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Verardi F, Maul LV, Borsky K, Steinmann S, Rosset N, Pons HO, Sorbe C, Yawalkar N, Micheroli R, Egeberg A, Thyssen JP, Heidemeyer K, Boehncke WH, Conrad C, Cozzio A, Pinter A, Kündig T, Navarini AA, Maul JT. Sex differences in adverse events from systemic treatments for psoriasis: A decade of insights from the Swiss Psoriasis Registry (SDNTT). J Eur Acad Dermatol Venereol 2024; 38:719-731. [PMID: 38084852 DOI: 10.1111/jdv.19730] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Accepted: 10/26/2023] [Indexed: 03/26/2024]
Abstract
BACKGROUND Psoriasis is a disease that often requires prolonged systemic treatment. It is important to determine the safety of available therapies. There is currently little insight into sex-specific differences in the safety of systemic psoriasis therapies. OBJECTIVES To examine the real-world, long-term safety of systemic psoriasis therapies with sex stratification in drug-related adverse events (ADRs). METHODS Ten-year data from adults with moderate-to-severe psoriasis requiring systemic treatment (conventional systemic therapies [CST], biologics) were obtained from the Swiss psoriasis registry (SDNTT). ADRs were categorized according to the international terminology Medical Dictionary for Regulatory Activities (MedDRA). Safety was assessed by calculating event rates per 100 patient-years (PY). We used descriptive statistics for patient and disease characteristics, and binomial and t-tests to compare treatment groups and sex. RESULTS In total, 791 patients (290 females) were included with a mean age of 46 years. 358 (45%) received CSTs and 433 (55%) biologics; both groups had similar baseline characteristics except for more joint involvement in patients using biologics (26.86% vs. 14.8%, p < 0.0001). CSTs were associated with a 2.2-fold higher ADR rate (40.43/100 PY vs. 18.22/100 PY, p < 0.0001) and an 8.0-fold higher drug-related discontinuation rate than biologics (0.16/PY vs. 0.02/PY, p < 0.0001). Trends showed non-significant higher serious adverse event rates per 100 PY for biologics (8.19, CI 6.87-9.68) compared to CSTs (7.08, CI 5.39-9.13) (p = 0.3922). Sex stratification revealed a significantly higher overall ADR rate for all treatments in females (1.8-fold for CSTs [57.30/100 PY vs. 31.69/100 PY] and 2.0-fold for biologics [27.36/100 PY vs. 13.9/100 PY], p < 0.0001), and drug-related discontinuation rates for most CSTs in females. CONCLUSION Females were associated with a significantly higher rate of ADRs and drug-related discontinuation rates. Sex stratification should be taken into consideration when designing studies in the patient-tailored management of psoriasis.
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Affiliation(s)
- Fabio Verardi
- Department of Dermatology, University Hospital Zurich, Zurich, Switzerland
- Faculty of Medicine, University of Zurich, Zurich, Switzerland
| | - Lara Valeska Maul
- Department of Dermatology, University Hospital Zurich, Zurich, Switzerland
- Faculty of Medicine, University of Zurich, Zurich, Switzerland
- Department of Dermatology, University Hospital Basel, Basel, Switzerland
| | - Kim Borsky
- Oxford School of Surgery, Oxford Business Park, Oxford, UK
| | - Simona Steinmann
- Department of Dermatology, University Hospital Zurich, Zurich, Switzerland
- Faculty of Medicine, University of Zurich, Zurich, Switzerland
| | - Nina Rosset
- Department of Dermatology, University Hospital Zurich, Zurich, Switzerland
| | | | - Christina Sorbe
- Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Nikhil Yawalkar
- Department of Dermatology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Raphael Micheroli
- Department of Rheumatology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Alexander Egeberg
- Department of Dermato-Venereology and Wound Healing Centre, Copenhagen University Hospital Bispebjerg, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Jacob P Thyssen
- Department of Dermato-Venereology and Wound Healing Centre, Copenhagen University Hospital Bispebjerg, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Kristine Heidemeyer
- Department of Dermatology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Wolf-Henning Boehncke
- Division of Dermatology and Venereology, Geneva University Hospitals, Geneva, Switzerland
| | - Curdin Conrad
- Department of Dermatology, CHUV University Hospital and University of Lausanne (UNIL), Lausanne, Switzerland
| | - Antonio Cozzio
- Clinic of Dermatology, Venereology and Allergology, Cantonal Hospital St. Gallen, St. Gallen, Switzerland
| | - Andreas Pinter
- Department of Dermatology, Venerology and Allergology, University Hospital Frankfurt am Main, Frankfurt am Main, Germany
| | - Thomas Kündig
- Department of Dermatology, University Hospital Zurich, Zurich, Switzerland
| | | | - Julia-Tatjana Maul
- Department of Dermatology, University Hospital Zurich, Zurich, Switzerland
- Faculty of Medicine, University of Zurich, Zurich, Switzerland
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Macca L, Moscatt V, Ceccarelli M, Ingrasciotta Y, Nunnari G, Guarneri C. Hidradenitis Suppurativa in Patients with HIV: A Scoping Review. Biomedicines 2022; 10:2761. [PMID: 36359281 PMCID: PMC9687577 DOI: 10.3390/biomedicines10112761] [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: 09/30/2022] [Revised: 10/24/2022] [Accepted: 10/27/2022] [Indexed: 07/25/2023] Open
Abstract
Hidradenitis suppurativa (HS) is a chronic, debilitating skin disease of the apocrine glands. Bibliographic search revealed few studies concerning the association between HS and human immunodeficiency virus (HIV). To assess this link, we performed a systematic review of the current knowledge through a careful analysis of the relevant and authoritative medical literature in the field. Results showed that people with HIV are particularly susceptible to developing HS with the characteristic involvement of atypical sites, such as face or thighs, due to HIV-related immunosuppression. Based on the pathogenesis of both conditions and according to our review, we suggest that HIV screening should be routinely performed in suspected cases while monitoring and integrated approach in management are mandatory in the management of HIV-positive patients with HS.
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Affiliation(s)
- Laura Macca
- Department of Clinical and Experimental Medicine, Section of Dermatology, University of Messina, Italy C/O A.O.U.P. “Gaetano Martino”, via Consolare Valeria 1, 98125 Messina, Italy
| | - Vittoria Moscatt
- Unit of Infectious Diseases, Department of Clinical and Experimental Medicine, University of Catania, Italy C/O ARNAS “Garibaldi”, “Nesima” Hospital, Via Palermo 636, 95122 Catania, Italy
| | - Manuela Ceccarelli
- Unit of Infectious Diseases, Department of Clinical and Experimental Medicine, University of Catania, Italy C/O ARNAS “Garibaldi”, “Nesima” Hospital, Via Palermo 636, 95122 Catania, Italy
| | - Ylenia Ingrasciotta
- Department of Diagnostics and Public Health, University of Verona, 37134 Verona, Italy
| | - Giuseppe Nunnari
- Unit of Infectious Diseases, Department of Clinical and Experimental Medicine, University of Messina, Italy C/O A.O.U.P. “Gaetano Martino”, via Consolare Valeria 1, 98124 Messina, Italy
| | - Claudio Guarneri
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, Section of Dermatology, University of Messina, Italy C/O A.O.U.P. “Gaetano Martino”, via Consolare Valeria 1, 98125 Messina, Italy
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Anna C, Andrea M, Melania G, Monia O, Francesco F, Rachele N, Marco A, Primo TE, Annamaria O. Efficacy of calcipotriol plus betamethasone dipropionate foam on psoriatic skin lesions beyond human eyes: An observational study. Health Sci Rep 2022; 5:e597. [PMID: 35509415 PMCID: PMC9059184 DOI: 10.1002/hsr2.597] [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: 12/15/2021] [Revised: 02/25/2022] [Accepted: 03/27/2022] [Indexed: 11/30/2022] Open
Abstract
Background and Aims Calcipotriol plus betamethasone dipropionate foam has been developed as a new topical therapeutic option for psoriasis, whose effect has been documented mainly on clinical basis. Methods We decided to evaluate its efficacy on 11 patients, not only at the clinical level (by using Psoriasis Area Severity Index [PASI], Dermatology Life Quality Index [DLQI], and Psoriasis Global Assessment [PGA] clinimetric indexes) but especially from a subclinical viewpoint (by using videocapillaroscopy and thermography). Results After 4 weeks of treatment with calcipotriol plus betamethasone dipropionate foam, there was a marked reduction in all three clinimetric indixes PASI, PGA, and DLQI (DLQI mean value decreased from 13.45 ± 3.59 to 6.82 ± 3.31 (p = 0.001), PASI from 7.909 ± 2.857 to 4.582 ± 2.422 (p = 0.001), PGA from 1.8 ± 0.6 to 0.7 ± 0.4 (p = 0.002). From thermographic survey, a significant reduction of mean value of ΔT (temperature difference [°C] between center of the lesions and their periphery [healthy skin]), from 0.28 ± 0.99 to −0.42 ± 0.39 (p = 0.058), was observed. An exceptional reduction of capillaries of psoriatic plaques was detected through videocapillaroscopy (capillary density decreased from 27.91 ± 6.70 capillaries/mm2 to 4.54 ± 2.77 capillaries/mm2 (p = 0.001), with an 83.73% reduction). Conclusion Our results demonstrate both clinical and subclinical efficacy of calcipotriol plus betamethasone dipropionate foam on psoriatic skin lesions. The subclinical improvement detected, not only demonstrates that the therapeutic effect of foam is truly due to a decrease in inflammation, but, being earlier and more effectively detectable than clinical benefit, suggests future applications of thermography and videocapillaroscopy in evaluating the in vivo effect of therapies for psoriasis, and, in general, the course of the disease “beyond human eyes.”
