1
|
Mohamed MF, Qian Y, D'Cunha R, Sligh T, Ferris LK, Eldred A, Levy GF, Hao S, Gannu S, Rizzo DG, Liu W, Jazayeri S, Sofen H, Carcereri De Prati R. Pharmacokinetics, safety, and efficacy of cedirogant from phase I studies in healthy participants and patients with chronic plaque psoriasis. Clin Transl Sci 2024; 17:e13682. [PMID: 38112262 PMCID: PMC10766045 DOI: 10.1111/cts.13682] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Revised: 10/09/2023] [Accepted: 10/25/2023] [Indexed: 12/21/2023] Open
Abstract
Cedirogant is an inverse agonist of retinoic acid-related orphan receptor gamma thymus (RORγt) developed for the treatment of moderate to severe chronic plaque psoriasis. Here, we report the results from two phase I studies in which the pharmacokinetics (PK), safety, and efficacy of cedirogant in healthy participants and patients with moderate to severe chronic plaque psoriasis were evaluated. The studies consisted of single (20-750 mg) and multiple (75-375 mg once-daily [q.d.]) ascending dose designs, with effect of food and itraconazole on cedirogant exposure also evaluated. Safety and PK were evaluated for both healthy participants and psoriasis patients, and efficacy was assessed in psoriasis patients. Following single and multiple doses, cedirogant mean terminal half-life ranged from 16 to 28 h and median time to reach maximum plasma concentration ranged from 2 to 5 h across both populations. Cedirogant plasma exposures were dose-proportional after single doses and less than dose-proportional from 75 to 375 mg q.d. doses. Steady-state concentrations were achieved within 12 days. Accumulation ratios ranged from approximately 1.2 to 1.8 across tested doses. Food had minimal effect and itraconazole had limited impact on cedirogant exposure. No discontinuations or serious adverse events due to cedirogant were recorded. Psoriasis Area and Severity Index (PASI) and Self-Assessment of Psoriasis Symptoms (SAPS) assessments demonstrated numerical improvement with treatment of cedirogant 375 mg q.d. compared with placebo. The PK, safety, and efficacy profiles of cedirogant supported advancing it to phase II clinical trial in psoriasis patients.
Collapse
Affiliation(s)
| | - Yuli Qian
- Clinical PharmacologyAbbVie Inc.North ChicagoIllinoisUSA
| | | | - Teresa Sligh
- Velocity Clinical ResearchNorth HollywoodCaliforniaUSA
| | - Laura K. Ferris
- Department of DermatologyUniversity of Pittsburgh School of MedicinePittsburghPennsylvaniaUSA
| | - Ann Eldred
- Immunology DevelopmentAbbVie Inc.North ChicagoIllinoisUSA
| | - Gweneth F. Levy
- Pharmacovigilance and Patient SafetyAbbVie Inc.North ChicagoIllinoisUSA
| | - Shuai Hao
- Discovery and Exploratory StatisticsAbbVie Inc.North ChicagoIllinoisUSA
| | | | - David G. Rizzo
- Regulated BioanalysisAbbVie Inc.North ChicagoIllinoisUSA
| | - Wei Liu
- Clinical PharmacologyAbbVie Inc.North ChicagoIllinoisUSA
| | | | - Howard Sofen
- University of California Los Angeles School of Medicine and Dermatology Research AssociatesLos AngelesCaliforniaUSA
| | | |
Collapse
|
2
|
Rusiñol L, Carmona-Rocha E, Puig L. Durability and long-term outcomes of biologic therapies in psoriasis. Expert Rev Clin Immunol 2024; 20:71-82. [PMID: 37610817 DOI: 10.1080/1744666x.2023.2250918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2023] [Revised: 07/19/2023] [Accepted: 08/18/2023] [Indexed: 08/24/2023]
Abstract
INTRODUCTION Significant advances in psoriasis treatment have taken place since the introduction of biologics. Tumor necrosis factor inhibitors were the first class of biologics approved and at that time greatly improved psoriasis treatment. However, newer biologics, directed to interleukin(IL)-23/IL-17 pathways central to psoriasis pathogenesis, have improved complete or nearly complete clearance rates and are characterized by an excellent safety profile.Real-world setting experiences have generally confirmed the results of clinical trials, but real-world data regarding newer biologics is relatively scarce. AREAS COVERED We provide an extensive review of real-world survival of biologic treatments for moderate to severe psoriasis. EXPERT OPINION There is growing and consistent evidence of higher drug survival of IL-23 inhibitors, possibly due to their favorable efficacy and safety profiles, dosing convenience and persistence of response despite treatment interruption; eventual confirmation of their potential role as modifiers of the natural history of psoriasis might provide additional reasons for therapeutic persistence of this class of biologics.
