1
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George A, Lansang RP, Lansang P, Gooderham M. A Practical Guide to Using Biologics in Pediatric Dermatology. J Cutan Med Surg 2024; 28:59-67. [PMID: 38229411 PMCID: PMC10908204 DOI: 10.1177/12034754231222415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2024]
Abstract
Psoriasis, hidradenitis suppurativa (HS), atopic dermatitis (AD), and chronic spontaneous urticaria (CSU), are common, immune-mediated, chronic, inflammatory skin diseases that can affect the pediatric population. While there is adequate evidence supporting the use of biologics in pediatric patients, concerns regarding safety and efficacy amongst healthcare providers are not uncommon. However, new emerging evidence in this population highlights the safety of biologic therapy, making it crucial to review and establish a practical guide for their use. This article describes a methodological framework for initiating biologics in the management of pediatric psoriasis, HS, AD, and CSU, with a special focus on baseline work-up, monitoring, dosing, and considerations in this population.
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Affiliation(s)
- Annie George
- Temerty School of Medicine, University of Toronto, Toronto, ON, Canada
| | - Rafael Paolo Lansang
- Michael G. Degroote School of Medicine, McMaster University, Hamilton, ON, Canada
| | - Perla Lansang
- Temerty School of Medicine, University of Toronto, Toronto, ON, Canada
- Division of Dermatology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - Melinda Gooderham
- SKiN Centre for Dermatology, Peterborough, ON, Canada
- Probity Medical Research, Waterloo, ON, Canada
- Department of Medicine, Queen’s University, Kingston, ON, Canada
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2
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Martinez-Cabriales S, Marcoux D, Liy-Wong C, Prajapati VH, Sibbald C, Cunningham N, Lansang P, Tonkin R, Joseph M, Wong L, Spring S, Gavigan G, Ramien M. Multicenter Canadian case series of pediatric patients less than 12 years of age with moderate-to-severe atopic dermatitis treated with dupilumab. Pediatr Dermatol 2024; 41:5-11. [PMID: 37906120 DOI: 10.1111/pde.15418] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Accepted: 08/05/2023] [Indexed: 11/02/2023]
Abstract
BACKGROUND Dupilumab is approved for moderate-severe atopic dermatitis (AD) in patients aged ≥6 months by the US Food and Drug Administration and Health Canada; however, there are little real-world data because providers have limited practical experience with this recently approved therapy. OBJECTIVES To describe the real-world effectiveness and safety in patients aged <12 years with moderate-severe AD currently receiving or previously having received dupilumab. METHODS A multicenter retrospective study was conducted at six Canadian sites. Cases were divided into Group 1 ≤2 years old, Group 2 >2 to <6 years old, and Group 3 ≥6 to <12 years old. Medical history and details of dupilumab treatment were collected. The primary outcome was to measure the improvement in eczema area and severity index. Secondary outcomes examined included the children's dermatology life quality index/infant's dermatitis quality of life, peak pruritus numerical rating scale, and delay to dupilumab access for patients who were considered off-label for dupilumab due to their age. RESULTS Sixty three pediatric patients (37 males) with moderate-to-severe AD were included; the mean age was 6.4 years old (range: 2-11) when dupilumab treatment was started. Overall, 75% (36/48) achieved EASI-75% and 71% (34/48) achieved EASI-90. EASI-75 and EASI-90 were achieved in 90% (17/19) and 73% (12/19) in patients <6 years old, and 76% (22/29) and 59% (17/29) in patients >6 years old, respectively. No serious adverse events were reported. CONCLUSIONS Dupilumab is safe and effective for patients under the age of 12. However, even for experienced providers, access to the medication was challenging.
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Affiliation(s)
- Sylvia Martinez-Cabriales
- Alberta Children's Hospital, Department of Pediatrics, University of Calgary, Calgary, Canada
- Division of Dermatology, Department of Medicine, University of Toronto, Toronto, Canada
| | - Danielle Marcoux
- Division of Dermatology, Department of Pediatrics, Sainte-Justine University Hospital Center, University of Montreal, Montreal, Canada
| | - Carmen Liy-Wong
- Department of Pediatrics, Division of Dermatology and Rheumatology, Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, Canada
| | - Vimal H Prajapati
- Dermatology Research Institute, Calgary, Canada
- Division of Dermatology, Department of Medicine, University of Calgary, Calgary, Canada
- Section of Community Pediatrics, Department of Pediatrics, University of Calgary, Calgary, Canada
- Section of Pediatric Rheumatology, Department of Pediatrics, University of Calgary, Calgary, Canada
- Skin Health & Wellness Centre, Calgary, Canada
- Probity Medical Research, Calgary, Canada
| | - Cathryn Sibbald
- Division of Dermatology, Department of Medicine, University of Toronto, Toronto, Canada
- The Hospital for Sick Children and Department of Pediatrics, University of Toronto, Toronto, Canada
| | - Natalie Cunningham
- Division of Dermatology, Department of Medicine, IWK Health Centre, Dalhousie University, Halifax, Canada
| | - Perla Lansang
- Division of Dermatology, Department of Medicine, University of Toronto, Toronto, Canada
- The Hospital for Sick Children and Department of Pediatrics, University of Toronto, Toronto, Canada
| | - Rochelle Tonkin
- Division of Dermatology, Department of Medicine, University of Calgary, Calgary, Canada
| | - Marissa Joseph
- Division of Dermatology, Department of Medicine, University of Toronto, Toronto, Canada
- The Hospital for Sick Children and Department of Pediatrics, University of Toronto, Toronto, Canada
| | - Lauren Wong
- Faculty of Medicine, University of Alberta, Edmonton, Canada
| | - Shanna Spring
- Department of Pediatrics, Division of Dermatology and Rheumatology, Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, Canada
| | - Genevieve Gavigan
- Department of Pediatrics, Division of Dermatology and Rheumatology, Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, Canada
| | - Michele Ramien
- Alberta Children's Hospital, Department of Pediatrics, University of Calgary, Calgary, Canada
- Division of Dermatology, Department of Medicine, University of Calgary, Calgary, Canada
- Section of Community Pediatrics, Department of Pediatrics, University of Calgary, Calgary, Canada
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3
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Lansang RP, Xiong G, Lansang P. Generalized granuloma annulare treated with mycophenolate mofetil. Int J Dermatol 2023; 62:e534-e535. [PMID: 37326299 DOI: 10.1111/ijd.16753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2023] [Revised: 04/10/2023] [Accepted: 06/01/2023] [Indexed: 06/17/2023]
Affiliation(s)
| | - Grace Xiong
- Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
| | - Perla Lansang
- Division of Dermatology, University of Toronto, Toronto, ON, Canada
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4
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Lansang RP, Zhao IX, Lansang P. Atopic dermatitis treated with tralokinumab and upadacitinib combination therapy: A case report. SAGE Open Med Case Rep 2023; 11:2050313X231180766. [PMID: 37377458 PMCID: PMC10291146 DOI: 10.1177/2050313x231180766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Accepted: 05/01/2023] [Indexed: 06/29/2023] Open
Abstract
A patient presented to clinic with atopic dermatitis that had been previously unresponsive to multiple topical and systemic therapies. They were successfully treated with a combination of tralokinumab and upadacitinib, showing significant improvement after 3 weeks and near-resolution after 6 months.
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Affiliation(s)
- Rafael Paolo Lansang
- Michael G. Degroote School of Medicine, McMaster University, Hamilton, ON, Canada
| | - Irene X Zhao
- Michael G. Degroote School of Medicine, McMaster University, Hamilton, ON, Canada
| | - Perla Lansang
- Division of Dermatology, University of Toronto, Toronto, ON, Canada
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5
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Yeung J, Gooderham MJ, Hong HCH, Lynde C, Prajapati VH, Lansang P, Turchin I, Wiseman M, Jack C, Ramien M, Purdy K, Grewal P. Treat-to-target in the management of moderate-to-severe atopic dermatitis in adults: A Canadian perspective. J Am Acad Dermatol 2023:S0190-9622(23)00520-0. [PMID: 37074241 DOI: 10.1016/j.jaad.2023.01.053] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Revised: 01/20/2023] [Accepted: 01/30/2023] [Indexed: 04/20/2023]
Affiliation(s)
- Jensen Yeung
- Division of Dermatology, Women's College Hospital, Toronto, Ontario, Canada; Department of Medicine, University of Toronto, Toronto, Ontario, Canada; Probity Medical Research Inc, Waterloo, Ontario, Canada; Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Ontario, Canada.
| | - Melinda J Gooderham
- Probity Medical Research Inc, Waterloo, Ontario, Canada; Queen's University, Kingston, Ontario, Canada; Skin Centre for Dermatology, Peterborough, Ontario, Canada
| | - H Chih-Ho Hong
- Probity Medical Research Inc, Waterloo, Ontario, Canada; Department of Dermatology and Skin Science, University of British Columbia, Vancouver, British Columbia, Canada; Dr Chih-Ho Hong Medical Inc, Surrey, British Columbia, Canada; Probity Medical Research Inc, Surrey, British Columbia, Canada
| | - Charles Lynde
- Probity Medical Research Inc, Waterloo, Ontario, Canada; Lynde Institute for Dermatology, Markham, Ontario, Canada
| | - Vimal H Prajapati
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada; Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada; Dermatology Research Institute, Calgary, Alberta, Canada; Skin Health & Wellness Centre, Calgary, Alberta, Canada; Probity Medical Research Inc, Calgary, Alberta, Canada
| | - Perla Lansang
- Division of Dermatology, Women's College Hospital, Toronto, Ontario, Canada; Department of Medicine, University of Toronto, Toronto, Ontario, Canada; Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Ontario, Canada; The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Irina Turchin
- Probity Medical Research Inc, Waterloo, Ontario, Canada; Brunswick Dermatology Center, Fredericton, New Brunswick, Canada; Dalhousie University, Halifax, Nova Scotia, Canada
| | - Marni Wiseman
- Probity Medical Research Inc, Waterloo, Ontario, Canada; SKiNWISE Dermatology, Winnipeg, Manitoba, Canada; Department of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Carolyn Jack
- Department of Medicine, Faculty of Medicine and Health Sciences, McGill University, Montreal, Quebec, Canada; Infectious Diseases and Immunity in Global Health, Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada; Innovaderm Research, Montreal, Quebec, Canada
| | - Michele Ramien
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada; Department of Pediatrics, Alberta Children's Hospital, Calgary, Alberta, Canada
| | - Kerri Purdy
- Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Parbeer Grewal
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada; Rejuvenation Dermatology, Edmonton, Alberta, Canada
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6
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Alsenaid A, Piguet V, Lansang P, Miller-Monthrope Y, Yeung J, Joseph M. Brodalumab-Induced Eczematous Reactions in Psoriasis Patients: Management With Switching to Risankizumab. J Cutan Med Surg 2023:12034754231167140. [PMID: 37014149 DOI: 10.1177/12034754231167140] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2023]
Abstract
Biological treatments targeting IL-17 are highly efficacious with rapid onset of action in psoriasis. Cutaneous adverse events are associated with different biological treatments, including paradoxical psoriasis and eczematous reactions. Brodalumab was previously suggested as an alternative treatment option in psoriasis patients who developed dermatitis or paradoxical psoriasis while on a biologic. Here we report three psoriasis patients who developed brodalumab induced eczematous reaction with complete clearance after switching to risankizumab. Early recognition is crucial for appropriate management. We propose switching patients with psoriasis who develop severe eczematous reaction while on a biologic targeting IL-17 to an IL 23 inhibitor due to efficacy in psoriasis and rarely reported eczematous reaction.