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Affiliation(s)
- Campanati Anna
- Department of Clinical and Molecular Sciences ‐ Dermatological Clinic Polytechnic Marche University Ancona Italy
| | - Marani Andrea
- Department of Clinical and Molecular Sciences ‐ Dermatological Clinic Polytechnic Marche University Ancona Italy
| | - Giannoni Melania
- Department of Clinical and Molecular Sciences ‐ Dermatological Clinic Polytechnic Marche University Ancona Italy
| | - Orciani Monia
- Department of Clinical and Molecular Sciences ‐ Histology Section Polytechnic Marche University Ancona Italy
| | - Fabiani Francesco
- Department of Industrial Engineering and Mathematical Sciences Polytechnic Marche University Ancona Italy
| | - Napolitano Rachele
- Department of Industrial Engineering and Mathematical Sciences Polytechnic Marche University Ancona Italy
| | - Arnesano Marco
- Dr. Arnesano Marco Università Telematica eCAMPUS Novedrate (CO) Italy
| | - Tomasini Enrico Primo
- Department of Industrial Engineering and Mathematical Sciences Polytechnic Marche University Ancona Italy
| | - Offidani Annamaria
- Department of Clinical and Molecular Sciences ‐ Dermatological Clinic Polytechnic Marche University Ancona Italy
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Treatment of Moderate to Severe Psoriasis during the COVID-19 Pandemic: Lessons Learned and Opportunities. J Clin Med 2022; 11:jcm11092422. [PMID: 35566548 PMCID: PMC9101352 DOI: 10.3390/jcm11092422] [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: 01/18/2022] [Revised: 04/20/2022] [Accepted: 04/22/2022] [Indexed: 01/27/2023] Open
Abstract
Since the beginning of the coronavirus disease 2019 (COVID-19) pandemic, clinicians have been overwhelmed by questions beyond the SARS-CoV-2 infection itself. In dermatology practice, clinicians have been facing difficulties concerning therapeutic management of chronic immune-mediated skin disease, above all psoriasis. Major challenges arisen were to understand the role of immunosuppression or immunomodulation on COVID-19 evolution, the benefit/risk ratio related to discontinuation or modification of ongoing treatment, and the appropriateness of initiating new treatments, the optimization of timing in vaccination administration to patients under immunomodulatory treatments, and finally how to find new strategy of patients’ management through remote assistance. In this comprehensive review, we present the current evidence about the course and management of psoriasis during the COVID-19 pandemic. The general message from dermatologists was that data did not suggest that having PSO or its treatment significantly increased risk of SARS-CoV-2 infection or more severe COVID-19 course, the vaccination is highly recommended in all psoriatic patients, beyond ongoing treatment, and that the telehealth experience was a success overall.
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The Challenge Arising from New Knowledge about Immune and Inflammatory Skin Diseases: Where We Are Today and Where We Are Going. Biomedicines 2022; 10:biomedicines10050950. [PMID: 35625686 PMCID: PMC9138773 DOI: 10.3390/biomedicines10050950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2022] [Accepted: 04/12/2022] [Indexed: 11/16/2022] Open
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Benfaremo D, Svegliati S, Paolini C, Agarbati S, Moroncini G. Systemic Sclerosis: From Pathophysiology to Novel Therapeutic Approaches. Biomedicines 2022; 10:biomedicines10010163. [PMID: 35052842 PMCID: PMC8773282 DOI: 10.3390/biomedicines10010163] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Revised: 01/07/2022] [Accepted: 01/08/2022] [Indexed: 12/30/2022] Open
Abstract
Systemic sclerosis (SSc) is a systemic, immune-mediated chronic disorder characterized by small vessel alterations and progressive fibrosis of the skin and internal organs. The combination of a predisposing genetic background and triggering factors that causes a persistent activation of immune system at microvascular and tissue level is thought to be the pathogenetic driver of SSc. Endothelial alterations with subsequent myofibroblast activation, excessive extracellular matrix (ECM) deposition, and unrestrained tissue fibrosis are the pathogenetic steps responsible for the clinical manifestations of this disease, which can be highly heterogeneous according to the different entity of each pathogenic step in individual subjects. Although substantial progress has been made in the management of SSc in recent years, disease-modifying therapies are still lacking. Several molecular pathways involved in SSc pathogenesis are currently under evaluation as possible therapeutic targets in clinical trials. These include drugs targeting fibrotic and metabolic pathways (e.g., TGF-β, autotaxin/LPA, melanocortin, and mTOR), as well as molecules and cells involved in the persistent activation of the immune system (e.g., IL4/IL13, IL23, JAK/STAT, B cells, and plasma cells). In this review, we provide an overview of the most promising therapeutic targets that could improve the future clinical management of SSc.
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Affiliation(s)
- Devis Benfaremo
- Clinica Medica, Department of Internal Medicine, Ospedali Riuniti “Umberto I-G.M. Lancisi-G. Salesi”, 60126 Ancona, Italy;
| | - Silvia Svegliati
- Department of Clinical and Molecular Sciences, Marche Polytechnic University, 60126 Ancona, Italy; (S.S.); (C.P.); (S.A.)
| | - Chiara Paolini
- Department of Clinical and Molecular Sciences, Marche Polytechnic University, 60126 Ancona, Italy; (S.S.); (C.P.); (S.A.)
| | - Silvia Agarbati
- Department of Clinical and Molecular Sciences, Marche Polytechnic University, 60126 Ancona, Italy; (S.S.); (C.P.); (S.A.)
| | - Gianluca Moroncini
- Clinica Medica, Department of Internal Medicine, Ospedali Riuniti “Umberto I-G.M. Lancisi-G. Salesi”, 60126 Ancona, Italy;
- Department of Clinical and Molecular Sciences, Marche Polytechnic University, 60126 Ancona, Italy; (S.S.); (C.P.); (S.A.)
