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Kampaite A, Gustafsson R, York EN, Foley P, MacDougall NJJ, Bastin ME, Chandran S, Waldman AD, Meijboom R. Brain connectivity changes underlying depression and fatigue in relapsing-remitting multiple sclerosis: A systematic review. PLoS One 2024; 19:e0299634. [PMID: 38551913 PMCID: PMC10980255 DOI: 10.1371/journal.pone.0299634] [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] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 02/13/2024] [Indexed: 04/01/2024] Open
Abstract
Multiple Sclerosis (MS) is an autoimmune disease affecting the central nervous system, characterised by neuroinflammation and neurodegeneration. Fatigue and depression are common, debilitating, and intertwined symptoms in people with relapsing-remitting MS (pwRRMS). An increased understanding of brain changes and mechanisms underlying fatigue and depression in RRMS could lead to more effective interventions and enhancement of quality of life. To elucidate the relationship between depression and fatigue and brain connectivity in pwRRMS we conducted a systematic review. Searched databases were PubMed, Web-of-Science and Scopus. Inclusion criteria were: studied participants with RRMS (n ≥ 20; ≥ 18 years old) and differentiated between MS subtypes; published between 2001-01-01 and 2023-01-18; used fatigue and depression assessments validated for MS; included brain structural, functional magnetic resonance imaging (fMRI) or diffusion MRI (dMRI). Sixty studies met the criteria: 18 dMRI (15 fatigue, 5 depression) and 22 fMRI (20 fatigue, 5 depression) studies. The literature was heterogeneous; half of studies reported no correlation between brain connectivity measures and fatigue or depression. Positive findings showed that abnormal cortico-limbic structural and functional connectivity was associated with depression. Fatigue was linked to connectivity measures in cortico-thalamic-basal-ganglial networks. Additionally, both depression and fatigue were related to altered cingulum structural connectivity, and functional connectivity involving thalamus, cerebellum, frontal lobe, ventral tegmental area, striatum, default mode and attention networks, and supramarginal, precentral, and postcentral gyri. Qualitative analysis suggests structural and functional connectivity changes, possibly due to axonal and/or myelin loss, in the cortico-thalamic-basal-ganglial and cortico-limbic network may underlie fatigue and depression in pwRRMS, respectively, but the overall results were inconclusive, possibly explained by heterogeneity and limited number of studies. This highlights the need for further studies including advanced MRI to detect more subtle brain changes in association with depression and fatigue. Future studies using optimised imaging protocols and validated depression and fatigue measures are required to clarify the substrates underlying these symptoms in pwRRMS.
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Affiliation(s)
- Agniete Kampaite
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom
- Edinburgh Imaging, Edinburgh Imaging Facility, University of Edinburgh, Edinburgh, United Kingdom
| | - Rebecka Gustafsson
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom
| | - Elizabeth N. York
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom
- Edinburgh Imaging, Edinburgh Imaging Facility, University of Edinburgh, Edinburgh, United Kingdom
- Anne Rowling Regenerative Neurology Clinic, University of Edinburgh, Edinburgh, United Kingdom
| | - Peter Foley
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom
- Anne Rowling Regenerative Neurology Clinic, University of Edinburgh, Edinburgh, United Kingdom
| | - Niall J. J. MacDougall
- Anne Rowling Regenerative Neurology Clinic, University of Edinburgh, Edinburgh, United Kingdom
- Department of Neurology, Institute of Neurological Sciences, Queen Elizabeth University Hospital, Glasgow, United Kingdom
| | - Mark E. Bastin
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom
- Edinburgh Imaging, Edinburgh Imaging Facility, University of Edinburgh, Edinburgh, United Kingdom
| | - Siddharthan Chandran
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom
- Anne Rowling Regenerative Neurology Clinic, University of Edinburgh, Edinburgh, United Kingdom
- UK Dementia Research Institute, University of Edinburgh, Edinburgh, United Kingdom
| | - Adam D. Waldman
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom
- Edinburgh Imaging, Edinburgh Imaging Facility, University of Edinburgh, Edinburgh, United Kingdom
| | - Rozanna Meijboom
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom
- Edinburgh Imaging, Edinburgh Imaging Facility, University of Edinburgh, Edinburgh, United Kingdom
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2
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Strober B, Blauvelt A, Warren RB, Papp KA, Armstrong AW, Gordon KB, Morita A, Alexis AF, Lebwohl M, Foley P, Kisa RM, Colston E, Wang T, Banerjee S, Thaçi D. Deucravacitinib in moderate-to-severe plaque psoriasis: Pooled safety and tolerability over 52 weeks from two phase 3 trials (POETYK PSO-1 and PSO-2). J Eur Acad Dermatol Venereol 2024. [PMID: 38451052 DOI: 10.1111/jdv.19925] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Accepted: 01/30/2024] [Indexed: 03/08/2024]
Abstract
BACKGROUND Two phase 3 trials, POETYK PSO-1 and PSO-2, previously established the efficacy and overall safety of deucravacitinib, an oral, selective, allosteric tyrosine kinase 2 (TYK2) inhibitor, in plaque psoriasis. OBJECTIVES To further assess the safety of deucravacitinib over 52 weeks in the pooled population from these two trials. METHODS Pooled safety data were evaluated from PSO-1 and PSO-2 in which patients with moderate-to-severe plaque psoriasis were randomized 1:2:1 to receive oral placebo, deucravacitinib or apremilast. RESULTS A total of 1683 patients were included in the pooled analysis. Adverse event (AE) incidence rates were similar in each treatment group, serious AEs were low and balanced across groups, and discontinuation rates were lower with deucravacitinib versus placebo or apremilast. No new safety signals emerged with longer deucravacitinib treatment. Exposure-adjusted incidence rates of AEs of interest with placebo, deucravacitinib and apremilast, respectively, were as follows: serious infections (0.8/100 person-years [PY], 1.7/100 PY, and 1.8/100 PY), major adverse cardiovascular events (1.2/100 PY, 0.3/100 PY, and 0.9/100 PY), venous thromboembolic events (0, 0.2/100 PY, and 0), malignancies (0, 1.0/100 PY and 0.9/100 PY), herpes zoster (0.4/100 PY, 0.8/100 PY, and 0), acne (0.4/100 PY, 2.9/100 PY, and 0) and folliculitis (0, 2.8/100 PY, and 0.9/100 PY). No clinically meaningful changes from baseline in mean levels, or shifts from baseline to CTCAE grade ≥3 abnormalities, were reported in laboratory parameters with deucravacitinib. CONCLUSIONS Deucravacitinib was well-tolerated with acceptable safety over 52 weeks in patients with psoriasis.
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Affiliation(s)
- Bruce Strober
- Department of Dermatology, Yale University, New Haven, Connecticut, USA
- Central Connecticut Dermatology Research, Cromwell, Connecticut, USA
| | | | - Richard B Warren
- Dermatology Centre, Northern Care Alliance NHS Foundation Trust, Manchester, UK
- Manchester NIHR Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | - Kim A Papp
- Alliance Clinical Trials and Probity Medical Research, Waterloo, Ontario, Canada
- Division of Dermatology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - April W Armstrong
- Department of Dermatology, University of California Los Angeles, Los Angeles, California, USA
| | - Kenneth B Gordon
- Dermatology - Froedtert Cancer Center, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Akimichi Morita
- Department of Geriatric and Environmental Dermatology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Andrew F Alexis
- Department of Dermatology, Weill Cornell Medicine, New York, New York, USA
| | - Mark Lebwohl
- Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Peter Foley
- Skin Health Institute and Probity Medical Research, Melbourne, Victoria, Australia
| | | | | | - Tao Wang
- Bristol Myers Squibb, Princeton, New Jersey, USA
| | | | - Diamant Thaçi
- Institute and Comprehensive Centre for Inflammation Medicine, University of Luebeck, Luebeck, Germany
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Mahar PD, Robertson SJ, Orchard D, Baker C, Foley P. Paediatric indications and dosing guidance for advanced targeted treatments in Australia. Australas J Dermatol 2024. [PMID: 38445760 DOI: 10.1111/ajd.14230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2024] [Accepted: 02/08/2024] [Indexed: 03/07/2024]
Abstract
As with adults, paediatric patients may benefit from a number of advanced targeted therapies for inflammatory skin disease. This brief report aims to be an accessible reference tool with respect to regulatory approval and reimbursement of these treatments within Australia.