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Affiliation(s)
- Adel Alsenaid
- 233846 Division of Dermatology, Department of Medicine, University of Toronto, Toronto, Canada
- 204570 Division of Dermatology, College of Medicine, Shaqra University, Dawadmi, Saudi Arabia
- 7985 Division of Dermatology, Women's College Hospital, Toronto, ON, Canada
- Division of Dermatology, Johns Hopkins Aramco Healthcare, Dhahran, Saudi Arabia
| | - Vincent Piguet
- 233846 Division of Dermatology, Department of Medicine, University of Toronto, Toronto, Canada
- 7985 Division of Dermatology, Women's College Hospital, Toronto, ON, Canada
| | - Perla Lansang
- 233846 Division of Dermatology, Department of Medicine, University of Toronto, Toronto, Canada
- 71545 Division of Dermatology, Department of Medicine, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Yvette Miller-Monthrope
- 233846 Division of Dermatology, Department of Medicine, University of Toronto, Toronto, Canada
- 7985 Division of Dermatology, Women's College Hospital, Toronto, ON, Canada
| | - Jensen Yeung
- 233846 Division of Dermatology, Department of Medicine, University of Toronto, Toronto, Canada
- 7985 Division of Dermatology, Women's College Hospital, Toronto, ON, Canada
- 71545 Division of Dermatology, Department of Medicine, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Marissa Joseph
- 233846 Division of Dermatology, Department of Medicine, University of Toronto, Toronto, Canada
- 7985 Division of Dermatology, Women's College Hospital, Toronto, ON, Canada
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7
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Akuffo-Addo E, Nicholas MN, Lansang P. Reported Pregnancy Outcomes in Women With Severe Atopic Dermatitis Treated With Dupilumab: A Systematic Review. J Cutan Med Surg 2023; 27:177-178. [PMID: 36721993 DOI: 10.1177/12034754231152223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Affiliation(s)
- Edgar Akuffo-Addo
- 12366 Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Mathew N Nicholas
- 12366 Division of Dermatology, Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Perla Lansang
- 12366 Division of Dermatology, Department of Medicine, University of Toronto, Toronto, ON, Canada
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8
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Maliyar K, Lansang P, Doiron P. Use of risankizumab in two HIV-positive patients with psoriasis. JAAD Case Rep 2023; 33:54-55. [PMID: 36860809 PMCID: PMC9969266 DOI: 10.1016/j.jdcr.2023.01.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Affiliation(s)
| | | | - Philip Doiron
- Correspondence to: Philip Doiron, MD, FRCPC, Derm, Division of Dermatology, Women’s College Hospital, 76 Greenville St, 5th floor, Toronto, ON, Canada M5S 1B2.
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9
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Adam DN, Gooderham MJ, Beecker JR, Hong CH, Jack CS, Jain V, Lansang P, Lynde CW, Papp KA, Prajapati VH, Turchin I, Yeung J. Expert consensus on the systemic treatment of atopic dermatitis in special populations. J Eur Acad Dermatol Venereol 2023; 37:1135-1148. [PMID: 36695072 DOI: 10.1111/jdv.18922] [Citation(s) in RCA: 20] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Accepted: 01/16/2023] [Indexed: 01/26/2023]
Abstract
With the increasing number of options for the treatment of moderate-to-severe atopic dermatitis, clinicians need guidance on a practical approach to selecting a systemic agent for specific patient populations. We convened an expert panel consisting of 12 members to conduct a literature review and summarize relevant data related to six scenarios of clinical interest: comorbid asthma, ocular surface disease, history of cancer, past and ongoing infections of interest (including herpes simplex virus, herpes zoster, hepatitis B, and tuberculosis), pregnancy and lactation, and the elderly. We performed a literature search and examined each clinical scenario with respect to three major categories of available systemic agents: traditional systemics (azathioprine, cyclosporine A, methotrexate, and mycophenolate mofetil), Janus kinase inhibitors (abrocitinib, baricitinib, and upadacitinib), and biologics (dupilumab, lebrikizumab, and tralokinumab). The expert panel and steering committee met virtually to review the data and discuss the drafted consensus statements. A modified Delphi process was used to arrive at a set of final consensus statements related to the systemic treatment of AD in these specific patient populations. To provide practical guidance on the choice of systemic therapy for atopic dermatitis in these six topics of clinical interest, 25 expert consensus statements and a summary of the supporting data are presented herein.
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Affiliation(s)
- D N Adam
- Division of Dermatology, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.,CCA Medical Research, Ajax, Ontario, Canada.,Probity Medical Research Inc., Waterloo, Ontario, Canada
| | - M J Gooderham
- Probity Medical Research Inc., Waterloo, Ontario, Canada.,SKiN Centre for Dermatology, Peterborough, Ontario, Canada
| | - J R Beecker
- Probity Medical Research Inc., Waterloo, Ontario, Canada.,Division of Dermatology, University of Ottawa, Ottawa, Ontario, Canada.,Division of Dermatology, The Ottawa Hospital, Ottawa, Ontario, Canada.,Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - C H Hong
- Probity Medical Research Inc., Waterloo, Ontario, Canada.,Department of Dermatology and Skin Science, University of British Columbia, Vancouver, British Columbia, Canada.,Dr. Chih-ho Hong Medical Inc., Surrey, British Columbia, Canada
| | - C S Jack
- Division of Dermatology, McGill University, Montreal, Quebec, Canada.,Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
| | - V Jain
- Probity Medical Research Inc., Waterloo, Ontario, Canada.,Division of Clinical Immunology and Allergy, McMaster University, Hamilton, Ontario, Canada
| | - P Lansang
- Division of Dermatology, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.,Division of Dermatology, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.,Division of Dermatology, Women's College Hospital, Toronto, Ontario, Canada
| | - C W Lynde
- Division of Dermatology, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.,Probity Medical Research Inc., Waterloo, Ontario, Canada.,Lynde Institute for Dermatology, Markham, Ontario, Canada
| | - K A Papp
- Probity Medical Research Inc., Waterloo, Ontario, Canada.,K Papp Clinical Research, Waterloo, Ontario, Canada
| | - V H Prajapati
- Probity Medical Research Inc., Waterloo, Ontario, Canada.,Division of Dermatology, Department of Medicine, University of Calgary, Calgary, Alberta, Canada.,Section of Community Pediatrics, Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada.,Section of Pediatric Rheumatology, Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada.,Dermatology Research Institute, Calgary, Alberta, Canada.,Skin Health & Wellness Centre, Calgary, Alberta, Canada
| | - I Turchin
- Probity Medical Research Inc., Waterloo, Ontario, Canada.,Brunswick Dermatology Centre, Fredericton, New Brunswick, Canada.,Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - J Yeung
- Division of Dermatology, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.,Probity Medical Research Inc., Waterloo, Ontario, Canada.,Division of Dermatology, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.,Division of Dermatology, Women's College Hospital, Toronto, Ontario, Canada
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10
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Yeung J, Bourcier M, Gooderham MJ, Grewal P, Hong C, Lansang P, Lynde C, Maari C, Prajapati VH, Turchin I, Vender R. Management of Moderate‐to‐Severe Plaque Psoriasis with Biologics: A Treat‐to‐Target Position Paper. Dermatol Ther 2022; 35:e15777. [DOI: 10.1111/dth.15777] [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: 05/03/2022] [Revised: 08/04/2022] [Accepted: 08/17/2022] [Indexed: 11/30/2022]
Affiliation(s)
- Jensen Yeung
- Division of Dermatology, Women's College Hospital and the Department of Medicine University of Toronto Toronto ON Canada
- Probity Medical Research, Inc. Waterloo ON Canada
| | - Marc Bourcier
- Faculty of Medicine Université de Sherbrooke, Sherbrooke QC Canada
| | - Melinda J. Gooderham
- Probity Medical Research, Inc. Waterloo ON Canada
- Queen's University Kingston ON Canada
- Skin Centre for Dermatology Peterborough ON Canada
| | - Parbeer Grewal
- Division of Dermatology University of Alberta Edmonton AB Canada
- Rejuvenation Dermatology Edmonton AB Canada
| | - Chih‐Ho Hong
- Department of Dermatology and Skin Science University of British Columbia Vancouver BC Canada
- Probity Medical Research Waterloo ON Canada
- Dr. Chih‐Ho Hong Medical Inc. Surrey BC Canada
| | - Perla Lansang
- Division of Dermatology Women's College Hospital Toronto ON Canada
- Division of Dermatology, Faculty of Medicine University of Toronto Toronto ON Canada
- Division of Dermatology, Department of Medicine, Sunnybrook Health Sciences Centre University of Toronto ON Canada
- The Hospital for Sick Children Toronto ON Canada
| | - Charles Lynde
- Probity Medical Research, Inc. Waterloo ON Canada
- Lynde Institute for Dermatology Markham ON Canada
| | | | - Vimal H. Prajapati
- Division of Dermatology, Department of Medicine University of Calgary Calgary AB Canada
- Section of Community Pediatrics, Department of Pediatrics University of Calgary Calgary AB Canada
- Section of Pediatric Rheumatology, Department of Pediatrics University of Calgary Calgary AB Canada
- Dermatology Research Institute Calgary AB Canada
- Skin Health & Wellness Centre Calgary AB Canada
| | - Irina Turchin
- Probity Medical Research Waterloo ON Canada
- Brunswick Dermatology Center Fredericton NB Canada
- Dalhousie University Halifax NS Canada
| | - Ron Vender
- Department of Medicine, Division of Dermatology McMaster University Hamilton ON Canada
- Dermatrials Research Inc Hamilton ON Canada
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11
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Rankin BD, Georgakopoulos JR, Sachdeva M, Mufti A, Devani AR, Gooderham MJ, Hong CH, Jain V, Lansang P, Vender R, Yeung J, Prajapati VH. Incidence and prognosis of COVID-19 in patients with atopic diseases on dupilumab: a multicentre retrospective cohort study. J DERMATOL TREAT 2022; 33:2692-2694. [PMID: 35446185 DOI: 10.1080/09546634.2022.2036673] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Brian D Rankin
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | | | - Muskaan Sachdeva
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Asfandyar Mufti
- Division of Dermatology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Alim R Devani
- Dermatology Research Institute, Calgary, Alberta, Canada.,Skin Health & Wellness Centre, Calgary, Alberta, Canada.,Probity Medical Research, Calgary, Alberta, Canada
| | - Melinda J Gooderham
- Queen's University, Kingston, Ontario, Canada.,SKiN Centre for Dermatology, Peterborough, Ontario, Canada.,Probity Medical Research, Peterborough, Ontario, Canada
| | - Chih-Ho Hong
- Department of Dermatology and Skin Science, University of British Columbia, Vancouver, British Columbia, Canada.,Dr. Chih-Ho Hong Medical Inc, Surrey, British Columbia, Canada
| | - Vipul Jain
- Division of Clinical Immunology and Allergy, McMaster University, Hamilton, Ontario, Canada.,Niagara Region Medical, Niagara Falls, Ontario, Canada.,Allergy Research Canada Inc, Niagara Falls, Ontario, Canada.,Probity Medical Research, Niagara Falls, Ontario, Canada
| | - Perla Lansang