- Correspondence:
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Lang Y, Wu B, Sun Z, Ye E, Dou G, Guan X. Patient Preference for Biologic Treatments of Psoriasis in the Chinese Setting. Patient Prefer Adherence 2022; 16:1071-1084. [PMID: 35479654 PMCID: PMC9038155 DOI: 10.2147/ppa.s357795] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Accepted: 04/09/2022] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE Assessments of patients' preferences can support in clinical decision-making regarding biologic therapies for psoriasis. Our objective was to investigate patient preference for biologic treatments in patients with psoriasis in China. METHODS From October 2020 to January 2021, psoriasis patients were recruited for a survey that included demographic and disease-related questions, as well as a discrete choice experiment to measure their preferences for biologic therapy. A discrete-choice experiment was used in which respondents selected psoriasis treatments based on benefits (ie, early onset of efficacy, long-term efficacy, sustained efficacy) and treatment costs. We analyzed choice data using conditional logit model. RESULTS This study included 236 patients with moderate-to-severe psoriasis. The relative importance of the cost of biologic treatments, probability of keeping PASI100 at 5 years, probability of achieving PASI100 at 3 months and time to achieve PASI50 after initiation the biologic treatment were 0.593, 0.137, 0.185 and 0.085. Over 50% of patients regarded the cost of biologic treatments as the most important attribute. High-income and low-income subgroups had higher preference weight in probability of achieving PASI100 at 3-month and monthly cost. CONCLUSION The cost of biologic treatments was found as the most important attribute for Chinese patients with psoriasis. Among efficacy attributes, the probability of achieving PASI100 at 3 months showed most sensitive. These results may be helpful to understand patient preference for biologic treatments used for psoriasis in China.
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Affiliation(s)
- Yitian Lang
- Department of Pharmacy, Huangpu Branch, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200011, People’s Republic of China
| | - Bin Wu
- Medical Decision and Economic Group, Department of Pharmacy, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, 201100, People’s Republic of China
| | - Zhilin Sun
- Department of Dermatology, Peking University Third Hospital, Peking University, Haidian District, Beijing, People’s Republic of China
| | - Erjia Ye
- Lilly China Drug Development and Medical Affairs Center, Eli Lilly and Company, Shanghai, People’s Republic of China
| | - Guanshen Dou
- Lilly China Drug Development and Medical Affairs Center, Eli Lilly and Company, Shanghai, People’s Republic of China
| | - Xin Guan
- Department of Dermatology, Peking University Third Hospital, Peking University, Haidian District, Beijing, People’s Republic of China
- Correspondence: Xin Guan, Department of Dermatology, Peking University Third Hospital, Peking University, No. 49, Huayuan North Road, Haidian District, Beijing, People’s Republic of China, Email
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Radi G, Campanati A, Diotallevi F, Rizzetto G, Martina E, Bobyr I, Giannoni M, Offidani A. Long-term efficacy and safety of apremilast in the treatment of plaques psoriasis: A real-world, single-center experience. Dermatol Ther 2021; 34:e15179. [PMID: 34704350 DOI: 10.1111/dth.15179] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Revised: 09/24/2021] [Accepted: 10/23/2021] [Indexed: 12/18/2022]
Abstract
Apremilast is a small molecule approved for the treatment of plaques psoriasis and adult psoriatic arthritis. Pivotal studies have demonstrated short and long term efficacy and safety of apremilast but few data in real life are still available. The aim of this study is to report the efficacy and safety results of apremilast in clinical practice in patients with moderate-to-severe plaque psoriasis, focusing on therapeutic results obtained after 24 and 52 weeks of treatment. From May 2018 to December 2018, 40 patients with plaques psoriasis have been enrolled. Psoriasis Area Severity Index (PASI), body surface area, Physician Global Assessment, and Dermatology Life Quality Index (DLQI) were performed at baseline at 24 (W24) and 52 (W52) weeks after treatment initiation. Primary endpoint was to evaluate the percentage of patient that achieved PASI 75, PASI 90 and PASI 100 at week 24 and 52 of treatment. Additional measure of efficacy was percentage of patients reaching the minimal disease activity (MDA = PGA0/1 and DLQI 0/1) after 24 and 52 weeks of treatment. As secondary endpoint, we evaluated the percentage of patient that achieved DLQI 0-1 at W24 and W52, and long-term safety of apremilast. The percentage of patients who achieved PASI75, PASI90 and PASI100 was 47.5%, 30% and 10% and 25%, 35% and 10% at W24 and W52 respectively. About the half of the reported patients reached MDA at W24 (n = 21) and at W52 (n = 20). The 60% of patients achieved and maintained DLQI 0-1 at W24 until W52. Diarrhea, nausea, headache, insomnia, and other AEs have been reported by 28 patients. Apremilast in real life experience confirmed the levels of efficacy and safety obtained in pivotal trials. In particular, the good initial response to the treatment is predictive of the maintenance or improvement of the outcome over W52. The efficacy is supported by an excellent safety profile even in frail patients.
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Affiliation(s)
- Giulia Radi
- Department of Clinical and Molecular Sciences, Dermatological Clinic, Polytechnic University of the Marche Region, Ancona, Italy
| | - Anna Campanati
- Department of Clinical and Molecular Sciences, Dermatological Clinic, Polytechnic University of the Marche Region, Ancona, Italy
| | - Federico Diotallevi
- Department of Clinical and Molecular Sciences, Dermatological Clinic, Polytechnic University of the Marche Region, Ancona, Italy
| | - Giulio Rizzetto
- Department of Clinical and Molecular Sciences, Dermatological Clinic, Polytechnic University of the Marche Region, Ancona, Italy
| | - Emanuela Martina
- Department of Clinical and Molecular Sciences, Dermatological Clinic, Polytechnic University of the Marche Region, Ancona, Italy
| | - Ivan Bobyr
- Department of Clinical and Molecular Sciences, Dermatological Clinic, Polytechnic University of the Marche Region, Ancona, Italy
| | - Melania Giannoni
- Department of Clinical and Molecular Sciences, Dermatological Clinic, Polytechnic University of the Marche Region, Ancona, Italy
| | - Annamaria Offidani
- Department of Clinical and Molecular Sciences, Dermatological Clinic, Polytechnic University of the Marche Region, Ancona, Italy
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Welihinda A, Ravikumar P, Kaur M, Mechanic J, Yadav S, Kang GJ, Amento E. Positive Allosteric Modulation of A 2AR Alters Immune Cell Responses and Ameliorates Psoriasis-Like Dermatitis in Mice. J Invest Dermatol 2021; 142:624-632.e6. [PMID: 34536482 DOI: 10.1016/j.jid.2021.07.174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Revised: 07/15/2021] [Accepted: 07/20/2021] [Indexed: 10/20/2022]
Abstract
Psoriasis is an immune cell‒mediated inflammatory disease of the skin with a mixed T helper type 1/T helper type17 cytokine environment combined with an innate immune response engaging toll-like receptors. Inflammatory diseases are characterized by dysregulated immune cell responses and elevated levels of adenosine at disease sites. Adenosine, acting through the A2AR, regulates inflammation, immune response, T-cell homeostasis, and tissue repair. We have identified a unique means to enhance A2AR function using a positive allosteric modulator. We show that oral administration of the A2AR-positive allosteric modulator AEA061 reduced ear swelling, skin thickness, erythema, scale formation, and inflammatory cytokine expression in A2Ar+/+ but not in A2Ar-/- mice with imiquimod-induced psoriasis-like dermatitis. Similar clinical and mRNA improvements were observed with topical administration. AEA061 also reduced clinical scores and cytokine expression in a mouse model of IL-23‒induced psoriasis-like dermatitis. In addition, AEA061 attenuated imiquimod-induced expression of IFN-α in plasmacytoid dendritic cells in vivo and IL-23 and IL-36α in conventional dendritic cells. TCR-mediated IL-17 expression in γδT cells in vivo and IL-17 production by CD4+ T cells enriched for γδT cells in vitro were also inhibited. Thus, the enhancement of A2AR responsiveness to the endogenous agonist adenosine through positive allosteric modulation is sufficient to enhance intrinsic homeostatic mechanisms attenuating disease progression.