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Affiliation(s)
- Patrick D Mahar
- Skin Health Institute, Melbourne, Victoria, Australia
- Department of Dermatology, The Royal Children's Hospital, Melbourne, Victoria, Australia
- Faculty of Medicine, Dentistry & Health Sciences, The University of Melbourne, Melbourne, Victoria, Australia
| | - Susan J Robertson
- Department of Dermatology, The Royal Children's Hospital, Melbourne, Victoria, Australia
- Department of Dermatology, The Royal Melbourne Hospital, Melbourne, Victoria, Australia
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - David Orchard
- Department of Dermatology, The Royal Children's Hospital, Melbourne, Victoria, Australia
- Faculty of Medicine, Dentistry & Health Sciences, The University of Melbourne, Melbourne, Victoria, Australia
| | - Christopher Baker
- Skin Health Institute, Melbourne, Victoria, Australia
- Faculty of Medicine, Dentistry & Health Sciences, The University of Melbourne, Melbourne, Victoria, Australia
- Department of Dermatology, St Vincent's Hospital, Melbourne, Victoria, Australia
| | - Peter Foley
- Skin Health Institute, Melbourne, Victoria, Australia
- Faculty of Medicine, Dentistry & Health Sciences, The University of Melbourne, Melbourne, Victoria, Australia
- Department of Dermatology, St Vincent's Hospital, Melbourne, Victoria, Australia
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Armstrong A, Eyerich K, Conrad C, Zhu Y, Yang YW, Miller M, You Y, Shen YK, Foley P, Griffiths CEM, Strober B. Immunogenicity and pharmacokinetics of guselkumab among patients with moderate-to-severe psoriasis in VOYAGE-1 and VOYAGE-2. J Eur Acad Dermatol Venereol 2023; 37:e1375-e1379. [PMID: 37415560 DOI: 10.1111/jdv.19309] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Accepted: 06/27/2023] [Indexed: 07/08/2023]
Affiliation(s)
- A Armstrong
- Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - K Eyerich
- University of Freiburg, Baden-Württemberg, Germany
| | - C Conrad
- Lausanne University Hospital CHUV, Lausanne, Switzerland
| | - Y Zhu
- Janssen Research & Development, LLC, Spring House, Pennsylvania, USA
| | - Y-W Yang
- Immunology Global Medical Affairs, Janssen Pharmaceutical Companies of Johnson & Johnson, Horsham, Pennsylvania, USA
| | - M Miller
- Janssen Research & Development, LLC, Spring House, Pennsylvania, USA
| | - Y You
- Janssen Research & Development, LLC, Spring House, Pennsylvania, USA
| | - Y-K Shen
- Janssen Research & Development, LLC, Spring House, Pennsylvania, USA
| | - P Foley
- The University of Melbourne, St. Vincent's Hospital Melbourne and Probity Medical Research, Skin Health Institute, Carlton, Victoria, Australia
| | - C E M Griffiths
- Dermatology Centre, NIHR Manchester Biomedical Research Centre, University of Manchester, Manchester, UK
- King's College Hospital, King's College London, London, UK
| | - B Strober
- Yale University, New Haven, Connecticut, USA
- Central Connecticut Dermatology Research, Cromwell, Connecticut, USA
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Merola JF, Chiou AS, During E, Costanzo A, Foley P, Alfalasi A, Gogate S, Pinter A, Dodiuk-Gad R, Simon D, Tauber M, Weller R, Pereyra-Rodriguez JJ, Ardeleanu M, Wu J, Ozturk ZE. Dupilumab significantly improves sleep in adults with atopic dermatitis: results from the 12-week placebo-controlled period of the 24-week phase IV randomized double-blinded placebo-controlled DUPISTAD study. Br J Dermatol 2023; 189:685-694. [PMID: 37562034 DOI: 10.1093/bjd/ljad284] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Revised: 08/03/2023] [Accepted: 08/05/2023] [Indexed: 08/12/2023]
Abstract
BACKGROUND Sleep disturbance is a prominent symptom of atopic dermatitis (AD) and can result in insomnia, daytime fatigue, drowsiness, reduced productivity and impaired quality of life (QoL). OBJECTIVES The Dupilumab Effect on Sleep in AD Patients (DUPISTAD) phase IV randomized double-blinded placebo-controlled study evaluated the impact of dupilumab treatment on sleep and other patient- and physician-reported outcomes. METHODS Adults with moderate-to-severe AD were randomized 2 : 1 to dupilumab 300 mg once every 2 weeks (q2w) or placebo for 12 weeks; concomitant topical corticosteroids were permitted. Patients subsequently entered an open-label phase and received dupilumab 300 mg q2w for a further 12 weeks. The primary endpoint was the percentage change in sleep quality from baseline to week 12, assessed using a novel numeric rating scale (NRS). Secondary and exploratory endpoints included percentage change in peak pruritus NRS (PP NRS), change in SCORing Atopic Dermatitis (SCORAD), SCORAD sleep visual analogue scale (VAS), Eczema Area and Severity Index, Patient-Reported Outcomes Measurement Information System (PROMIS) sleep-related impairment T-score and the Epworth Sleepiness Scale. Sleep diary and wrist actigraphy measurements were recorded throughout the study. RESULTS In total, 127 patients received dupilumab and 61 patients received placebo. Demographic and baseline disease characteristics were balanced between groups. Sleep quality NRS significantly improved in patients treated with dupilumab by week 12 vs. placebo [least squares mean of the difference (LSMD) -15.5%, P < 0.001]. PP NRS (LSMD -27.9%, P < 0.001), SCORAD (LSMD -15.1, P < 0.001), SCORAD sleep VAS (LSMD -2.1, P < 0.001) and PROMIS T-score (LSMD -3.6, P < 0.001) were also significantly improved at week 12 with dupilumab vs. placebo. The overall percentage of patients reporting treatment-emergent adverse events was lower in the dupilumab group (56.7%) than in the placebo group (67.2%). CONCLUSIONS Dupilumab significantly improved sleep quality and perception of sleep continuity, itch, metrics of AD severity and QoL in adults with moderate-to-severe AD, with an acceptable safety profile compared with placebo.
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Affiliation(s)
- Joseph F Merola
- Department of Dermatology, Brigham and Women's Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Albert S Chiou
- Department of Dermatology, Stanford University, Palo Alto, CA, USA
| | - Emmanuel During
- Department of Neurology & Neurological Sciences, Stanford University, Palo Alto, CA, USA
- Department of Psychiatry and Behavioral Sciences, Division of Sleep Medicine, Stanford University, Palo Alto, CA, USA
| | - Antonio Costanzo
- Dermatology Unit, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Peter Foley
- Skin Health Institute, Carlton, VIC, Australia
- Department of Dermatology, St Vincent's Hospital Melbourne, Fitzroy, VIC, Australia
- Department of Medicine, The University of Melbourne, Melbourne, VIC, Australia
| | | | | | - Andreas Pinter
- Department of Dermatology, University Hospital Frankfurt am Main, Frankfurt am Main, Germany
| | - Roni Dodiuk-Gad
- Bruce Rappaport Faculty of Medicine, Technion Institute of Technology, Haifa, Israel
- Division of Dermatology, Department of Medicine, University of Toronto, Toronto, ON, Canada
- Dermatology Department, Emek Medical Center, Afula, Israel
| | - Dagmar Simon
- Department of Dermatology, Universitätsspital Bern, Bern, Switzerland
| | - Marie Tauber
- Department of Allergology and Clinical Immunology, CIRI Inserm U1111, Lyon Sud Hospital, Lyon, France
| | - Richard Weller
- Centre for Inflammation Research, University of Edinburgh, Edinburgh, UK
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6
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Footner E, Firipis K, Liu E, Baker C, Foley P, Kapsa RMI, Pirogova E, O'Connell C, Quigley A. Layer-by-Layer Analysis of In Vitro Skin Models. ACS Biomater Sci Eng 2023; 9:5933-5952. [PMID: 37791888 DOI: 10.1021/acsbiomaterials.3c00283] [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: 10/05/2023]
Abstract
In vitro human skin models are evolving into versatile platforms for the study of skin biology and disorders. These models have many potential applications in the fields of drug testing and safety assessment, as well as cosmetic and new treatment development. The development of in vitro skin models that accurately mimic native human skin can reduce reliance on animal models and also allow for more precise, clinically relevant testing. Recent advances in biofabrication techniques and biomaterials have led to the creation of increasingly complex, multilayered skin models that incorporate important functional components of skin, such as the skin barrier, mechanical properties, pigmentation, vasculature, hair follicles, glands, and subcutaneous layer. This improved ability to recapitulate the functional aspects of native skin enhances the ability to model the behavior and response of native human skin, as the complex interplay of cell-to-cell and cell-to-material interactions are incorporated. In this review, we summarize the recent developments in in vitro skin models, with a focus on their applications, limitations, and future directions.