- Division of Dermatology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada.,Division of Dermatology, Department of Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.,Section of Paediatric Dermatology, Department of Paediatric Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Ronald Vender
- Department of Dermatology, McMaster University, Hamilton, Ontario, Canada.,Dermatrials Research Inc. & Venderm Innovations in Psoriasis, Hamilton, Ontario, Canada
| | - Jensen Yeung
- Division of Dermatology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada.,Division of Dermatology, Department of Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.,Section of Paediatric Dermatology, Department of Paediatric Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada.,Probity Medical Research Inc, Waterloo, Ontario, Canada
| | - Vimal H Prajapati
- Dermatology Research Institute, Calgary, Alberta, Canada.,Skin Health & Wellness Centre, Calgary, Alberta, Canada.,Probity Medical Research, Calgary, Alberta, Canada.,Division of Dermatology, Department of Medicine, University of Calgary, Calgary, Alberta, Canada.,Section of Community Pediatrics, Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada.,Section of Pediatric Rheumatology, Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada
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12
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Jackson K, Chua L, Velez de Mendizabal N, Pitou C, Rodriguez Capriles C, Paller AS, Lansang P, Seyger MMB, Papp K. Population pharmacokinetic and exposure-efficacy analysis of ixekizumab in paediatric patients with moderate-to-severe plaque psoriasis (IXORA-PEDS). Br J Clin Pharmacol 2022; 88:1074-1086. [PMID: 34378230 PMCID: PMC9291793 DOI: 10.1111/bcp.15034] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 07/23/2021] [Accepted: 07/31/2021] [Indexed: 12/24/2022] Open
Abstract
AIMS Ixekizumab is a high-affinity monoclonal antibody that selectively targets interleukin-17A used in the treatment of adult and paediatric patients with moderate-to-severe psoriasis. This analysis evaluated the pharmacokinetics (PK) of ixekizumab and the exposure-efficacy relationship in paediatric patients aged 6 to <18 years with psoriasis. METHODS Population PK and exposure-efficacy models were developed. The models used data from paediatric patients with psoriasis participating in the Phase 3 IXORA-PEDS trial in which patients were dosed according to weight categories. The exposure-efficacy model is a Psoriasis Area and Severity Index (PASI) time course model using data up to Week 12, a co-primary efficacy endpoint. RESULTS A 2-compartment population PK model describes the PK of ixekizumab in paediatric patients with the effect of body weight incorporated on clearance and volume terms using an allometric relationship. The weight category-based dosing ensured that ixekizumab mean trough serum concentrations in paediatric patients with psoriasis (3.20-3.33 μg/mL) were within the range of concentrations observed in adult patients with psoriasis (mean [standard deviation]: 3.48 [2.16] μg/mL) administered an efficacious dosing regimen. The observed PASI response rates at Week 12 in paediatric patients (91.9/81.8/52.5% for PASI75/90/100) are well predicted by the final exposure-efficacy model and response rates are similar or higher than those achieved in adults (86.2/66.6/35.0% for PASI75/90/100). CONCLUSION This analysis is the first to describe the PK and exposure-efficacy relationship of ixekizumab in paediatric patients with psoriasis. The analyses support the selection of the weight category-based ixekizumab dosing regimens approved for use in paediatric patients with psoriasis.
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Affiliation(s)
| | - Laiyi Chua
- Lilly Centre for Clinical PharmacologySingaporeSingapore
| | | | | | | | - Amy S. Paller
- Department of DermatologyNorthwestern University Feinberg School of MedicineChicagoILUSA
| | | | - Marieke M. B. Seyger
- Department of DermatologyRadboud University Medical CentreNijmegenThe Netherlands
| | - Kim Papp
- K Papp Clinical Research and Probity Medical ResearchWaterlooONCanada
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13
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Lytvyn Y, Georgakopoulos JR, Mufti A, Devani AR, Gooderham MJ, Jain V, Lansang P, Vender R, Prajapati VH, Yeung J. Incidence and prognosis of COVID-19 in patients with psoriasis on apremilast: a multicentre retrospective cohort study. J Eur Acad Dermatol Venereol 2021; 36:e94-e95. [PMID: 34657332 PMCID: PMC8656447 DOI: 10.1111/jdv.17749] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Accepted: 10/14/2021] [Indexed: 01/02/2023]
Affiliation(s)
- Y Lytvyn
- Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - J R Georgakopoulos
- Division of Dermatology, Department of Medicine, University of Toronto, ON, Canada
| | - A Mufti
- Division of Dermatology, Department of Medicine, University of Toronto, ON, Canada
| | - A R Devani
- Dermatology Research Institute, Calgary, AB, Canada.,Skin Health & Wellness Centre, Calgary, AB, Canada.,Probity Medical Research, Calgary, AB, Canada
| | - M J Gooderham
- Queen's University, Kingston, ON, Canada.,SKiN Centre for Dermatology, Peterborough, ON, Canada.,Probity Medical Research, Peterborough, ON, Canada
| | - V Jain
- Clinal Immunology and Allergy, McMaster University, Hamilton, ON, Canada.,Probity Medical Research, Hamilton, ON, Canada
| | - P Lansang
- Division of Dermatology, Department of Medicine, University of Toronto, ON, Canada.,Division of Dermatology, Department of Medicine, Sunnybrook Health Sciences Centre, Toronto, ON, Canada.,Section␣of Paediatric Dermatology, Department of Paediatric Medicine, The Hospital for Sick Children, Toronto, ON, Canada
| | - R Vender
- Department of Dermatology, McMaster University, Hamilton, ON, Canada.,Dermatrials Research Inc. & Venderm Innovations in Psoriasis, Hamilton, ON, Canada
| | - V H Prajapati
- Skin Health & Wellness Centre, Calgary, AB, Canada.,Probity Medical Research, Calgary, AB, Canada.,Division of Dermatology, Department of Medicine, University of Calgary, Calgary, AB, Canada.,Section␣of Community Pediatrics, Department of Pediatrics, University of Calgary, Calgary, AB, Canada.,Section␣of Pediatric Rheumatology, Department of Pediatrics, University of Calgary, Calgary, AB, Canada
| | - J Yeung
- Division of Dermatology, Department of Medicine, University of Toronto, ON, Canada.,Department of Dermatology, McMaster University, Hamilton, ON, Canada.,Department of Dermatology, Women's College Hospital, Toronto, ON, Canada.,Probity Medical Research Inc, Waterloo, ON, Canada
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14
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Abduelmula A, Georgakopoulos JR, Mufti A, Devani AR, Gooderham MJ, Hong CH, Jain V, Lansang P, Vender R, Prajapati VH, Yeung J. Incidence of COVID-19 in Patients With Chronic Idiopathic Urticaria and Asthma on Omalizumab: A Multicentre Retrospective Cohort Study. J Cutan Med Surg 2021; 26:319-320. [PMID: 34587789 DOI: 10.1177/12034754211049707] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
| | | | - Asfandyar Mufti
- 7938 Division of Dermatology, Department of Medicine, University of Toronto, ON, Canada
| | | | | | - Chih-Ho Hong
- Department of Dermatology and Skin Science, University of British Columbia, Vancouver, BC, Canada
| | - Vipul Jain
- 3710 Division of Clinical Immunology and Allergy, McMaster University, Hamilton, ON, Canada
| | - Perla Lansang
- Division of Dermatology, Department of Medicine, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Ronald Vender
- Department of Dermatology, McMaster University, Hamilton, ON, Canada
| | - Vimal H Prajapati
- 70401 Division of Dermatology, Department of Medicine, University of Calgary, AB, Canada
| | - Jensen Yeung
- Department of Dermatology, Women's College Hospital, Toronto, ON, Canada
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15
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Elsawi R, Brooks SG, Georgakopolous JR, Lansang P, Piguet V, Croitoru D. The Utility of IL-17 Inhibitors in Neutrophilic Dermatoses: A Systematic Review. J Cutan Med Surg 2021; 26:210-211. [PMID: 34498508 DOI: 10.1177/12034754211045389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Rawaan Elsawi
- 12366 Temerty Faculty of Medicine, University of Toronto, ON, Canada
| | | | - Jorge R Georgakopolous
- 12366 Temerty Faculty of Medicine, University of Toronto, ON, Canada.,12366 Division of Dermatology, Department of Medicine, University of Toronto, ON, Canada
| | - Perla Lansang
- 12366 Temerty Faculty of Medicine, University of Toronto, ON, Canada.,12366 Division of Dermatology, Department of Medicine, University of Toronto, ON, Canada.,Division of Dermatology, Sunnybrook Hospital, Toronto, ON, Canada
| | - Vincent Piguet
- 12366 Temerty Faculty of Medicine, University of Toronto, ON, Canada.,12366 Division of Dermatology, Department of Medicine, University of Toronto, ON, Canada.,Division of Dermatology, Department of Medicine, Women's College Hospital, Toronto, ON, Canada
| | - David Croitoru
- 12366 Temerty Faculty of Medicine, University of Toronto, ON, Canada.,12366 Division of Dermatology, Department of Medicine, University of Toronto, ON, Canada
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16
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Le M, Berman-Rosa M, Ghazawi FM, Bourcier M, Fiorillo L, Gooderham M, Guenther L, Hanna S, Hong HCH, Landells I, Lansang P, Marcoux D, Wiseman MC, Yeung J, Lynde C, Litvinov IV. Systematic Review on the Efficacy and Safety of Oral Janus Kinase Inhibitors for the Treatment of Atopic Dermatitis. Front Med (Lausanne) 2021; 8:682547. [PMID: 34540860 PMCID: PMC8440866 DOI: 10.3389/fmed.2021.682547] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [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: 03/18/2021] [Accepted: 06/21/2021] [Indexed: 12/24/2022] Open
Abstract
Background: Atopic dermatitis is a chronic, relapsing and remitting disease that can be difficult to treat despite a recently approved biologic therapy targeting IL-4/IL-13 receptor. Oral janus kinase inhibitors (JAKi) represent a novel therapeutic class of targeted therapy to treat moderate-to-severe atopic dermatitis (AD). Objective: To review the efficacy, safety, and pharmacokinetic characteristics of oral JAKi in the treatment of AD. Methods: A PRISMA systematic review was conducted using MEDLINE, EMBASE (Ovid), and PubMed databases for studies assessing the efficacy, safety, and/or pharmacokinetic properties of oral forms of JAKi in the treatment of AD in pediatric or adult populations from inception to June 2021. Results: 496 papers were reviewed. Of 28 articles that underwent full text screening, 11 met our inclusion criteria for final qualitative review. Four studies examined abrocitinib; three studies examined baricitinib; three examined upadacitinib and one examined gusacitinib (ASN002). Significant clinical efficacy and a reassuring safety profile was reported for all JAKi agents reviewed. Rapid symptom control was reported for abrocitinib, baricitinib and upadacitinib. Limitations: Given the relatively limited evidence for each JAKi and the differences in patient eligibility criteria between studies, the data was not deemed suitable for a meta-analysis at this time. Conclusion: Given their ability to achieve rapid symptom control with a reassuring safety profile, we recommend considering the use of JAKi as a reliable systemic treatment option for adult patients with moderate-to-severe AD, who are unresponsive to topical or skin directed treatments.
