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Huang IH, Wu PC, Chiu HY, Huang YH. Small-Molecule Inhibitors and Biologics for Palmoplantar Psoriasis and Palmoplantar Pustulosis: A Systematic Review and Network Meta-Analysis. Am J Clin Dermatol 2024; 25:347-358. [PMID: 38438782 DOI: 10.1007/s40257-024-00849-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 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] [Accepted: 01/26/2024] [Indexed: 03/06/2024]
Abstract
BACKGROUND The comparative efficacy of biologics and small-molecule inhibitors in treating palmoplantar psoriasis (PP) and palmoplantar pustulosis (PPP) remains uncertain. OBJECTIVE The aim was to perform a systematic review and network meta-analysis (NMA) to compare the efficacy of biologics and small-molecule inhibitors for the treatment of PP and PPP. METHODS MEDLINE, Embase, and Cochrane Central Register of Controlled Trials were searched for eligible studies from inception to May 13, 2023. This NMA was conducted and reported following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension Statement for Network Meta-Analyses guidelines. Frequentist random-effects models NMA was performed with the surface under the cumulative ranking curve calculated for ranking. Our primary outcome was the proportion of patients achieving a clear/minimal Palmoplantar Psoriasis/Pustulosis Physician Global Assessment score (PPPGA 0/1 or PPPPGA 0/1) response at 12-16 weeks. Secondary outcomes consisted of the percentage of overall improvement in palmoplantar score and of improvement ≥ 75%, at 12-16 weeks. RESULTS The study comprised a total of 29 randomized controlled trials (RCTs), involving 4798 psoriasis patients with palmoplantar diseases. For PP, 16 RCTs with nine different treatments, including adalimumab, apremilast, bimekizumab, etanercept, guselkumab, infliximab, ixekizumab, secukinumab, and ustekinumab were included for the analysis. In the NMA of PP, secukinumab 300 mg ranked highest (odds ratio [OR] 33.50, 95% confidence interval [CI] 4.37-256.86) in achieving PPPGA 0/1, followed by guselkumab 100 mg (OR 18.68, 95% CI 10.07-34.65). In the case of PPP, seven RCTs with six treatments, including apremilast, etanercept, guselkumab, imsidolimab, spesolimab, and ustekinumab, were included for the analysis. In the NMA of PPP, although no treatment demonstrated a significant difference compared to placebo in achieving PPPPGA 0/1, guselkumab 100 mg showed the greatest statistically significant improvement in the palmoplantar score (weighted mean difference 31.73, 95% CI 19.89-43.57) as a secondary outcome. CONCLUSION Among all available biologics and small-molecule inhibitors, secukinumab 300 mg and guselkumab 100 mg had the most favorable efficacy in treating PP and PPP, respectively.
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Affiliation(s)
- I-Hsin Huang
- Department of Dermatology, Chang Gung Memorial Hospital, Linkou, Taoyuan, Taiwan
- Research Center of Big Data and Meta-analysis, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
| | - Po-Chien Wu
- Department of Dermatology, Chang Gung Memorial Hospital, Linkou, Taoyuan, Taiwan
- Research Center of Big Data and Meta-analysis, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
| | - Hsien-Yi Chiu
- Department of Dermatology, National Taiwan University Hospital Hsin-Chu Branch, Hsinchu, Taiwan.
- Department of Dermatology, National Taiwan University Hospital, Taipei, Taiwan.
- Department of Dermatology, College of Medicine, National Taiwan University, Taipei, Taiwan.
- Department of Medical Research, National Taiwan University Hospital Hsin-Chu Branch, Hsinchu, Taiwan.
| | - Yu-Huei Huang
- Department of Dermatology, Chang Gung Memorial Hospital, Linkou, Taoyuan, Taiwan.
- College of Medicine, Chang Gung University, Taoyuan, Taiwan.
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Li Y, Lv C, Dang L, Lin B, Tao J, Zhang C, Zhou X, Ma H, Lu Y, Chen R, Li J, Dou G, Liang Y, Liang Y, Shi Y. Effectiveness of Ixekizumab in Chinese Patients with Moderate-Severe Plaque Psoriasis with Special Area Involvement: Subanalysis of a Prospective, Multicenter, Observational Real-World Study. Dermatol Ther (Heidelb) 2024; 14:907-918. [PMID: 38536616 PMCID: PMC11052755 DOI: 10.1007/s13555-024-01134-y] [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: 12/14/2023] [Accepted: 02/28/2024] [Indexed: 04/29/2024] Open
Abstract
INTRODUCTION Ixekizumab, a monoclonal antibody against interleukin-17A, demonstrated effectiveness in the treatment of psoriasis in a Chinese real-world study that was consistent with previous randomized controlled trials. Here, we report further analyses from this study to explore the effectiveness of ixekizumab for treating patients with psoriasis and the involvement of special body areas (scalp, nail, joint, palmoplantar, or genital areas). METHODS A multicenter, prospective, observational, single-arm, post-marketing surveillance study was conducted in patients aged ≥ 18 years with moderate-to-severe plaque psoriasis and prescribed with ixekizumab in 26 Chinese hospitals. Psoriasis Area and Severity Index (PASI) and Dermatology Life Quality Index (DLQI) scores were compared between patients with versus without psoriasis in special body areas in the overall study population and across subgroups by body area. RESULTS In total, 612 patients were included. At baseline, most patients (93.6%) had psoriasis involvement in at least one special body area. Overall, patients with psoriasis in special body areas reported a worse quality of life (QoL) than those without. Patients with versus without psoriasis in special body areas achieved a comparable mean reduction from baseline in PASI score (10.9 vs. 9.2 at week 2, and 16.9 vs. 14.7 at week 12, respectively) and DLQI score (6.0 vs. 4.4 at week 2, and 9.9 vs. 7.5 at week 12, respectively); a similar proportion of patients also achieved PASI 50 at week 2, and PASI 75 and PASI 90 at week 12, and a DLQI (0/1) at weeks 2 and 12. Several significantly different results were reported between subgroups, the majority of which favored patients with special body area involvement. CONCLUSION Most patients had psoriasis involvement in a special body area which was associated with worse QoL. Ixekizumab is similarly effective in reducing disease severity and improving QoL in patients with plaque psoriasis across different special body areas.
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Affiliation(s)
- Ying Li
- Department of Dermatology, Shanghai Skin Disease Hospital, Tongji University School of Medicine, Shanghai, 200443, China
| | - Chengzhi Lv
- Department of Dermatology, Dalian Dermatosis Hospital, Dalian, Liaoning, China
| | - Lin Dang
- Department of Dermatology, Longgang Central Hospital of Shenzhen, Shenzhen, Guangdong, China
| | - Bingjiang Lin
- Department of Dermatology, Ningbo First Hospital, Ningbo, Zhejiang, China
| | - Juan Tao
- Department of Dermatology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology (HUST), Wuhan, Hubei, China
| | - Chunlei Zhang
- Department of Dermatology, Peking University Third Hospital, Beijing, China
| | - Xiaoyong Zhou
- Department of Dermatology, Wuhan No. 1 Hospital, Wuhan, Hubei, China
| | - Han Ma
- Department of Dermatology, Fifth Affiliated Hospital of Sun Yat-Sen University, Zhuhai City, China
| | - Yi Lu
- Eli Lilly and Company, Shanghai, China
| | - Rong Chen
- Eli Lilly and Company, Shanghai, China
| | - Jinnan Li
- Eli Lilly and Company, Shanghai, China
| | | | - Yunsheng Liang
- Department of Dermatology, Dermatology Hospital, Southern Medical University, Baiyun, Guangzhou, 516006, China.
| | - Yanhua Liang
- Department of Dermatology, Cosmetology and Venereology, Shenzhen Hospital, Southern Medical University, Shenzhen, 510086, China.
| | - Yuling Shi
- Department of Dermatology, Shanghai Skin Disease Hospital, Tongji University School of Medicine, Shanghai, 200443, China.
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Valenti M, Gargiulo L, Ibba L, Cortese A, Toso F, Orsini D, Lora V, Frascione P, Sena P, Carugno A, Assorgi C, Costanzo A, Narcisi A. Effectiveness of ixekizumab for the treatment of moderate-to-severe plaque psoriasis with involvement of difficult-to-treat areas: A 52-week multicenter retrospective study. J Dermatol 2024. [PMID: 38292002 DOI: 10.1111/1346-8138.17115] [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: 07/31/2023] [Revised: 11/28/2023] [Accepted: 12/28/2023] [Indexed: 02/01/2024]
Abstract
Biological drugs have dramatically changed the approach to treating moderate-to-severe plaque psoriasis, achieving excellent skin clearance and safety outcomes. However, the management of difficult-to-treat areas (e.g., scalp, palms/soles, nails, and genitalia) still represents a challenge in psoriasis treatment. Data in the literature on difficult-to-treat sites are limited and, frequently, no specific analysis is performed during clinical trials. We conducted a 52-week, retrospective study to evaluate the effectiveness of ixekizumab in 120 patients with moderate-to-severe plaque psoriasis of at least one difficult-to-treat area (scalp, palmoplantar surfaces, nails, and genitalia). Ninety-nine patients had scalp psoriasis, 35 had involvement of the palms or soles, 27 were affected by genital psoriasis, and 22 patients reported involvement of the nails. After 1 year of treatment, 96% of patients with scalp involvement, 95.6% of patients with palmoplantar psoriasis, 95.2% of patients with genital psoriasis, and 85% of patients with nail involvement achieved a site-specific Physician's Global Assessment of 0 or 1 (clear or almost clear). No serious adverse events were observed during the study. Our study supports the effectiveness of ixekizumab in plaque psoriasis involving difficult-to-treat sites.