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Affiliation(s)
- Elizabeth Footner
- Electrical and Biomedical Engineering, School of Engineering, RMIT University, Melbourne, VIC 3000, Australia
- Aikenhead Centre for Medical Discovery, St Vincent's Hospital Melbourne, Fitzroy, VIC 3065, Australia
| | - Kate Firipis
- Electrical and Biomedical Engineering, School of Engineering, RMIT University, Melbourne, VIC 3000, Australia
- Aikenhead Centre for Medical Discovery, St Vincent's Hospital Melbourne, Fitzroy, VIC 3065, Australia
| | - Emily Liu
- Electrical and Biomedical Engineering, School of Engineering, RMIT University, Melbourne, VIC 3000, Australia
- Aikenhead Centre for Medical Discovery, St Vincent's Hospital Melbourne, Fitzroy, VIC 3065, Australia
| | - Chris Baker
- Department of Dermatology, St Vincent's Hospital Melbourne, Fitzroy, VIC 3065, Australia
- Skin Health Institute, Carlton, VIC 3053, Australia
- Department of Medicine, University of Melbourne, St Vincent's Hospital Melbourne, Fitzroy, VIC 3065, Australia
| | - Peter Foley
- Department of Dermatology, St Vincent's Hospital Melbourne, Fitzroy, VIC 3065, Australia
- Skin Health Institute, Carlton, VIC 3053, Australia
- Department of Medicine, University of Melbourne, St Vincent's Hospital Melbourne, Fitzroy, VIC 3065, Australia
| | - Robert M I Kapsa
- Electrical and Biomedical Engineering, School of Engineering, RMIT University, Melbourne, VIC 3000, Australia
- Aikenhead Centre for Medical Discovery, St Vincent's Hospital Melbourne, Fitzroy, VIC 3065, Australia
- Department of Medicine, University of Melbourne, St Vincent's Hospital Melbourne, Fitzroy, VIC 3065, Australia
- Centre for Clinical Neurosciences and Neurological Research, St. Vincent's Hospital Melbourne, Fitzroy, VIC 3065, Australia
| | - Elena Pirogova
- Electrical and Biomedical Engineering, School of Engineering, RMIT University, Melbourne, VIC 3000, Australia
- Aikenhead Centre for Medical Discovery, St Vincent's Hospital Melbourne, Fitzroy, VIC 3065, Australia
| | - Cathal O'Connell
- Electrical and Biomedical Engineering, School of Engineering, RMIT University, Melbourne, VIC 3000, Australia
- Aikenhead Centre for Medical Discovery, St Vincent's Hospital Melbourne, Fitzroy, VIC 3065, Australia
| | - Anita Quigley
- Electrical and Biomedical Engineering, School of Engineering, RMIT University, Melbourne, VIC 3000, Australia
- Aikenhead Centre for Medical Discovery, St Vincent's Hospital Melbourne, Fitzroy, VIC 3065, Australia
- Department of Medicine, University of Melbourne, St Vincent's Hospital Melbourne, Fitzroy, VIC 3065, Australia
- Centre for Clinical Neurosciences and Neurological Research, St. Vincent's Hospital Melbourne, Fitzroy, VIC 3065, Australia
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Zhou C, Yang X, Yang B, Yan G, Dong X, Ding Y, Fan W, Li L, Yang D, Fang H, Ji C, Cheng H, Zhang S, Goh AH, Liu R, Gu X, Weng Z, Foley P, Sinclair R, Zhang J. A randomized, double-blind, placebo-controlled phase II study to evaluate the efficacy and safety of ivarmacitinib (SHR0302) in adult patients with moderate-to-severe alopecia areata. J Am Acad Dermatol 2023; 89:911-919. [PMID: 37019385 DOI: 10.1016/j.jaad.2023.02.063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Revised: 02/08/2023] [Accepted: 02/16/2023] [Indexed: 04/05/2023]
Abstract
BACKGROUND Alopecia areata (AA) is a CD8+ T cell-mediated autoimmune disease characterized by nonscarring hair loss. Ivarmacitinib, which is a selective oral Janus kinase 1 inhibitor, may interrupt certain cytokine signaling implicated in the pathogenesis of AA. OBJECTIVE To evaluate the efficacy and safety of ivarmacitinib in adult patients with AA who have ≥25% scalp hair loss. METHODS Eligible patients were randomized 1:1:1:1 to receive ivarmacitinib 2, 4, or 8 mg once daily or placebo for 24 weeks. The primary end point was the percentage change from baseline in the Severity of Alopecia Tool score at week 24. RESULTS A total of 94 patients were randomized. At week 24, the least squares mean difference in the percentage change from baseline in the Severity of Alopecia Tool score for ivarmacitinib 2, 4, and 8 mg and placebo groups were -30.51% (90% CI, -45.25, -15.76), -56.11% (90% CI, -70.28, -41.95), -51.01% (90% CI, -65.20, -36.82), and -19.87% (90% CI, -33.99, -5.75), respectively. Two serious adverse events-follicular lymphoma and COVID-19 pneumonia-were reported. LIMITATIONS A small sample size limits the generalizability of the results. CONCLUSION Treatment with ivarmacitinib 4 and 8 mg doses in patients with moderate and severe AA for 24 weeks was efficacious and generally tolerated.
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Affiliation(s)
- Cheng Zhou
- Peking University People's Hospital, Beijing
| | | | - Bin Yang
- Dermatology Hospital of Southern Medical University, Guangzhou
| | - Guofu Yan
- Chongqing Traditional Chinese Medicine Hospital, Chongqing
| | - Xiuqin Dong
- Guangdong Provincial People's Hospital, Guangzhou
| | | | - Weixin Fan
- Jiangsu Province Hospital, The First Affiliated Hospital with Nanjing Medical University, Nanjing
| | - Linfeng Li
- Beijing Friendship Hospital, Capital Medical University, Beijing
| | | | - Hong Fang
- First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou
| | - Chao Ji
- First Affiliated Hospital of Fujian Medical University, Fuzhou
| | - Hao Cheng
- Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou
| | | | | | | | | | | | - Peter Foley
- University of Melbourne, Skin & Cancer Foundation Inc., Melbourne
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8
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Foley P, Gebauer K, Sullivan J, McMeniman E, Shumack S, Ng J, James A, Rawlin M, Sidhu S, Tilakaratne D, Turner M, Radulski B, Nash P, Baker C. Australian consensus: Treatment goals for moderate to severe psoriasis in the era of targeted therapies - Adult patients. Australas J Dermatol 2023; 64:476-487. [PMID: 37501636 DOI: 10.1111/ajd.14138] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Accepted: 07/15/2023] [Indexed: 07/29/2023]
Abstract
BACKGROUND Over the last decade, the treatment landscape for moderate-severe psoriasis has rapidly evolved. The Australasian College of Dermatologists sought to review and update previously published treatment goals for moderate-severe psoriasis. METHODS A modified Delphi approach was used. Comprehensive literature review and guideline evaluation resulted in the development of statements and other questions to establish current clinical practices. Two rounds of anonymous voting were undertaken, with a collaborative meeting held in between to discuss areas of discordance. Overall, consensus was defined as achievement of ≥75% agreement in the range 7-9 on a 9-point scale (1 strongly disagree; 9 strongly agree). RESULTS Consensus was achieved on 26/29 statements in round 1 and a further 20 statements in round 2. There was strong agreement to expanding the classification/definition of psoriasis severity by including a choice of metrics, incorporating quality of life measures, and widening the scope of high-impact sites. Consensus was also reached on revised treatment response criteria, which were then incorporated into a new treatment algorithm. There was discordance with the current requirement to undertake a trial with established systemic agents before accessing targeted therapy. CONCLUSION The ability of new targeted treatment options to change the narrative in psoriasis patient care can only be properly realised if challenges to timely and equitable access are addressed. The proposed framework for the assessment, classification and management of moderate-severe psoriasis aligns with international recommendations. Its adoption into Australian clinical practice is hoped to improve treatment outcomes and patients' satisfaction with their care.
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Affiliation(s)
- Peter Foley
- Skin Health Institute, Carlton, Victoria, Australia
- Department of Dermatology, St Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia
- The University of Melbourne, Melbourne, Victoria, Australia
| | - Kurt Gebauer
- Fremantle Dermatology, Fremantle, Western Australia, Australia
- The University of Western Australia, Nedlands, Western Australia, Australia
| | - John Sullivan
- Kareena Private Hospital, Ramsay Surgical Centre, Miranda, New South Wales, Australia
- Kingsway Dermatology & Aesthetics, Miranda, New South Wales, Australia
| | - Erin McMeniman
- Dermatology Research Centre, Princess Alexandra Hospital Southside Clinical Unit, University of Queensland, Brisbane, Queensland, Australia
| | - Stephen Shumack
- Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
- Department of Dermatology, Royal North Shore Hospital, Sydney, New South Wales, Australia
| | - Jonathan Ng
- Hobart Medical Specialists, Hobart, Tasmania, Australia
| | - Amelia James
- Department of Dermatology, St Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia
| | - Morton Rawlin
- General Practitioner, Lower Templestowe, Victoria, Australia
| | - Shireen Sidhu
- Department of Dermatology, Royal Adelaide Hospital, Adelaide, South Australia, Australia
- Faculty of Health Sciences, School of Medicine, University of Adelaide, Adelaide, South Australia, Australia
| | - Dev Tilakaratne
- Department of Dermatology, Royal Darwin Hospital, Tiwi, Northwest Territories, Australia
- Darwin Dermatology, Tiwi, Northwest Territories, Australia
| | | | - Barbara Radulski
- CNC Dermatology, The Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - Peter Nash
- School of Medicine and Dentistry, Griffith University, Gold Coast, Queensland, Australia
- Department of Medicine, University of Queensland, Brisbane, Queensland, Australia
- Rheumatology Research Unit, Sunshine Coast, Queensland, Australia
| | - Christopher Baker
- Skin Health Institute, Carlton, Victoria, Australia
- Department of Dermatology, St Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia
- The University of Melbourne, Melbourne, Victoria, Australia
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Soleimani B, Board C, Yu T, Tracey I, Irani SR, Foley P. Immunotherapy-Responsive Neuropathic Pain and Allodynia in a Patient With Glycine Receptor Autoantibodies: A Case Report. Neurol Neuroimmunol Neuroinflamm 2023; 10:e200160. [PMID: 37640544 PMCID: PMC10462052 DOI: 10.1212/nxi.0000000000200160] [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] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Accepted: 07/13/2023] [Indexed: 08/31/2023]
Abstract
OBJECTIVES Neuropathic pain is common and distressing. Improved mechanistic understanding and pharmacotherapies are urgently needed. Molecularly specific pain syndromes may provide insights with translational relevance. Glycine receptors are known to play a key role in inhibitory neurotransmission in the spinal dorsal horn and have therefore been considered as targets for analgesic development. While autoantibodies directed against glycine receptors may rarely arise spontaneously in humans, a detailed phenotype of neuropathic pain and allodynia in association with these autoantibodies has not been described. METHODS We describe the case of a previously well adult presenting with severe neuropathic pain and allodynia as part of an autoimmune brainstem and spinal syndrome with glycine receptor autoantibodies. RESULTS Our patient experienced a severe illness, including marked neuropathic pain and allodynia, hypoventilation, tetraparesis, and ophthalmoplegia. A diagnosis of progressive encephalomyelitis with rigidity and myoclonus was made. Neuropathic pain was characterized with validated instruments and responded promptly to cause-directed immunotherapy. DISCUSSION A detailed longitudinal phenotyping, using validated pain measurement instruments, of severe neuropathic pain and allodynia associated with likely pathogenic glycine receptor autoantibodies is reported. This case may have relevance for translational development of analgesics targeting glycinergic neurotransmission.