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Affiliation(s)
- Michelle Le
- Division of Dermatology, McGill University Health Centre, Montreal, QC, Canada
| | - Melissa Berman-Rosa
- Division of Dermatology, McGill University Health Centre, Montreal, QC, Canada
| | - Feras M. Ghazawi
- Division of Dermatology, University of Ottawa, Ottawa, ON, Canada
| | - Marc Bourcier
- Faculty of Medicine, University of Sherbrooke, Sherbrooke, QC, Canada
| | - Loretta Fiorillo
- Division of Pediatric Dermatology, University of Alberta, Edmonton, AB, Canada
| | - Melinda Gooderham
- SKiN Centre for Dermatology, Probity Medical Research, and Queens University, Peterborough, ON, Canada
| | - Lyn Guenther
- Division of Dermatology, University of Western Ontario, London, ON, Canada
| | | | - H. Chih-Ho Hong
- Department of Dermatology and Skin Sciences, University of British Columbia, Vancouver, BC, Canada
| | - Ian Landells
- Division of Dermatology, Memorial University of Newfoundland, St. John's, NL, Canada
| | - Perla Lansang
- Division of Dermatology, University of Toronto, Toronto, ON, Canada
| | - Danielle Marcoux
- Division of Pediatric Dermatology, University of Montreal, Montreal, QC, Canada
| | - Marni C. Wiseman
- Section of Dermatology, Department of Medicine, University of Manitoba, Winnipeg, MB, Canada
| | - Jensen Yeung
- Division of Dermatology, University of Toronto, Toronto, ON, Canada
- Probity Medical Research, Waterloo, ON, Canada
| | | | - Ivan V. Litvinov
- Division of Dermatology, McGill University Health Centre, Montreal, QC, Canada
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17
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Swanson E, Eichenfield L, Capriles CR, Li L, Ridenour T, Garrelts A, Lansang P. 26291 Rapid skin improvement with ixekizumab treatment for pediatric patients with psoriasis: Results from IXORA-peds. J Am Acad Dermatol 2021. [DOI: 10.1016/j.jaad.2021.06.401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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18
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Kinoshita-Ise M, Sachdeva M, Martinez-Cabriales SA, Shear NH, Lansang P. Oral Methotrexate Monotherapy for Severe Alopecia Areata: A Single Center Retrospective Case Series. J Cutan Med Surg 2021; 25:490-497. [PMID: 33715460 DOI: 10.1177/1203475421995712] [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: 11/15/2022]
Abstract
BACKGROUND Although several therapeutic options have been suggested for alopecia areata (AA), none of them are consistently effective, thus making the management of severe or refractory cases challenging. Several studies have recently reported the usage of methotrexate (MTX) in AA; however, the pure effect of MTX monotherapy remains elusive. OBJECTIVE To evaluate efficacy and safety of oral methotrexate monotherapy for AA. METHODS We retrospectively reviewed the clinical course of AA patients including pediatric cases treated with MTX monotherapy. Their detailed clinical data including original severity of AA, final treatment outcome, the duration until the maximum response, and side effects, were assessed. Statistical analysis was performed to evaluate if the clinical factors including the duration of current alopecia, age, the presence of body hair loss, and sex were associated with treatment response. RESULTS All included patients had severe AA and failed standard therapies. Thirteen out of 15 cases demonstrated improvement during the monotherapy, and all responders demonstrated the maximum response within 1 year. Female patients had significantly better outcomes than male patients. Other factors did not significantly influence on the treatment outcome. None of the patients experienced side effects that were severe enough to terminate the treatment. CONCLUSIONS Our results support MTX monotherapy as a feasible option for severe AA patients who fail other standard therapies or for whom systemic corticosteroids are contraindicated.
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Affiliation(s)
- Misaki Kinoshita-Ise
- 71545 Division of Dermatology, Department of Medicine, Sunnybrook Health Sciences Centre, Toronto, Canada.,7938 Department of Medicine, University of Toronto, Toronto, Canada.,38103 Department of Dermatology, Kyorin University Faculty of Medicine, Tokyo, Japan
| | - Muskaan Sachdeva
- 7938 Department of Medicine, University of Toronto, Toronto, Canada
| | - Sylvia A Martinez-Cabriales
- 71545 Division of Dermatology, Department of Medicine, Sunnybrook Health Sciences Centre, Toronto, Canada.,7938 Department of Medicine, University of Toronto, Toronto, Canada.,12366 School of Medicine, Autonomous University of Nuevo Leon
| | - Neil H Shear
- 71545 Division of Dermatology, Department of Medicine, Sunnybrook Health Sciences Centre, Toronto, Canada.,7938 Department of Medicine, University of Toronto, Toronto, Canada
| | - Perla Lansang
- 71545 Division of Dermatology, Department of Medicine, Sunnybrook Health Sciences Centre, Toronto, Canada.,7938 Department of Medicine, University of Toronto, Toronto, Canada.,Section of Paediatric Dermatology, Department of Paediatric Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada
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19
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Georgakopoulos JR, Croitoru D, Felfeli T, Alhusayen R, Lansang P, Shear NH, Yeung J, Walsh S. Long-term dupilumab treatment for chronic refractory generalized prurigo nodularis: A retrospective cohort study. J Am Acad Dermatol 2021; 85:1049-1051. [PMID: 33617911 DOI: 10.1016/j.jaad.2021.02.038] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Revised: 02/11/2021] [Accepted: 02/14/2021] [Indexed: 01/08/2023]
Affiliation(s)
- Jorge R Georgakopoulos
- Division of Dermatology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - David Croitoru
- Division of Dermatology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Tina Felfeli
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada
| | - Raed Alhusayen
- Division of Dermatology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada; Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Perla Lansang
- Division of Dermatology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada; Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Neil H Shear
- Division of Dermatology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada; Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Women's College Hospital, Toronto, Ontario, Canada
| | - Jensen Yeung
- Division of Dermatology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada; Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Women's College Hospital, Toronto, Ontario, Canada; Probity Medical Research Inc, Waterloo, Ontario, Canada
| | - Scott Walsh
- Division of Dermatology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada; Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Women's College Hospital, Toronto, Ontario, Canada.
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20
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Yeung J, Vender R, Turchin I, Shukla R, Maari C, Hong CH, Barakat M, Lansang P. Brodalumab success in patients with moderate-to-severe psoriasis who failed previous interleukin-17A inhibitors. J Am Acad Dermatol 2020; 84:1169-1171. [PMID: 33221464 DOI: 10.1016/j.jaad.2020.11.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Revised: 11/03/2020] [Accepted: 11/09/2020] [Indexed: 11/18/2022]
Affiliation(s)
- Jensen Yeung
- Department of Dermatology, Women's College Hospital, Toronto, Ontario, Canada; Division of Dermatology, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; Division of Dermatology, Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada; Probity Medical Research, Waterloo, Ontario, Canada.