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Affiliation(s)
- Mario Valenti
- Dermatology Unit, IRCCS Humanitas Research Hospital, Rozzano, Italy
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy
| | - Luigi Gargiulo
- Dermatology Unit, IRCCS Humanitas Research Hospital, Rozzano, Italy
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy
| | - Luciano Ibba
- Dermatology Unit, IRCCS Humanitas Research Hospital, Rozzano, Italy
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy
| | - Andrea Cortese
- Dermatology Unit, IRCCS Humanitas Research Hospital, Rozzano, Italy
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy
| | - Francesco Toso
- Dermatology Unit, IRCCS Humanitas Research Hospital, Rozzano, Italy
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy
| | - Diego Orsini
- Clinical Dermatology Unit, San Gallicano Dermatological Institute IRCCS, Rome, Italy
| | - Viviana Lora
- Clinical Dermatology Unit, San Gallicano Dermatological Institute IRCCS, Rome, Italy
| | - Pasquale Frascione
- Dermatology Oncology Unit, San Gallicano Dermatological Institute IRCCS, Rome, Italy
| | - Paolo Sena
- Dermatology Unit, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Andrea Carugno
- Dermatology Unit, ASST Papa Giovanni XXIII, Bergamo, Italy
- Ph.D. Program in Molecular and Translational Medicine (DIMET), University of Milan-Bicocca, Milan, Italy
| | - Chiara Assorgi
- Section of Dermatology, Department of Clinical Medicine and Surgery, University of Naples Federico II, Napoli, Italy
| | - Antonio Costanzo
- Dermatology Unit, IRCCS Humanitas Research Hospital, Rozzano, Italy
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy
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Giacomo C, Emanuele T, Martina B, Eugenio C, Federico D, Viviana L, Maria PL, Ruslana GS, Thais FM, Marco M, Elena C, Annamaria O, Aurora P, Francesca P. Real-life experience with dimethylfumarate in palmoplantar psoriasis: A multicentre retrospective Italian study. Australas J Dermatol 2024. [PMID: 38268135 DOI: 10.1111/ajd.14213] [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: 08/03/2023] [Revised: 11/27/2023] [Accepted: 01/10/2024] [Indexed: 01/26/2024]
Abstract
Palmoplantar (PP) psoriasis is considered one of the most hard-to-treat areas with important impact on patients' quality of life, and few data are available about the efficacy of dimethylfumarate (DMF) on these areas. In our noninterventional multicentre retrospective cohort study of patients with PP psoriasis treated with DMF, effectiveness was evaluated as mean pp Psoriasis Area and Severity Index (ppPASI) reduction and as proportion of patients that reach ppPASI 75 at 4, 12, 24 and 48 weeks. The reduction in ppPASI was 23.5% at w4, 49.7% at w12, 69.1% at w24 and 81.1% at w48. pp Investigator's Global Assessment (ppIGA) 0/1 was reached by 5 patients (10.64%) at w4, 10 patients (23.8%) at w12, 11 patients (40.7%) at w24 and 12 patients (60%) at w48 confirming that DMF could represent an effective therapy in patients affected by PP psoriasis. Overall, the treatment was well tolerated although only 24 patients made it to 24 weeks of therapy and 28 patients completed the observation period at 48 weeks. None of the patients reported adverse events requiring discontinuation of the drug. However, this discontinuation rate is in line with clinical trials and real-world evidence.
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Affiliation(s)
- Caldarola Giacomo
- Dermatology Unit, Department of Medical and Surgical Sciences, A. Gemelli University Hospital Foundation-IRCCS, Rome, Italy
- Dermatology Unit, Department of Medicine and Traslational Surgery, Catholic University of Sacred Heart, Rome, Italy
| | - Trovato Emanuele
- Unit of Dermatology, Department of Medical, Surgical and Neurological Sciences, University of Siena, Siena, Italy
| | - Burlando Martina
- Department of Dermatology, DISSAL, University of Genoa, Genoa, Italy
- IRCCS San Martino Hospital, Genoa, Italy
| | - Capalbo Eugenio
- Unit of Dermatology, Department of Medical, Surgical and Neurological Sciences, University of Siena, Siena, Italy
| | - Diotallevi Federico
- Dermatological Clinic, Department of Clinical and Molecular Sciences, Polytechnic Marche University, Ancona, Italy
| | - Lora Viviana
- Dermatology Unit, San Gallicano Dermatological Institute, IRCCS, Rome, Italy
| | - Pinto Lorenzo Maria
- Dermatology Unit, Department of Medical and Surgical Sciences, A. Gemelli University Hospital Foundation-IRCCS, Rome, Italy
- Dermatology Unit, Department of Medicine and Traslational Surgery, Catholic University of Sacred Heart, Rome, Italy
| | | | - Fastame Maria Thais
- Department of Health Sciences, Section of Dermatology, University of Florence, Florence, Italy
| | - Mariani Marco
- Section of Hygiene, University Department of Health Sciences and Public Health, Rome, Italy
| | - Campione Elena
- Department of Systems Medicine, University of Rome 'Tor Vergata', Rome, Italy
| | - Offidani Annamaria
- Dermatological Clinic, Department of Clinical and Molecular Sciences, Polytechnic Marche University, Ancona, Italy
| | - Parodi Aurora
- Department of Dermatology, DISSAL, University of Genoa, Genoa, Italy
- IRCCS San Martino Hospital, Genoa, Italy
| | - Prignano Francesca
- Department of Health Sciences, Section of Dermatology, University of Florence, Florence, Italy
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Carmona-Rocha E, Puig L. Ixekizumab for the treatment of moderate-to-severe plaque psoriasis: the first septennium. Immunotherapy 2023; 15:1209-1225. [PMID: 37609785 DOI: 10.2217/imt-2023-0013] [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] [Indexed: 08/24/2023] Open
Abstract
Ixekizumab is a humanized monoclonal antibody that specifically inhibits IL-17A. It has been approved for the treatment of adult and pediatric psoriasis, psoriatic arthritis and axial spondyloarthropathies by the US FDA and the EMA. Phase III trials, post hoc analyses and real-life data have reported its efficacy, effectiveness and safety. This review summarizes the latest evidence on the clinical efficacy, pharmacology and safety profile of ixekizumab for the treatment of moderate-to-severe psoriasis. A literature search was performed for articles published through December 2022. Ixekizumab is one of the most efficacious biologics for psoriasis, with a rapid onset of response, favorable long-term outcomes and an adequate safety profile.
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Affiliation(s)
- Elena Carmona-Rocha
- Dermatology Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Lluís Puig
- Dermatology Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
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Xia R, Liu J, Gao Y, Diao Z, Chen D, Zhou C, Zhang Z, Yin Z. Local injection of micro-dose anti-interleukin-17A antibody for palmoplantar pustulosis: A real-world study. Clin Immunol 2023:109694. [PMID: 37433424 DOI: 10.1016/j.clim.2023.109694] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Revised: 05/29/2023] [Accepted: 07/02/2023] [Indexed: 07/13/2023]
Abstract
Palmoplantar pustulosis (PPP), a chronic and stubborn skin disease, is mainly confined to the palms or/and soles, making it possible for localized use of therapeutic antibodies. In this real-world prospective cohort study, 8 patients with PPP received palms/soles injections of ixekizumab (0.8 mg in 0.1 ml) every 2 to 8 weeks due to the COVID-19 pandemic. The treatment endpoint was a 75% improvement from baseline in Palmoplantar Psoriasis Area and Severity Index (PPPASI 75). At week 8, 75%, 50% and 12.5% of 8 patients reached PPPASI 50, PPPASI 75 and PPPASI 90. At week 12, 100%, 67.5% and 25% of 8 patients reached PPPASI 50, PPPASI 75 and PPPASI 90. This is the first study to evaluate the efficacy and safety of local injection of micro-dose ixekizumab for PPP in real clinical practice. A high proportion of patients rapidly achieved PPPASI 75, and maintained long-term efficacy with satisfactory safety.
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Affiliation(s)
- RuiYuan Xia
- Department of Dermatology, First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Jian Liu
- Department of Dermatology, First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - YaMei Gao
- Department of Dermatology, First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - ZiYue Diao
- Department of Dermatology, First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - DanDan Chen
- Department of Dermatology, First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - ChaoJing Zhou
- Department of Dermatology, First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - ZhiQin Zhang
- Department of Dermatology, First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - ZhiQiang Yin
- Department of Dermatology, First Affiliated Hospital of Nanjing Medical University, Nanjing, China.
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García-Martín E, Romero-Jiménez RM, Baniandrés-Rodríguez O, Escudero-Vilaplana V, Benedí-González J, de Los Ríos Luna PM, Herranz-Alonso A, Sanjurjo-Sáez M. Anti-interleukin-17 therapies for moderate/severe psoriasis in clinical practice: effectiveness, safety and association with clinical patient factors. Eur J Hosp Pharm 2023:ejhpharm-2022-003594. [PMID: 37094886 DOI: 10.1136/ejhpharm-2022-003594] [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: 10/25/2022] [Accepted: 04/03/2023] [Indexed: 04/26/2023] Open
Abstract
OBJECTIVES Interleukin-17 (IL-17) contributes to the pathogenesis of psoriasis. Secukinumab, ixekizumab, and brodalumab are monoclonal antibodies anti-IL-17 antibodies, approved for the treatment of moderate/severe plaque psoriasis.The aim of the study was to describe the effectiveness and safety of anti-IL-17 agents in moderate/severe plaque psoriasis in clinical practice. We also analysed anti-IL-17 therapies' survival, dose adjustment, and clinical patients' factors associated with their effectiveness and safety. METHODS A retrospective, longitudinal study was conducted at a tertiary hospital. We included patients with moderate/severe psoriasis treated with anti-IL-17 agents. The effectiveness was evaluated with Psoriasis Area and Severity Index (PASI) score and safety through the adverse drug reactions (ADRs) collected. RESULTS 38 patients were studied (median age=47.4 years, 71.0% male). The mean number of biological therapies that patients received was 2.6, and anti-IL-17 therapy was the first biological therapy for 36.8% of patients. The median years in treatment were 2.5 (95% CI 1.95 to 2.98) for secukinumab, 1.2 (95% CI 0.36 to 1.47) for ixekizumab, and 0.7 (IQR 0.71) for brodalumab. The median PASI score after 6 months of treatment was 0 (IQR 0) and 85.3% of patients achieved a PASI of 90 (84.0% with secukinumab, 87.5% with ixekizumab, and 100% with brodalumab). Dose adjustment was associated with the line of treatment (p=0.034 for naïve patients), age (p=0.044 for younger patients), and concomitant pathologies (p=0.015 without more diseases).24 patients suffered from ADRs, mainly infections of the upper respiratory tract, and there were no statistically significant differences between the three therapies. CONCLUSIONS Anti-IL-17 agents constitute an effective treatment for patients with moderate/severe plaque psoriasis and for longer. Dose reductions were associated with fewer lines of treatment, younger patients and absence of concomitant pathologies. ADR were minor and similar among the anti-IL-17.