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Affiliation(s)
- Babak Soleimani
- From the Department of Neurology (B.S.), Oxford University Hospitals; Department of Clinical Neurology (C.B.), John Radcliffe Hospital Oxford; Oxford Autoimmune Neurology Group (C.B., S.R.I.), Nuffield Department of Clinical Neurosciences University of Oxford; Department of Clinical Neurosciences (T.Y.), Royal Infirmary Edinburgh; Wellcome Centre for Integrative Neuroimaging (I.T.), University of Oxford; Department of Clinical Neurosciences (P.F.), Royal Infirmary of Edinburgh; and Anne Rowling Regenerative Neurology Clinic (P.F.), University of Edinburgh
| | - Callum Board
- From the Department of Neurology (B.S.), Oxford University Hospitals; Department of Clinical Neurology (C.B.), John Radcliffe Hospital Oxford; Oxford Autoimmune Neurology Group (C.B., S.R.I.), Nuffield Department of Clinical Neurosciences University of Oxford; Department of Clinical Neurosciences (T.Y.), Royal Infirmary Edinburgh; Wellcome Centre for Integrative Neuroimaging (I.T.), University of Oxford; Department of Clinical Neurosciences (P.F.), Royal Infirmary of Edinburgh; and Anne Rowling Regenerative Neurology Clinic (P.F.), University of Edinburgh
| | - Tony Yu
- From the Department of Neurology (B.S.), Oxford University Hospitals; Department of Clinical Neurology (C.B.), John Radcliffe Hospital Oxford; Oxford Autoimmune Neurology Group (C.B., S.R.I.), Nuffield Department of Clinical Neurosciences University of Oxford; Department of Clinical Neurosciences (T.Y.), Royal Infirmary Edinburgh; Wellcome Centre for Integrative Neuroimaging (I.T.), University of Oxford; Department of Clinical Neurosciences (P.F.), Royal Infirmary of Edinburgh; and Anne Rowling Regenerative Neurology Clinic (P.F.), University of Edinburgh
| | - Irene Tracey
- From the Department of Neurology (B.S.), Oxford University Hospitals; Department of Clinical Neurology (C.B.), John Radcliffe Hospital Oxford; Oxford Autoimmune Neurology Group (C.B., S.R.I.), Nuffield Department of Clinical Neurosciences University of Oxford; Department of Clinical Neurosciences (T.Y.), Royal Infirmary Edinburgh; Wellcome Centre for Integrative Neuroimaging (I.T.), University of Oxford; Department of Clinical Neurosciences (P.F.), Royal Infirmary of Edinburgh; and Anne Rowling Regenerative Neurology Clinic (P.F.), University of Edinburgh
| | - Sarosh R Irani
- From the Department of Neurology (B.S.), Oxford University Hospitals; Department of Clinical Neurology (C.B.), John Radcliffe Hospital Oxford; Oxford Autoimmune Neurology Group (C.B., S.R.I.), Nuffield Department of Clinical Neurosciences University of Oxford; Department of Clinical Neurosciences (T.Y.), Royal Infirmary Edinburgh; Wellcome Centre for Integrative Neuroimaging (I.T.), University of Oxford; Department of Clinical Neurosciences (P.F.), Royal Infirmary of Edinburgh; and Anne Rowling Regenerative Neurology Clinic (P.F.), University of Edinburgh
| | - Peter Foley
- From the Department of Neurology (B.S.), Oxford University Hospitals; Department of Clinical Neurology (C.B.), John Radcliffe Hospital Oxford; Oxford Autoimmune Neurology Group (C.B., S.R.I.), Nuffield Department of Clinical Neurosciences University of Oxford; Department of Clinical Neurosciences (T.Y.), Royal Infirmary Edinburgh; Wellcome Centre for Integrative Neuroimaging (I.T.), University of Oxford; Department of Clinical Neurosciences (P.F.), Royal Infirmary of Edinburgh; and Anne Rowling Regenerative Neurology Clinic (P.F.), University of Edinburgh.
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10
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Blauvelt A, Thaçi D, Papp KA, Ho V, Ghoreschi K, Kim BS, Miller M, Shen YK, You Y, Chan D, Yu J, Yang YW, Lebwohl MG, Gottlieb AB, Crowley J, Foley P. Safety of guselkumab in patients with psoriasis with a history of malignancy: 5-year results from the VOYAGE 1 and VOYAGE 2 trials. Br J Dermatol 2023; 189:132-134. [PMID: 36944555 DOI: 10.1093/bjd/ljad081] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Accepted: 04/02/2023] [Indexed: 03/23/2023]
Abstract
The VOYAGE 1 and 2 studies of guselkumab in moderate-to-severe psoriasis are among the first studies of biologics to include patients with a history of malignancy. In these studies, 18 guselkumab-treated patients had a history of malignancy (excluding nonmelanoma skin cancer) > 5 years prior to enrolment. These 18 patients were exposed to guselkumab for up to 5 years; during this time, one patient had a recurrence of bronchial carcinoma, and three patients developed new malignancies (breast cancer, melanoma and sebaceous carcinoma). All patients with new or recurrent malignancies had underlying risk factors for malignancy. Overall, the results of this analysis in a small population of patients with a history of malignancy support the favourable long-term safety profile of guselkumab.
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Affiliation(s)
| | - Diamant Thaçi
- Institute and Comprehensive Center for Inflammatory Medicine, University of Luebeck, Luebeck, Germany
| | - Kim A Papp
- Alliance Clinical Research and Probity Medical Research, Waterloo, ON, Canada
| | - Vincent Ho
- Department of Dermatology and Skin Science, University of British Columbia, Vancouver, BC, Canada
| | - Kamran Ghoreschi
- Department of Dermatology, Venereology and Allergology, Charité - Universitätsmedizin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health Berlin, Germany
| | - Byung Soo Kim
- Pusan National University Hospital, Busan, South Korea
| | - Megan Miller
- Janssen Research & Development, LLC, Spring House, PA, USA
| | | | - Yin You
- Janssen Research & Development, LLC, Spring House, PA, USA
| | - Daphne Chan
- Janssen Scientific Affairs, LLC, Horsham, PA, USA
| | - Jenny Yu
- Janssen Research & Development, LLC, Spring House, PA, USA
| | - Ya-Wen Yang
- Immunology Global Medical Affairs, Janssen Pharmaceutical Companies of Johnson & Johnson, Horsham, PA, USA
| | - Mark G Lebwohl
- Department of Dermatology, Icahn School of Medicine at Mt Sinai, New York, NY, USA
| | - Alice B Gottlieb
- Department of Dermatology, Icahn School of Medicine at Mt Sinai, New York, NY, USA
| | - Jeffrey Crowley
- Bakersfield Dermatology and Skin Cancer Medical Group, Bakersfield, CA, USA
| | - Peter Foley
- The University of Melbourne, St Vincent's Hospital Melbourne and Probity Medical Research, Skin Health Institute, Carlton, VIC, Australia
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11
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Strober B, Thaçi D, Sofen H, Kircik L, Gordon KB, Foley P, Rich P, Paul C, Bagel J, Colston E, Throup J, Kundu S, Sekaran C, Linaberry M, Banerjee S, Papp KA. Treatment of plaque psoriasis with deucravacitinib (POETYK PSO-2 study): a plain language summary. Immunotherapy 2023. [PMID: 37150956 DOI: 10.2217/imt-2023-0062] [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: 05/09/2023] Open
Abstract
WHAT IS THIS SUMMARY ABOUT? This is a summary of a paper published in a medical journal that describes the results of a study called POETYK PSO-2, which investigated a new treatment for plaque psoriasis. Plaque psoriasis appears on the body as dry, discolored, patches of skin that can be flaky and covered in scales. This can make the skin itch, crack or bleed and make it difficult for people with psoriasis to perform basic everyday tasks. Treatments are available, but some do not always reduce symptoms or may need to be injected or taken multiple times a day, which can be difficult to do, or can have undesirable side effects. Researchers are looking for new treatments for psoriasis. WHAT HAPPENED IN THE STUDY? Deucravacitinib is a once-daily pill taken by mouth (orally) that was studied as a treatment for moderate to severe plaque psoriasis in two large studies conducted globally, PSO-1 and PSO-2. POETYK PSO-2 was a Phase 3 research study, which is a study that tests a treatment in a large group of participants, that looked at how well deucravacitinib worked in participants with moderate to severe plaque psoriasis compared to a placebo (an inactive pill that has no effect) and an approved psoriasis treatment called apremilast, which is a pill taken twice a day. These medications were tested in adults with moderate to severe plaque psoriasis, which is psoriasis involving 10% or more of their body (equal to 10 or more handprints). The aims of the POETYK PSO-2 study were to find out if treatment with deucravacitinib could improve psoriasis for the participants in the study and to see if there were any side effects. Side effects are events that happened during treatment that may or may not be caused by that treatment. The study also wanted to find out what would happen after stopping treatment with deucravacitinib in participants who had shown major improvements in their psoriasis. WHAT DO THE RESULTS OF THE POETYK PSO-2 STUDY SHOW? After 4 months of treatment, more participants taking deucravacitinib had significantly greater improvements in psoriasis than those taking placebo or apremilast. The study also showed that participants continued to see these improvements after taking deucravacitinib for up to 1 year. Some participants maintained the improvements in their psoriasis with deucravacitinib after stopping treatment and switching to a placebo. Side effects for participants taking deucravacitinib were generally mild and occurred in similar numbers to those in participants taking placebo. The most common side effects in participants taking deucravacitinib were inflammation of the nose and throat (a common cold) which occurred at a similar rate in participants who took placebo. Clinical Trial Registration: NCT03611751 (POETYK PSO-2 study) (ClinicalTrials.gov).