Collapse
Affiliation(s)
- Lluís Rusiñol
- Department of dermatology, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, spain
| | - Elena Carmona-Rocha
- Department of dermatology, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, spain
| | - Lluís Puig
- Department of dermatology, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, spain
| |
Collapse
|
3
|
Armstrong AW, Park SH, Patel V, Hogan M, Wang WJ, Davidson D, Chirikov V. Matching-Adjusted Indirect Comparison of the Long-Term Efficacy of Deucravacitinib Versus Adalimumab for Moderate to Severe Plaque Psoriasis. Dermatol Ther (Heidelb) 2023; 13:2589-2603. [PMID: 37525000 PMCID: PMC10613163 DOI: 10.1007/s13555-023-00977-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Accepted: 07/03/2023] [Indexed: 08/02/2023] Open
Abstract
INTRODUCTION Deucravacitinib, an oral tyrosine kinase 2 (TYK2) inhibitor, is approved in the United States to treat adults with moderate-to-severe plaque psoriasis (PsO). This study compared the long-term efficacy of deucravacitinib and adalimumab using results from long-term extension (LTE) trials. METHODS Open-label LTE trials were identified for an indirect treatment comparison (deucravacitinib: POETYK PSO-LTE [NCT04036435]; adalimumab: REVEAL extension [NCT00195676]). To ensure study design comparability, patients initially randomized to placebo and switched to deucravacitinib or adalimumab after week 16 were compared. The primary outcome was an ≥ 75% reduction in Psoriasis Area and Severity Index score (PASI 75) at week 112 postrandomization. Secondary outcomes were PASI 75 at week 52 and an ≥ 90% reduction in PASI score (PASI 90) at weeks 52 and 112. Missing PASI data were imputed. A matching-adjusted indirect comparison was conducted; individual patient-level data from POETYK PSO-LTE were reweighted to balance baseline characteristics with those from the REVEAL extension. RESULTS Before reweighting, on average, patients in the POETYK PSO-LTE (N = 329) versus the REVEAL (N = 345) extension were older, had a lower body weight, received more prior systemic treatments, and had higher baseline PASI scores and week 16 placebo PASI 75 and PASI 90 response rates. Following reweighting, adjusted week 112 PASI 75 response rates were significantly higher for deucravacitinib versus adalimumab (67.2% vs. 54.0%; mean difference [95% CI], 13.2 [4.0-22.5] percentage points). Deucravacitinib had a numerically higher adjusted week 112 PASI 90 response rate (41.3% vs. 34.0%; mean difference [95% CI], 7.3 [-2.0 to 16.7] percentage points). The treatments had similar week 52 adjusted PASI 75 and PASI 90 response rates. CONCLUSION In this interim analysis, adults with moderate to severe PsO had higher long-term response rates at 2 years when treated with deucravacitinib versus adalimumab. Deucravacitinib response rates remained stable whereas adalimumab response rates declined in year 2.