| | - Ron Vender
- Department of Medicine, Division of Dermatology, McMaster University, Hamilton, Ontario, Canada; Dermatrials Research Inc, Hamilton, Ontario, Canada
| | - Irina Turchin
- Brunswick Dermatology Center, Fredericton, New Brunswick, Canada; Dalhousie University, Halifax, Nova Scotia, Canada; Probity Medical Research, Waterloo, Ontario, Canada
| | - Rahul Shukla
- Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Catherine Maari
- Division of Dermatology, Faculty of Medicine, Montreal University Hospital Center, Montreal, Quebec, Canada
| | - Chih-Ho Hong
- Department of Dermatology and Skin Science, University of British Columbia, Vancouver, British Columbia, Canada; Probity Medical Research, Waterloo, Ontario, Canada
| | | | - Perla Lansang
- Department of Dermatology, Women's College Hospital, Toronto, Ontario, Canada; Division of Dermatology, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; Division of Dermatology, Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada; The Hospital for Sick Children, Toronto, Ontario, Canada
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21
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Lansang P, Orrell KA, Tran J, Chen T. Skin Damage Prevention Strategies During COVID-19: Assessing Their Effect on N95 Mask Seal Integrity. J Cutan Med Surg 2020; 24:646-647. [PMID: 32755408 DOI: 10.1177/1203475420943861] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Perla Lansang
- 7938 Division of Dermatology, Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto, ON, Canada
| | - Kelsey A Orrell
- 7938 Division of Dermatology, Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto, ON, Canada
| | - Jennifer Tran
- 7938 Division of Dermatology, Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto, ON, Canada
| | - Tiffany Chen
- 7938 Division of Dermatology, Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto, ON, Canada
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22
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Yeung J, Gooderham MJ, Grewal P, Hong CH, Lansang P, Papp KA, Poulin Y, Turchin I, Vender R. Management of Plaque Psoriasis With Biologic Therapies in Women of Child-Bearing Potential Consensus Paper. J Cutan Med Surg 2020; 24:3S-14S. [PMID: 32500730 DOI: 10.1177/1203475420928376] [Citation(s) in RCA: 12] [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] [Indexed: 12/16/2022]
Abstract
BACKGROUND Plaque psoriasis (PsO) is a chronic inflammatory disease that often presents at peak reproductive age in women of child-bearing potential (WOCBP). With the emergence of biologic therapies to treat PsO, guidance on disease management in WOCBP is needed to inform treatment decisions before, during, and after pregnancy. OBJECTIVES To develop a practical, up-to-date consensus document, based on available evidence and expert opinion where evidence was lacking, in order to guide both Canadian and international clinicians treating PsO in WOCBP. METHODS A panel of 9 Canadian dermatologists with extensive clinical experience managing PsO reviewed the relevant literature from the past 25 years in 3 key domains: overview of PsO in WOCBP and clinical considerations, treatment considerations, and postpartum considerations. The structured literature search focused on WOCBP treated with TNF-alpha inhibitors (adalimumab, certolizumab, etanercept, golimumab, infliximab), IL-23 inhibitors (guselkumab, risankizumab, tildrakizumab), IL-12/23 inhibitors (ustekinumab), and IL-17 inhibitors (brodalumab, ixekizumab, secukinumab). This literature review, along with clinical expertise and opinion, was used to develop concise and clinically relevant consensus statements to guide practical management of PsO in WOCBP. Experts voted on the statements using a modified Delphi process and prespecified agreement cut-off of 75%. RESULTS AND IMPLICATIONS After review, discussion, and voting on 19 draft consensus statements at an in-person meeting and remotely, 12 consensus statements were approved by the expert panel. The statements presented here will guide healthcare providers in practical disease management using biologic therapies for the treatment of PsO in WOCBP.
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Affiliation(s)
- Jensen Yeung
- Division of Dermatology, Sunnybrook Health Sciences Centre, Toronto, ON, Canada.,468790 2129 Probity Medical Research, Waterloo, ON, Canada.,Division of Dermatology, Women's College Hospital, Toronto, ON, Canada.,7938 Division of Dermatology, Faculty of Medicine, University of Toronto, ON, Canada
| | - Melinda J Gooderham
- 468790 2129 Probity Medical Research, Waterloo, ON, Canada.,SKiN Centre for Dermatology, Peterborough, ON, Canada.,Queen's University, Kingston, ON, Canada
| | - Parbeer Grewal
- 468790 2129 Probity Medical Research, Waterloo, ON, Canada.,3158 Division of Dermatology, Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada.,Stratica Medical Centre for Dermatology, Edmonton, AB, Canada
| | - Chih-Ho Hong
- 468790 2129 Probity Medical Research, Waterloo, ON, Canada.,Dr. Chih-ho Hong Medical Inc., Surrey, BC, Canada.,Department of Dermatology and Skin Science, University of British Columbia, Vancouver, BC, Canada
| | - Perla Lansang
- Division of Dermatology, Sunnybrook Health Sciences Centre, Toronto, ON, Canada.,Division of Dermatology, Women's College Hospital, Toronto, ON, Canada.,7938 Division of Dermatology, Faculty of Medicine, University of Toronto, ON, Canada
| | - Kim A Papp
- 468790 2129 Probity Medical Research, Waterloo, ON, Canada.,K Papp Clinical Research, Waterloo, ON, Canada
| | - Yves Poulin
- Centre de Recherche Dermatologique du Québec Métropolitain, Quebec City, QC, Canada
| | - Irina Turchin
- 468790 2129 Probity Medical Research, Waterloo, ON, Canada.,Brunswick Dermatology Centre, Fredericton, NB, Canada.,Department of Medicine, Dalhousie University, Halifax, NS, Canada
| | - Ronald Vender
- Department of Medicine, McMaster University, Hamilton, ON, Canada.,Dermatrials Research, Dermatology Centre, Hamilton, ON, Canada
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23
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Lansang P, Lara-Corrales I, Bergman JN, Hong CH, Joseph M, Kim VHD, Lam JM, Landells I, Marcoux D, Prajapati VH, Ramien ML, Spring S. Approach to the Assessment and Management of Pediatric Patients With Atopic Dermatitis: A Consensus Document. Section IV: Consensus Statements on the Assessment and Management of Pediatric Atopic Dermatitis. J Cutan Med Surg 2020; 23:32S-39S. [PMID: 31692378 DOI: 10.1177/1203475419882654] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [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: 11/16/2022]
Abstract
This document is intended to provide practical guidance to physicians treating pediatric atopic dermatitis (AD), especially dermatologists, pediatricians, allergists, and other health-care professionals. The recommendations contained here were formalized based on a consensus of 12 Canadian pediatric dermatologists, dermatologists, pediatricians, and pediatric allergists with extensive experience managing AD in the pediatric population. A modified Delphi process was adopted with iterative voting on a 5-point Likert scale, with a prespecified agreement cutoff of 75%. Topic areas addressed in the 17 consensus statements reflect areas of practical management, including counselling, assessment, comorbidity management, and therapy.
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Affiliation(s)
- Perla Lansang
- Division of Dermatology, Sunnybrook Health Sciences Centre, Toronto, ON, Canada.,Division of Dermatology, Faculty of Medicine, University of Toronto, ON, Canada.,Section of Dermatology, Division of Paediatric Medicine, The Hospital for Sick Children, Toronto, ON, Canada
| | - Irene Lara-Corrales
- Section of Dermatology, Division of Paediatric Medicine, The Hospital for Sick Children, Toronto, ON, Canada.,Department of Pediatrics, Faculty of Medicine, University of Toronto, ON, Canada
| | - James N Bergman
- Department of Dermatology and Skin Science, University of British Columbia, Vancouver, Canada
| | - Chih-Ho Hong
- Department of Dermatology and Skin Science, University of British Columbia, Vancouver, Canada.,Dr. Chih-ho Hong Medical Inc., Surrey, BC, Canada.,Probity Medical Research, Waterloo, ON, Canada
| | - Marissa Joseph
- Section of Dermatology, Division of Paediatric Medicine, The Hospital for Sick Children, Toronto, ON, Canada.,Department of Pediatrics, Faculty of Medicine, University of Toronto, ON, Canada.,Division of Dermatology, Women's College Hospital, Toronto, ON, Canada
| | - Vy H D Kim
- Department of Pediatrics, Faculty of Medicine, University of Toronto, ON, Canada.,Division of Immunology & Allergy, Department of Paediatrics, The Hospital for Sick Children, Toronto, ON, Canada
| | - Joseph M Lam
- Department of Dermatology and Skin Science, University of British Columbia, Vancouver, Canada.,Department of Pediatrics, University of British Columbia, Vancouver, Canada
| | - Ian Landells
- Division of Dermatology, Departments of Medicine and Pediatrics, Memorial University, St. John's, NL, Canada.,Nexus Clinical Research, St. John's, NL, Canada
| | - Danielle Marcoux
- Division of Dermatology, Department of Pediatrics, University of Montreal and CHU Sainte-Justine University Hospital Center, Montreal, QC, Canada
| | - Vimal H Prajapati
- Division of Dermatology, Department of Medicine, University of Calgary, AB, Canada.,Division of Community Pediatrics, Department of Pediatrics, University of Calgary, AB, Canada.,Division of Pediatric Rheumatology, Department of Pediatrics, University of Calgary, AB, Canada.,Dermatology Research Institute, Calgary, AB, Canada
| | - Michele L Ramien
- Division of Dermatology, Department of Medicine, University of Calgary, AB, Canada.,Division of Community Pediatrics, Department of Pediatrics, University of Calgary, AB, Canada
| | - Shanna Spring
- Division of Dermatology and Rheumatology, Children's Hospital of Eastern Ontario, Ottawa, Canada.,Department of Pediatrics, University of Ottawa, ON, Canada.,Division of Dermatology, Department of Medicine, University of Ottawa, ON, Canada
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Lansang P, Bergman JN, Fiorillo L, Joseph M, Lara-Corrales I, Marcoux D, McCuaig C, Pope E, Prajapati VH, Li SZ, Landells I. Management of pediatric plaque psoriasis using biologics. J Am Acad Dermatol 2020; 82:213-221. [DOI: 10.1016/j.jaad.2019.05.056] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Revised: 05/21/2019] [Accepted: 05/23/2019] [Indexed: 12/31/2022]
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25
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Lansang P, Lam JM, Marcoux D, Prajapati VH, Spring S, Lara-Corrales I. Approach to the Assessment and Management of Pediatric Patients With Atopic Dermatitis: A Consensus Document. Section III: Treatment Options for Pediatric Atopic Dermatitis. J Cutan Med Surg 2019; 23:19S-31S. [PMID: 31692376 DOI: 10.1177/1203475419882647] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [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: 12/16/2022]
Abstract
Because atopic dermatitis (AD) is a chronic, relapsing disease, treatment requires the use of both active therapy to control flares and preventative maintenance therapy to promote integrity of the skin barrier. In this third of four sections, important clinical considerations for the treatment of pediatric AD are reviewed. Emerging therapies in development for pediatric AD are introduced.