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Affiliation(s)
- Bruce Strober
- Department of Dermatology, Yale University School of Medicine, New Haven, & Central Connecticut Dermatology Research, Cromwell, CT, USA
| | - Diamant Thaçi
- Comprehensive Center for Inflammation Medicine, University of Lübeck, Lübeck, Germany
| | - Howard Sofen
- Department of Dermatology & Pediatrics, UCLA School of Medicine, Los Angeles, CA, USA
| | - Leon Kircik
- Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Kenneth B Gordon
- Department of Dermatology, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Peter Foley
- Department of Dermatology, The University of Melbourne, Skin Health Institute & Probity Medical Research, Carlton, VIC, Australia
| | - Phoebe Rich
- Oregon Dermatology & Research Center, Portland, OR, USA
| | - Carle Paul
- University of Toulouse & CHU, Toulouse, France
| | - Jerry Bagel
- Psoriasis Treatment Center of New Jersey, East Windsor, NJ, USA
| | | | | | | | | | | | | | - Kim A Papp
- Alliance Clinical Trials & Probity Medical Research, Waterloo, ON, Canada
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12
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De Bruin-Weller M, Deleuran M, Biedermann T, Bissonnette R, Foley P, Girolomoni G, Hercogová J, Hong CH, Katoh N, Pink A, Richard MA, Shumack S, Silvestre JF, Thyssen JP, Weidinger S. The Treat-to-Target Project in Atopic Dermatitis: One Year On. Acta Derm Venereol 2023; 103:adv5382. [PMID: 37083095 PMCID: PMC10134065 DOI: 10.2340/actadv.v103.5382] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Accepted: 02/28/2023] [Indexed: 04/22/2023] Open
Abstract
Atopic dermatitis is a chronic skin condition for which a range of systemic treatments have recently been approved. A treat-to-target strategy has been developed previously alongside an algorithm to guide the management of patients with atopic dermatitis. Here, we review the strategy and algorithm in the context of the evolving therapeutic landscape, and identify areas for further refinement and development.
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Affiliation(s)
- Marjolein De Bruin-Weller
- Department of Allergology and Dermatology, UMC Utrecht, National Expertise Center for Eczema, Utrecht, The Netherlands.
| | - Mette Deleuran
- Department of Dermatology and Venereology, Aarhus University Hospital, Aarhus, Denmark
| | - Tilo Biedermann
- Department of Dermatology and Allergy, Technical University of Munich, Munich, Germany
| | | | - Peter Foley
- The University of Melbourne, St Vincent's Hospital Melbourne, Melbourne, Australia; Probity Medical Research, Skin Health Institute, Melbourne, Victoria, Australia
| | - Giampiero Girolomoni
- Department of Medicine, Section of Dermatology and Venereology, University of Verona, Italy
| | - Jana Hercogová
- Institute of Clinical and Experimental Medicine, Prague, Czech Republic
| | - Chih-Ho Hong
- Department of Dermatology and Skin Science, University of British Columbia, Vancouver, Canada
| | - Norito Katoh
- Department of Dermatology, Kyoto Prefectural University of Medicine Graduate School of Medical Science, Kyoto, Japan
| | - Andrew Pink
- St John's Institute of Dermatology, Guy's and St, Thomas' NHS Foundation Trust, London, UK; Department of Dermatology, Kings College, London, UK
| | - Marie-Aleth Richard
- CEReSSEA 3279, Research Center in Health Services and Quality of Life, Aix Marseille University, Marseille, France; Department of Dermatology, University Hospital of La Timone, Marseille, France; Dermatology Department, Assistance Publique Hôpitaux de Marseille, APHM, Marseille, France
| | - Stephen Shumack
- Department of Dermatology, Royal North Shore Hospital, Sydney, New South Wales, Australia
| | | | - Jacob P Thyssen
- Department of Dermatology, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Stephan Weidinger
- Department of Dermatology and Allergy, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
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13
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Blauvelt A, Lebwohl M, Langley RG, Rowland K, Yang YW, Chan D, Miller M, You Y, Yu J, Thaҫi D, Foley P, Papp KA. Malignancy Rates Through 5 Years of Follow-up in Patients With Moderate-to-Severe Psoriasis Treated With Guselkumab: Pooled Results From the VOYAGE 1 and VOYAGE 2 Trials. J Am Acad Dermatol 2023:S0190-9622(23)00524-8. [PMID: 37019386 DOI: 10.1016/j.jaad.2023.03.035] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Revised: 03/05/2023] [Accepted: 03/09/2023] [Indexed: 04/05/2023]
Abstract
BACKGROUND Malignancy risk surveillance among patients receiving long-term immunomodulatory psoriasis treatments remains an important safety objective. OBJECTIVE To report malignancy rates in patients with moderate-to-severe psoriasis treated with guselkumab for up to 5 years vs. general and psoriasis patient populations. METHODS Cumulative rates of malignancies/100 patient-years (PY) were evaluated in 1721 guselkumab-treated patients from VOYAGE 1&2. Malignancy rates (excluding nonmelanoma skin cancer [NMSC]) were compared with rates in the Psoriasis Longitudinal Assessment and Registry (PSOLAR). Standardized incidence ratios (SIRs) comparing malignancy rates (excluding NMSC and cervical cancer in situ) between guselkumab-treated patients and the general US population using Surveillance, Epidemiology, and End Results data were calculated, adjusting for age, sex, and race. RESULTS Of 1721 guselkumab-treated patients (>7100 PY), 24 had NMSC (0.34/100PY; basal:squamous cell carcinoma ratio=2.2:1) and 32 had malignancies excluding NMSC (0.45/100PY). For comparison, the malignancy rate excluding NMSC was 0.68/100PY in PSOLAR. Malignancy rates (excluding NMSC/cervical cancer in situ) in guselkumab-treated patients were consistent with those expected in the general US population (SIR=0.93). LIMITATIONS Inherent imprecision in determining malignancy rates. CONCLUSIONS In patients treated with guselkumab for up to 5 years, malignancy rates were low and generally consistent with rates in general and psoriasis patient populations.
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14
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Strober B, Tada Y, Mrowietz U, Lebwohl M, Foley P, Langley RG, Warren RB, Wang M, Vanvoorden V, Szilagyi B, Ciaravino V, Paul C. Bimekizumab maintenance of response through three years in patients with moderate to severe plaque psoriasis: Results from the BE BRIGHT open-label extension trial. Br J Dermatol 2023; 188:749-759. [PMID: 36967713 DOI: 10.1093/bjd/ljad035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Revised: 02/06/2023] [Accepted: 02/13/2023] [Indexed: 03/29/2023]
Abstract
Abstract
Background
Given the chronic nature of psoriasis and the loss of response that can be observed with therapies over time, it is important to understand the long-;term efficacy of new treatments.
Objective
To evaluate maintenance of Week 16 responses with bimekizumab treatment through Year 3, in patients with moderate to severe plaque psoriasis.
Methods
Data were pooled from bimekizumab-treated patients in the 52-week (BE VIVID) and 56-week (BE READY and BE SURE) phase 3 studies, and their ongoing open-label extension (OLE), BE BRIGHT. Efficacy outcomes are reported through three years of bimekizumab treatment in patients with an efficacy response at Week 16. Missing data were imputed primarily using modified non-responder imputation (mNRI), with non-responder imputation and observed case data also reported.
Results
A total of 989 patients were randomized to bimekizumab at baseline in BE VIVID, BE READY, and BE SURE. At Week 16, 693 patients achieved ≥90% reduction from baseline in Psoriasis Area and Severity Index (PASI 90), 503 achieved 100% reduction from baseline in PASI (PASI 100), 694 achieved absolute PASI ≤2, and 597 achieved body surface area (BSA) ≤1%, and continued into the OLE. Of these, 93.0% maintained PASI 90, 80.8% maintained PASI 100, 94.0% maintained PASI ≤2, and 90.3% maintained BSA ≤1% responses through to three years of bimekizumab treatment (mNRI). Among Week 16 PASI 90 responders, 96.8% and 72.5% also achieved Investigator’s Global Assessment (IGA) 0/1 and PASI 100 at Week 16, respectively, and 92.2% and 73.4% achieved these responses at Year 3 (mNRI). Among Week 16 PASI 100 responders, 76.3% also achieved Dermatology Life Quality Index (DLQI) 0/1 at Week 16, and DLQI 0/1 response increased with continuous bimekizumab treatment to 89.0% at Year 3 (mNRI).