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Affiliation(s)
- Estela García-Martín
- Pharmacy Department, Hospital Universitario Infanta Sofía, San Sebastián de los Reyes, Madrid, Spain
| | - R M Romero-Jiménez
- Pharmacy Department, Hospital General Universitario Gregorio Marañón. Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain
| | - Ofelia Baniandrés-Rodríguez
- Dermatology Department, Hospital General Universitario Gregorio Marañón. Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain
| | - Vicente Escudero-Vilaplana
- Pharmacy Department, Hospital General Universitario Gregorio Marañón. Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain
| | - Juana Benedí-González
- Pharmacology, Pharmacognosy and Botany Department, Facultad de Farmacia, Universidad Complutense de Madrid, Madrid, Spain
| | - Paloma Morales de Los Ríos Luna
- Dermatology Department, Hospital General Universitario Gregorio Marañón. Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain
| | - Ana Herranz-Alonso
- Pharmacy Department, Hospital General Universitario Gregorio Marañón. Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain
| | - María Sanjurjo-Sáez
- Pharmacy Department, Hospital General Universitario Gregorio Marañón. Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain
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Wang CQ, Haxhinasto S, Garcet S, Kunjravia N, Cueto I, Gonzalez J, Rambhia D, Harari O, Sleeman MA, Hamilton JD, Lim WK, Freudenberg J, Kalliolias GD, Thakker P, Bissonnette R, Krueger JG. Comparison of the Inflammatory Circuits in Psoriasis Vulgaris, Non‒Pustular Palmoplantar Psoriasis, and Palmoplantar Pustular Psoriasis. J Invest Dermatol 2023; 143:87-97.e14. [PMID: 35934055 DOI: 10.1016/j.jid.2022.05.1094] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 05/26/2022] [Accepted: 05/27/2022] [Indexed: 11/20/2022]
Abstract
Palmoplantar pustular psoriasis (PPPP) and non‒pustular palmoplantar psoriasis (NPPP) are localized, debilitating forms of psoriasis. The inflammatory circuits involved in PPPP and NPPP are not well-understood. To compare the cellular and immunological features that differentiate PPPP and NPPP, skin biopsies were collected from a total of 30 participants with PPPP, NPPP, and psoriasis vulgaris (PV) and from 10 healthy participants. A subset consented to a second biopsy after 3 additional weeks off medication. Histologic staining of lesional and nonlesional skin showed higher neutrophil counts in PPPP than in NPPP and PV and higher CD8+ T-cell counts in NPPP. RNA sequencing and transcriptional analysis of skin biopsies showed enhanced IFN-γ pathway activation in NPPP lesions but stronger signatures of IL-17 pathway and neutrophil-related genes (e.g., IL36A) in PPPP lesional skin. Serum analysis on the Olink platform detected higher concentrations of T helper type 1, IFN-γ‒inducible chemokines in NPPP, and higher neutrophil-associated cytokines in PPPP. Taken together, this evidence suggests more pronounced T helper 1‒mediated inflammation in NPPP than in PV and PPPP and stronger neutrophil-associated activity in PPPP than in NPPP and PV. These data support targeting inflammatory pathways associated with neutrophilic inflammation (e.g., IL-36 signaling) for therapeutic development in PPPP.
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Akhter S, Tasnim FM, Islam MN, Rauf A, Mitra S, Emran TB, Alhumaydhi FA, Khalil AA, Aljohani ASM, Al Abdulmonem W, Thiruvengadam M. Role of Th17 and IL-17 Cytokines on Inflammatory and Auto-immune Diseases. Curr Pharm Des 2023; 29:2078-2090. [PMID: 37670700 DOI: 10.2174/1381612829666230904150808] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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: 03/09/2023] [Revised: 06/21/2023] [Accepted: 07/24/2023] [Indexed: 09/07/2023]
Abstract
BACKGROUND The IL-17 (interleukin 17) family consists of six structurally related pro-inflammatory cytokines, namely IL-17A to IL-17F. These cytokines have garnered significant scientific interest due to their pivotal role in the pathogenesis of various diseases. Notably, a specific subset of T-cells expresses IL-17 family members, highlighting their importance in immune responses against microbial infections. INTRODUCTION IL-17 cytokines play a critical role in host defense mechanisms by inducing cytokines and chemokines, recruiting neutrophils, modifying T-cell differentiation, and stimulating the production of antimicrobial proteins. Maintaining an appropriate balance of IL-17 is vital for overall health. However, dysregulated production of IL-17A and other members can lead to the pathogenesis of numerous inflammatory and autoimmune diseases. METHOD This review provides a comprehensive overview of the IL-17 family and its involvement in several inflammatory and autoimmune diseases. Relevant literature and research studies were analyzed to compile the data presented in this review. RESULTS IL-17 cytokines, particularly IL-17A, have been implicated in the development of various inflammatory and autoimmune disorders, including multiple sclerosis, Hashimoto's thyroiditis, systemic lupus erythematosus, pyoderma gangrenosum, autoimmune hepatic disorders, rheumatoid arthritis, psoriasis, psoriatic arthritis, ankylosing spondylitis, osteoarthritis, and graft-versus-host disease. Understanding the role of IL-17 in these diseases is crucial for developing targeted therapeutic strategies. CONCLUSION The significant involvement of IL-17 cytokines in inflammatory and autoimmune diseases underscores their potential as therapeutic targets. Current treatments utilizing antibodies against IL-17 cytokines and IL-17RA receptors have shown promise in managing these conditions. This review consolidates the understanding of IL-17 family members and their roles, providing valuable insights for the development of novel immunomodulators to effectively treat inflammatory and autoimmune diseases.
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Affiliation(s)
- Saima Akhter
- Department of Pharmacy, International Islamic University Chittagong, Chittagong 4318, Bangladesh
| | - Farhin Muntaha Tasnim
- Department of Pharmacy, International Islamic University Chittagong, Chittagong 4318, Bangladesh
| | - Mohammad Nazmul Islam
- Department of Pharmacy, International Islamic University Chittagong, Chittagong 4318, Bangladesh
| | - Abdur Rauf
- Department of Chemistry, University of Swabi, Swabi, Pakistan
| | - Saikat Mitra
- Department of Pharmacy, Faculty of Pharmacy, University of Dhaka, Dhaka, 1000, Bangladesh
| | - Talha Bin Emran
- Department of Pharmacy, BGC Trust University Bangladesh, Chittagong 4381, Bangladesh
| | - Fahad A Alhumaydhi
- Department of Medical Laboratories, College of Applied Medical Science, Qassim University, Buraydah, Saudi Arabia
| | - Anees Ahmed Khalil
- University Institute of Diet and Nutritionals Sciences, Faculty of Allied Health Sciences, The University of Lahore, Lahore, Pakistan
| | - Abdullah S M Aljohani
- Department of Veterinary Medicine, College of Agriculture and Veterinary Medicine, Qassim University, Buraydah, Saudi Arabia
| | - Waleed Al Abdulmonem
- Department of Pathology, College of Medicine, Qassim University, Buraydah, Saudi Arabia
| | - Muthu Thiruvengadam
- Department of Crop Science, College of Sanghuh Life Science, Konkuk University, Seoul 05029, Republic of Korea
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10
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Caldarola G, Zangrilli A, Palmisano G, Bavetta M, Moretta G, Pagnanelli G, Panasiti V, Bianchi L, De Simone C, Peris K. Effectiveness of risankizumab in the treatment of palmoplantar psoriasis: a 52-week Italian real-life experience. Drugs Context 2023; 12:dic-2023-1-8. [PMID: 37077769 PMCID: PMC10108662 DOI: 10.7573/dic.2023-1-8] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Accepted: 03/13/2023] [Indexed: 04/21/2023] Open
Abstract
Background Data on the treatment of palmoplantar psoriasis (PP) are scarce, representing a therapeutic challenge. This study aims to assess the efficacy and safety of risankizumab in a population of patients with psoriasis with a palmoplantar involvement, over a 52-week treatment period. Methods We performed a retrospective analysis in a cohort of patients with PP, with or without involvement of other skin sites. Palmoplantar Psoriasis Area and Severity Index (ppPASI) was assessed at baseline and after 4, 16, 28 and 52 weeks, to evaluate the PP severity. Results Sixteen patients were enrolled. The rates of ppPASI90 responses constantly increased during the period of observation and were 18.7%, 62.2%, 75.0% and 81.2% at weeks 4, 16, 28 and 52, respectively. Only two patients suspended treatment because of ineffectiveness at week 16. Conclusion Our data from a series of 16 patients reveal that risankizumab could represent an effective and safe therapeutic choice in patients with PP.
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Affiliation(s)
- Giacomo Caldarola
- Institute of Dermatology, Università Cattolica del Sacro Cuore, Rome, Italy
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Arianna Zangrilli
- Department of Dermatology, University of Rome Tor Vergata, Rome, Italy
| | - Gerardo Palmisano
- Institute of Dermatology, Università Cattolica del Sacro Cuore, Rome, Italy
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Mauro Bavetta
- UOC Dermatologia, Ospedale San Sebastiano, Frascati (RM), Italy
| | - Gaia Moretta
- Istituto Dermopatico dell’Immacolata – IRCCS, Roma, Italy
| | | | - Vincenzo Panasiti
- Plastic and Reconstructive Surgery Unit, Campus Bio-Medico University, Rome, Italy
| | - Luca Bianchi
- Department of Dermatology, University of Rome Tor Vergata, Rome, Italy
| | - Clara De Simone
- Institute of Dermatology, Università Cattolica del Sacro Cuore, Rome, Italy
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Ketty Peris
- Institute of Dermatology, Università Cattolica del Sacro Cuore, Rome, Italy
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
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11
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Abstract
INTRODUCTION Psoriasis is currently regarded an immune-mediated inflammatory disease. The central pathogenic axis comprises interleukin-23, TH17-lymphocytes differentiating under its influence, and interleukin-17A as a key effector cytokine of these T-lymphocytes. All of these can selectively be targeted using biological therapies, thus potentially increasing efficacy and reducing adverse events when compared to conventional systemic therapeutics. AREAS COVERED We review the current concept of psoriasis as an immune-mediated inflammatory disease, assessing the evidence for a role of elements of the innate and adaptive immune system. We then correlate the pharmacological effects of biologics in psoriasis in light of the known physiologic as well as pathophysiological role of the respective targets. This is done on the basis of an extensive literature search of publications since 2018 which describe the role of the above-mentioned elements in health and disease or the effects of blocking these as an attempt to treat psoriasis. EXPERT OPINION Biologics targeting the above-mentioned central pathogenic axis provide a particularly effective and safe way to treat psoriasis. Given the impact of comorbidities on therapeutic decision-making, and the efficacy of some biologics also on certain comorbidities, these drugs represent a first step toward personalized medicine in the management of psoriasis.
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Affiliation(s)
- Wolf-Henning Boehncke
- Division of Dermatology and Venereology, Geneva University Hospitals, Geneva, Switzerland.,Department of Pathology and Immunology, Faculty of Medicine, University of Geneva, Geneva, Switzerland
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12
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Demirel Öğüt N, Koç Yıldırım S, Erbağcı E, Hapa FA. Ixekizumab treatment in patients with moderate-to-severe plaque psoriasis in a real-world clinical setting. J Cosmet Dermatol 2022; 21:6215-6224. [PMID: 35801372 DOI: 10.1111/jocd.15217] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [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: 04/18/2022] [Revised: 06/29/2022] [Accepted: 07/04/2022] [Indexed: 12/27/2022]
Abstract
BACKGROUND The efficacy and safety reports of ixekizumab for moderate-to-severe plaque psoriasis may vary between clinical trials and real-world studies. AIM To analyze the real-world data of ixekizumab therapy to evaluate its efficacy and safety and highlight the factors influencing the treatment response in the real-world scenario. PATIENTS/METHODS Data of 82 adult patients with moderate-to-severe chronic plaque psoriasis are included in this study. Psoriasis area severity index (PASI) 75/90/100 responses at 4, 16, 24, and 48 weeks were analyzed retrospectively from patient charts by examining demographic and clinical characteristics of the patients, especially their previous biologic experience, obesity, and involvement of hard-to-treat areas. RESULTS PASI75, PASI90, and PASI100 responses were achieved in 92.4%, 86.1%, and 26.6% patients at week 16 and maintained till week 48 in 92.3%, 86.5%, and 17.3% patients. PASI90 responses in obese patients were significantly lower than non-obese patients at week 4 (33.3% vs. 69.6%, p = 0.042), but this difference was minimized by week 16 (82.4% vs. 90%, p = 0.405). PASI90 responses in biologic-naive patients were significantly higher than biologic-experienced patients at week 16 (p = 0.015). Involvement of hard-to-treat areas was negatively associated with PASI90 responses at week 16 (OR: 1591805.842; 95% CI: 1.223-2071404486740.201; p = 0.047). CONCLUSION Ixekizumab provides an effective and safe biologic treatment option to patients with moderate-to-severe plaque psoriasis. Obesity, though it affects the early treatment response (till week 4), does not upset the overall treatment response beyond week 16. Previous biologic exposure and involvement of hard-to-treat areas are important prognostic factors for achieving high PASI responses in psoriatic patients.