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Affiliation(s)
- Ajith Welihinda
- Molecular Medicine Research Institute, Sunnyvale, California, USA.
| | - Puja Ravikumar
- Molecular Medicine Research Institute, Sunnyvale, California, USA
| | - Manmeet Kaur
- Molecular Medicine Research Institute, Sunnyvale, California, USA
| | - Jordan Mechanic
- Molecular Medicine Research Institute, Sunnyvale, California, USA
| | - Shruti Yadav
- Molecular Medicine Research Institute, Sunnyvale, California, USA
| | - Gyeong Jin Kang
- Molecular Medicine Research Institute, Sunnyvale, California, USA
| | - Edward Amento
- Molecular Medicine Research Institute, Sunnyvale, California, USA
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Campanati A, Martina E, Diotallevi F, Radi G, Marani A, Sartini D, Emanuelli M, Kontochristopoulos G, Rigopoulos D, Gregoriou S, Offidani A. Saliva Proteomics as Fluid Signature of Inflammatory and Immune-Mediated Skin Diseases. Int J Mol Sci 2021; 22:ijms22137018. [PMID: 34209865 PMCID: PMC8267971 DOI: 10.3390/ijms22137018] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Revised: 06/22/2021] [Accepted: 06/24/2021] [Indexed: 12/11/2022] Open
Abstract
Saliva is easy to access, non-invasive and a useful source of information useful for the diagnosis of serval inflammatory and immune-mediated diseases. Following the advent of genomic technologies and -omic research, studies based on saliva testing have rapidly increased and human salivary proteome has been partially characterized. As a proteomic protocol to analyze the whole saliva proteome is not currently available, the most common aim of the proteomic analysis is to discriminate between physiological and pathological conditions. The salivary proteome has been initially investigated in several diseases: oral squamous cell carcinoma and oral leukoplakia, chronic graft-versus-host disease, and Sjögren's syndrome. Otherwise, salivary proteomics studies in the dermatological field are still in the initial phase, thus the aim of this review is to collect the best research evidence on the role of saliva proteomics analysis in immune-mediated skin diseases to understand the direction of research in this field. The results of PRISMA analysis reported herein suggest that human saliva analysis could provide significant data for the diagnosis and prognosis of several immune-mediated and inflammatory skin diseases in the next future.
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Affiliation(s)
- Anna Campanati
- Dermatological Unit, Department of Clinical and Molecular Sciences, Polytechnic Marche University, 60100 Ancona, Italy; (E.M.); (F.D.); (G.R.); (A.M.); (A.O.)
- Correspondence:
| | - Emanuela Martina
- Dermatological Unit, Department of Clinical and Molecular Sciences, Polytechnic Marche University, 60100 Ancona, Italy; (E.M.); (F.D.); (G.R.); (A.M.); (A.O.)
| | - Federico Diotallevi
- Dermatological Unit, Department of Clinical and Molecular Sciences, Polytechnic Marche University, 60100 Ancona, Italy; (E.M.); (F.D.); (G.R.); (A.M.); (A.O.)
| | - Giulia Radi
- Dermatological Unit, Department of Clinical and Molecular Sciences, Polytechnic Marche University, 60100 Ancona, Italy; (E.M.); (F.D.); (G.R.); (A.M.); (A.O.)
| | - Andrea Marani
- Dermatological Unit, Department of Clinical and Molecular Sciences, Polytechnic Marche University, 60100 Ancona, Italy; (E.M.); (F.D.); (G.R.); (A.M.); (A.O.)
| | - Davide Sartini
- Biochemistry, Department of Clinical Sciences, Polytechnic Marche University, 60100 Ancona, Italy; (D.S.); (M.E.)
| | - Monica Emanuelli
- Biochemistry, Department of Clinical Sciences, Polytechnic Marche University, 60100 Ancona, Italy; (D.S.); (M.E.)
| | - George Kontochristopoulos
- Department of Dermatology-Venereology, Faculty of Medicine, National and Kapodistrian University of Athens, Andreas Sygros Hospital, 124 62 Athens, Greece; (G.K.); (D.R.); (S.G.)
| | - Dimitris Rigopoulos
- Department of Dermatology-Venereology, Faculty of Medicine, National and Kapodistrian University of Athens, Andreas Sygros Hospital, 124 62 Athens, Greece; (G.K.); (D.R.); (S.G.)
| | - Stamatis Gregoriou
- Department of Dermatology-Venereology, Faculty of Medicine, National and Kapodistrian University of Athens, Andreas Sygros Hospital, 124 62 Athens, Greece; (G.K.); (D.R.); (S.G.)
| | - Annamaria Offidani
- Dermatological Unit, Department of Clinical and Molecular Sciences, Polytechnic Marche University, 60100 Ancona, Italy; (E.M.); (F.D.); (G.R.); (A.M.); (A.O.)
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Nast A, Smith C, Spuls P, Avila Valle G, Bata‐Csörgö Z, Boonen H, De Jong E, Garcia‐Doval I, Gisondi P, Kaur‐Knudsen D, Mahil S, Mälkönen T, Maul J, Mburu S, Mrowietz U, Reich K, Remenyik E, Rønholt K, Sator P, Schmitt‐Egenolf M, Sikora M, Strömer K, Sundnes O, Trigos D, Van Der Kraaij G, Yawalkar N, Dressler C. EuroGuiDerm Guideline on the systemic treatment of Psoriasis vulgaris – Part 1: treatment and monitoring recommendations. J Eur Acad Dermatol Venereol 2020; 34:2461-2498. [DOI: 10.1111/jdv.16915] [Citation(s) in RCA: 62] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Accepted: 08/13/2020] [Indexed: 12/14/2022]
Affiliation(s)
- A. Nast
- Department of Dermatology, Venereology and Allergology Charité – Universitätsmedizin BerlinCorporate Member of Freie Universität BerlinHumboldt‐Universität zu BerlinBerlin Institute of Health Berlin Germany
| | - C. Smith
- St John’s Institute of Dermatology London UK
| | - P.I. Spuls
- Academic Medical Centre Amsterdam Amsterdam Netherlands
| | - G. Avila Valle
- Department of Dermatology, Venereology and Allergology Charité – Universitätsmedizin BerlinCorporate Member of Freie Universität BerlinHumboldt‐Universität zu BerlinBerlin Institute of Health Berlin Germany
| | | | - H. Boonen
- Office‐Based Dermatology Practice Geel Belgium
| | - E. De Jong
- Radboud University medical centre Nijmegen Netherlands
| | - I. Garcia‐Doval
- Unidad de InvestigaciónFundación Piel Sana AEDV Madrid España
| | | | | | - S. Mahil
- Guy's and St Thomas' NHS Foundation Trust London UK
| | - T. Mälkönen
- Helsinki University Central Hospital Helsinki Finland
| | - J.T. Maul
- Department of Dermatology University Hospital of Zürich Zürich Switzerland
| | - S. Mburu
- International Federation of Psoriasis Associations (IFPA)
| | - U. Mrowietz
- Universitätsklinikum Schleswig‐Holstein Kiel Germany
| | - K. Reich
- Translational Research in Inflammatory Skin Diseases Institute for Health Services Research in Dermatology and Nursing University Medical Center Hamburg‐Eppendorf Hamburg Germany
| | | | | | - P.G. Sator
- Municipal Hospital Hietzing Vienna Austria
| | - M. Schmitt‐Egenolf
- Dermatology Department of Public Health & Clinical Medicine Umeå University Umeå Sweden
| | - M. Sikora
- Department of Dermatology Medical University of Warsaw Warszawa Poland
| | - K. Strömer
- Office‐Based Dermatology Practice Mönchengladbach Germany
| | | | - D. Trigos
- International Federation of Psoriasis Associations (IFPA)
| | | | - N. Yawalkar
- Department of Dermatology, Inselspital Bern University HospitalUniversity of Bern Bern Switzerland
| | - C. Dressler
- Department of Dermatology, Venereology and Allergology Charité – Universitätsmedizin BerlinCorporate Member of Freie Universität BerlinHumboldt‐Universität zu BerlinBerlin Institute of Health Berlin Germany
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12
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Molinelli E, Sapigni C, Campanati A, Brisigotti V, Offidani A. Metabolic, pharmacokinetic, and toxicological issues of biologic therapies currently used in the treatment of hidradenitis suppurativa. Expert Opin Drug Metab Toxicol 2020; 16:1019-1037. [PMID: 32896186 DOI: 10.1080/17425255.2020.1810233] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
INTRODUCTION Hidradenitis suppurativa is a chronic, relapsing, debilitating inflammatory dermatologic disease of the terminal hair follicles at intertriginous sites clinically characterized by painful inflammatory nodules, abscesses, draining sinus tracts, and dermal fibrosis. The management of hidradenitis suppurativa is a challenge and usually consists of both medical and surgical approaches, which must often be combined for best outcome. The introduction of biological therapies, specifically TNFα-inhibitors such as adalimumab, has profoundly changed the therapeutic armamentarium of the disease. AREAS COVERED The PubMed database was searched using combinations of the following keywords: hidradentis suppurativa, biologic therapy, TNF-α inhibitors, adalimumab, etanercept, infliximab, certolizumab pegol, golimumab, adverse effects, pharmacodynamics, pharmacology, adverse events, pharmacokinetics, drug interaction. This article reviews and updates the chemistry, pharmacokinetics, mechanism of action, adverse effects, drug interactions of on-label and off-label use of TNF-α inhibitors in HS. EXPERT OPINION Biologic agents, particularly adalimumab, exhibit clinical efficacy in patients with hidradenitis suppurativa. Careful patient selection and close monitoring during treatment are mandatory to provide safe and effective use of the TNF-α inhibitor. Familiarity with biologic agents is crucial because these agents could become a consolidated treatment option in the clinician's therapeutic approaches.