Conclusions
High levels of clinical response were maintained through to three years of bimekizumab treatment in the vast majority of Week 16 responders. Long-term treatment with bimekizumab was efficacious, with important benefits on health-related quality of life (HRQoL), in patients with moderate to severe plaque psoriasis.
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Affiliation(s)
- Bruce Strober
- Department of Dermatology, Yale University, New Haven, Connecticut, USA
- Central Connecticut Dermatology Research, Cromwell, Connecticut, USA
| | - Yayoi Tada
- Department of Dermatology, Teikyo University School of Medicine, Tokyo, Japan
| | - Ulrich Mrowietz
- Psoriasis Center, Department of Dermatology, University Medical Center Schleswig-Holstein, Campus Kiel, Germany
| | - Mark Lebwohl
- Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Peter Foley
- The University of Melbourne, St. Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia
- Probity Medical Research Inc., Skin Health Institute, Carlton, Victoria, Australia
| | | | - Richard B Warren
- Dermatology Centre, Salford Royal NHS Foundation Trust, Manchester NIHR Biomedical Research Centre, The University of Manchester, Manchester, UK
| | - Maggie Wang
- UCB Pharma, Morrisville, North Carolina, USA
| | | | | | | | - Carle Paul
- Toulouse University and CHU, Toulouse, France
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15
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Brown FS, Glasmacher SA, Taylor D, Jenkins R, Chandran S, Gillespie D, Foley P. Pain and cognitive performance in adults with multiple sclerosis: A systematic review. Mult Scler Relat Disord 2023; 71:104584. [PMID: 36871373 DOI: 10.1016/j.msard.2023.104584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2022] [Revised: 02/08/2023] [Accepted: 02/16/2023] [Indexed: 02/22/2023]
Abstract
INTRODUCTION Pain and cognitive dysfunction are separately known to be important manifestations of multiple sclerosis (MS). Although pain is a complex subjective phenomenon with affective and cognitive aspects, it is not known if people with MS reporting pain are at greater risk of reduced performance in objective tests of cognition. The presence or direction of any association remains to be clarified, as do the roles of confounders such as fatigue, medication and mood. METHODS We conducted a systematic review of studies examining the relationship between pain and objectively measured cognition in adults with confirmed MS, according to a pre-registered protocol (PROSPERO 42,020,171,469). We carried out searches in MEDLINE, Embase and PsychInfo. Studies of adults with any subtype of MS, with chronic pain and in which cognitive evaluation was conducted by validated instruments were included. We evaluated the role of potential confounders (medication, depression, anxiety, fatigue and sleep) and described findings by eight pre-specified cognitive domains. Risk of bias was assessed using the Newcastle-Ottawa Scale. RESULTS 11 studies (n = 3714 participants, range 16 to 1890 per study) were included in the review. Four studies included longitudinal data. Nine studies identified a relationship between pain and objectively measured cognitive performance. In seven of these studies, higher pain scores were associated with poorer cognitive performance. However, no evidence was available for some cognitive domains. Heterogeneous study methodology precluded meta-analysis. Studies infrequently controlled for the specified confounders. Most studies were judged to be at risk of bias. DISCUSSION Several studies, but not all, identified a negative relationship between pain severity and objectively measured cognitive performance. Our ability to further characterise this relationship is limited by study design and lack of evidence in many cognitive domains. Future studies should better establish this relationship and delineate the neurological substrate underpinning it.
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Affiliation(s)
| | - Stella A Glasmacher
- Anne Rowling Regenerative Neurology Clinic, University of Edinburgh, Chancellor's Building, Edinburgh, UK; Centre for Clinical Brain Sciences, University of Edinburgh, Chancellor's Building, Edinburgh, UK; Department of Neurology, RWTH Aachen University, Aachen, Germany
| | | | | | - Siddharthan Chandran
- Anne Rowling Regenerative Neurology Clinic, University of Edinburgh, Chancellor's Building, Edinburgh, UK; Centre for Clinical Brain Sciences, University of Edinburgh, Chancellor's Building, Edinburgh, UK; Euan MacDonald Centre for Motor Neurone Disease Research, University of Edinburgh, Chancellor's Building, Edinburgh, UK; UK Dementia Research Institute at University of Edinburgh, Chancellor's Building, Edinburgh, UK
| | - David Gillespie
- Department of Clinical Neurosciences, NHS Lothian, Edinburgh, UK
| | - Peter Foley
- Anne Rowling Regenerative Neurology Clinic, University of Edinburgh, Chancellor's Building, Edinburgh, UK; Centre for Clinical Brain Sciences, University of Edinburgh, Chancellor's Building, Edinburgh, UK
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16
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Wong C, Gregory JM, Liao J, Egan K, Vesterinen HM, Ahmad Khan A, Anwar M, Beagan C, Brown FS, Cafferkey J, Cardinali A, Chiam JY, Chiang C, Collins V, Dormido J, Elliott E, Foley P, Foo YC, Fulton-Humble L, Gane AB, Glasmacher SA, Heffernan Á, Jayaprakash K, Jayasuriya N, Kaddouri A, Kiernan J, Langlands G, Leighton D, Liu J, Lyon J, Mehta AR, Meng A, Nguyen V, Park NH, Quigley S, Rashid Y, Salzinger A, Shiell B, Singh A, Soane T, Thompson A, Tomala O, Waldron FM, Selvaraj BT, Chataway J, Swingler R, Connick P, Pal S, Chandran S, Macleod M. Systematic, comprehensive, evidence-based approach to identify neuroprotective interventions for motor neuron disease: using systematic reviews to inform expert consensus. BMJ Open 2023; 13:e064169. [PMID: 36725099 PMCID: PMC9896226 DOI: 10.1136/bmjopen-2022-064169] [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] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Accepted: 01/10/2023] [Indexed: 02/03/2023] Open
Abstract
OBJECTIVES Motor neuron disease (MND) is an incurable progressive neurodegenerative disease with limited treatment options. There is a pressing need for innovation in identifying therapies to take to clinical trial. Here, we detail a systematic and structured evidence-based approach to inform consensus decision making to select the first two drugs for evaluation in Motor Neuron Disease-Systematic Multi-arm Adaptive Randomised Trial (MND-SMART: NCT04302870), an adaptive platform trial. We aim to identify and prioritise candidate drugs which have the best available evidence for efficacy, acceptable safety profiles and are feasible for evaluation within the trial protocol. METHODS We conducted a two-stage systematic review to identify potential neuroprotective interventions. First, we reviewed clinical studies in MND, Alzheimer's disease, Huntington's disease, Parkinson's disease and multiple sclerosis, identifying drugs described in at least one MND publication or publications in two or more other diseases. We scored and ranked drugs using a metric evaluating safety, efficacy, study size and study quality. In stage two, we reviewed efficacy of drugs in MND animal models, multicellular eukaryotic models and human induced pluripotent stem cell (iPSC) studies. An expert panel reviewed candidate drugs over two shortlisting rounds and a final selection round, considering the systematic review findings, late breaking evidence, mechanistic plausibility, safety, tolerability and feasibility of evaluation in MND-SMART. RESULTS From the clinical review, we identified 595 interventions. 66 drugs met our drug/disease logic. Of these, 22 drugs with supportive clinical and preclinical evidence were shortlisted at round 1. Seven drugs proceeded to round 2. The panel reached a consensus to evaluate memantine and trazodone as the first two arms of MND-SMART. DISCUSSION For future drug selection, we will incorporate automation tools, text-mining and machine learning techniques to the systematic reviews and consider data generated from other domains, including high-throughput phenotypic screening of human iPSCs.