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Affiliation(s)
- Neslihan Demirel Öğüt
- Department of Dermatology and Venereology, Uşak Training and Research Hospital, Uşak, Turkey
| | - Sema Koç Yıldırım
- Department of Dermatology and Venereology, Uşak Training and Research Hospital, Uşak, Turkey
| | - Ece Erbağcı
- Department of Dermatology and Venereology, Uşak Training and Research Hospital, Uşak, Turkey
| | - Fatma Aslı Hapa
- Department of Dermatology and Venereology, İzmir Democracy University, İzmir, Turkey
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13
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Ruggiero A, Megna M, Fabbrocini G, Fornaro L, Villani A. Drug safety evaluation of ixekizumab for psoriasis: a review of the current knowledge. Expert Opin Drug Saf 2022; 21:1249-1257. [PMID: 36250261 DOI: 10.1080/14740338.2022.2134855] [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] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Since Anti-IL-17s availability, concerns about their safety have been raised due to the inhibition of physiological activities that IL-17A plays in the immune response against infections. Ixekizumab is a humanized monoclonal antibody specifically targeting IL-17A approved for the treatment of moderate-to-severe psoriasis. AREAS COVERED The aim of this review is to evaluate the safety profile of ixekizumab in moderate to severe psoriasis patients. A compressive literature review included article since March 2022. EXPERT OPINION in our analysis, most of the reported AEs were mild or moderate and rarely required treatment discontinuation. Among the class specific AEs to consider during ixekizumab treatment, there are the risk of Candida spp infections and the risk of IBD, which both were reported more frequently than if compared with placebo or other biologics (etanercept, ustekinumab, guselkumab). However, the reported candidiasis resulted mild-to moderate, and easily managed. The risk of IBD (both exacerbation and de novo diagnosis) represents a class effect of IL-17 inhibitors, which should be well evaluated before considering starting ixekizumab treatment. the most common AEs were represented by nasopharyngitis, upper respiratory tract infection, and injection-site reactions. The analysed studies confirmed the favourable safety profile of ixekizumab even in more recently published studies.
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Affiliation(s)
- Angelo Ruggiero
- Section of Dermatology - Department of Clinical Medicine and Surgery, University of Naples Federico II, Napoli, Italy
| | - Matteo Megna
- Section of Dermatology - Department of Clinical Medicine and Surgery, University of Naples Federico II, Napoli, Italy
| | - Gabriella Fabbrocini
- Section of Dermatology - Department of Clinical Medicine and Surgery, University of Naples Federico II, Napoli, Italy
| | - Luigi Fornaro
- Section of Dermatology - Department of Clinical Medicine and Surgery, University of Naples Federico II, Napoli, Italy
| | - Alessia Villani
- Section of Dermatology - Department of Clinical Medicine and Surgery, University of Naples Federico II, Napoli, Italy
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14
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Al Muqrin AM, Alghamdi AA, AlShaalan ZM. Rapid Response of Palmoplantar Psoriasis to Risankizumab: A Case Report. Clin Cosmet Investig Dermatol 2022; 15:2129-2132. [PMID: 36217411 PMCID: PMC9547619 DOI: 10.2147/ccid.s384990] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Accepted: 09/23/2022] [Indexed: 11/23/2022]
Abstract
Palmoplantar psoriasis, a clinical variant of plaque psoriasis, has a significant impact by causing deterioration in the social and functional aspects of patients' lives. Numerous therapeutic interventions are available for palmoplantar psoriasis. Although emerging biological agents have had an enormous positive impact on chronic plaque psoriasis, studies assessing their effectiveness in the palmoplantar phenotype are limited in the literature. We therefore present a case report of a patient with a 10-year history of palmoplantar psoriasis, which has significantly impacted her occupational life. She was treated with Risankizumab, showing a significant and rapid improvement in her symptoms. We believe that Risankizumab could be one of the most effective therapeutic interventions in the clinical context where rapid clearance of palmoplantar psoriasis is required.
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Affiliation(s)
- Abdullah Muqrin Al Muqrin
- Dermatology, Prince Mohammed Medical City, Skaka, AlJouf, Saudi Arabia,Correspondence: Abdullah Muqrin Al Muqrin, Dermatology, Prince Mohammed Medical City, Skaka City, 72345, AlJouf, Saudi Arabia, Tel +96654777446, Email
| | | | - Ziad M AlShaalan
- Department of Internal Medicine, College of Medicine, Jouf University, Skakak, AlJouf, Saudi Arabia
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15
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Megna M, Potestio L, Camela E, Fabbrocini G, Ruggiero A. Ixekizumab and brodalumab indirect comparison in the treatment of moderate to severe psoriasis: results from an Italian single-centre retrospective study in a real-life setting. Dermatol Ther 2022; 35:e15667. [PMID: 35762107 PMCID: PMC9540270 DOI: 10.1111/dth.15667] [Citation(s) in RCA: 26] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Revised: 05/22/2022] [Accepted: 06/25/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Eleven biologic drugs are currently approved for psoriasis management. Real-life studies are needed to guide clinicians in choosing a tailored-tail therapy. The aim of our retrospective study is to indirectly compare the efficacy and safety of ixekizumab and brodalumab in psoriasis patients. METHODS A single-centre real-life retrospective study was performed enrolling moderate-to-severe psoriatic patients under biologic treatment with ixekizumab or brodalumab. For each patient, clinical and demographic data were collected and the effectiveness and safety of brodalumab and ixekizumab treatment were evaluated at weeks 4, 12 and 24. Psoriasis Area Severity Index (PASI) and Body Surface Area (BSA) were used for psoriasis severity. RESULTS A total of 139 patients were included in the study: 98(70.5%) and 41(29.5%) patients received ixekizumab and brodalumab, respectively. Mean PASI and BSA significantly reduced at each follow up for both ixekizumab and brodalumab groups. Even if ixekizumab reached higher rates of PASI90 and PASI100 than brodalumab (PASI90: 43.8%vs39.0% PASI100: 20.4%vs17.1% at week4 and PASI90: 83.6%vs75.6% PASI100: 71.5%vs60.9% at week24), these results were not statistically significant. Adverse events, mainly mild, were registered in 25.5% of ixekizumab and 26.8% of brodalumab group, respectively. Discontinuation rate was higher for brodalumab (17.1%vs9.1%), without statistical significance. CONCLUSION Our study showed comparable efficacy and safety for ixekizumab and brodalumab.
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Affiliation(s)
- Matteo Megna
- Section of Dermatology - Department of Clinical Medicine and Surgery, University of Naples Federico II
| | - Luca Potestio
- Section of Dermatology - Department of Clinical Medicine and Surgery, University of Naples Federico II
| | - Elisa Camela
- Section of Dermatology - Department of Clinical Medicine and Surgery, University of Naples Federico II
| | - Gabriella Fabbrocini
- Section of Dermatology - Department of Clinical Medicine and Surgery, University of Naples Federico II
| | - Angelo Ruggiero
- Section of Dermatology - Department of Clinical Medicine and Surgery, University of Naples Federico II
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16
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Manzo Margiotta F, Michelucci A, Panduri S, Tonini A, Davini G, Romanelli M, Morganti R, Dini V. Family history of psoriasis: a novel protective factor for therapy switch in patients treated with Secukinumab or Ixekizumab. J Eur Acad Dermatol Venereol 2022; 36:e454-e456. [DOI: 10.1111/jdv.17944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Revised: 12/04/2021] [Accepted: 01/05/2022] [Indexed: 11/29/2022]
Affiliation(s)
- Flavia Manzo Margiotta
- Department of Dermatology University of Pisa Pisa Italy
- Institute of Life Sciences Scuola Superiore Sant'Anna Pisa Italy
| | | | | | | | - Giulia Davini
- Department of Dermatology University of Pisa Pisa Italy
| | | | - Riccardo Morganti
- Statistical Support to Clinical Trials Department University of Pisa Pisa Italy
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17
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Pavia G, Gargiulo L, Cortese A, Valenti M, Sanna F, Borroni RG, Costanzo A, Narcisi A. Apremilast for the treatment of palmo-plantar non-pustular psoriasis: A real-life single-center retrospective study. Dermatol Ther 2021; 35:e15253. [PMID: 34877758 DOI: 10.1111/dth.15253] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 07/26/2021] [Revised: 11/09/2021] [Accepted: 12/04/2021] [Indexed: 12/14/2022]
Abstract
Palmoplantar psoriasis (PP) is a type of psoriasis that involves the skin of the palms and soles and can present as hyperkeratotic, similar to the vulgaris psoriasis of the body. Apremilast, as an oral inhibitor of phosphodiesterase 4 (PDE4), is currently approved for the treatment of psoriatic arthritis and for moderate-to-severe psoriasis in adult patients who have not responded or have contraindications or do not tolerate other systemic treatments. We evaluated the efficacy and safety of apremilast in the treatment of non-pustular palmo-plantar psoriasis in a cohort of 12 patients. We found a clinical response of clear/almost clear palmoplantar psoriasis (PPPGA score 0/1) in 83.33% of our patients, at week 16. No significant safety issues were reported and none of our patients had to discontinue the drug.