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Affiliation(s)
- Elisa Molinelli
- Dermatological Unit, Department of Clinical and Molecular Sciences, Polytechnic Marche University , Ancona, Italy
| | - Claudia Sapigni
- Dermatological Unit, Department of Clinical and Molecular Sciences, Polytechnic Marche University , Ancona, Italy
| | - Anna Campanati
- Dermatological Unit, Department of Clinical and Molecular Sciences, Polytechnic Marche University , Ancona, Italy
| | - Valerio Brisigotti
- Dermatological Unit, Department of Clinical and Molecular Sciences, Polytechnic Marche University , Ancona, Italy
| | - Annamaria Offidani
- Dermatological Unit, Department of Clinical and Molecular Sciences, Polytechnic Marche University , Ancona, Italy
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13
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Doolan BJ, Koye D, Ling J, Cains GD, Baker C, Foley P, Dolianitis C. Treatment modalities and risk of adverse events associated with biologic therapy: A 10-year observational review of the Australasian Psoriasis Registry. Australas J Dermatol 2020; 62:e47-e54. [PMID: 32885846 DOI: 10.1111/ajd.13450] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Accepted: 08/02/2020] [Indexed: 12/01/2022]
Abstract
BACKGROUND Psoriasis is a chronic inflammatory disease affecting ~2-3% of the Australasian population. Therapeutic options include topical agents, phototherapy, systemic immunomodulators and biologic agents. Biologics present an acceptable short- and medium-term safety profile, derived mainly from randomised controlled trials (RCTs) and, however, may not represent real-world rates of adverse events (AEs). METHODS A retrospective, observational study of patients enrolled in The Australasian Psoriasis Registry from April 2008 to October 2018 was conducted. Data were collected from 104 sites in Australia and New Zealand. Patient characteristics, treatments and AE data were collected. AEs were classified by MedDRA System events. RESULTS 2094 patients were included (3765 patient-treatments), comprising; 1110 phototherapy, 1280 systemic and 1375 biologic therapy patient-treatments. Treatment arms were not mutually exclusive. The mean ± SD from date of diagnosis of psoriasis to commencement of biologic therapy was 8.9 ± 12.3 years. Methotrexate had the longest exposure time (3740.3 patient-years), and ustekinumab had the longest median (95% CI) time on treatment, 4.3 years (2.2, 6.6). AE differences on biologic treatment were present between patients who would have been eligible or ineligible for RCTs. Approximately 29% of registry patients would have been excluded from clinical trials enrolment. Patients ineligible for RCTs had increased adjusted hazard ratios (95% CI) of: infections and infestations (2.3, 1.7-3.1; P < 0.001), cardiac (8.2, 3.5-25.6; P < 0.001), gastrointestinal (3.5, 1.52-8.0; P < 0.001), hepatobiliary (5.6 1.7-19.1; P < 0.001), psychiatric (4.7, 1.5-14.1; P = 0.006) and eye disorders (4.8 1.5-15.6; P = 0.008), compared to those eligible for RCTs. Incidence rates in the trial eligible patients were similar to those reported from RCT rates. CONCLUSIONS This study establishes treatment modalities in use for severe psoriasis and the clinical rates of AEs associated with biologic therapy.
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Affiliation(s)
- Brent J Doolan
- Department of Dermatology, The Royal Melbourne Hospital, Melbourne, Victoria, Australia.,Skin Health Institute, Carlton, Victoria, Australia.,The Skin Hospital, Sydney, New South Wales, Australia
| | - Digsu Koye
- The Melbourne EpiCentre, University of Melbourne and Melbourne Health, Melbourne, Victoria, Australia
| | - Joanna Ling
- The Melbourne EpiCentre, University of Melbourne and Melbourne Health, Melbourne, Victoria, Australia
| | - Geoffrey D Cains
- Department of Dermatology, Liverpool Hospital, Sydney, New South Wales, Australia.,School of Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Christopher Baker
- Skin Health Institute, Carlton, Victoria, Australia.,Department of Dermatology and Medicine, St Vincent's Hospital, Melbourne, The University of Melbourne, Fitzroy, Victoria, Australia
| | - Peter Foley
- Skin Health Institute, Carlton, Victoria, Australia.,Department of Dermatology and Medicine, St Vincent's Hospital, Melbourne, The University of Melbourne, Fitzroy, Victoria, Australia
| | - Con Dolianitis
- Department of Dermatology, The Royal Melbourne Hospital, Melbourne, Victoria, Australia.,Department of Medicine, The University of Melbourne, Melbourne, Victoria, Australia
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Silfvast-Kaiser A, Menter MA. How can we manage the safety concerns associated with the increase in biologics for psoriasis? Expert Opin Drug Saf 2020; 19:361-364. [PMID: 31951750 DOI: 10.1080/14740338.2020.1718102] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
| | - Martin Alan Menter
- Division of Dermatology, Baylor Scott and White - Dallas, Dallas, TX, USA
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15
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Campanati A, Diotallevi F, Martina E, Paolinelli M, Radi G, Offidani A. Safety update of etanercept treatment for moderate to severe plaque psoriasis. Expert Opin Drug Saf 2020; 19:439-448. [PMID: 32178543 DOI: 10.1080/14740338.2020.1740204] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Introduction: Conventional topical therapies and disease-modifying anti-rheumatic drugs (DMARDs) for patients with psoriasis are often linked to inadequate outcomes and risk of multiple adverse effects. Biologic agents such as etanercept (ETN) have revolutionized the therapeutic management of psoriasis, allowing the treatment of most difficult cases, and fragile patients.Areas covered: The authors searched PubMed using the term 'psoriasis,' 'etanercept,' and 'safety.' Articles considered by the authors to be most relevant, such as randomized controlled studies, cohort studies, and review articles placing emphasis on studies of efficacy and safety were selected. Case reports and letters relating to safety were also included. The main sources of data referenced by these articles were also included in the review. Besides, to get the relevant studies, the reference lists were examined to identify the potentially available studies. The aim of this review is to describe the safety profile of ETN, used for psoriasis treatment, focusing on related clinical implications.Expert opinion: ETN has a favorable safety profile, and its use should be largely considered in psoriatic patients. Caution should be recommended in case of chronic heart failure, autoimmune disease, previous malignancies, familial history of demyelinating diseases, latent TBC infection, chronic HBV and HCV infection or HIV.