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Affiliation(s)
- Perla Lansang
- Division of Dermatology, Sunnybrook Health Sciences Centre, Toronto, ON, Canada.,Division of Dermatology, Faculty of Medicine, University of Toronto, ON, Canada.,Division of Paediatric Medicine, Section of Dermatology, The Hospital for Sick Children, Toronto, ON, Canada
| | - Joseph M Lam
- Department of Dermatology and Skin Science, University of British Columbia, Vancouver, Canada.,Department of Pediatrics, University of British Columbia, Vancouver, Canada
| | - Danielle Marcoux
- Division of Dermatology, Department of Paediatrics, Sainte-Justine University Hospital Center, University of Montreal, QC, Canada
| | - Vimal H Prajapati
- Division of Dermatology, Department of Medicine, University of Calgary, AB, Canada.,Division of Community Pediatrics, Department of Pediatrics, University of Calgary, AB, Canada.,Division of Pediatric Rheumatology, Department of Pediatrics, University of Calgary, AB, Canada.,Dermatology Research Institute, Calgary, AB, Canada
| | - Shanna Spring
- Division of Dermatology and Rheumatology, Children's Hospital of Eastern Ontario, Ottawa, Canada.,Department of Pediatrics, University of Ottawa, ON, Canada.,Division of Dermatology, Department of Medicine, University of Ottawa, ON, Canada
| | - Irene Lara-Corrales
- Division of Paediatric Medicine, Section of Dermatology, The Hospital for Sick Children, Toronto, ON, Canada.,Department of Pediatrics, Faculty of Medicine, University of Toronto, ON, Canada
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26
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Hong CH, Joseph M, Kim VHD, Lansang P, Lara-Corrales I. Approach to the Assessment and Management of Pediatric Patients with Atopic Dermatitis: A Consensus Document. Section II: Comorbid Disease in Pediatric Atopic Dermatitis. J Cutan Med Surg 2019; 23:12S-18S. [DOI: 10.1177/1203475419882655] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Pediatric atopic dermatitis (AD) is one of the most common skin conditions encountered by health-care providers caring for infants, children, and adolescents. Pediatric patients with AD may present with other allergic and nonallergic comorbidities that require appropriate treatment and referral. They may also experience a trajectory of allergic diseases known as the atopic march, which depends on a complex interaction between genetic and environmental factors and likely involves early epidermal barrier dysfunction. Here we provide a review and clinical recommendations on the assessment and referral of comorbidities in pediatric AD.
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Affiliation(s)
- Chih-ho Hong
- Dr. Chih-ho Hong Medical Inc., Surrey, BC, Canada
- Probity Medical Research, Waterloo, ON, Canada
- Department of Dermatology and Skin Science, University of British Columbia, Vancouver, BC, Canada
| | - Marissa Joseph
- Department of Pediatrics, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Section of Dermatology, Division of Paediatric Medicine, The Hospital for Sick Children, Toronto, ON, Canada
- Division of Dermatology, Women's College Hospital, Toronto, ON, Canada
| | - Vy HD Kim
- Section of Dermatology, Division of Paediatric Medicine, The Hospital for Sick Children, Toronto, ON, Canada
- Division of Immunology & Allergy, Department of Paediatrics, The Hospital for Sick Children, Toronto, ON, Canada
| | - Perla Lansang
- Section of Dermatology, Division of Paediatric Medicine, The Hospital for Sick Children, Toronto, ON, Canada
- Division of Dermatology, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
- Division of Dermatology, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Irene Lara-Corrales
- Department of Pediatrics, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Section of Dermatology, Division of Paediatric Medicine, The Hospital for Sick Children, Toronto, ON, Canada
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Lara-Corrales I, Bergman JN, Landells I, Ramien ML, Lansang P. Approach to the Assessment and Management of Pediatric Patients With Atopic Dermatitis: A Consensus Document. Section I: Overview of Pediatric Atopic Dermatitis. J Cutan Med Surg 2019; 23:3S-11S. [DOI: 10.1177/1203475419882049] [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: 01/01/2023]
Abstract
Pediatric atopic dermatitis (AD) is one of the most common dermatoses encountered by health-care providers treating children. Diagnosis of AD is clinical, with no universally accepted biomarkers or assessment tools. Patient-reported outcomes and subjective assessments of quality of life in both the patient and family are important considerations when treating pediatric AD. Here, we provide an overview of pediatric AD epidemiology, its clinical presentation, burden, diagnosis, and assessment, with a focus on implications for patient counseling in order to optimize care.
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Affiliation(s)
- Irene Lara-Corrales
- Section of Dermatology, Division of Paediatric Medicine, The Hospital for Sick Children, Toronto, ON, Canada
- Department of Pediatrics, Faculty of Medicine, University of Toronto, ON, Canada
| | - James N. Bergman
- Department of Dermatology and Skin Science, University of British Columbia, Vancouver, BC, Canada
| | - Ian Landells
- Departments of Medicine and Pediatrics, Division of Dermatology, Memorial University, St. John’s, NL, Canada
- Nexus Clinical Research, St. John’s, NL, Canada
| | - Michele L. Ramien
- Department of Medicine, Division of Dermatology, University of Calgary, AB, Canada
- Division of Community Pediatrics, Department of Pediatrics, Alberta Children’s Hospital, Calgary, AB, Canada
| | - Perla Lansang
- Section of Dermatology, Division of Paediatric Medicine, The Hospital for Sick Children, Toronto, ON, Canada
- Division of Dermatology, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
- Division of Dermatology, Faculty of Medicine, University of Toronto, ON, Canada
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Waller BAM, Liu A, Fleming P, Lansang P. Undergraduate Dermatology Medical Education: Results of a Large-Scale Patient Viewing Program. J Cutan Med Surg 2019; 23:482-487. [DOI: 10.1177/1203475419848350] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background: Delivering quality dermatologic instruction to medical students can be difficult; time constraints, limited clinical teachers, and a lack of standardization pose challenges. The literature suggests that many trainees and primary care physicians could benefit from increased clinical dermatology teaching. Objective: We sought to deliver and analyze the results of a large-scale patient-viewing undergraduate dermatology education program. Methods: A total of 250 third-year medical students participated in a 32-station patient-viewing program. Voluntary pre- and posttest surveys were administered to evaluate knowledge and self-perceived abilities in dermatology. The identical tests were composed of 20 multiple-choice and 5 self-perception questions. Results: The response rate for completion of pre- and posttests was 24% (N = 59). Pre- and postknowledge test score means were 69.0% and 93.20%, respectively. Pre- and post–self-perception test score means were 3.95/10 and 7.25/10, respectively. Positive student feedback was received on the patient-viewing educational experience. Conclusion: Improvements in knowledge scores and self-assessment scores support the potential integration of structured patient-viewing teaching into undergraduate dermatology medical education curricula.
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Affiliation(s)
| | - Annie Liu
- Division of Dermatology, University of Toronto, ON, Canada
| | | | - Perla Lansang
- Division of Dermatology, University of Toronto, ON, Canada
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Phung M, Ighani A, Georgakopoulos JR, Vender R, Giroux L, Lansang P, Yeung J. Off-Label High-Dose Secukinumab for the Treatment of Moderate-to-Severe Psoriasis. J Cutan Med Surg 2019; 23:391-393. [DOI: 10.1177/1203475419843118] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background: Secukinumab is an anti-IL-17A monoclonal antibody approved for the treatment of moderate-to-severe psoriasis in adult patients. Despite its favourable safety and efficacy profile in clinical trials, some patients in clinical practice fail to respond adequately to the approved maintenance regimen of 300 mg subcutaneous monthly. Some clinicians manage these patients by using off-label high-dose secukinumab regimens, which include shortening the dosing interval to 300 mg every 2 or 3 weeks instead of monthly, or increasing the monthly dose to 450 mg. Objective: This study aims to investigate the safety and efficacy of high-dose secukinumab regimens for the treatment of psoriasis to inform real-world clinical practice. Methods: We performed a retrospective chart review at 5 dermatology clinics for adult patients diagnosed with moderate-to-severe psoriasis treated with an off-label high-dose secukinumab regimen. Efficacy was measured using the Psoriasis Area and Severity Index or a Physician Global Assessment score of 0 or 1 after dose escalation. Adverse events were recorded to assess safety outcomes. Results: Twenty-five patients were included in this case series, and 14 of them achieved efficacy from dose escalation with secukinumab based on our study endpoints. There was 1 case of the common cold and 1 upper respiratory tract infection reported after dose escalation. Conclusion: Our study provides evidence that dose escalation with secukinumab results in clinical benefit and is well tolerated among patients with moderate-to-severe psoriasis who failed to respond adequately to the approved regimen. This work necessitates larger studies to fully characterize the efficacy and long-term safety profile of secukinumab dose escalation.
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Affiliation(s)
- Michelle Phung
- Department of Pharmacology and Toxicology, Faculty of Medicine, University of Toronto, ON, Canada
| | - Arvin Ighani
- Faculty of Medicine, University of Toronto, ON, Canada
| | | | - Ron Vender
- Dermatrials Research Inc, Hamilton, ON, Canada
- Venderm Innovations in Psoriasis, Hamilton, ON, Canada
| | - Lyne Giroux
- Department of Dermatology, The Northern Ontario School of Medicine, Sudbury, Canada
| | - Perla Lansang
- Division of Dermatology, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
- Division of Dermatology, Women’s College Hospital, Toronto, ON, Canada
- Division of Dermatology, Faculty of Medicine, University of Toronto, ON, Canada
| | - Jensen Yeung
- Division of Dermatology, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
- Division of Dermatology, Women’s College Hospital, Toronto, ON, Canada
- Division of Dermatology, Faculty of Medicine, University of Toronto, ON, Canada
- Probity Medical Research, Waterloo, ON, Canada
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Gooderham MJ, Hong CH, Albrecht L, Bissonnette R, Dhadwal G, Gniadecki R, Grewal P, Kirchhof MG, Landells I, Lansang P, Lynde CW, Papp KA, Poulin Y, Sussman G, Turchin I, Wiseman M, Yeung J. Approach to the Assessment and Management of Adult Patients With Atopic Dermatitis: A Consensus Document. J Cutan Med Surg 2019; 22:3S-5S. [PMID: 30439298 DOI: 10.1177/1203475418803627] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND: Atopic dermatitis (AD) is a chronic, relapsing, and remitting inflammatory skin disease with complex pathophysiology, primarily driven by type 2 inflammation. Existing guidelines often do not reflect all current therapeutic options and guidance on the practical management of patients with AD is lacking. OBJECTIVES: To develop practical, up-to-date guidance on the assessment and management of adult patients with AD. METHODS: An expert panel of 17 Canadian experts, including 16 dermatologists and 1 allergist, with extensive clinical experience managing moderate-to-severe AD reviewed the available literature from the past 5 years using a defined list of key search terms. This literature, along with clinical expertise and opinion, was used to draft concise, clinically relevant reviews of the current literature. Based on these reviews, experts developed and voted on recommendations and statements to reflect the practical management of adult patients with AD as a guide for health care providers in Canada and across the globe, using a prespecified agreement cutoff of 75%. RESULTS: Eleven consensus statements were approved by the expert panel and reflected 4 key domains: pathophysiology, assessment, comorbidities, and treatment. CONCLUSIONS: These statements aim to provide a framework for the assessment and management of adult patients with AD and to guide health care providers in practically relevant aspects of patient management.