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Affiliation(s)
- Giulia Pavia
- Dermatology Unit, Department of Biomedical Sciences, Humanitas University, Milan, Italy.,Dermatology Unit, Humanitas Clinical and Research Center - IRCCS, Milan, Italy
| | - Luigi Gargiulo
- Dermatology Unit, Department of Biomedical Sciences, Humanitas University, Milan, Italy.,Dermatology Unit, Humanitas Clinical and Research Center - IRCCS, Milan, Italy
| | - Andrea Cortese
- Dermatology Unit, Department of Biomedical Sciences, Humanitas University, Milan, Italy.,Dermatology Unit, Humanitas Clinical and Research Center - IRCCS, Milan, Italy
| | - Mario Valenti
- Dermatology Unit, Department of Biomedical Sciences, Humanitas University, Milan, Italy.,Dermatology Unit, Humanitas Clinical and Research Center - IRCCS, Milan, Italy
| | - Federica Sanna
- Dermatology Unit, Humanitas Clinical and Research Center - IRCCS, Milan, Italy
| | - Riccardo G Borroni
- Dermatology Unit, Department of Biomedical Sciences, Humanitas University, Milan, Italy.,Dermatology Unit, Humanitas Clinical and Research Center - IRCCS, Milan, Italy
| | - Antonio Costanzo
- Dermatology Unit, Department of Biomedical Sciences, Humanitas University, Milan, Italy.,Dermatology Unit, Humanitas Clinical and Research Center - IRCCS, Milan, Italy
| | - Alessandra Narcisi
- Dermatology Unit, Humanitas Clinical and Research Center - IRCCS, Milan, Italy
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18
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Menter A, Krueger GG, Paek SY, Kivelevitch D, Adamopoulos IE, Langley RG. Interleukin-17 and Interleukin-23: A Narrative Review of Mechanisms of Action in Psoriasis and Associated Comorbidities. Dermatol Ther (Heidelb) 2021; 11:385-400. [PMID: 33512665 PMCID: PMC8019008 DOI: 10.1007/s13555-021-00483-2] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Indexed: 12/13/2022] Open
Abstract
Psoriasis is an immune-mediated inflammatory skin disease associated with numerous inflammatory comorbidities, including increased cardiovascular risk. The interleukin (IL)-23/IL-17 axis plays a central role in the immunopathogenesis of psoriasis and related comorbidities by acting to stimulate keratinocyte hyperproliferation and feed-forwarding circuits of perpetual T cell-mediated inflammation. IL-17 plays an important role in the downstream portion of the psoriatic inflammatory cascade. This review discusses the distinct mechanisms of action of IL-17 and IL-23 in the immunopathogenesis of psoriasis and related comorbidities plus the significant therapeutic benefits of selectively inhibiting these cytokines in patients with moderate to severe plaque psoriasis.
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Affiliation(s)
| | | | | | | | - Iannis E Adamopoulos
- Division of Rheumatology, Allergy and Clinical Immunology, University of California at Davis, Sacramento, CA, USA
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19
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Wu JJ, Harrison RW, Zhu B, Goldblum OM, Malatestinic WN, Burge R, Murage MJ. Understanding characteristics of patients newly initiating ixekizumab: findings from the Corrona Psoriasis Registry. J Comp Eff Res 2020; 10:157-167. [PMID: 33355477 DOI: 10.2217/cer-2020-0113] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Background: Real-world data on patients newly initiating ixekizumab is limited. Our study describes the characteristics of patients who initiated ixekizumab and other biologics for psoriasis treatment in North American dermatological practices. Materials & methods: Characteristics of patients ascertained at registry enrollment are described via means and frequencies. Results: Compared with other biologic initiators, ixekizumab initiators had: longer disease duration (17.1 vs 15.1 years); more were considered least severe by body surface area (33 vs 26%); moderate-to-severe by IGA (56 vs 48%); were biologic-experienced (80 vs 52%); obese (54 vs 47%); and experienced greater impact in work productivity (5.3 vs 2.9%) versus other biologic initiators. Conclusion: Psoriasis patients initiating ixekizumab had more severe disease, biologic experience, and worse patient-reported outcomes than those initiating other biologics.
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Affiliation(s)
- Jashin J Wu
- Dermatology Research & Education Foundation, Irvine, CA 92620, USA
| | | | - Baojin Zhu
- Eli Lilly & Company, Indianapolis, IN 46225, USA
| | | | | | - Russel Burge
- Eli Lilly & Company, Indianapolis, IN 46225, USA.,Division of Pharmaceutical Sciences, Winkle College of Pharmacy, University of Cincinnati, Cincinnati, OH 45229, USA
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20
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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21
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Shahriari M, Harrison RW, Burge R, Lin CY, Malatestinic WN, Goldblum OM, McLean RR, Crabtree MM, O'Brien J, Grace EL, Murage MJ. Disease response and patient-reported outcomes among initiators of ixekizumab. J DERMATOL TREAT 2020; 33:1538-1546. [PMID: 33267635 DOI: 10.1080/09546634.2020.1853023] [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] [Indexed: 10/22/2022]
Abstract
OBJECTIVES There is limited real-world evidence on using ixekizumab in psoriasis patients. Therefore, we characterized patients with psoriasis initiating ixekizumab and report 6-month changes in disease and patient-reported outcomes. METHODS Adult patients with psoriasis who initiated ixekizumab and completed a 6-month follow-up visit were enrolled from the Corrona Psoriasis Registry. Disease characteristics and outcomes were assessed at ixekizumab initiation. Outcomes included the mean 6-month change in Psoriasis Area and Severity Index (PASI), body surface area (BSA), Investigator Global Assessment (IGA), and IGA*BSA. RESULTS From baseline to follow-up in all patients (n = 136), means decreased for IGA*BSA (-45.5) and BSA (-12.4), and a higher % achieved an absolute PASI ≤ 5 (84.6%), BSA 0-3 (72.1%), and IGA 0/1 (50.7%). Within stratified groups, means decreased for PASI <12 for IGA*BSA (-21.1) and BSA (-6.3); PASI≥12 for IGA*BSA (-94.8) and BSA (-24.6); weight <100 kg for IGA*BSA (-45.1) and BSA (-12.4); weight ≥100 kg for IGA*BSA (-46.2) and BSA (-12.3); concomitant PsA for IGA*BSA (-56.0) and BSA (-15.3); and in no concomitant PsA for IGA*BSA (-36.9) and BSA (-10.0). CONCLUSIONS We provide real-world evidence on the benefits of ixekizumab for treating psoriasis, regardless of baseline disease severity, weight, or concomitant PsA.
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Affiliation(s)
- Mona Shahriari
- Department of Dermatology, Yale University, New Haven, CT, USA.,Central Connecticut Dermatology Research, Cromwell, CT, USA
| | | | - Russel Burge
- Eli Lilly and Company, Indianapolis, IN, USA.,Department of Sciences and Health, University of Cincinnati, Cincinnati, OH, USA
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22
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Herrera-Acosta E, Garriga-Martina GG, Suárez-Pérez JA, Martínez-García E, Herrera-Ceballos E. Ixekizumab vs ustekinumab for skin clearance in patients with moderate to severe psoriasis after a year of treatment: Real-world practice. Dermatol Ther 2020; 33:e14202. [PMID: 32808703 DOI: 10.1111/dth.14202] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [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: 06/10/2020] [Revised: 07/27/2020] [Accepted: 08/03/2020] [Indexed: 02/06/2023]
Abstract
There is a lack of real practice studies comparing ustekinumab and ixekizumab effectiveness and safety. The main aim of this study was to compare the effectiveness and safety of both drugs used to treat moderate-to-severe psoriasis patients over 52 weeks. The secondary objective was to identify which clinical variables could have an impact on its effectiveness. A retrospective observational study was carried out, comparing the first 28 patients treated with ustekinumab after its commercialization was compared to the first 35 patients treated with ixekizumab. Although a higher level of skin clearance was achieved with ixekizumab with a PASI 90 and 100 response of 54.3% and 40% compared to 42.9% and 25% for ustekinumab, these differences were not statistically significant. Ixekizumab achieved a higher PASI 90 response in those patients with BMI > 27 (slightly overweight), which was statistically significant (P = .024). Ustekinumab had a greater survival at 52 weeks than ixekizumab, with a trend towards statistical significance (P = .052). Ixekizumab achieved higher skin clearance rates (PASI 90 and 100 response) than ustekinumab, with no statistically significant differences. However, ixekizumab should be specially considered in overweight patients.
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Herrera-Acosta E, Garriga-Martina GG, Suárez-Pérez JA, Martínez-García EA, Herrera-Ceballos E. Comparative study of the efficacy and safety of secukinumab vs ixekizumab in moderate-to-severe psoriasis after 1 year of treatment: Real-world practice. Dermatol Ther 2020; 33:e13313. [PMID: 32181962 DOI: 10.1111/dth.13313] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [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: 02/03/2020] [Revised: 03/05/2020] [Accepted: 03/13/2020] [Indexed: 12/20/2022]
Abstract
There are no studies which directly compare efficacy in Psoriasis Area and Severity Index (PASI) response of secukinumab and ixekizumab. The main aim of this study was to compare the efficacy and safety of both drugs used to treat moderate-to-severe psoriasis patients over 52 weeks. Secondary objectives were to identify which factors related to prior biologic treatment influenced their efficacy and analyze data obtained at 12 weeks. A retrospective observational study was carried out, in which a group of the first 59 patients treated with secukinumab after its commercialization, was compared with another group of the first 29 patients treated with ixekizumab. The PASI 75, 90, and 100 response obtained at 52 weeks was 64.4%, 49.2%, and 41.4% for secukinumab and 75.9%, 62.1%, and 41.4% for ixekizumab, respectively, with no statistically significant differences. Regarding previous biological treatment, both treatments showed a decrease in efficacy as the number of prior biologics increases. No differences were found between secukinumab and ixekizumab in bio-naïve or bio-experienced patients, with the exception of a higher PASI 75 response at week 52 for ixekizumab in those patients with two or more previous biologics (P = .039) Secukinumab and ixekizumab have demonstrated high efficacy and safety, with no statistically significant differences.
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Affiliation(s)
- Enrique Herrera-Acosta
- Department of Dermatology, Hospital Clínico Virgen de la Victoria, University of Malaga, Malaga, Spain
| | - Gustavo G Garriga-Martina
- Department of Dermatology, Hospital Clínico Virgen de la Victoria, University of Malaga, Malaga, Spain
| | - Jorge A Suárez-Pérez
- Department of Dermatology, Hospital Clínico Virgen de la Victoria, University of Malaga, Malaga, Spain
| | - Eliseo A Martínez-García
- Department of Dermatology, Hospital Clínico Virgen de la Victoria, University of Malaga, Malaga, Spain
| | - Enrique Herrera-Ceballos
- Department of Dermatology, Hospital Clínico Virgen de la Victoria, University of Malaga, Malaga, Spain
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Caldarola G, Pirro F, Di Stefani A, Talamonti M, Galluzzo M, D'Adamio S, Magnano M, Bernardini N, Malagoli P, Bardazzi F, Potenza C, Bianchi L, Peris K, De Simone C. Clinical and histopathological characterization of eczematous eruptions occurring in course of anti IL-17 treatment: a case series and review of the literature. Expert Opin Biol Ther 2020; 20:665-672. [PMID: 32045273 DOI: 10.1080/14712598.2020.1727439] [Citation(s) in RCA: 45] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Background: Real-life data often highlight the side effects of certain drugs not previously reported in randomized controlled trials (RCTs).Objective: To describe cutaneous inflammatory eruptions in psoriatic patients treated with an anti IL-17A agent (secukinumab or ixekizumab).Methods: Retrospective analysis of a cohort of patients with chronic plaque psoriasis who started an anti IL-17A agent between September 2016-February 2019 and who developed cutaneous inflammatory eruptions during treatment. A systematic review of similar events reported in the literature was performed.Results: Data of 468 patients were reviewed and 27 cutaneous inflammatory eruptions of 27 (5.8%) patients were collected. The eruptions appeared after a mean of 16.9 ± 17.0 weeks of therapy showing a classical acute eczema in 11 patients (40.7%), an atopic dermatitis-like rash in 11 patients (40.7%) and a psoriasiform eruption in 5 patients (18.5%). Histopathology of 12/27 cases showed epidermal spongiosis in all these variants.Conclusion: We described the clinic-pathologic features of some eczematous eruptions occurring in psoriatic patients, 3-4 months after treatment initiation with an anti IL-17A agent. Further investigations are needed to explain this phenomenon, that might be defined a paradoxical adverse event, based upon the role of IL17 in eczema pathogenesis.