Collapse
Affiliation(s)
- April W Armstrong
- Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Sang Hee Park
- Bristol Myers Squibb, 3410 Princeton Pike, Princeton, NJ, 08648, USA
| | - Vardhaman Patel
- Bristol Myers Squibb, 3410 Princeton Pike, Princeton, NJ, 08648, USA.
| | | | | | - David Davidson
- Bristol Myers Squibb, 3410 Princeton Pike, Princeton, NJ, 08648, USA
| | | |
Collapse
|
4
|
Abstract
Psoriasis is a chronic disease that is caused by multiple factors and is identified by itchiness, unpleasant, red, or white scaly patches on the skin, particularly on regularly chafed body regions such as the lateral areas of the limbs. Reports suggest that globally around 2%-3% of the population suffers from psoriasis. In this review, we have discussed the clinical classification of psoriasis and also the ideal characteristics of the biomarkers. An overview regarding the discovery of the biomarker and method for validating the study has been discussed. A growing body of research suggests a link to certain other systemic symptoms such as cardiovascular disorder, metabolic syndrome, and few other comorbidities such as hypertension and nonalcoholic fatty liver disease. Natural killer (NK) cells are lymphocyte cells that concentrate on the destruction of virally infected and malignant cells; these tend to produce a wide range of inflammatory cytokines, some of which are associated with the etiology of psoriasis. Detailed information on the molecular pathogenesis of psoriasis in which interleukin (IL)-17, IL-23, tumor necrosis factor-α (TNF-α), and CCL20 play a very significant role in the development of psoriasis. In this review, we have discussed an overview of the recent state of the biomarkers available for the diagnosis and treatment of psoriasis by emphasizing on the available biomarkers such as epigenomic, transcriptomic, glycomic, and metabolomic. The most recent advancements in molecular-targeted therapy utilizing biologics and oral systemic therapy (methotrexate, apremilast) enable to adequately treat the most serious psoriatic symptoms and also the studies have validated the efficacy of biologic therapy such as TNF-α antagonist (infliximab, adalimumab), IL-23 antagonist (guselkumab, risankizumab), and IL-17 antagonist (secukinumab, ixekizumab). Finally, an overview about the technological opportunities as well as various challenges has been discussed.
Collapse
Affiliation(s)
- Deblina Dan
- Department of Pharmaceutics, Amity Institute of Pharmacy, Lucknow, Amity University Uttar Pradesh, Noida, India
| | - Nimisha Srivastava
- Department of Pharmaceutics, Amity Institute of Pharmacy, Lucknow, Amity University Uttar Pradesh, Noida, India
| |
Collapse
|
5
|
Topaloğlu Demir F, Polat Ekinci A, Aytekin S, Topkarcı Z, Aslan Kayıran M, Özkök Akbulut T, Oğuz Topal İ, Sarıkaya Solak S, Kara Polat A, Karadağ AS. Clinical course of psoriasis patients that discontinued biologics during the COVID-19 pandemic. J Cosmet Dermatol 2023; 22:722-731. [PMID: 36630728 DOI: 10.1111/jocd.15638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Accepted: 01/03/2023] [Indexed: 01/12/2023]
Abstract
BACKGROUND Since psoriasis is a chronic disease, it is not recommended to discontinue the treatment agents used. However, in real life, the treatment of psoriasis patients may be interrupted for various reasons. During the pandemic period, the treatment of many patients was also interrupted. OBJECTIVES To evaluate relapse and clinical worsening in psoriasis patients whose biological therapy was interrupted during the pandemic and reveal associated factors. METHODS The study included patients aged ≥18 years, who were followed up with moderate and severe chronic psoriasis controlled by the last biological agent [Psoriasis Area Severity Index (PASI) 75 response achieved] but had to discontinue their treatment during the pandemic. The patients' demographic and clinical characteristics, clinical course after the discontinuation of these agents, presence of clinical worsening, and relapse were evaluated. Risk factors were analyzed with the logistic regression analysis. RESULTS The study included 169 patients, with a mean age of 47.3 ± 14.5 (18-87) years. The mean biologics-free time was 18.2 ± 12.3 (2-56) weeks. Clinical worsening was detected in 41.4% and relapse in 48.5% of the patients. The significant risk factors for clinical worsening and relapse in both univariate and multivariate analyses were alcohol use during the biologics-free period, total time off biologics, and the presence of an additional triggering factor. The use of secukinumab and ustekinumab was found to be a protective factor against clinical worsening in multivariate analyses. CONCLUSION As the biologics-free period is prolonged, the likelihood of clinical worsening and relapse increases, therefore, we do not recommend discontinuing biological agents.
