forrer P, Wraith L, Patekar M. A phase 3 open-label, randomized multicenter study to evaluate efficacy and safety of secukinumab in pediatric patients with moderate to severe plaque psoriasis: 24-week results. J Am Acad Dermatol 2021; 86:122-130. [PMID: 34555481 DOI: 10.1016/j.jaad.2021.08.066] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Revised: 08/05/2021] [Accepted: 08/26/2021] [Indexed: 01/18/2023]
Abstract
BACKGROUND Psoriasis affects 0.13%-2.1% of children and adolescents. Despite a high unmet need, the current treatment options approved for pediatric psoriasis are limited. OBJECTIVE To evaluate the efficacy and safety of 2 secukinumab dosage regimens (low dose: 75/75/150 mg; high dose: 75/150/300 mg) stratified and randomized by weight (<25 kg, 25 to <50 kg, ≥50 kg) and disease severity (moderate, severe) in pediatric patients aged 6-<18 years with moderate to severe plaque psoriasis. METHODS This is a phase 3, open-label, randomized, multicenter study (NCT03668613). RESULTS Both secukinumab doses were superior to historical placebo with respect to psoriasis area and severity index (PASI)-75/90 and investigator global assessment 0/1 responses at week 12. The estimated probability of a positive treatment effect (ie, log odds ratio > 0) for low- or high-dose secukinumab compared to historical placebo is 1 (ie, 100%). For the low and high doses at week 12, the investigator global assessment 0/1 response rates were 78.6% and 83.3%, respectively, and the PASI-90 response rates were 69% and 76.2%, respectively. The PASI-75 response rate was 92.9% for both the doses. LIMITATIONS This is an open-label study design without a control arm. CONCLUSION Secukinumab dosing regimens were efficacious and well tolerated in pediatric patients with moderate to severe plaque psoriasis.
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Affiliation(s)
| | - Külli Kingo
- Tartu University Hospital and University of Tartu, Tartu, Estonia
| | | | | | | | - Jacek C Szepietowski
- Department of Dermatology, Venereology and Allergology, Wroclaw Medical University, Wroclaw, Poland
| | - Deborah Keefe
- Novartis Pharmaceuticals Corporation, East Hanover, New Jersey
| | | | | | | | - LindaAnn Wraith
- Novartis Pharmaceuticals Corporation, East Hanover, New Jersey
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Megna M, Fornaro L, De Lucia M, Rescigno O, Camela E, Fabbrocini G. A case of pediatric psoriasis successfully and rapidly treated with ixekizumab. Dermatol Ther 2021; 34:e15108. [PMID: 34427377 PMCID: PMC9285929 DOI: 10.1111/dth.15108] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Revised: 08/14/2021] [Accepted: 08/20/2021] [Indexed: 01/16/2023]
Affiliation(s)
- Matteo Megna
- Section of Dermatology - Department of Clinical Medicine and Surgery, University of Naples Federico II, Napoli
| | - Luigi Fornaro
- Section of Dermatology - Department of Clinical Medicine and Surgery, University of Naples Federico II, Napoli
| | - Mario De Lucia
- Section of Dermatology - Department of Clinical Medicine and Surgery, University of Naples Federico II, Napoli
| | - Orsola Rescigno
- Section of Dermatology - Department of Clinical Medicine and Surgery, University of Naples Federico II, Napoli
| | - Elisa Camela
- Section of Dermatology - Department of Clinical Medicine and Surgery, University of Naples Federico II, Napoli
| | - Gabriella Fabbrocini
- Section of Dermatology - Department of Clinical Medicine and Surgery, University of Naples Federico II, Napoli
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Refractory Pediatric Psoriasis and Atopic Dermatitis: The Importance of Therapeutical Adherence and Biological Management. Biomedicines 2021; 9:biomedicines9080958. [PMID: 34440162 PMCID: PMC8391197 DOI: 10.3390/biomedicines9080958] [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: 06/30/2021] [Revised: 07/27/2021] [Accepted: 07/30/2021] [Indexed: 11/25/2022] Open
Abstract
The rates of refractory pediatric psoriasis and atopic dermatitis (AD) have steadily risen over the last few decades, demanding newer and more effective therapies. This review aims to explore the reasons for resistant disease, as well as its management; this includes the indications for, efficacy of, and safety of current therapies for refractory pediatric dermatologic disease. A PubMed search for key phrases was performed. Poor medication adherence is the most common cause of resistant disease and may be managed with techniques such as simplified treatment regimens, more follow-ups and educational workshops, as well as framing and tailoring. Once problems with adherence are ruled out, escalating treatment to stronger biologic therapy may be indicated. Development of anti-drug antibodies (ADAs) can cause patients’ disease to be refractory in the presence of potent biologics, which may be addressed with regular medication use or concomitant methotrexate. If patients with AD fail to respond to biologic therapy, a biopsy to rule out mycosis fungoides, or patch testing to rule out allergic contact dermatitis, may be indicated. A limitation of this study is the absence of more techniques for the management of poor medication adherence. Managing medication adherence, escalating treatment when appropriate, and addressing possible anti-drug antibodies will help assure control and relief for patients with resistant disease.