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Affiliation(s)
- G Caldarola
- Institute of Dermatology, Università Cattolica del Sacro Cuore, Rome, Italy.,Department of Dermatology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - F Pirro
- Institute of Dermatology, Università Cattolica del Sacro Cuore, Rome, Italy.,Department of Dermatology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - A Di Stefani
- Institute of Dermatology, Università Cattolica del Sacro Cuore, Rome, Italy.,Department of Dermatology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - M Talamonti
- Dermatology Unit, University of Rome "Tor Vergata", Rome, Italy
| | - M Galluzzo
- Dermatology Unit, University of Rome "Tor Vergata", Rome, Italy
| | - S D'Adamio
- Dermatology Unit, University of Rome "Tor Vergata", Rome, Italy
| | - M Magnano
- Division of Dermatology, Department of Specialized, Clinical and Experimental Medicine, University of Bologna, Bologna, Italy
| | - N Bernardini
- Dermatology Unit, Sapienza University of Rome, Polo Pontino, Terracina, Italy
| | - P Malagoli
- Dermatology Unit, Azienda Ospedaliera San Donato Milanese, Milan, Italy
| | - F Bardazzi
- Division of Dermatology, Department of Specialized, Clinical and Experimental Medicine, University of Bologna, Bologna, Italy
| | - C Potenza
- Dermatology Unit, Sapienza University of Rome, Polo Pontino, Terracina, Italy
| | - L Bianchi
- Dermatology Unit, University of Rome "Tor Vergata", Rome, Italy
| | - K Peris
- Institute of Dermatology, Università Cattolica del Sacro Cuore, Rome, Italy.,Department of Dermatology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - C De Simone
- Institute of Dermatology, Università Cattolica del Sacro Cuore, Rome, Italy.,Department of Dermatology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
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25
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Affiliation(s)
- Lluís Puig
- Department of Dermatology, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
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26
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Abstract
Psoriasis is a chronic, inflammatory disease with a varying degree of clinical presentations. Managing psoriasis has always been arduous due to its chronicity and its propensity to relapse. Prior to the development of targeted biologic therapies, there were few effective treatments for psoriasis. Ancient psoriasis therapies included pinetar, plant extracts, psychotherapy, arsenic, and ammoniated mercury. In the 19th century, chrysarobin was developed. Then, in the early half of the 20th century, anthralin and coal tar were in widespread use. In the latter half of the 20th century, treatments were limited to topical first-line therapies, systemic drugs, and phototherapy. However, as the treatment of psoriasis has undergone a revolutionary change with the development of novel biologic therapies, patients with moderate to severe psoriasis have been able to avail therapies with high efficacy and durability along with an acceptable safety profile. This article is a brief historical review of the management of psoriasis prior to the inception of biologics and with the development of novel biologic therapies.
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Affiliation(s)
- Khalad Maliyar
- Department of Medicine, University of Toronto, ON, Canada
| | | | - Boluwaji Ogunyemi
- Discipline of Medicine, Memorial University of Newfoundland, St. John’s, NL, Canada
| | - Charles Lynde
- Division of Dermatology, University of Toronto, ON, Canada
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Blauvelt A, Shi N, Burge R, Malatestinic WN, Lin CY, Lew CR, Zimmerman NM, Goldblum OM, Zhu B, Murage MJ. Comparison of Real-World Treatment Patterns Among Psoriasis Patients Treated with Ixekizumab or Adalimumab. Patient Prefer Adherence 2020; 14:517-527. [PMID: 32210539 PMCID: PMC7074803 DOI: 10.2147/ppa.s233993] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Accepted: 02/11/2020] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND There is lack of real-world treatment pattern comparison data between ixekizumab and adalimumab which are approved for the treatment of moderate-to-severe plaque psoriasis. OBJECTIVE To compare real-world treatment patterns among psoriasis patients initiating ixekizumab or adalimumab in the United States. METHODS Psoriasis patients with ≥1 claim for ixekizumab or adalimumab between March 1, 2016, and May 31, 2018, were identified (index date = date of first ixekizumab or adalimumab claim) from the IBM Watson Health MarketScan® databases. Patients were required to be continuously enrolled for ≥12 months before the index date and followed for a minimum of 6 months until inpatient death, enrollment end, or study end, whichever occurred first. Treatment persistence, adherence, discontinuation, restart, and switching were analyzed. Inverse probability of treatment weighting and multivariable regression modeling were employed to address cohort imbalances and estimate the adjusted risk of non-persistence, discontinuation, and switching, and the odds of adherence. RESULTS A total of 646 ixekizumab and 3668 adalimumab users were included and followed for a mean of 14.0 and 16.5 months, respectively. Compared to adalimumab, ixekizumab was associated with 19% lower risk of non-persistence (hazard ratio [HR]=0.81, 95% confidence interval [CI]: 0.69-0.95), 26% lower risk of discontinuation (HR=0.74, 95% CI: 0.62-0.88), and 28% lower risk of switching (HR=0.72, 95% CI: 0.57-0.91). Ixekizumab users had higher odds of medication possession ratio ≥80% (odds ratio [OR]=1.36, 95% CI: 1.10-1.69) but similar odds by proportion of days covered ≥80% (OR=1.22, 95% CI: 0.98-1.53). CONCLUSION Psoriasis patients treated with ixekizumab demonstrated longer persistency, higher adherence and were less likely to discontinue or switch treatment compared to adalimumab users. However, while patients achieving highly adherent threshold significantly differed by MPR ≥80%, it did not by PDC ≥80%; hence, further analysis using fixed-length follow-up is required.
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Affiliation(s)
| | | | - Russel Burge
- Eli Lilly and Company, Indianapolis, IN, USA
- University of Cincinnati, Cincinnati, OH, USA
| | | | | | | | | | | | - Baojin Zhu
- Eli Lilly and Company, Indianapolis, IN, USA
| | - Mwangi J Murage
- Eli Lilly and Company, Indianapolis, IN, USA
- Correspondence: Mwangi J Murage Global Patient Outcomes and Real World Evidence (GPORWE), Eli Lilly and Company, LCT – South Building 171-2, Drop Code 5221, 1555 Harding St, Indianapolis, IN46221, USATel +1-317-460-3619 Email
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28
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Gottlieb A, Kubanov A, Doorn M, Sullivan J, Papp K, You R, Regnault P, Frueh J. Sustained efficacy of secukinumab in patients with moderate‐to‐severe palmoplantar psoriasis: 2·5‐year results from
GESTURE
, a randomized, double‐blind, placebo‐controlled trial. Br J Dermatol 2019; 182:889-899. [DOI: 10.1111/bjd.18331] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/04/2019] [Indexed: 01/23/2023]
Affiliation(s)
- A.B. Gottlieb
- Department of Dermatology Icahn School of Medicine at Mount Sinai New York NY U.S.A
| | - A. Kubanov
- State Scientific Center of Dermatology, Venereology and Cosmetology Moscow Russia
| | - M. Doorn
- Department of Dermatology Erasmus University Medical Center Rotterdam the Netherlands
| | - J. Sullivan
- Kingsway Dermatology & Aesthetics Miranda Australia
| | - K.A. Papp
- K. Papp Research and Probity Medical Research, Inc. Waterloo ON Canada
| | - R. You
- China Novartis Institutes for BioMedical Research Shanghai China
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Abstract
Introduction: Psoriasis is a chronic, immune-mediated disease with significant associated comorbidities. Its pathogenesis is likely multifactorial, however, the interleukin-23/T helper 17 pathway has been identified as a critical axis in its pathogenesis. Interleukin-17A is the primary effector of this pathway and overexpression of IL-17A results in epidermal hyperplasia and an overly robust inflammatory response, resulting in the skin plaques and systemic inflammation seen in psoriasis. Targeted anti IL-17 therapies have demonstrated efficacy in the treatment of moderate-to-severe plaque psoriasis.Areas covered: A PubMed search was conducted for relevant literature. Secukinumab, ixekizumab, and brodalumab are anti IL-17 inhibitors currently approved for the treatment of moderate-to-severe plaque psoriasis. The efficacy and safety data from key phase III clinical trials are reviewed here.Expert opinion: By targeting a key mediator of the interleukin-23/T helper 17 pathway, IL-17 antagonists are an effective treatment for plaque psoriasis. It has demonstrated efficacy and a favorable safety profile in key phase III clinical trials. In addition to efficacy, IL-17 antagonists have also shown long-term maintenance of treatment response and a quick onset of action. The efficacy of IL-17 inhibitors in the treatment of moderate-to-severe psoriasis underscores the importance of the IL-23/Th17 pathway in the pathogenesis of psoriasis.
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Affiliation(s)
- Karen Ly
- Department of Dermatology, University of California San Francisco, San Francisco, CA, USA
| | - Mary P Smith
- Department of Dermatology, University of California San Francisco, San Francisco, CA, USA
| | - Quinn Thibodeaux
- Department of Dermatology, University of California San Francisco, San Francisco, CA, USA
| | - Vidhatha Reddy
- Department of Dermatology, University of California San Francisco, San Francisco, CA, USA
| | - Wilson Liao
- Department of Dermatology, University of California San Francisco, San Francisco, CA, USA
| | - Tina Bhutani
- Department of Dermatology, University of California San Francisco, San Francisco, CA, USA
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30
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D’Adamio S, Silvaggio D, Lombardo P, Bianchi L, Talamonti M, Galluzzo M. The safety of anti-interleukins monoclonal antibodies for the treatment of psoriasis. Expert Opin Drug Saf 2019; 18:1031-1041. [DOI: 10.1080/14740338.2019.1663168] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- S. D’Adamio
- Dermatology Unit, University of Rome “Tor Vergata”, Rome, Italy
| | - D. Silvaggio
- Dermatology Unit, University of Rome “Tor Vergata”, Rome, Italy
| | - P. Lombardo
- Dermatology Unit, University of Rome “Tor Vergata”, Rome, Italy
| | - L. Bianchi
- Dermatology Unit, University of Rome “Tor Vergata”, Rome, Italy
| | - M. Talamonti
- Dermatology Unit, University of Rome “Tor Vergata”, Rome, Italy
| | - M. Galluzzo
- Dermatology Unit, University of Rome “Tor Vergata”, Rome, Italy
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31
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Al-Mossawi H, Taams LS, Goodyear CS, Kirkham BW, McInnes IB, Siebert S, Coates LC. Precision medicine in psoriatic arthritis: how should we select targeted therapies? Lancet Rheumatol 2019; 1:e66-e73. [PMID: 38229362 DOI: 10.1016/s2665-9913(19)30008-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Revised: 05/31/2019] [Accepted: 06/04/2019] [Indexed: 01/17/2023]
Abstract
Psoriatic arthritis (PsA) is a heterogeneous inflammatory arthritis associated with psoriasis. Patients manifest variable presentations with potential involvement of peripheral joints, spine, tendons, skin, and nails. There has been a rapid expansion in targeted treatment options for patients with PsA, but typically less than half of those who receive therapy achieve optimal treatment targets. Many patients respond to second-line or third-line biological therapies, but little evidence exists to guide the choice of therapeutics for each individual. At present, choice of therapy is driven by active clinical disease domains, clinician familiarity with existing treatments, and cost. Here, we review recent data that highlight the potential for personalised, or precision, medicine in PsA and other forms of inflammatory arthritis, noting that this research is still at a preliminary stage. In the future, a combination of detailed immunophenotyping and sophisticated statistical analyses should help to facilitate a personalised medicine approach in PsA, following examples from other clinical areas, such as oncology. This change in approach to the treatment of PsA has the potential to maximise outcomes for patients and to provide optimal therapies without delay.