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Affiliation(s)
- Melinda J Gooderham
- 1 SKiN Centre for Dermatology, Peterborough, ON, Canada.,2 Probity Medical Research, Waterloo, ON, Canada
| | - Chih-Ho Hong
- 2 Probity Medical Research, Waterloo, ON, Canada.,3 Dr. Chih-ho Hong Medical, Inc, Surrey, BC, Canada
| | - Lorne Albrecht
- 2 Probity Medical Research, Waterloo, ON, Canada.,4 Enverus Medical, Surrey, BC, Canada
| | | | - Gurbir Dhadwal
- 2 Probity Medical Research, Waterloo, ON, Canada.,6 Dr. Gurbir Dhadwal, MD, Inc, Vancouver, BC, Canada
| | - Robert Gniadecki
- 7 Division of Dermatology, Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Parbeer Grewal
- 2 Probity Medical Research, Waterloo, ON, Canada.,7 Division of Dermatology, Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada.,8 Stratica Medical Centre for Dermatology, Edmonton, AB, Canada
| | - Mark G Kirchhof
- 9 Division of Dermatology, Department of Medicine, University of Ottawa and The Ottawa Hospital, Ottawa, ON, Canada
| | - Ian Landells
- 10 Nexus Clinical Research, St John's, NL, Canada
| | - Perla Lansang
- 11 Division of Dermatology, Sunnybrook Health Sciences Centre, Toronto, ON, Canada.,12 Division of Dermatology, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Chuck W Lynde
- 2 Probity Medical Research, Waterloo, ON, Canada.,13 Lynde Institute for Dermatology, Markham, ON, Canada
| | - Kim A Papp
- 2 Probity Medical Research, Waterloo, ON, Canada.,14 K Papp Clinical Research, Waterloo, ON, Canada
| | - Yves Poulin
- 15 Centre de Recherche Dermatologique du Québec Métropolitain, Quebec City, QC, Canada
| | | | - Irina Turchin
- 17 Brunswick Dermatology Centre, Fredericton, NB, Canada
| | | | - Jensen Yeung
- 2 Probity Medical Research, Waterloo, ON, Canada.,11 Division of Dermatology, Sunnybrook Health Sciences Centre, Toronto, ON, Canada.,12 Division of Dermatology, Faculty of Medicine, University of Toronto, Toronto, ON, Canada.,19 Division of Dermatology, Women's College Hospital, Toronto, ON, Canada
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Gooderham MJ, Bissonnette R, Grewal P, Lansang P, Papp KA, Hong CH. Approach to the Assessment and Management of Adult Patients With Atopic Dermatitis: A Consensus Document. Section II: Tools for Assessing the Severity of Atopic Dermatitis. J Cutan Med Surg 2019; 22:10S-16S. [PMID: 30439297 DOI: 10.1177/1203475418803628] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Clinicians rely on clinical measures to define the severity of atopic dermatitis and assess outcomes of therapy. These measures can be objective (ie, physician assessments of disease severity) or subjective (ie, patient-reported symptoms and quality of life outcomes). In this review, the most commonly used tools for assessing atopic dermatitis severity in adult patients are presented and compared. These include Eczema Area and Severity Index (EASI); SCORing Atopic Dermatitis (SCORAD); Physician Global Assessment (PGA); body surface area (BSA); Atopic Dermatitis Severity Index (ADSI); Six Area, Six Sign Atopic Dermatitis (SASSAD); Patient Oriented Eczema Measure (POEM); Dermatology Life Quality Index (DLQI); and pruritus Numerical Rating Scale (NRS). Available severity strata for the tools are summarized, although the use of severity strata in clinical practice is not recommended. Since both objective and subjective assessments of disease severity are important to assess, consideration of clinical characteristics such as disease recurrence or persistence, as well as location of the affected areas, should be considered in the overall judgement of disease severity and consideration of therapy choice.
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Hong CH, Gooderham MJ, Albrecht L, Bissonnette R, Dhadwal G, Gniadecki R, Grewal P, Kirchhof MG, Landells I, Lansang P, Lynde CW, Papp KA, Poulin Y, Sussman G, Turchin I, Wiseman M, Yeung J. Approach to the Assessment and Management of Adult Patients With Atopic Dermatitis: A Consensus Document. Section V: Consensus Statements on the Assessment and Management of Adult Patients With Moderate-to-Severe Atopic Dermatitis. J Cutan Med Surg 2019; 22:30S-35S. [PMID: 30439300 DOI: 10.1177/1203475418803625] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [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: 11/15/2022]
Abstract
This document is a concise, current, and practical guide for dermatologists and other health care providers managing adult patients with moderate-to-severe atopic dermatitis (AD). The recommendations made here are based on a consensus of specialists with extensive experience managing patients with AD. Topics reviewed in this publication include AD pathophysiology, assessment, comorbidities, and treatment options.
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Affiliation(s)
- Chih-Ho Hong
- 1 Dr. Chih-ho Hong Medical, Inc, Surrey, BC, Canada.,2 Probity Medical Research, Waterloo, ON, Canada
| | - Melinda J Gooderham
- 2 Probity Medical Research, Waterloo, ON, Canada.,3 SKiN Centre for Dermatology, Peterborough, ON, Canada
| | - Lorne Albrecht
- 2 Probity Medical Research, Waterloo, ON, Canada.,4 Enverus Medical, Surrey, BC, Canada
| | | | - Gurbir Dhadwal
- 2 Probity Medical Research, Waterloo, ON, Canada.,6 Dr. Gurbir Dhadwal, MD, Inc, Vancouver, BC, Canada
| | - Robert Gniadecki
- 7 Division of Dermatology, Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Parbeer Grewal
- 2 Probity Medical Research, Waterloo, ON, Canada.,7 Division of Dermatology, Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada.,8 Stratica Medical Centre for Dermatology, Edmonton, AB, Canada
| | - Mark G Kirchhof
- 9 Division of Dermatology, Department of Medicine, University of Ottawa and The Ottawa Hospital, Ottawa, ON, Canada
| | - Ian Landells
- 10 Nexus Clinical Research, St John's, NL, Canada
| | - Perla Lansang
- 11 Division of Dermatology, Sunnybrook Health Sciences Centre, Toronto, ON, Canada.,12 Division of Dermatology, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Chuck W Lynde
- 2 Probity Medical Research, Waterloo, ON, Canada.,13 Lynde Institute for Dermatology, Markham, ON, Canada
| | - Kim A Papp
- 2 Probity Medical Research, Waterloo, ON, Canada.,14 K Papp Clinical Research, Waterloo, ON, Canada
| | - Yves Poulin
- 15 Centre de Recherche Dermatologique du Québec métropolitain, Quebec City, QC, Canada
| | | | - Irina Turchin
- 17 Brunswick Dermatology Centre, Fredericton, NB, Canada
| | | | - Jensen Yeung
- 2 Probity Medical Research, Waterloo, ON, Canada.,11 Division of Dermatology, Sunnybrook Health Sciences Centre, Toronto, ON, Canada.,12 Division of Dermatology, Faculty of Medicine, University of Toronto, Toronto, ON, Canada.,19 Division of Dermatology, Women's College Hospital, Toronto, ON, Canada
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Jaque A, Mereniuk A, Sade S, Lansang P, Imrie K, Shear NH. Eosinophils in the skin-a red herring masking lymphoma: a case series. SAGE Open Med Case Rep 2018; 6:2050313X18773127. [PMID: 29899986 PMCID: PMC5985601 DOI: 10.1177/2050313x18773127] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Eosinophilia, both peripheral and in cutaneous tissue, is not a typical finding in mycosis fungoides; in fact, when faced with a lymphoeosinophilic infiltrate, mycosis fungoides is often not part of initial differential considerations. However, eosinophilia has been described in certain subtypes of mycosis fungoides, namely, in folliculotropic mycosis fungoides. We describe three challenging cases of folliculotropic mycosis fungoides presenting with varied clinical morphologies and a dense lymphoeosinophilic infiltrate and/or severe hypereosinophilia that obscured the final diagnosis for years. Only after treatment of the eosinophilia were the underlying atypical lymphocytes more apparent on histology and a correct diagnosis made. Thus, when characteristic features of mycosis fungoides are subtle, eosinophils can act as a red herring in terms of clinico-pathologic correlation and may prevent early and accurate diagnosis of mycosis fungoides. We suggest that further studies are needed to evaluate whether treatments to reduce eosinophilia, once other causes have been excluded, may help clear the confounding reactive inflammatory infiltrate and facilitate the diagnosis of mycosis fungoides.
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Affiliation(s)
- Alejandra Jaque
- University of Toronto and Department of Medicine, Sunnybrook Hospital, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Alexandra Mereniuk
- University of Toronto and Department of Medicine, Sunnybrook Hospital, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Shachar Sade
- University of Toronto and Department of Pathology, Sunnybrook Hospital, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Perla Lansang
- University of Toronto and Department of Medicine, Sunnybrook Hospital, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Kevin Imrie
- University of Toronto and Department of Medicine, Sunnybrook Hospital, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Neil H Shear
- University of Toronto and Department of Medicine, Sunnybrook Hospital, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
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Lee EY, Alhusayen R, Lansang P, Shear N, Yeung J. What is hidradenitis suppurativa? Can Fam Physician 2017; 63:114-120. [PMID: 28209676 PMCID: PMC5395382] [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] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
OBJECTIVE To provide family physicians with an understanding of the epidemiology, clinical features, diagnosis, and management of hidradenitis suppurativa (HS). SOURCES OF INFORMATION A PubMed literature search was performed using the MeSH term hidradenitis suppurativa. MAIN MESSAGE Hidradenitis suppurativa is a chronic, recurrent, and debilitating skin condition. It is an inflammatory disorder of the follicular epithelium, but secondary bacterial infection can often occur. The diagnosis is made clinically based on typical lesions (nodules, abscesses, sinus tracts), locations (skin folds), and nature of relapses and chronicity. Multiple comorbidities are associated with HS, including obesity, metabolic syndrome, inflammatory bowel disease, and spondyloarthropathy. Although the lack of curative therapy and the recurrent nature makes HS treatment challenging, there are effective symptomatic management options. CONCLUSION Family physicians should be suspicious of HS in patients presenting with recurrent skin abscesses at the skin folds. Family physicians play an important role in early diagnosis, initiation of treatment, and referral to a dermatologist before HS progresses to debilitating end-stage disease.