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Affiliation(s)
- Anna Campanati
- Dermatological Clinic, Department of Clinical and Molecular Sciences, Polytechnic Marche University, Ancona, Italy
| | - Federico Diotallevi
- Dermatological Clinic, Department of Clinical and Molecular Sciences, Polytechnic Marche University, Ancona, Italy
| | - Emanuela Martina
- Dermatological Clinic, Department of Clinical and Molecular Sciences, Polytechnic Marche University, Ancona, Italy
| | - Matteo Paolinelli
- Dermatological Clinic, Department of Clinical and Molecular Sciences, Polytechnic Marche University, Ancona, Italy
| | - Giulia Radi
- Dermatological Clinic, Department of Clinical and Molecular Sciences, Polytechnic Marche University, Ancona, Italy
| | - Annamaria Offidani
- Dermatological Clinic, Department of Clinical and Molecular Sciences, Polytechnic Marche University, Ancona, Italy
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16
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Campanati A, Paolinelli M, Diotallevi F, Martina E, Molinelli E, Offidani A. Pharmacodynamics OF TNF α inhibitors for the treatment of psoriasis. Expert Opin Drug Metab Toxicol 2019; 15:913-925. [PMID: 31623470 DOI: 10.1080/17425255.2019.1681969] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Introduction: The treatment of psoriasis with conventional topical therapies and disease-modifying anti-rheumatic drugs (DMARDs) is often linked to unsatisfactory outcomes and the risk of serious adverse events. Over the last decades, research advances in understanding the role of tumor necrosis factor alpha (TNF α) and other cytokines in the pathogenesis of psoriasis have driven the introduction of biologic agents targeting specific immune mediators in everyday clinical practice. TNF α inhibitors are a consolidated treatment option for patients with moderate-to-severe disease with remarkable efficacy and a reassuring safety profile.Areas covered: The PubMed database was searched using combinations of the following keywords: psoriasis, TNF α inhibitors, biologic therapy, pharmacodynamics, adalimumab, etanercept, infliximab, certolizumab pegol, golimumab, adverse effects. The aim of this review is to describe the pharmacodynamic profile of anti-TNF α inhibitors, currently approved by the European Medicines Agency (EMA) for the treatment of psoriasis, focusing on related clinical implications, also in comparison to the new generation biological therapies targeting the interleukin 23/interleukin 17 axis.Expert opinion: Pharmacodynamics of TNF α inhibitors should be fully considered in planning patient's therapy strategies, especially in case of secondary failures, poor adherence to treatment, instable psoriasis, high risk of infection, pregnant or lactating women, metabolic comorbidities, coexistence of other immune-mediated inflammatory diseases.
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Affiliation(s)
- Anna Campanati
- Dermatological Clinic, Department of Clinical and Molecular Sciences, Polytechnic Marche University, Ancona, Italy
| | - Matteo Paolinelli
- Dermatological Clinic, Department of Clinical and Molecular Sciences, Polytechnic Marche University, Ancona, Italy
| | - Frederico Diotallevi
- Dermatological Clinic, Department of Clinical and Molecular Sciences, Polytechnic Marche University, Ancona, Italy
| | - Emanuela Martina
- Dermatological Clinic, Department of Clinical and Molecular Sciences, Polytechnic Marche University, Ancona, Italy
| | - Elisa Molinelli
- Dermatological Clinic, Department of Clinical and Molecular Sciences, Polytechnic Marche University, Ancona, Italy
| | - Annamaria Offidani
- Dermatological Clinic, Department of Clinical and Molecular Sciences, Polytechnic Marche University, Ancona, Italy
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Tang L, He S, Wang X, Liu H, Zhu Y, Feng B, Su Z, Zhu W, Liu B, Xu F, Li C, Zhao J, Zheng X, Lu C, Zheng G. Cryptotanshinonereduces psoriatic epidermal hyperplasia via inhibiting the activation of STAT3. Exp Dermatol 2018; 27:268-275. [PMID: 29427477 DOI: 10.1111/exd.13511] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/19/2018] [Indexed: 12/11/2022]
Affiliation(s)
- Lipeng Tang
- Department of Pharmacology of Traditional Chinese Medicine; The Second Affiliated Hospital of Guangzhou University of Chinese Medicine; Guangzhou China
- The Postdoctoral Research Station; Guangzhou University of Chinese Medicine; Guangzhou, Guangdong China
| | - Songmin He
- Department of Pharmacology of Traditional Chinese Medicine; The Second Affiliated Hospital of Guangzhou University of Chinese Medicine; Guangzhou China
| | - Xieqi Wang
- The Second Clinical Medical College; Guangzhou University of Chinese Medicine; Guangzhou China
| | - Hongying Liu
- Department of Pathology; The Second Affiliated Hospital of Guangzhou University of Chinese Medicine; Guangzhou China
| | - Ying Zhu
- Department of Pharmacology of Traditional Chinese Medicine; The Second Affiliated Hospital of Guangzhou University of Chinese Medicine; Guangzhou China
| | - Bing Feng
- Department of Pharmacology of Traditional Chinese Medicine; The Second Affiliated Hospital of Guangzhou University of Chinese Medicine; Guangzhou China
| | - Zuqing Su
- Department of Pharmacology of Traditional Chinese Medicine; The Second Affiliated Hospital of Guangzhou University of Chinese Medicine; Guangzhou China
| | - Wei Zhu
- Traditional Chinese Medicine Material Basic Research Team; The Second Affiliated Hospital of Guangzhou University of Chinese Medicine; Guangzhou China
| | - Bo Liu
- Department of Chemical Research and Structural Optimization based on Chinese Material Medicine; The Second Affiliated Hospital of Guangzhou University of Chinese Medicine; Guangzhou China
| | - Fangfang Xu
- Department of Chemical Research and Structural Optimization based on Chinese Material Medicine; The Second Affiliated Hospital of Guangzhou University of Chinese Medicine; Guangzhou China
| | - Chutian Li
- Department of Pathology; The Second Affiliated Hospital of Guangzhou University of Chinese Medicine; Guangzhou China
| | - Jie Zhao
- Department of Pathology; The Second Affiliated Hospital of Guangzhou University of Chinese Medicine; Guangzhou China
| | - Xirun Zheng
- Department of Pathology; The Second Affiliated Hospital of Guangzhou University of Chinese Medicine; Guangzhou China
| | - Chuanjian Lu
- Department of Dermatology; The Second Affiliated Hospital of Guangzhou University of Chinese Medicine; Guangzhou China
| | - Guangjuan Zheng
- Department of Pharmacology of Traditional Chinese Medicine; The Second Affiliated Hospital of Guangzhou University of Chinese Medicine; Guangzhou China
- Department of Pathology; The Second Affiliated Hospital of Guangzhou University of Chinese Medicine; Guangzhou China
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Abstract
INTRODUCTION Childhood psoriasis is a special situation that is a management challenge for the treating dermatologist. As is the situation with traditional systemic agents, which are commonly used in managing severe psoriasis in children, the biologics are being increasingly used in the recalcitrant disease despite limited data on long term safety. AREAS COVERED We performed an extensive literature search to collect evidence-based data on the use of biologics in pediatric psoriasis. The relevant literature published from 2000 to September 2017 was obtained from PubMed, using the MeSH words 'biologics', 'biologic response modifiers' and 'treatment of pediatric/childhood psoriasis'. All clinical trials, randomized double-blind or single-blind controlled trials, open-label studies, retrospective studies, reviews, case reports and letters concerning the use of biologics in pediatric psoriasis were screened. Articles covering the use of biologics in pediatric psoriasis were screened and reference lists in the selected articles were scrutinized to identify other relevant articles that had not been found in the initial search. Articles without relevant information about biologics in general (e.g. its mechanism of action, pharmacokinetics and adverse effects) and its use in psoriasis in particular were excluded. We screened 427 articles and finally selected 41 relevant articles. EXPERT OPINION The available literature on the use of biologics such as anti-tumor necrosis factor (TNF)-α agents, and anti-IL-12/23 agents like ustekinumab suggests that these are effective and safe in managing severe pediatric psoriasis although there is an urgent need to generate more safety data. Dermatologists must be careful about the potential adverse effects of the biologics before administering them to children with psoriasis. It is likely that with rapidly evolving scenario of biologics in psoriasis, these will prove to be very useful molecules particularly in managing severe and recalcitrant psoriasis in pediatric age group.