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Affiliation(s)
- Hussein Al-Mossawi
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Leonie S Taams
- Centre for Inflammation Biology and Cancer Immunology, Department of Inflammation Biology, School of Immunology and Microbial Sciences, King's College London, London, UK
| | - Carl S Goodyear
- Institute of Infection, Immunity and Inflammation, University of Glasgow, Glasgow, UK
| | - Bruce W Kirkham
- Department of Rheumatology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Iain B McInnes
- Institute of Infection, Immunity and Inflammation, University of Glasgow, Glasgow, UK
| | - Stefan Siebert
- Institute of Infection, Immunity and Inflammation, University of Glasgow, Glasgow, UK
| | - Laura C Coates
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK.
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32
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Menter A, Strober BE, Kaplan DH, Kivelevitch D, Prater EF, Stoff B, Armstrong AW, Connor C, Cordoro KM, Davis DMR, Elewski BE, Gelfand JM, Gordon KB, Gottlieb AB, Kavanaugh A, Kiselica M, Korman NJ, Kroshinsky D, Lebwohl M, Leonardi CL, Lichten J, Lim HW, Mehta NN, Paller AS, Parra SL, Pathy AL, Rupani RN, Siegel M, Wong EB, Wu JJ, Hariharan V, Elmets CA. Joint AAD-NPF guidelines of care for the management and treatment of psoriasis with biologics. J Am Acad Dermatol 2019; 80:1029-1072. [PMID: 30772098 DOI: 10.1016/j.jaad.2018.11.057] [Citation(s) in RCA: 438] [Impact Index Per Article: 87.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2018] [Revised: 11/26/2018] [Accepted: 11/27/2018] [Indexed: 12/29/2022]
Abstract
Psoriasis is a chronic, inflammatory multisystem disease that affects up to 3.2% of the US population. This guideline addresses important clinical questions that arise in psoriasis management and care, providing recommendations based on the available evidence. The treatment of psoriasis with biologic agents will be reviewed, emphasizing treatment recommendations and the role of the dermatologist in monitoring and educating patients regarding benefits as well as associated risks.
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Affiliation(s)
| | - Bruce E Strober
- University of Connecticut, Farmington, Connecticut; Probity Medical Research, Waterloo, Ontario, Canada
| | | | | | | | | | | | | | - Kelly M Cordoro
- University of California, San Francisco School of Medicine, Department of Dermatology, San Francisco, California
| | | | | | - Joel M Gelfand
- University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | | | - Alice B Gottlieb
- Department of Dermatology, Icahn School of Medicine at Mt. Sinai, New York
| | | | | | - Neil J Korman
- University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | | | - Mark Lebwohl
- Department of Dermatology, Icahn School of Medicine at Mt. Sinai, New York
| | | | | | - Henry W Lim
- Department of Dermatology, Henry Ford Hospital, Detroit, Michigan
| | - Nehal N Mehta
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | - Amy S Paller
- Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | | | - Arun L Pathy
- Colorado Permanente Medical Group, Centennial, Colorado
| | | | | | - Emily B Wong
- San Antonio Uniformed Services Health Education Consortium, Joint-Base San Antonio
| | - Jashin J Wu
- Dermatology Research and Education Foundation, Irvine, California
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Lynde CW, Beecker J, Dutz J, Flanagan C, Guenther LC, Gulliver W, Papp K, Rahman P, Sholter D, Searles GE. Treating to Target(s) With Interleukin-17 Inhibitors. J Cutan Med Surg 2019; 23:3S-34S. [DOI: 10.1177/1203475418824565] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Background: The treat-to-target (T2T) strategy has become established in several medical specialties as a key guidance to optimal therapeutic decision making. T2T may be effective in the assessment of the biologic class of agents called interleukin (IL)-17 inhibitors, which are emerging as a safe and effective treatment option for autoimmune inflammatory conditions such as plaque psoriasis, psoriatic arthritis (PsA), and ankylosing spondylitis (AS). Objective: The objective of this article is to use a T2T approach for the evaluation of the effectiveness and safety of IL-17 inhibitors in the management of patients with plaque psoriasis, PsA, and AS. Methods: Following a comprehensive literature search, a full-day meeting was convened to discuss and identify the T2T targets for psoriasis, PsA, and AS. Clinical trial evidence was presented for the approved IL-17 inhibitors—secukinumab, ixekizumab, and brodalumab—to assess whether these data meet T2T safety and efficacy targets. Results: All 3 approved agents were significantly superior to placebo and active controls in the achievement of T2T targets for psoriasis. Secukinumab and ixekizumab were likewise associated with significantly better outcomes than controls in the PsA targets, and secukinumab resulted in significant AS target improvements vs placebo. The IL-17 inhibitors were also associated with low rates of serious adverse events and exacerbations of common comorbid conditions. Conclusion: Phase III trial results support the T2T benefit and safety of IL-17 inhibitors according to their specific indications for the management of patients with plaque psoriasis, PsA, and AS.
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Affiliation(s)
- Charles W. Lynde
- University of Toronto, ON, Canada
- University Health Network, Toronto, ON, Canada
- Probity Medical Research, Markham, ON, Canada
| | - Jennifer Beecker
- The Ottawa Hospital, ON, Canada
- The University of Ottawa, ON, Canada
- Probity Medical Research, Ottawa, ON, Canada
| | - Jan Dutz
- University of British Columbia, Vancouver, BC, Canada
- BC Children’s Hospital Research Institute, Vancouver, BC, Canada
| | | | | | - Wayne Gulliver
- Memorial University of Newfoundland, St. John’s, NL, Canada
| | - Kim Papp
- Probity Medical Research, Waterloo, ON, Canada
| | - Proton Rahman
- Memorial University of Newfoundland, St. John’s, NL, Canada
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34
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Abstract
Introduction: Psoriasis is a chronic immune-mediated skin disease with a multifactorial etiology. Studies have shown that the inflammatory cytokine interleukin-17A (IL-17A) is a key mediator in the pathogenesis. Targeted biologics have changed the outcome for patients in a variety of diseases including psoriasis. Ixekizumab is a humanized monoclonal antibody directed against IL-17A and it has been approved for the treatment of moderate-to-severe plaque psoriasis, and recently also psoriatic arthritis. Areas covered: In this review, we summarize the latest clinical study results on ixekizumab. Long-term Phase III study data on efficacy and safety are now available for both plaque psoriasis and psoriatic arthritis. Additionally, new indications for ixekizumab are under investigation. Expert commentary: Overall, the efficacy and safety of ixekizumab are promising. In plaque psoriasis, the efficacy of ixekizumab was superior to etanercept and ustekinumab, while the efficacy was comparable to adalimumab in psoriatic arthritis. The safety profile has also been found very tolerable and similar to other biologics; however, vigilance regarding non-invasive Candida infections is necessary. Also, caution is advised when treating patients with concomitant inflammatory bowel disease, since ixekizumab could cause exacerbations. Long-term studies in real-life treatment settings are needed to decide the actual potential and safety of ixekizumab.
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Affiliation(s)
- Christoffer Blegvad
- a Copenhagen Research Group for Inflammatory Skin (CORGIS), Department of Dermatology and Allergy, Herlev and Gentofte Hospital , University of Copenhagen , Hellerup , Denmark
| | - Lone Skov
- a Copenhagen Research Group for Inflammatory Skin (CORGIS), Department of Dermatology and Allergy, Herlev and Gentofte Hospital , University of Copenhagen , Hellerup , Denmark
| | - Claus Zachariae
- a Copenhagen Research Group for Inflammatory Skin (CORGIS), Department of Dermatology and Allergy, Herlev and Gentofte Hospital , University of Copenhagen , Hellerup , Denmark
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Affiliation(s)
| | - So Yeon Paek
- Division of Dermatology, Baylor University Medical Center, Dallas, TX, USA
| | - Alan Menter
- Division of Dermatology, Baylor University Medical Center, Dallas, TX, USA
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36
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37
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Abstract
PURPOSE OF REVIEW Biologics and small molecules are key therapeutic options in the treatment of chronic immunologic and allergic skin conditions. By directly targeting innate and inflammatory responses within the skin, including pro-inflammatory cytokines and cellular signaling pathways, these new agents have the potential to counteract the inflammatory cascade responsible for various conditions, including psoriasis and atopic dermatitis. Over the past decade, groundbreaking research identifying key cytokines and receptors involved in the pathogenesis of these diseases has allowed for the development of highly efficacious biologics and small molecules that are associated with unprecedented rates of skin clearance and favorable adverse event profiles. RECENT FINDINGS This narrative review evaluates new and upcoming biologic and small molecule agents for the treatment of two allergic/immunologic skin diseases-atopic dermatitis and psoriasis. Numerous small molecules and biologics targeting TNF-α, IL-12/23, IL-17 and IL-17R, and IL-23 are commercially available for the treatment of psoriasis, and newer agents are in various stages of development. Currently, dupilumab, a monoclonal antibody that blocks IL-4R∝, is the only approved biologic for atopic dermatitis. Antibodies targeting IL-13 and IL-31 and small molecules that inhibit Janus kinase and pruritus-mediating receptors are currently being studied in clinical trials. Further investigations into the pathophysiology of atopic dermatitis will likely yield additional therapeutic options in the future. This article reviews recent literature on small molecules and biologics for the treatment of atopic dermatitis and psoriasis.