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Affiliation(s)
- Erika Yue Lee
- Internal medicine resident at the University of Toronto in Ontario.
| | - Raed Alhusayen
- Assistant Professor in the Division of Dermatology at the University of Toronto
| | - Perla Lansang
- Assistant Professor and full-time staff dermatologist in the Division of Dermatology at the University of Toronto
| | - Neil Shear
- Professor in the Division of Clinical Pharmacology and Toxicology at the University of Toronto, and Head of Dermatology at Sunnybrook and Health Sciences Centre in Toronto
| | - Jensen Yeung
- Lecturer in the Division of Dermatology at the University of Toronto
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Lee EY, Alhusayen R, Lansang P, Shear N, Yeung J. [Not Available]. Can Fam Physician 2017; 63:e86-e93. [PMID: 28209697 PMCID: PMC5395403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Objectif Permettre aux médecins de famille de comprendre l’épidémiologie, le tableau clinique, le diagnostic et la prise en charge de l’hidradénite suppurée. Sources d’information Une recherche de la littérature a été effectuée sur PubMed à l’aide des mots-clés MeSH hidradenitis suppurativa. Message principal L’hidradénite suppurée est une affection cutanée chronique, récidivante et incapacitante. C’est un trouble inflammatoire de l’épithélium folliculaire, bien qu’une infection bactérienne secondaire se produise souvent. Le diagnostic, posé en clinique, repose sur les lésions typiques (nodules, abcès, tractus sinusal), le siège (plis cutanés), la nature des rechutes et le caractère chronique. De nombreuses comorbidités sont associées à l’hidradénite suppurée, y compris l’obésité, le syndrome métabolique, la maladie intestinale inflammatoire et la spondylarthropathie. Même si l’absence de traitement curatif et la nature récidivante de l’hidradénite suppurée en compliquent le traitement, il existe des options efficaces pour prendre en charge les symptômes. Conclusion Les médecins de famille doivent soupçonner l’hidradénite suppurée chez les patients qui présentent des abcès cutanés récidivants dans les plis cutanés. Les médecins de famille jouent un rôle important dans le diagnostic précoce, l’instauration du traitement et la recommandation en dermatologie avant que l’hidradénite suppurée ne progresse vers une atteinte terminale incapacitante.
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Affiliation(s)
- Erika Yue Lee
- Résidente en médecine interne à l'Université de Toronto, en Ontario.
| | - Raed Alhusayen
- Professeur agrégé à la Division de dermatologie de l'Université de Toronto
| | - Perla Lansang
- Professeure adjointe et dermatologue à temps plein à la Division de dermatologie de l'Université de Toronto
| | - Neil Shear
- Professeur à la Division de pharmacologie clinique et de toxicologie de l'Université de Toronto, et chef du Service de dermatologie au Sunnybrook and Health Sciences Centre à Toronto
| | - Jensen Yeung
- Chargé de cours à la Division de dermatologie de l'Université de Toronto
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Heelan K, Al-Mohammedi F, Smith MJ, Knowles S, Lansang P, Walsh S, Shear NH. Durable remission of pemphigus with a fixed-dose rituximab protocol. JAMA Dermatol 2014; 150:703-8. [PMID: 24500264 DOI: 10.1001/jamadermatol.2013.6739] [Citation(s) in RCA: 76] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Rituximab induces B-lymphocyte apoptosis by targeting CD20 antigen and has shown efficacy in antibody-mediated autoimmune disease. Rituximab is increasingly being acknowledged as an effective and safe treatment option for pemphigus. OBJECTIVE To assess the clinical response of patients with pemphigus to rituximab using a modified fixed-dose rheumatoid arthritis protocol (1 g intravenously on days 1 and 15, followed by 500 mg intravenously if clinically warranted at 6-month intervals or repeated full dosing). DESIGN, SETTING, AND PARTICIPANTS A retrospective cohort study was conducted using records from a tertiary referral center for autoimmune bullous disorders. Participants included 92 patients (pemphigus vulgaris, 84 [91%], and pemphigus foliaceus, 8 [9%]) who received rituximab treatment between May 1, 2006, and August 30, 2012. MAIN OUTCOMES AND MEASURES The primary outcomes were time to relapse and achievement of a complete response with or without treatment at the end of the study. RESULTS Median time to relapse after the first treatment cycle was 15 months (95% CI, 10.3-19.7). All patients experienced improvement. Complete remission rates with or without adjuvant treatment at final follow-up were 89% (56 patients [61%] were in complete remission without treatment and 26 patients [28%] were in complete remission during adjuvant treatment). No serious infectious adverse events occurred. CONCLUSIONS AND RELEVANCE The fixed-dose, modified rheumatoid arthritis protocol for rituximab was efficacious and well tolerated in patients with pemphigus. Patients who do not achieve remission after 1 cycle or patients who experience relapse benefit from further cycles of rituximab. Our results need to be confirmed in larger and controlled trials.
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Lara-Corrales I, Ramnarine S, Lansang P. Erratum for “Treatment of Childhood Psoriasis with Phototherapy and Photochemotherapy”. Clin Med Insights Pediatr 2014. [DOI: 10.4137/cmped.s13775] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Irene Lara-Corrales
- University of Toronto, Staff Physician Pediatric Dermatology, Hospital for Sick Children, 555 University Avenue, Toronto, ON M5G1X8
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Lara-Corrales I, Corrales IL, Ramnarine S, Lansang P. Treatment of childhood psoriasis with phototherapy and photochemotherapy. Clin Med Insights Pediatr 2013; 7:25-33. [PMID: 23966809 PMCID: PMC3735876 DOI: 10.4137/cmped.s8045] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [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: 12/03/2022]
Abstract
Phototherapy and photochemotherapy are well-described treatment modalities for psoriasis in adults. Like many other treatments, the experience and long-term safety of their use in children is limited. We conducted a literature search and identified publications reporting the use of phototherapy and photochemotherapy in pediatric populations. This article summarizes the existing literature on this topic. Although many studies report good improvement with these treatment modalities, long-term safety data on their use is lacking for pediatric patients.
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Affiliation(s)
| | - Irene Lara Corrales
- Assistant Professor of Pediatrics, University of Toronto, Staff Physician Pediatric Dermatology, Hospital for Sick Children, 555 University Avenue, Toronto, ON M5G1X8
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Balma-Mena A, Chakkittakandiyil A, Weinstein M, Lansang P, Ho N, Cammisuli S, Pope E. Propranolol in the Management of Infantile Hemangiomas: Clinical Response and Predictors. J Cutan Med Surg 2012; 16:169-73. [DOI: 10.1177/120347541201600306] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Background: Recent data suggest that propranolol is an effective treatment for infantile hemangiomas (IHs). Data on the optimal dose, duration of therapy, and predictors of response are currently lacking. Objective: To assess the clinical response to and predictors of propranolol use in the treatment of IH. Methods: Retrospective cohort study of 44 patients. Two independent assessors evaluated improvement by comparing serial digital photographs using a 100 mm visual analogue scale (VAS), where 5 mm change represented 10% change in the size or appearance of the IH. Results: Propranolol was started at a mean age of 7.8 (SD 8.21) months and was used for 7.3 (SD 4.8) months before weaning. The mean percent improvement compared to baseline (as measured by the VAS) was 78% (SD 23%). Minor adverse events were noted in 32% of patients. The most significant predictor of regrowth after weaning was a IH > 5 cm in size ( p = .017). Conclusions: Propranolol is effective in IH, but the side effects and the possibility of regrowth should be considered.
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Affiliation(s)
| | | | - Miriam Weinstein
- Pediatric Dermatology, The Hospital for Sick Children, Toronto, ON
| | - Perla Lansang
- Pediatric Dermatology, The Hospital for Sick Children, Toronto, ON
| | - Nhung Ho
- Pediatric Dermatology, The Hospital for Sick Children, Toronto, ON
| | | | - Elena Pope
- Department of Dermatology, Sunnybrook Hospital, Toronto, ON
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Ho NTC, Lansang P, Pope E. Topical imiquimod in the treatment of infantile hemangiomas: A retrospective study. J Am Acad Dermatol 2007; 56:63-8. [PMID: 17190622 DOI: 10.1016/j.jaad.2006.06.011] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2005] [Revised: 06/13/2006] [Accepted: 06/13/2006] [Indexed: 10/23/2022]
Abstract
BACKGROUND Active nonintervention remains the mainstay of therapy for most uncomplicated infantile hemangiomas (IH) because of their expected involution. Topical imiquimod, with its ability to induce the production of interferon, tumor necrosis factor-alpha, and the antiangiogenesis factor tissue inhibitor of matrix metalloproteinase, has been recently reported to be efficacious in the treatment of IH. OBJECTIVE We sought to evaluate the efficacy of imiquimod 5% cream in the treatment of noncomplicated IH and possible side effects. METHODS A retrospective chart review analysis was performed in 18 children (16 girls and 2 boys) with a median age of 18 weeks (range: 4-256 weeks). A total of 22 hemangiomas (14 located on head, 3 on genitalia, 2 on trunk, and 3 on extremities) were treated with imiquimod 5% cream. Imiquimod was applied 3 times weekly in 10 patients and 5 times weekly in 8 patients for a mean duration of 17 weeks (7-46 weeks). RESULTS All superficial IH improved, and remission was achieved in 4 hemangiomas. There was little improvement in mixed IH with no or minimal change in all deep hemangiomas. One case with ulcerated hemangioma substantially improved with accelerated ulcer healing and hemangioma size reduction. No systemic complication was observed in any of our patients, with irritation and crusting being the most common reactive effects. LIMITATIONS The small-sample, retrospective study limits the interpretation of results. CONCLUSION Imiquimod 5% cream may be most effective in superficial IH. There was no significant correlation between response and early onset of treatment for any IH in our small sample study. Pharmacokinetic analysis and placebo-controlled study should follow to ascertain the safety and efficacy of imiquimod 5% cream in the pediatric age group.
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Affiliation(s)
- Nhung T C Ho
- Department of Pediatrics, Section of Dermatology, The Hospital for Sick Children, Faculty of Medicine, University of Toronto, Ontario, M5G 1X8, Canada.
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