Collapse
Affiliation(s)
- Filiz Topaloğlu Demir
- Department of Dermatology and Venereology, Faculty of Medicine, Istanbul Medipol University, Istanbul, Turkey
| | - Algün Polat Ekinci
- Department of Dermatology and Venereology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Sema Aytekin
- Department of Dermatology and Venereology, Faculty of Medicine, Tekirdag Namik Kemal University, Tekirdag, Turkey
| | - Zeynep Topkarcı
- Department of Dermatology and Venereology, Istanbul Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Health Sciences University, Istanbul, Turkey
| | - Melek Aslan Kayıran
- Department of Dermatology and Venereology, Goztepe Training and Research Hospital, Istanbul Medeniyet University, Istanbul, Turkey
| | - Tuğba Özkök Akbulut
- Department of Dermatology and Venereology, Haseki Training and Research Hospital, Health Sciences University, Istanbul, Turkey
| | - İlteriş Oğuz Topal
- Department of Dermatology and Venereology, Prof. Dr. Cemil Tascioglu City Hospital, Health Sciences University, Istanbul, Turkey
| | - Sezgi Sarıkaya Solak
- Department of Dermatology and Venereology, Faculty of Medicine, Trakya University, Edirne, Turkey
| | - Asude Kara Polat
- Department of Dermatology and Venereology, Istanbul Training and Research Hospital, Health Sciences University, Istanbul, Turkey
| | - Ayşe Serap Karadağ
- Department of Dermatology and Venereology, Memorial Atasehir Hospital, Istanbul Arel University, Istanbul, Turkey
| |
Collapse
|
6
|
Elberdín L, Fernández-Torres RM, Mateos M, Outeda M, Blanco E, Gómez-Besteiro MI, Martín-Herranz I, Fonseca E. Real-world use of ustekinumab therapeutic drug monitoring in moderate to severe psoriasis. Front Med (Lausanne) 2022; 9:1017323. [PMID: 36569163 PMCID: PMC9773264 DOI: 10.3389/fmed.2022.1017323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Accepted: 11/23/2022] [Indexed: 12/13/2022] Open
Abstract
Introduction There is growing evidence that therapeutic drug monitoring of biologic therapy is beneficial in psoriatic patients. With respect to ustekinumab, the available evidence has not shown any relationship yet. The objective of this study is to identify correlations among ustekinumab trough concentrations, anti-ustekinumab antibodies and clinical response in moderate-to-severe plaque psoriasis patients, in a real-world setting. Methods Observational prospective follow-up study in psoriatic patients treated with ustekinumab. Patients were classified in optimal (PASI ≤ 3) and suboptimal responders (PASI > 3). Mann-Whitney U test and Spearman's rank correlation coefficient were used. Receiver-operator characteristic curve analysis was performed to identify ustekinumab concentration cut-off to achieve optimal response. A p-value < 0.05 was considered statistically significant. Results A total of 59 patients were included. Forty-eight patients (81.4%) corresponded to optimal responders and 11 (18.6%) to suboptimal responders. There was significant difference to ustekinumab concentrations: 0.7 μg/mL (range <0.1-1.8) vs. 0.4 μg/mL (range <0.1-0.8) respectively (p = 0.007). Positive correlation between ustekinumab concentration and psoriasis area and severity index (PASI) value was detected (p = 0.009). A cut-off value of 0.6 μg/mL ustekinumab concentration was found to achieve clinical response. Anti-ustekinumab antibodies were detected in 2 (3.4%) samples, both suboptimal responders. Conclusion A positive correlation exits between ustekinumab concentration and clinical response (optimal response PASI values ≤ 3) in blood draws performed before drug administration. The measurement of anti-ustekinumab antibodies could be considered in treatment failure.