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Affiliation(s)
- Charis Wong
- Anne Rowling Regenerative Neurology Clinic, The University of Edinburgh, Edinburgh, UK
- Euan MacDonald Centre for Motor Neuron Disease Research, The University of Edinburgh, Edinburgh, UK
- Centre for Clinical Brain Sciences, The University of Edinburgh, Edinburgh, UK
- Medical Research Council Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, University College London, London, UK
| | - Jenna M Gregory
- Euan MacDonald Centre for Motor Neuron Disease Research, The University of Edinburgh, Edinburgh, UK
- Centre for Clinical Brain Sciences, The University of Edinburgh, Edinburgh, UK
- Institute of Medical Sciences, University of Aberdeen, Aberdeen, UK
| | - Jing Liao
- Centre for Clinical Brain Sciences, The University of Edinburgh, Edinburgh, UK
| | - Kieren Egan
- Centre for Clinical Brain Sciences, The University of Edinburgh, Edinburgh, UK
- Computer and Information Science, University of Strathclyde, Glasgow, UK
| | - Hanna M Vesterinen
- Centre for Clinical Brain Sciences, The University of Edinburgh, Edinburgh, UK
| | - Aimal Ahmad Khan
- Edinburgh Medical School, The University of Edinburgh, Edinburgh, UK
| | - Maarij Anwar
- Edinburgh Medical School, The University of Edinburgh, Edinburgh, UK
| | - Caitlin Beagan
- Edinburgh Medical School, The University of Edinburgh, Edinburgh, UK
| | - Fraser S Brown
- Anne Rowling Regenerative Neurology Clinic, The University of Edinburgh, Edinburgh, UK
- Centre for Clinical Brain Sciences, The University of Edinburgh, Edinburgh, UK
| | - John Cafferkey
- Royal Infirmary of Edinburgh, NHS Lothian, Edinburgh, UK
| | - Alessandra Cardinali
- Euan MacDonald Centre for Motor Neuron Disease Research, The University of Edinburgh, Edinburgh, UK
- Centre for Clinical Brain Sciences, The University of Edinburgh, Edinburgh, UK
- UK Dementia Research Institute, University of Edinburgh, Edinburgh, UK
| | - Jane Yi Chiam
- Edinburgh Medical School, The University of Edinburgh, Edinburgh, UK
| | - Claire Chiang
- Edinburgh Medical School, The University of Edinburgh, Edinburgh, UK
| | - Victoria Collins
- Edinburgh Medical School, The University of Edinburgh, Edinburgh, UK
| | | | - Elizabeth Elliott
- Anne Rowling Regenerative Neurology Clinic, The University of Edinburgh, Edinburgh, UK
- Euan MacDonald Centre for Motor Neuron Disease Research, The University of Edinburgh, Edinburgh, UK
- Centre for Clinical Brain Sciences, The University of Edinburgh, Edinburgh, UK
| | - Peter Foley
- Anne Rowling Regenerative Neurology Clinic, The University of Edinburgh, Edinburgh, UK
- Centre for Clinical Brain Sciences, The University of Edinburgh, Edinburgh, UK
| | - Yu Cheng Foo
- Edinburgh Medical School, The University of Edinburgh, Edinburgh, UK
| | | | - Angus B Gane
- College of Medicine and Veterinary Medicine, The University of Edinburgh, Edinburgh, UK
| | - Stella A Glasmacher
- Anne Rowling Regenerative Neurology Clinic, The University of Edinburgh, Edinburgh, UK
- Centre for Clinical Brain Sciences, The University of Edinburgh, Edinburgh, UK
| | - Áine Heffernan
- UK Dementia Research Institute, University of Edinburgh, Edinburgh, UK
| | - Kiran Jayaprakash
- Anne Rowling Regenerative Neurology Clinic, The University of Edinburgh, Edinburgh, UK
- Centre for Clinical Brain Sciences, The University of Edinburgh, Edinburgh, UK
| | - Nimesh Jayasuriya
- Royal Infirmary of Edinburgh, NHS Lothian, Edinburgh, UK
- College of Medicine and Veterinary Medicine, The University of Edinburgh, Edinburgh, UK
| | - Amina Kaddouri
- Edinburgh Medical School, The University of Edinburgh, Edinburgh, UK
| | - Jamie Kiernan
- Edinburgh Medical School, The University of Edinburgh, Edinburgh, UK
| | - Gavin Langlands
- Institute of Neurological Sciences, NHS Greater Glasgow and Clyde, Glasgow, UK
| | - D Leighton
- Euan MacDonald Centre for Motor Neuron Disease Research, The University of Edinburgh, Edinburgh, UK
- Centre for Clinical Brain Sciences, The University of Edinburgh, Edinburgh, UK
- School of Psychology and Neuroscience, University of Glasgow, Glasgow, UK
| | - Jiaming Liu
- Edinburgh Medical School, The University of Edinburgh, Edinburgh, UK
| | - James Lyon
- Royal Infirmary of Edinburgh, NHS Lothian, Edinburgh, UK
| | - Arpan R Mehta
- Anne Rowling Regenerative Neurology Clinic, The University of Edinburgh, Edinburgh, UK
- Euan MacDonald Centre for Motor Neuron Disease Research, The University of Edinburgh, Edinburgh, UK
- Centre for Clinical Brain Sciences, The University of Edinburgh, Edinburgh, UK
- UK Dementia Research Institute, University of Edinburgh, Edinburgh, UK
| | - Alyssa Meng
- Centre for Discovery Brain Sciences, The University of Edinburgh, Edinburgh, UK
| | - Vivienne Nguyen
- Edinburgh Medical School, The University of Edinburgh, Edinburgh, UK
| | - Na Hyun Park
- Royal Infirmary of Edinburgh, NHS Lothian, Edinburgh, UK
| | - Suzanne Quigley
- Anne Rowling Regenerative Neurology Clinic, The University of Edinburgh, Edinburgh, UK
- Centre for Clinical Brain Sciences, The University of Edinburgh, Edinburgh, UK
| | - Yousuf Rashid
- Edinburgh Medical School, The University of Edinburgh, Edinburgh, UK
| | - Andrea Salzinger
- Centre for Clinical Brain Sciences, The University of Edinburgh, Edinburgh, UK
- UK Dementia Research Institute, University of Edinburgh, Edinburgh, UK
| | - Bethany Shiell
- College of Medicine and Veterinary Medicine, The University of Edinburgh, Edinburgh, UK
| | - Ankur Singh
- College of Medicine and Veterinary Medicine, The University of Edinburgh, Edinburgh, UK
| | - Tim Soane
- Neurology Department, NHS Forth Valley, Stirling, UK
| | - Alexandra Thompson
- College of Medicine and Veterinary Medicine, The University of Edinburgh, Edinburgh, UK
| | - Olaf Tomala
- Edinburgh Medical School, The University of Edinburgh, Edinburgh, UK
| | - Fergal M Waldron
- Institute of Medical Sciences, University of Aberdeen, Aberdeen, UK
- Institute of Evolutionary Biology, The University of Edinburgh, Edinburgh, UK
| | - Bhuvaneish T Selvaraj
- Anne Rowling Regenerative Neurology Clinic, The University of Edinburgh, Edinburgh, UK
- Euan MacDonald Centre for Motor Neuron Disease Research, The University of Edinburgh, Edinburgh, UK
- Centre for Clinical Brain Sciences, The University of Edinburgh, Edinburgh, UK
- UK Dementia Research Institute, University of Edinburgh, Edinburgh, UK
| | - Jeremy Chataway
- Medical Research Council Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, University College London, London, UK
- Queen Square Multiple Sclerosis Centre, Department of Neuroinflammation, UCL Queen Square Institute of Neurology, London, UK
- University College London Hospitals, Biomedical Research Centre, National Institute for Health Research, London, UK
| | - Robert Swingler
- Euan MacDonald Centre for Motor Neuron Disease Research, The University of Edinburgh, Edinburgh, UK
| | - Peter Connick
- Anne Rowling Regenerative Neurology Clinic, The University of Edinburgh, Edinburgh, UK
- Centre for Clinical Brain Sciences, The University of Edinburgh, Edinburgh, UK
| | - Suvankar Pal
- Anne Rowling Regenerative Neurology Clinic, The University of Edinburgh, Edinburgh, UK
- Euan MacDonald Centre for Motor Neuron Disease Research, The University of Edinburgh, Edinburgh, UK
- Centre for Clinical Brain Sciences, The University of Edinburgh, Edinburgh, UK
| | - Siddharthan Chandran
- Anne Rowling Regenerative Neurology Clinic, The University of Edinburgh, Edinburgh, UK
- Euan MacDonald Centre for Motor Neuron Disease Research, The University of Edinburgh, Edinburgh, UK
- Centre for Clinical Brain Sciences, The University of Edinburgh, Edinburgh, UK
- UK Dementia Research Institute, University of Edinburgh, Edinburgh, UK
| | - Malcolm Macleod
- Centre for Clinical Brain Sciences, The University of Edinburgh, Edinburgh, UK
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Merola JF, Chiou AS, During E, Costanzo A, Foley P, Ardeleanu M, Wu J, Ozturk ZE. 335 Improvement in sleep quality, anxiety and depression in adults with moderate-to-severe atopic dermatitis with dupilumab treatment. Br J Dermatol 2023. [DOI: 10.1093/bjd/ljac140.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Abstract
Sleep disturbance is considered one of the most prevalent symptoms of atopic dermatitis (AD), and is associated with daytime sleepiness, anxiety and depression. In previous phase 3 trials, dupilumab treatment demonstrated significant improvement in objective AD signs and severity of symptoms, including sleep disturbance and mental health symptoms. To investigate the effect of dupilumab for up to 24 weeks on sleep quality, daytime sleepiness, anxiety and depression, using data from the DUPISTAD (NCT04033367) study. The randomized, phase 4 DUPISTAD study, was divided into two 12-week periods: an initial double-blind placebo-controlled period, and a subsequent 12-week open-label extension (OLE) period. The 24-week study enrolled adult patients with moderate-to-severe AD (Eczema Area and Severity Index score ≥12, Peak Pruritus Numeric Rating Scale [NRS] score ≥3, Sleep Disturbance NRS average score ≥5) who showed an inadequate response to topical treatments. These patients were randomized 2 : 1 to dupilumab 300 mg every 2 weeks (q2w) for both the double-blind and OLE periods or placebo for the initial double-blind period, followed by dupilumab 300 mg q2w for the OLE period. The use of concomitant topical corticosteroids was permitted as needed by both groups throughout the study. Endpoints included mean change from baseline to week 24 for Patient-Reported Outcome Measures Information System (PROMIS) Sleep T-score (standardized score ranging from 30 [best] to 80 [worst], with a mean of 50), Epworth Sleepiness Scale (ESS; scored 0–24; higher values indicate increased daytime sleepiness), and Hospital Anxiety and Depression Scale (HADS; scored 0–21; higher values indicate a worse outcome). Throughout the study, patients also completed a Sleep Diary, recording the NRS of restfulness upon waking up (scored 0–10; lower values indicate a worse outcome). Statistical comparisons were not performed on the data collected during the OLE observation period. A total of 188 patients were enrolled in the study: 127 received continuous dupilumab (dupilumab–dupilumab group) and 61 received placebo to week 12 and then dupilumab to week 24 (placebo–dupilumab group). Baseline demographics and disease characteristics were well balanced. Improvement from baseline in sleep quality, daytime sleepiness, anxiety and depression was observed at week 24 in both groups, as illustrated by the mean change from baseline in PROMIS Sleep T-scores (−12.5 in the dupilumab–dupilumab group and −11.7 in the placebo–dupilumab group), ESS scores (−4.6 in the dupilumab–dupilumab group and −3.7 in the placebo–dupilumab group), HADS anxiety scores (−3.8 in the dupilumab–dupilumab group and −4.4 in the placebo–dupilumab group), HADS depression scores (−4.4 in the dupilumab–dupilumab group and −3.4 in the placebo–dupilumab group), and the NRS of restfulness upon a waking-up item of the Sleep Diary (+3.3 in the dupilumab–dupilumab group and +3.4 in the placebo–dupilumab group). The improvement achieved by the placebo–dupilumab group converged with that of the dupilumab–dupilumab group during the OLE period, as shown by the mean change from week 12 to week 24 in PROMIS Sleep T-score (−3.8), ESS score (−1.9), HADS anxiety score (−1.6), HADS depression score (−0.9) and NRS of restfulness upon a waking-up item of the Sleep Diary (+1.5). The safety profile of dupilumab was consistent with the known safety profile. Dupilumab provided sustained improvement through 24 weeks in patient-reported measures of sleep, daytime sleepiness, anxiety, and depression in adult patients with moderate-to-severe AD. Patients who were switched from placebo to dupilumab at week 12 showed rapid improvement in these parameters after the switch, eventually matching the improvement achieved by patients who received dupilumab from baseline through week 24.