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Pediatric Psoriasis: From New Insights into Pathogenesis to Updates on Treatment. Biomedicines 2021; 9:biomedicines9080940. [PMID: 34440145 PMCID: PMC8393839 DOI: 10.3390/biomedicines9080940] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Revised: 07/26/2021] [Accepted: 07/28/2021] [Indexed: 01/08/2023] Open
Abstract
Psoriasis is a chronic inflammatory systemic disease primarily affecting the skin, but which often involves considerable comorbidities as well. One-third of psoriasis cases start during childhood. In pediatric psoriasis, an association with several medical comorbidities is also indicated. Furthermore, because of its chronic nature and frequent relapses, psoriatic patients tend to require long-term treatment and experience negative impacts on their quality of life. Considering the different clinical characteristics of pediatric psoriasis, it has recently been presented that the pathogenesis of pediatric psoriasis is distinct from adult psoriasis. Treatment for pediatric psoriasis usually involves the same methods as for adults. However, most treatments in pediatric psoriasis are used off-label and research in this regard is still lacking. Targeted therapies involving newly developed biologics are also increasingly being applied to psoriasis in children. This review summarizes the clinical characteristics of pediatric psoriasis and focuses mainly on the updated concepts of pathogenesis and treatments in pediatric psoriasis. This was undertaken to widen the understanding of these relevant aspects and to provide better management of pediatric psoriasis by clinicians.
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Libon F, Lebas E, De Schaetzen V, Sabatiello M, De Schepper S, Nikkels AF. Biologicals for moderate-to-severe plaque type psoriasis in pediatric patients. Expert Rev Clin Immunol 2021; 17:947-955. [PMID: 34328370 DOI: 10.1080/1744666x.2021.1958675] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
INTRODUCTION Psoriasis affects around 2% of children in Europe. The majority of cases is readily managed with topical treatments using corticosteroids without or with calcipotriol. More resistant and extensive moderate-to-severe cases require UVA or UVB phototherapies or conventional systemic treatment including ciclosporin, acitretin and methotrexate. However, these therapies are associated with a low tolerability and potential cumulative long-term adverse effects and toxicities. AREAS COVERED About 15 years ago, the first biological appeared for the treatment of moderate-to-severe plaque type psoriasis in adult patients. Several years later, the first biologic treatment to be approved in children was etanercept, a soluble receptor that binds both tumor necrosis factor (TNF)-α and β followed by adalimumab, a monoclonal antibody against TNF-α, and currently by ustekinumab, a monoclonal IL12/23 p40 antagonist and, very recently, secukinumab and ixekizumab, both IL17 antagonists. All these biologic treatments brought significantly improved treatment results compared to light-based therapies and conventional treatments and present very good tolerance and safety profiles. EXPERT OPINION Due to their excellent efficacy and safety profiles ustekinumab, secukinumab and ixekizumab could currently be considered as a first-line treatment options for moderate-to-severe childhood and adolescent psoriasis requiring a systemic treatment.
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Affiliation(s)
- Florence Libon
- Department of Dermatology, CHU Du Sart Tilman, University of Liège, Liège, Belgium
| | - Eve Lebas
- Department of Dermatology, CHU Du Sart Tilman, University of Liège, Liège, Belgium
| | | | | | - Sofie De Schepper
- Department of Dermatology, University Hospital of Gent, Gent, Belgium
| | - Arjen F Nikkels
- Department of Dermatology, CHU Du Sart Tilman, University of Liège, Liège, Belgium
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