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Affiliation(s)
- Bridget P Kaufman
- Mount Sinai St. Luke's and West, 1090 Amsterdam Avenue, Suite 11B, New York, NY, 10029, USA.
| | - Andrew F Alexis
- Mount Sinai St. Luke's and West, 1090 Amsterdam Avenue, Suite 11B, New York, NY, 10029, USA
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Chigutsa E, Velez de Mendizabal N, Chua L, Heathman M, Friedrich S, Jackson K, Reich K. Exposure-Response Modeling to Characterize the Relationship Between Ixekizumab Serum Drug Concentrations and Efficacy Responses at Week 12 in Patients With Moderate to Severe Plaque Psoriasis. J Clin Pharmacol 2018; 58:1489-1500. [DOI: 10.1002/jcph.1268] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Accepted: 05/10/2018] [Indexed: 12/19/2022]
Affiliation(s)
- Emmanuel Chigutsa
- Global PKPD and Pharmacometrics; Eli Lilly and Company; Indianapolis IN USA
| | | | - Laiyi Chua
- Lilly-NUS Centre for Clinical Pharmacology; Singapore
| | - Michael Heathman
- Global PKPD and Pharmacometrics; Eli Lilly and Company; Indianapolis IN USA
| | - Stuart Friedrich
- Global PKPD and Pharmacometrics; Eli Lilly and Company; Indianapolis IN USA
| | - Kimberley Jackson
- Global PKPD and Pharmacometrics; Eli Lilly and Company; Windlesham UK
| | - Kristian Reich
- Dermatologikum Berlin and SCIderm Research Institute; Hamburg Germany
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Raimondo A, Balato A, Megna M, Balato N. Limitations of current monoclonal antibodies for plaque-type psoriasis and an outlook for the future. Expert Opin Biol Ther 2018; 18:605-607. [PMID: 29788767 DOI: 10.1080/14712598.2018.1479738] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Affiliation(s)
- Annunziata Raimondo
- a Department of Clinical Medicine and Surgery , University of Naples Federico II , Naples , Italy
| | - Anna Balato
- b Department of Advanced Biomedical Sciences , University of Naples Federico II , Naples , Italy
| | - Matteo Megna
- a Department of Clinical Medicine and Surgery , University of Naples Federico II , Naples , Italy
| | - Nicola Balato
- a Department of Clinical Medicine and Surgery , University of Naples Federico II , Naples , Italy
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Kivelevitch D, Frieder J, Watson I, Paek SY, Menter MA. Pharmacotherapeutic approaches for treating psoriasis in difficult-to-treat areas. Expert Opin Pharmacother 2018; 19:561-575. [PMID: 29565192 DOI: 10.1080/14656566.2018.1448788] [Citation(s) in RCA: 24] [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] [Indexed: 02/06/2023]
Abstract
INTRODUCTION Despite great therapeutic advancements in psoriasis, four notable difficult-to-treat areas including the scalp, nails, intertriginous (including genitals), and palmoplantar regions, pose a challenge to both physicians and patients. Localized disease of these specific body regions inflicts a significant burden on patients' quality of life and requires an adequate selection of treatments. AREAS COVERED This manuscript discusses appropriate therapies and important treatment considerations for these difficult-to-treat areas based on the available clinical data from the literature. EXPERT OPINION Clinical trials assessing therapies for the difficult-to-treat areas have been inadequate. With the first biological clinical trial for genital psoriasis pending publication, it is with hope that other biological agents will be evaluated for region-specific psoriasis. A greater understanding of the genetic and immunologic aspects of regional psoriasis, as well as identification of unique biomarkers, will further guide management decisions. For example, the recent discovery of the IL-36 receptor gene for generalized pustular psoriasis may prove valuable for other forms of psoriasis. Ultimately, identification of the most beneficial treatments for each psoriasis subtype and difficult-to-treat area will provide patients with maximal quality of life.
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Affiliation(s)
- Dario Kivelevitch
- a Division of Dermatology , Baylor Scott and White , Dallas , TX , USA
| | - Jillian Frieder
- a Division of Dermatology , Baylor Scott and White , Dallas , TX , USA
| | - Ian Watson
- b Texas A&M Health Sciences Center College of Medicine , Bryan , TX , USA
| | - So Yeon Paek
- a Division of Dermatology , Baylor Scott and White , Dallas , TX , USA.,b Texas A&M Health Sciences Center College of Medicine , Bryan , TX , USA
| | - M Alan Menter
- a Division of Dermatology , Baylor Scott and White , Dallas , TX , USA
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Merola JF, Qureshi A, Husni ME. Underdiagnosed and undertreated psoriasis: Nuances of treating psoriasis affecting the scalp, face, intertriginous areas, genitals, hands, feet, and nails. Dermatol Ther 2018; 31:e12589. [PMID: 29512290 PMCID: PMC6901032 DOI: 10.1111/dth.12589] [Citation(s) in RCA: 77] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2017] [Revised: 12/01/2017] [Accepted: 12/14/2017] [Indexed: 12/11/2022]
Abstract
Psoriasis of the scalp, face, intertriginous areas, genitals, hands, feet, and nails is often underdiagnosed, and disease management can be challenging. Despite the small surface area commonly affected by psoriasis in these locations, patients have disproportionate levels of physical impairment and emotional distress. Limitations in current disease severity indices do not fully capture the impact of disease on a patient's quality of life, and, combined with limitations in current therapies, many patients do not receive proper or adequate care. In this review, we discuss the clinical manifestations of psoriasis in these less commonly diagnosed areas and its impact on patient quality of life. We also examine clinical studies evaluating the effectiveness of therapies on psoriasis in these regions. This article highlights the need to individualize treatment strategies for psoriasis based on the area of the body that is affected and the emerging role of biologic therapy in this regard.
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Affiliation(s)
- Joseph F Merola
- Department of Dermatology, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Abrar Qureshi
- Department of Dermatology, The Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - M Elaine Husni
- Department of Rheumatic and Immunologic Diseases, Cleveland Clinic, Cleveland, Ohio
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Sekhon S, Jeon C, Nakamura M, Yan D, Afifi L, Bhutani T, Levin E. Clinical utility of ixekizumab in the treatment of moderate-to-severe plaque psoriasis. Psoriasis (Auckl) 2017; 7:65-72. [PMID: 29387609 PMCID: PMC5774608 DOI: 10.2147/ptt.s129792] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Psoriasis vulgaris is a chronic, immune-mediated systemic disease that affectŝ7.5 million people in the US. It can be treated with many therapies, often in combination, which include topicals, phototherapy, oral systemics, and biologics. Biologic agents target specific components of the immune system involved in the pathogenesis of psoriasis including TNF-alpha, IL-12, IL-17, and IL-23. The biologic ixekizumab, approved for the treatment of moderate–severe plaque psoriasis in the US, targets IL-17. This review describes the role of IL-17 in psoriasis, the mechanism by which ixekizumab targets this cytokine, and the clinical utility of ixekizumab.
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Affiliation(s)
- Sahil Sekhon
- Department of Dermatology, University of California, San Francisco, San Francisco, CA, USA
| | - Caleb Jeon
- Department of Dermatology, University of California, San Francisco, San Francisco, CA, USA
| | - Mio Nakamura
- Department of Dermatology, University of California, San Francisco, San Francisco, CA, USA
| | - Di Yan
- Department of Dermatology, University of California, San Francisco, San Francisco, CA, USA
| | - Ladan Afifi
- Department of Dermatology, University of California, San Francisco, San Francisco, CA, USA
| | - Tina Bhutani
- Department of Dermatology, University of California, San Francisco, San Francisco, CA, USA
| | - Ethan Levin
- Department of Dermatology, University of California, San Francisco, San Francisco, CA, USA
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Sanchez IM, Sorenson E, Levin E, Liao W. The Efficacy of Biologic Therapy for the Management of Palmoplantar Psoriasis and Palmoplantar Pustulosis: A Systematic Review. Dermatol Ther (Heidelb) 2017; 7:425-46. [PMID: 29143230 DOI: 10.1007/s13555-017-0207-0] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2017] [Indexed: 01/30/2023] Open
Abstract
Introduction Palmoplantar psoriasis (PP) and palmoplantar pustulosis (PPP) are diseases affecting the hands and/or feet that can cause marked physical discomfort and functional disability. The tumor necrosis factor-alpha antagonists adalimumab, etanercept, and infliximab, the interleukin (IL)-17A inhibitors ixekizumab and secukinumab, and the IL-23 or IL-12/IL-23 inhibitors guselkumab and ustekinumab have been well studied for the treatment of moderate to severe plaque psoriasis. Less is known about the efficacy and safety of these agents for the treatment of PP (hyperkeratotic and pustular forms) and PPP. The aim of this review was to investigate the efficacy of biologic therapy for the treatment of hyperkeratotic PP, pustular PP, and PPP. Methods A systematic search of the medical electronic databases (Medline, Embase, and Cochrane Library) was conducted to identify studies or case reports which both used biologic therapy for the treatment of hyperkeratotic PP, pustular PP, and PPP and reported treatment outcomes. Results The systematic search identified 579 published articles, of which 44 were included in the analysis. Seven of the articles involved randomized placebo-controlled trials, two were open label trials, and the remaining were cohort studies, case series, or case reports. In the randomized controlled trials on the treatment of hyperkeratotic PP, adalimumab, guselkumab, infliximab, ixekizumab, and secukinumab each demonstrated superiority to placebo at 16, 16, 14, 12, and 12 or 16 weeks, respectively (p < 0.05). For the treatment of pustular PP, ustekinumab 45 mg was not superior to placebo at 12 and 16 weeks, respectively (p > 0.05), although an open label study demonstrated that four of five patients on a therapeutic regimen of ustekinumab 90 mg achieved clinical clearance at 16 weeks. For the treatment of PPP, etanercept and ustekinumab 45 mg were not superior to placebo at 12 and 16 weeks, respectively (p > 0.05). A combined analysis of studies for hyperkeratotic PP demonstrated that 94.7%, 90.0%, 82.5%, 89.1%, and 86.7% of patients experienced an improvement of at least 50% upon treatment with adalimumab, guselkumab, ixekizumab, secukinumab, and ustekinumab, respectively. In a combined analysis of case reports examining PPP, infliximab showed the greatest efficacy at 100.0% clinical improvement of patients from case reports, followed by ustekinumab at 58.8% clinical improvement. Few serious adverse events were reported, but several were reported in patients treated with infliximab or secukinumab. Conclusion Biologic therapy is effective and well-tolerated for the treatment of hyperkeratotic PP, but less data are available on the treatment of pustular PP or PPP. Adalimumab, guselkumab, ixekizumab, secukinumab, and ustekinumab all showed > 80% efficacy for the treatment of hyperkeratotic PP, while infliximab and ustekinumab showed moderate efficacy for the treatment of pustular PP, and infliximab was the most efficacious treatment for PPP. Electronic supplementary material The online version of this article (doi:10.1007/s13555-017-0207-0) contains supplementary material, which is available to authorized users.
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Abstract
Biological therapy became available for psoriasis with the introduction of alefacept at the beginning of this century. Up to then, systemic treatment options comprised small molecule drugs, targeting the immune system in a non-specific manner. The first biologics targeted T-cell activation and migration and served as an alternative to small molecules. However, significant improvement in outcome was first accomplished with the introduction of tumor necrosis factor-α inhibitors that were already approved for other inflammatory disorders, including rheumatic diseases. Along with the progress in understanding psoriasis pathogenesis, highly targeted and effective therapies have since developed with the perspective not only to improve but to clear psoriasis. These accomplishments enable future achievement of advanced goals to individualize treatment best suited for each patient. Mechanistic studies with patients treated with the new highly targeted biologics may guide us towards these goals. This review offers an overview of biologics developed for psoriasis and illustrate a historical progress in the treatment of this common chronic inflammatory skin condition.
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Affiliation(s)
- W.-H. Boehncke
- Division of Dermatology and Venereology; Geneva University Hospitals; Geneva Switzerland
- Department of Pathology and Immunology; Faculty of Medicine; University of Geneva; Geneva Switzerland
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