Collapse
Affiliation(s)
- Laida Elberdín
- Department of Pharmacy, Complexo Hospitalario Universitario de A Coruña (CHUAC), Sergas, Instituto de Investigación Biomédica de A Coruña (INIBIC), Universidade da Coruña (UDC), A Coruña, Spain,*Correspondence: Laida Elberdín,
| | - Rosa M. Fernández-Torres
- Department of Dermatology, Complexo Hospitalario Universitario de A Coruña (CHUAC), Sergas, Instituto de Investigación Biomédica de A Coruña (INIBIC), Universidade da Coruña (UDC), A Coruña, Spain
| | - María Mateos
- Department of Pharmacy, Complexo Hospitalario Universitario de A Coruña (CHUAC), Sergas, Instituto de Investigación Biomédica de A Coruña (INIBIC), Universidade da Coruña (UDC), A Coruña, Spain
| | - María Outeda
- Department of Pharmacy, Complexo Hospitalario Universitario de A Coruña (CHUAC), Sergas, Instituto de Investigación Biomédica de A Coruña (INIBIC), Universidade da Coruña (UDC), A Coruña, Spain
| | - Eva Blanco
- Department of Dermatology, Complexo Hospitalario Universitario de A Coruña (CHUAC), Sergas, Instituto de Investigación Biomédica de A Coruña (INIBIC), Universidade da Coruña (UDC), A Coruña, Spain
| | - María I. Gómez-Besteiro
- Clinical Epidemiology and Biostatistics Unit, Complexo Hospitalario Universitario de A Coruña (CHUAC), Sergas, Instituto de Investigación Biomédica de A Coruña (INIBIC), Universidade da Coruña (UDC), A Coruña, Spain
| | - Isabel Martín-Herranz
- Department of Pharmacy, Complexo Hospitalario Universitario de A Coruña (CHUAC), Sergas, Instituto de Investigación Biomédica de A Coruña (INIBIC), Universidade da Coruña (UDC), A Coruña, Spain
| | - Eduardo Fonseca
- Department of Dermatology, Complexo Hospitalario Universitario de A Coruña (CHUAC), Sergas, Instituto de Investigación Biomédica de A Coruña (INIBIC), Universidade da Coruña (UDC), A Coruña, Spain
| |
Collapse
|
7
|
Drakos A, Vender R. A Review of the Clinical Trial Landscape in Psoriasis: An Update for Clinicians. Dermatol Ther (Heidelb) 2022; 12:2715-2730. [PMID: 36319883 PMCID: PMC9674811 DOI: 10.1007/s13555-022-00840-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Accepted: 10/18/2022] [Indexed: 11/06/2022] Open
Abstract
As our understanding of the pathogenesis of psoriasis has evolved over the past two decades, so has the number of treatment options. The introduction of biologic agents targeting specific cytokines in the interleukin (IL)-23/IL-17 pathway has proven successful in promoting skin clearance among patients. However, their use is often limited owing to cost, parenteral administration, and possible reduced efficacy over time. Topical therapies have also seen limited advancement, with agents such as corticosteroids and vitamin D derivatives remaining the mainstay of treatment, despite side effects limiting their long-term use. New therapeutic agents are needed to improve disease management for patients. In this review, we summarize pipeline and recently approved therapies undergoing clinical trials for psoriasis during a 12-month search period (30 June 2021 to 30 June 2022) using ClinicalTrials.gov. New-generation biologics and oral small molecules in phase II or III development were included, and pivotal data identified through various search modalities (PubMed, conference presentations, etc.) evaluating each drug candidate will be discussed. Topical therapies will also be discussed in line with recent US Food and Drug Administration approvals. As new therapies continue to enter the treatment landscape, long-term data and comparative trials will be needed to better understand their place among existing therapeutic agents.
Collapse
Affiliation(s)
| | - Ronald Vender
- Dermatrials Research Inc., Venderm Innovations in Psoriasis, Hamilton, ON, Canada.
- Department of Medicine, McMaster University, Hamilton, ON, Canada.
| |
Collapse
|