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Affiliation(s)
- Joseph F Merola
- Brigham and Women’s Hospital, Harvard Medical School , Boston, MA , USA
| | | | | | | | - Peter Foley
- Skin Health Institute , Carlton, VIC , Australia
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18
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Merola JF, Chiou AS, During E, Costanzo A, Foley P, Ardeleanu M, Wu J, Ozturk ZE. 332 Improvement in symptoms of atopic dermatitis (AD) and AD-related quality of life with dupilumab treatment in adults: 24-week results of the DUPISTAD study. Br J Dermatol 2023. [DOI: 10.1093/bjd/ljac140.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Abstract
Atopic dermatitis (AD) is a chronic disease characterized by sleep disturbance, associated with night-time itching and scratching, along with skin pain, resulting in daytime drowsiness, diminished daytime productivity and overall reduced quality of life (QoL) in patients with AD. To report the effect of up to 24 weeks of dupilumab treatment on the QoL of adult patients with moderate-to-severe AD, using data from the DUPISTAD (NCT04033367) study. Phase 4, a randomized DUPISTAD study, comprised two 12-week periods: an initial placebo-controlled double-blind period, and a subsequent 12-week open-label extension (OLE) period. Adult patients with moderate-to-severe AD (Eczema Area and Severity Index score ≥12, Peak Pruritus Numeric Rating Scale [NRS] score ≥3, Sleep Disturbance NRS average score ≥5), showing an inadequate response to topical treatments, were randomized 2 : 1 to dupilumab 300 mg every 2 weeks (q2w) for both the double-blind and OLE periods or placebo for the initial double-blind period, followed by dupilumab 300 mg q2w for the OLE period. The use of concomitant topical corticosteroids was permitted during the entire course of the study. Endpoints, including Patient-Oriented Eczema Measure (POEM; scored 0–28, with higher values indicating a worse outcome), Dermatology Life Quality Index (DLQI; scored 0–30, with higher values indicating a poorer QoL), Skin Pain and Sensitivity NRS (scored 0–10, where 0 = no pain/normal sensitivity and 10 = worst possible pain/extremely sensitive) were assessed from baseline to week 24. The enrolled patients also completed a Work Productivity and Activity Impairment Questionnaire (WPAI-AD), including an NRS rating of the AD-Affected Ability to do Regular Daily Activities other than a Job (scored 0–10, where 0=‘no effect’ and 10=‘prevented me from doing my daily activities’). Formal statistical comparisons were not performed on the data resulting from the OLE period. The DUPISTAD study enrolled a total of 188 patients: 127 patients received dupilumab throughout (dupilumab–dupilumab group), and 61 patients received a placebo and then switched to dupilumab (placebo–dupilumab group). Baseline demographics and disease characteristics were well balanced. Improvement from baseline in AD-related patient-reported QoL indicators and AD symptoms was observed at week 24 in both groups, as illustrated by the mean change from baseline in POEM total scores (−14.6 in the dupilumab–dupilumab group and −15.9 in the placebo–dupilumab group), DLQI scores (−12.6 in the dupilumab–dupilumab group and −13.4 in the placebo–dupilumab group), Skin Pain NRS scores (−4.7 in the dupilumab–dupilumab group and −5.0 in the placebo–dupilumab group), Skin Sensitivity NRS scores (−4.6 in the dupilumab–dupilumab group and −5.0 in the placebo–dupilumab group), and the WPAI-AD NRS of Ability to do Regular Daily Activities scores (−4.2 in the dupilumab–dupilumab group and −3.8 in the placebo–dupilumab group). The placebo–dupilumab group experienced most of this improvement during the OLE period, as illustrated by the mean change from week 12 to week 24 in POEM total score (−11.5), DLQI score (−5.5), Skin Pain NRS score (−3.0), Skin Sensitivity NRS score (−3.0) and the WPAI-AD NRS of Ability to do Regular Daily Activities score (−2.0). The safety profile of dupilumab was consistent with the known safety profile. Dupilumab provided sustained improvements through 24 weeks in AD-related patient-reported measures of QoL and AD symptoms in adults with moderate-to-severe AD. Patients who were switched from placebo to dupilumab at week 12 showed rapid improvement in these parameters after the switch, eventually matching the improvement achieved by patients who received dupilumab from baseline through week 24.
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Affiliation(s)
- Joseph F Merola
- Brigham and Women’s Hospital, Harvard Medical School , Boston, MA , USA
| | | | | | | | - Peter Foley
- Skin Health Institute , Carlton, VIC , Australia
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Chang YT, Kearns PKA, Carson A, Gillespie DC, Meijboom R, Kampaite A, Valdés Hernández MDC, Weaver C, Stenson A, MacDougall N, O'Riordan J, Macleod MA, Carod-Artal FJ, Connick P, Waldman AD, Chandran S, Foley P. Network analysis characterizes key associations between subjective fatigue and specific depressive symptoms in early relapsing-remitting multiple sclerosis. Mult Scler Relat Disord 2023; 69:104429. [PMID: 36493562 DOI: 10.1016/j.msard.2022.104429] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Revised: 10/26/2022] [Accepted: 11/22/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND Fatigue is common and disabling in multiple sclerosis (MS), yet its mechanisms are poorly understood. In particular, overlap in measures of fatigue and depression complicates interpretation. We applied a multivariate network approach to quantify relationships between fatigue and other variables in early MS. METHODS Data were collected from patients with newly diagnosed immunotherapy-naïve relapsing-remitting MS at baseline and month 12 follow-up in FutureMS, a Scottish nationally representative cohort. Subjective fatigue was assessed by Fatigue Severity Scale. Detailed phenotyping included measures assessing each of physical disability, affective disorders, cognitive performance, sleep quality, and structural brain imaging. Network analysis was conducted to estimate partial correlations between variables. Baseline networks were compared between those with persistent and remitted fatigue at one-year follow up. RESULTS Data from 322 participants at baseline, and 323 at month 12, were included. At baseline, 154 patients (47.8%) reported clinically significant fatigue. In the network analysis, fatigue severity showed strongest connections with depression, followed by Expanded Disability Status Scale. Conversely, fatigue severity was not linked to objective cognitive performance or brain imaging variables. Even after controlling for measurement of "tiredness" in our measure of depression, four specific depressive symptoms remained linked to fatigue. Results were consistent at baseline and month 12. Overall network strength was not significantly different between groups with persistent and remitted fatigue (4.89 vs 2.90, p = 0.11). CONCLUSIONS Our findings support robust links between subjective fatigue and depression in early relapsing-remitting MS. Shared mechanisms between specific depressive symptoms and fatigue could be key targets of treatment and research in MS-related fatigue.
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Affiliation(s)
- Yuan-Ting Chang
- Anne Rowling Regenerative Neurology Clinic, University of Edinburgh, 49 Little France Crescent, Edinburgh EH16 4SB, UK; Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Patrick K A Kearns
- Anne Rowling Regenerative Neurology Clinic, University of Edinburgh, 49 Little France Crescent, Edinburgh EH16 4SB, UK; Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK; Institute of Genetics and Cancer, University of Edinburgh, Edinburgh, UK
| | - Alan Carson
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - David C Gillespie
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Rozanna Meijboom
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Agniete Kampaite
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | | | - Christine Weaver
- Anne Rowling Regenerative Neurology Clinic, University of Edinburgh, 49 Little France Crescent, Edinburgh EH16 4SB, UK; Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Amy Stenson
- Anne Rowling Regenerative Neurology Clinic, University of Edinburgh, 49 Little France Crescent, Edinburgh EH16 4SB, UK; Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | | | | | | | | | - Peter Connick
- Anne Rowling Regenerative Neurology Clinic, University of Edinburgh, 49 Little France Crescent, Edinburgh EH16 4SB, UK; Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Adam D Waldman
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Siddharthan Chandran
- