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Dapavo P, Burlando M, Guarneri C, Megna M, Narcisi A, Talamonti M, Gisondi P. Tildrakizumab: the value of a personalized and flexible approach for treating moderate-to-severe plaque psoriasis in patients with high body weight or high disease burden. Expert Opin Biol Ther 2024:1-6. [PMID: 38444107 DOI: 10.1080/14712598.2024.2325547] [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: 12/20/2023] [Accepted: 02/27/2024] [Indexed: 03/07/2024]
Abstract
INTRODUCTION The introduction of biologics for the treatment of plaque psoriasis is one of the major therapeutic advances of the last decades in dermatology. The efficacy of this class of drugs can be influenced by multiple factors including obesity, being overweight, prior treatment failures, and disease severity. AREAS COVERED Most of the currently available approved biologics are limited by their lack of dosing flexibility for adapting the therapy to the complexity of real-world patients with psoriasis. Among the class of anti-interleukin-23, tildrakizumab allows a greater dosing flexibility, increasing clinical benefits of patients with high burden of the disease or body weight >90 kg. EXPERT OPINION This meta-opinion discusses the clinical data that were foundational for tildrakizumab dosage flexibility, elaborates on the definition of high burden of disease specifically linked to tildrakizumab dosage, and profiles the ideal patient that could benefit from treatment with the higher approved tildrakizumab dosage of 200 mg.
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Affiliation(s)
- Paolo Dapavo
- Department of Medical Sciences, Section of Dermatology, University of Turin, Turin, Italy
| | - Martina Burlando
- Clinica Dermatologica Ospedale Policlinico San Martino - IRCCS, Università di Genova, Genova, Italy
| | - Claudio Guarneri
- Department of Biomedical and Dental Sciences and Morpho Functional Imaging, University of Messina, Messina, Italy
| | - Matteo Megna
- Section of Dermatology, Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Alessandra Narcisi
- Dermatology Unit, IRCCS Humanitas Research Hospital, Milan, Rozzano, Italy
- Department of Biomedical sciences, Humanitas University, Milan, Pieve Emanuele, Italy
| | - Marina Talamonti
- Dermatology Unit, Fondazione Policlinico "Tor Vergata", Rome, Italy
| | - Paolo Gisondi
- Dermatology and Venereology, Department of Medicine, University of Verona, Verona, Italy
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Armstrong AW, Fitzgerald T, McLean RR, Teeple A, Uy JP, Olurinde M, Rowland K, Guo L, Shan Y, Callis Duffin K. The Effectiveness of Guselkumab by BMI Category Among Patients with Moderate-to-Severe Plaque Psoriasis in the CorEvitas Psoriasis Registry. Adv Ther 2023; 40:2493-2508. [PMID: 36930429 DOI: 10.1007/s12325-023-02467-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Accepted: 02/15/2023] [Indexed: 03/18/2023]
Abstract
INTRODUCTION Prior studies have demonstrated guselkumab improves disease activity and patient-reported outcomes (PROs) among patients with moderate-to-severe plaque psoriasis. However, the real-world effectiveness of guselkumab across different subgroups [e.g., body mass index (BMI) categories] remains an area of active research. METHODS This study included patients enrolled in the CorEvitas Psoriasis Registry between July 18, 2017 and March 10, 2020 who had moderate-to-severe psoriasis [Investigator's Global Assessment (IGA) score ≥ 3], initiated guselkumab at a registry visit (index date), and had a follow-up registry visit after persistent guselkumab therapy for 9-12 months. Patients were stratified into three BMI categories: obese (≥ 30 kg/m2), overweight (25- < 30 kg/m2), and underweight/normal weight (< 25 kg/m2). Response rates and mean changes for disease activity outcomes and PROs at follow-up were assessed within each BMI category. RESULTS Of the 180 patients included in the study, 101 (56%) were obese, 52 (29%) were overweight, and 27 (15%) were underweight/normal weight. Among the obese, overweight, and underweight/normal weight patients, 57%, 58%, and 72%, respectively, achieved an IGA score of 0/1 after 9-12 months of persistent guselkumab treatment. An IGA score of 0 was achieved by 33%, 35%, and 48% of obese, overweight, and underweight/normal weight patients, respectively. A 90% improvement in the Psoriasis Area and Severity Index was achieved by 46%, 46%, and 56% in these respective subgroups. Mean improvements in disease activity and PRO scores were similar among BMI subgroups. CONCLUSION The results of this real-world study showed improvements in disease severity and several PRO scores within all BMI categories among patients with moderate-to-severe psoriasis treated with guselkumab. These unadjusted findings suggest that obese and overweight patients have comparable absolute improvements to those with lower BMI; however, they may be less likely to achieve relative endpoints. Additional analyses are needed to fully characterize this relationship.
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Affiliation(s)
- April W Armstrong
- University of Southern California, Los Angeles, CA, USA
- Harvard Medical School, Boston, MA, USA
| | | | | | | | | | | | | | - Lin Guo
- CorEvitas, LLC, Waltham, MA, USA
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Arlegui H, Mahé E, Richard MA, De Rycke Y, Viguier M, Beylot-Barry M, Dupuy A, Beneton N, Joly P, Jullien D, Bachelez H, Sbidian É, Chosidow O, Paul C, Tubach F. Impact of the first wave of the COVID-19 pandemic on the treatment of psoriasis with systemic therapies in France: Results from the PSOBIOTEQ cohort. Ann Dermatol Venereol 2023:S0151-9638(23)00009-1. [PMID: 36914553 PMCID: PMC9928748 DOI: 10.1016/j.annder.2023.01.005] [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: 08/19/2022] [Revised: 11/18/2022] [Accepted: 01/31/2023] [Indexed: 02/17/2023]
Abstract
BACKGROUND The nature of the COVID-19 pandemic led to concerns among patients and physicians about the potential impact of immunosuppressive treatments for chronic diseases such as psoriasis on the risk of severe COVID-19. OBJECTIVES To describe treatment modifications and determine the incidence of COVID-19 infection among psoriasis patients during the first wave of the pandemic, and identify the factors associated with these events. METHODS Data from PSOBIOTEQ cohort relating to the first COVID-19 wave in France (March to June, 2020), as well as a patient-centred COVID-19 questionnaire, were used to evaluate the impact of lockdown on changes (discontinuations, delays or reductions) in systemic therapies, and to determine the incidence of COVID-19 cases among these patients. Logistic regression models were used to assess associated factors. RESULTS Among the 1751 respondents (89.3%), 282 patients (16.9%) changed their systemic treatment for psoriasis, with 46.0% of these changes being initiated by the patients themselves. Patients were more likely to experience psoriasis flare-ups during the first wave if they changed their treatment during this period (58.7% vs 14.4%; P < 0.0001). Changes to systemic therapies were less frequent among patients with cardiovascular diseases (P < 0.001), and those aged ≥ 65 years (P = 0.02). Overall, 45 patients (2.9%) reported having COVID-19, and eight (17.8%) required hospitalization. Risk factors for COVID-19 infection were close contact with a positive case (P < 0.001) and living in a region with a high incidence of COVID-19 (P < 0.001). Factors associated with a lower risk of COVID-19 were avoiding seeing a physician (P = 0.002), systematically wearing a mask during outings (P = 0.011) and being a current smoker (P = 0.046). CONCLUSIONS Discontinuation of systemic psoriasis treatments during the first COVID-19 wave (16.9%) - mainly decided by patients themselves (46.0%) - was associated with a higher incidence of disease flares (58.7% vs 14.4%). This observation and factors associated with a higher risk of COVID-19 highlight the need to maintain and adapt patient-physician communication during health crises according to patient profiles, with the aim of avoiding unnecessary treatment discontinuations and ensuring that patients are informed about the risk of infection and the importance of complying with hygiene rules.
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Affiliation(s)
- H Arlegui
- AP-HP, Hôpital Pitié-Salpêtrière, Centre de Pharmaco-épidémiologie (Cephépi), INSERM, CIC-1901, Paris, France
| | - E Mahé
- Service de Dermatologie, Hôpital Victor Dupouy, Argenteuil, France
| | - M-A Richard
- Service de Dermatologie, EA 3279: CEReSS - Health Service Research and Quality of Life Centre, Timone Hospital, Assistance Publique-Hôpitaux de Marseille, Aix-Marseille University, Marseille, France
| | - Y De Rycke
- Sorbonne Université, INSERM, Institut Pierre Louis d'Épidémiologie et de Santé Publique, AP-HP, Hôpital Pitié-Salpêtrière, Département de Santé Publique, Centre de Pharmaco-épidémiologie (Cephépi), CIC-1901, 75013 Paris, France
| | - M Viguier
- Service de Dermatologie-Vénéréologie, Hôpital Robert Debré, Université Reims Champagne Ardenne, 51100 Reims, France
| | - M Beylot-Barry
- Service de Dermatologie, CHU de Bordeaux, Translational Research on Oncodermatology and Rare skin diseases, Bordeaux Institute of Oncology, UMR 1312 INSERM, Université Bordeaux, Bordeaux, France
| | - A Dupuy
- France Univ Rennes, CHU Rennes, 35000 Rennes, France
| | - N Beneton
- REPERES Pharmaco-Epidemiology and Health Services Research, University Rennes and French School of Public Health, Rennes, France
| | - P Joly
- Service de Dermatologie, Hôpital du Mans, Le Mans, France
| | - D Jullien
- Service de Dermatologie, Hospices Civils de Lyon, Edouard Herriot Hospital, Lyon F-69003; Lyon-1 University; INSERM U1111 - CIRI, Lyon F-69007, France
| | - H Bachelez
- Service de Dermatologie, Assistance Publique- Hôpitaux de Paris, Hôpital Saint-Louis, Université Paris Cité, Paris, France; INSERM UMR1163, Institut Imagine, Paris, France
| | - É Sbidian
- Service de Dermatologie, Assistance Publique- Hôpitaux de Paris, Hôpital Saint-Louis, Université Paris Cité, Paris, France; Hôpital Henri Mondor, Clinical Investigation Centre, Université Paris-Est Créteil (UPEC), Epidemiology in Dermatology and Evaluation of Therapeutics (EpiDermE) - EA 7379, Créteil, France
| | - O Chosidow
- Service de Dermatologie, Assistance Publique- Hôpitaux de Paris, Hôpital Saint-Louis, Université Paris Cité, Paris, France; Groupe de recherche Dynamyc, EA7380, Faculté de Santé de Créteil, École nationale vétérinaire d'Alfort, USC ANSES, Université Paris-Est Créteil, Créteil, France
| | - C Paul
- Service de Dermatologie, Toulouse University Hospital (CHU), Paul Sabatier University, Toulouse, France
| | - F Tubach
- Sorbonne Université, INSERM, Institut Pierre Louis d'Épidémiologie et de Santé Publique, AP-HP, Hôpital Pitié-Salpêtrière, Département de Santé Publique, Centre de Pharmaco-épidémiologie (Cephépi), CIC-1901, 75013 Paris, France.
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Balak DMW, Lambert J. Weighing in on weight-based secukinumab dosing for psoriasis. Br J Dermatol 2022; 187:10-11. [PMID: 35575459 DOI: 10.1111/bjd.21607] [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] [Indexed: 11/02/2022]
Affiliation(s)
- Deepak M W Balak
- Department of Dermatology, Ghent University Hospital, Ghent, Belgium.,Department of Dermatology, LangeLand Hospital, Zoetermeer, the Netherlands
| | - Jo Lambert
- Department of Dermatology, Ghent University Hospital, Ghent, Belgium
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Assan F, Husson B, Hegazy S, Seneschal J, Aubin F, Mahé E, Jullien D, Sbidian E, D'Incan M, Conrad C, Brenaut E, Girard C, Richard MA, Bachelez H, Viguier M. Palmoplantar pustulosis and acrodermatitis continua of Hallopeau: demographical and clinical comparative study in a large multicentre cohort. J Eur Acad Dermatol Venereol 2022; 36:1578-1583. [PMID: 35366356 PMCID: PMC9546063 DOI: 10.1111/jdv.18127] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 11/16/2021] [Accepted: 03/23/2022] [Indexed: 12/04/2022]
Abstract
Background Acral pustular disease within the pustular psoriasis/psoriasis‐like spectrum mainly includes palmoplantar pustulosis (PPP) and acrodermatitis continua of Hallopeau (ACH). Scarce data argue for a distinction between these two entities, but no study has compared the clinical and epidemiologic characteristics of ACH and PPP. Objectives We aimed to perform a comparative description of the epidemiological and clinical characteristics of PPP and ACH in a multicentre retrospective cohort. Methods In this multicentre national retrospective cohort study, we compared the epidemiological characteristics, comorbidities and psoriasis characteristics of patients with PPP and ACH. Results A total of 234 patients were included: 203 (87%) with PPP, 18 (8%) with ACH and 13 (6%) with both, according to 2017 ERASPEN criteria. As compared with ACH, PPP was associated with female sex, smoking activity and higher median BMI (P = 0.01, P = 0.02 and P = 0.05 respectively). A family background of psoriasis was more frequent in PPP than ACH. Age of onset of palmoplantar disease was similar between PPP and ACH patients, median age 44 and 48 years respectively. Peripheral joint inflammatory involvement was the only rheumatic disease associated with ACH. The association with another psoriasis type was similar in PPP and ACH (57.6% and 61.1% respectively). Conclusion Our study confirms in a large PPP cohort the predominance of females and a high prevalence of smoking and elevated body mass index but also shows an association of these features in PPP as compared with ACH. In addition, it highlights peripheral arthritis as the only arthritis endotype associated with ACH. Increased knowledge of the immunogenetic backgrounds underlying these two entities is warranted to better stratify pustular psoriasis or psoriasis‐like entities for precision medicine.
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Affiliation(s)
- F Assan
- Dermatology Department, Hôpital Robert-Debré, Reims, France
| | - B Husson
- Dermatology Department, Hôpital Robert-Debré, Reims, France
| | - S Hegazy
- Dermatology Department, Hôpital Larrey, Toulouse, France
| | - J Seneschal
- Dermatology Department, National Reference Center for Rare Skin Diseases, Hôpital Saint-André, Bordeaux, France
| | - F Aubin
- Dermatology Department and Inserm 1098, Centre Hospitalo-Universitaire (CHU), Besançon, France
| | - E Mahé
- Dermatology Department, Centre Hospitalier (CH), Argenteuil, France
| | - D Jullien
- Clinical Immunology Department, CH Lyon-Sud, Lyon, France
| | - E Sbidian
- Dermatology Department, Hôpital Henri-Mondor, Créteil, France
| | - M D'Incan
- Dermatology Department, CHU Estaing, Clermont-Ferrand, France
| | - C Conrad
- Dermatology Department, Lausanne University Hospital, CHUV, Lausanne, Switzerland
| | - E Brenaut
- Dermatology Department, CHU, Brest, France
| | - C Girard
- Dermatology Department, CHU Lapeyronie, Montpellier, France
| | - M A Richard
- Dermatology Department, CEReSS-EA 3279, Research Center in Health Services and Quality of Life Aix Marseille University, University Hospital Timone, Assistance Publique Hôpitaux de Marseille, Marseille, France
| | - H Bachelez
- Université de Paris, Paris, France.,Dermatology Department, Assistance Publique-Hôpitaux de Paris, Hôpital Saint-Louis, Paris, France.,Laboratory of Genetics of Skin Diseases, INSERM UMR1163, Institut Imagine, Necker Hospital, Paris, France
| | - M Viguier
- Dermatology Department, Hôpital Robert-Debré, Reims, France
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