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Affiliation(s)
- Sunil Dogra
- a Department of Dermatology, Venereology, and Leprology , Postgraduate Institute of Medical Education and Research , Chandigarh , India
| | - Rahul Mahajan
- a Department of Dermatology, Venereology, and Leprology , Postgraduate Institute of Medical Education and Research , Chandigarh , India
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Verma L, Mayba JN, Gooderham MJ, Verma A, Papp KA. Persistency of Biologic Therapies for Plaque Psoriasis in 2 Large Community Practices. J Cutan Med Surg 2017; 22:38-43. [PMID: 29056080 DOI: 10.1177/1203475417733957] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
BACKGROUND Biologics have transformed the management of moderate to severe psoriasis. The persistency of biologics lacks real-world data. OBJECTIVES To quantify drug survival of infliximab (IFX), adalimumab (ADA), etanercept (ETA), and ustekinumab (UST) and to identify potential factors affecting drug survival. METHODS An observational, retrospective 2-centre study consisting of 906 patients from private practices in Ontario between July 2003 and June 13, 2016, was conducted, including patients with plaque psoriasis receiving commercial treatment with ADA, ETA, IFX, and UST. Paper and electronic records of each patient were reviewed. RESULTS Median survival times for UST, IFX, ADA, and ETA were respectively, in months, 68, 23, 33, and 28. Female sex was determined to be a statistically significant positive predictor of drug survival. Our study was consistent with the literature in that UST had the highest survival rate compared to the other biologics, and the shape of our drug survival curve suggested that loss of drug efficacy is a stochastic occurrence. Compared to other studies, our data exhibited lower survival rates at various time points for all the biologics studied, and female sex did not predict drug survival in other studies. We also investigated potential reasons for differences in biologic survival times between different practices; the main differentiator was drug dosage, as higher dosages were associated with greater survival. CONCLUSION UST has a higher drug survival rate than ADA, ETA, and IFX, as observed in other studies. When practice patterns are compared, dosage difference is the main factor that may cause differing survival rates.
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Affiliation(s)
| | - Julia N Mayba
- 2 University of Manitoba Rady Faculty of Health Sciences, Max Rady College of Medicine, Winnipeg, MB, Canada
| | - Melinda J Gooderham
- 3 Queen's University, Kingston, ON, Canada.,4 SkiN Centre for Dermatology, Peterborough, ON, Canada.,5 Probity Medical Research Inc., Waterloo, ON, Canada
| | | | - Kim A Papp
- 5 Probity Medical Research Inc., Waterloo, ON, Canada.,7 K. Papp Clinical Research, Waterloo, ON, Canada
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20
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IgA nephropathy during treatment with TNF-alpha blockers: Could it be predicted? Med Hypotheses 2017; 107:12-13. [PMID: 28915952 DOI: 10.1016/j.mehy.2017.07.016] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2017] [Revised: 05/15/2017] [Accepted: 07/15/2017] [Indexed: 12/28/2022]
Abstract
Immunoglobulin A (IgA) nephropathy (IgAN) may sometimes be related to exposure to pharmacological agents, among which anti-Tumor Necrosis Factor (TNF)-alpha agents. The characteristic pathological feature is a deposition of IgA-containing immune complexes in vessel walls in the kidney mesangium. The link between TNF-alpha blockers and IgAN may be hypothesized examining diseases which share pathologic features. In this respect, idiopathic IgAN and Henoch Schonlein Purpura have been the object of studies revealing a pathogenetic role of aberrant glycosylation of IgA1 molecules. The Authors suggest that anti-drug antibodies against glycan structures of TNF-alpha inhibitors may cross react against serum aberrant IgA1 leading to large antigen-antibody complexes. These large polymeric IgA complexes are then able to deposit in the mesangium and activate the complement cascade. Such hypothesis may be tested by measuring serum levels of galactose-deficient IgA1 of patients developing IgAN following introduction of TNF-alpha blockers. Such a test would be useful also before administration of anti-TNF alpha agents. The presence of aberrant IgA1 may represent a contraindication for treatment with TNF blockers.
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21
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Alavi A, French LE, Davis MD, Brassard A, Kirsner RS. Pyoderma Gangrenosum: An Update on Pathophysiology, Diagnosis and Treatment. Am J Clin Dermatol 2017; 18:355-372. [PMID: 28224502 DOI: 10.1007/s40257-017-0251-7] [Citation(s) in RCA: 155] [Impact Index Per Article: 22.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Pyoderma gangrenosum (PG) is a rare inflammatory neutrophilic disorder with prototypical clinical presentations. Its pathophysiology is complex and not fully explained. Recent information regarding the genetic basis of PG and the role of auto-inflammation provides a better understanding of the disease and new therapeutic targets. PG equally affects patients of both sexes and of any age. Uncontrolled cutaneous neutrophilic inflammation is the cornerstone in a genetically predisposed individual. Multimodality management is often required to reduce inflammation, optimize wound healing, and treat underlying disease. A gold standard for the management of PG does not exist and high-level evidence is limited. Multiple factors must be taken into account when deciding on the optimum treatment for individual patients: location, number and size of lesion/ulceration(s), extracutaneous involvement, presence of associated disease, cost, and side effects of treatment, as well as patient comorbidities and preferences. Refractory and rapidly progressive cases require early initiation of systemic therapy. Newer targeted therapies represent a promising pathway for the management of PG, and the main focus of this review is the management and evidence supporting the role of new targeted therapies in PG.
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Campanati A, Benfaremo D, Luchetti MM, Ganzetti G, Gabrielli A, Offidani A. Certolizumab pegol for the treatment of psoriasis. Expert Opin Biol Ther 2017; 17:387-394. [DOI: 10.1080/14712598.2017.1283401] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Affiliation(s)
- A. Campanati
- Dermatological Clinic, Department of Clinical and Molecular Sciences, Polytechnic Marche University, Ancona, Italy
| | - D. Benfaremo
- Internal Medicine Department of Clinical and Molecular Sciences, Polytechnic Marche University, Ancona, Italy
| | - M. M. Luchetti
- Internal Medicine Department of Clinical and Molecular Sciences, Polytechnic Marche University, Ancona, Italy
| | - G. Ganzetti
- Dermatological Clinic, Department of Clinical and Molecular Sciences, Polytechnic Marche University, Ancona, Italy
| | - A. Gabrielli
- Internal Medicine Department of Clinical and Molecular Sciences, Polytechnic Marche University, Ancona, Italy
| | - A. Offidani
- Dermatological Clinic, Department of Clinical and Molecular Sciences, Polytechnic Marche University, Ancona, Italy
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Parthasaradhi A, Singh V, Parasramani SG, Yadav N, Krupashankar DS, Soni M, Bansal R. A Real-World Study to Assess the Effectiveness of Itolizumab in Patients with Chronic Plaque Psoriasis. Indian Dermatol Online J 2017; 8:246-249. [PMID: 28761839 PMCID: PMC5518574 DOI: 10.4103/idoj.idoj_330_16] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background: While clinical trial data on the efficacy of itolizumab in the management of psoriasis is relatively well documented, data on the effectiveness of this humanized IgG1 monoclonal antibody in real-world settings is sparse. Aims: The current study assessed the effectiveness of itolizumab in real-world settings. Materials and Methods: This study assessed psoriasis area severity index (PASI), dermatology quality of life index (DLQI), safety, and tolerability data from a registry of itolizumab maintained by Syngene International, Bangalore. Registry data of 155 patients who were prescribed itolizumab at a dose of 1.6 mg/kg every 2 weeks for the first 12 weeks followed by 1.6 mg/kg every 4 weeks for up to 24 weeks for chronic plaque psoriasis. Results: In the study, 35.48% completed itolizumab for 12 weeks and 76.59% of these patients achieved PASI 75. Furthermore, 24.51% patients completed the full Itolizumab regimen for 24 weeks, of whom 92.01% patients achieved PASI 75. The mean percent change in DLQI scores at weeks 12 and 24 were 60.19 and 82.72, respectively. Adverse events and infusion reactions noted in the study were generally of mild to moderate severity. Conclusion: Itolizumab is a safe and effective option in treatment-compliant patients with chronic plaque psoriasis. Effects of putative compliance-modulators such as cost, route of administration, and delayed onset of action warrant further investigation.
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Affiliation(s)
| | - Vinay Singh
- Department of Dermatology, Vibrance Skin Clinic, New Delhi, India
| | - S G Parasramani
- Department of Dermatology, Leelavati Hospital, Mumbai, Maharashtra, India
| | - Nishi Yadav
- Department of Dermatology, ESI Hospital, Okla, New Delhi, India
| | - D S Krupashankar
- Department of Dermatology, Mallige Hospital, Bengaluru, Karnataka, India
| | - Manish Soni
- Department of Dermatology, ESI Hospital, Okla, New Delhi, India
| | - Rakesh Bansal
- Department of Dermatology, ESI Hospital, Okla, New Delhi, India
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24
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He X, Shen C, Lu Q, Li J, Wei Y, He L, Bai R, Zheng J, Luan N, Zhang Z, Rong M, Lai R. Prokineticin 2 Plays a Pivotal Role in Psoriasis. EBioMedicine 2016; 13:248-261. [PMID: 27887936 PMCID: PMC5264273 DOI: 10.1016/j.ebiom.2016.10.022] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2016] [Revised: 10/15/2016] [Accepted: 10/17/2016] [Indexed: 02/08/2023] Open
Abstract
Psoriasis is histologically characterized by keratinocytes (KC) hyperproliferation, inflammation, and increased angiogenesis, but the pathological factor responsible for these symptoms is unknown. Here, a neuroendocrine peptide (prokineticin 2, PK2), is highly expressed in human and mouse psoriatic skins but no significant change in other autoimmune diseases, suggesting that PK2 is a psoriasis-specific factor. Bacterial products significantly up-regulated PK2, implying that infection induces PK2 over-expression. PK2 promoted KC and macrophage to produce interleukin-1 (IL-1), the central player of inflammation and psoriasis, which acts on adjacent fibroblast to induce inflammatory cascades and KC hyperproliferation. IL-1 feeds back on macrophages to induce PK2 production to perpetuate PK2-IL-1 positive feedback loop. PK2 also promoted angiogenesis, another psoriatic symptom. In mouse models, PK2 over-expression aggravated psoriasis while its knock-down inhibited pathological development. The results indicate that PK2 over-production perpetuates psoriatic symptoms by creating PK-2-IL-1 vicious loop. PK2 is a central player in psoriasis and a promising psoriasis-specific target. High level of PK2 is found in psoriasis but not in other autoimmunity diseases. Bacterial products induce PK2 over-expression to promote IL-1 signal. IL-1 induces PK2 secretion to create a PK2-IL-1 circle to perpetuate symptoms. PK2 is a central player in psoriasis and may be a psoriasis-specific target.
Psoriasis is a common autoimmune disease whose pathogenesis remains poorly understood. We found that PK2 was highly expressed in psoriasis but not in other autoimmune diseases. To investigate the role of PK2 in psoriasis, the effect of PK2 on keratinocyte proliferation, inflammation and angiogenesis were analyzed. PK2 expression mediated by virus in psoriasis was applied. The results demonstrated that PK2 promoted psoriasis development. PK2 over-expression in mouse model aggravates psoriasis while knock-down of PK2 improves the disease. PK2 plays a pivotal role in psoriasis.
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Affiliation(s)
- Xiaoqin He
- Key Laboratory of Animal Models and Human Disease Mechanisms of Chinese Academy of Sciences/Key Laboratory of Bioactive Peptides of Yunnan Province, Kunming Institute of Zoology, Kunming 650223, Yunnan, China
| | - Chuanbin Shen
- Key Laboratory of Animal Models and Human Disease Mechanisms of Chinese Academy of Sciences/Key Laboratory of Bioactive Peptides of Yunnan Province, Kunming Institute of Zoology, Kunming 650223, Yunnan, China; University of Chinese Academy of Sciences, Beijing 100009, China
| | - Qiumin Lu
- Key Laboratory of Animal Models and Human Disease Mechanisms of Chinese Academy of Sciences/Key Laboratory of Bioactive Peptides of Yunnan Province, Kunming Institute of Zoology, Kunming 650223, Yunnan, China
| | - Jiong Li
- State Key Laboratory of Biotherapy, Cancer Center, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Yuquan Wei
- State Key Laboratory of Biotherapy, Cancer Center, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Li He
- The Department of dermatology, The First Affiliated Hospital of Kunming Medical University, Kunming 650032, Yunnan, China
| | - Ruizhen Bai
- The Department of Pathology, The Affiliated Hospital of Jiangnan University Wuxi 4th People's Hospital, Wuxi 214062, Jiangsu, China
| | - Jie Zheng
- Department of Physiology and Membrane Biology, University of California, Davis, California 95616, United States
| | - Ning Luan
- Life Sciences College of Nanjing Agricultural University, Nanjing 210095, Jiangsu, China
| | - Zhiye Zhang
- Key Laboratory of Animal Models and Human Disease Mechanisms of Chinese Academy of Sciences/Key Laboratory of Bioactive Peptides of Yunnan Province, Kunming Institute of Zoology, Kunming 650223, Yunnan, China
| | - Mingqiang Rong
- Key Laboratory of Animal Models and Human Disease Mechanisms of Chinese Academy of Sciences/Key Laboratory of Bioactive Peptides of Yunnan Province, Kunming Institute of Zoology, Kunming 650223, Yunnan, China.
| | - Ren Lai
- Key Laboratory of Animal Models and Human Disease Mechanisms of Chinese Academy of Sciences/Key Laboratory of Bioactive Peptides of Yunnan Province, Kunming Institute of Zoology, Kunming 650223, Yunnan, China.
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25
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Vlachos C, Gaitanis G, Katsanos KH, Christodoulou DK, Tsianos E, Bassukas ID. Psoriasis and inflammatory bowel disease: links and risks. PSORIASIS-TARGETS AND THERAPY 2016; 6:73-92. [PMID: 29387596 PMCID: PMC5683131 DOI: 10.2147/ptt.s85194] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Psoriasis and the spectrum of inflammatory bowel diseases (IBD) are chronic, inflammatory, organotropic conditions. The epidemiologic coexistence of these diseases is corroborated by findings at the level of disease, biogeography, and intrafamilial and intrapatient coincidence. The identification of shared susceptibility loci and DNA polymorphisms has confirmed this correlation at a genetic level. The pathogenesis of both diseases implicates the innate and adaptive segments of the immune system. Increased permeability of the epidermal barrier in skin and intestine underlies the augmented interaction of allergens and pathogens with inflammatory receptors of immune cells. The immune response between psoriasis and IBD is similar and comprises phagocytic, dendritic, and natural killer cell, along with a milieu of cytokines and antimicrobial peptides that stimulate T-cells. The interplay between dendritic cells and Th17 cells appears to be the core dysregulated immune pathway in all these conditions. The distinct similarities in the pathogenesis are also reflected in the wide overlapping of their therapeutic approaches. Small-molecule pharmacologic immunomodulators have been applied, and more recently, biologic treatments that target proinflammatory interleukins have been introduced or are currently being evaluated. However, the fact that some treatments are quite selective for either skin or gut conditions also highlights their crucial pathophysiologic differences. In the present review, a comprehensive comparison of risk factors, pathogenesis links, and therapeutic strategies for psoriasis and IBD is presented. Specific emphasis is placed on the role of the immune cell species and inflammatory mediators participating in the pathogenesis of these diseases.
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Affiliation(s)
| | | | - Konstantinos H Katsanos
- Division of Gastroenterology, Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina, Greece
| | - Dimitrios K Christodoulou
- Division of Gastroenterology, Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina, Greece
| | - Epameinondas Tsianos
- Division of Gastroenterology, Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina, Greece
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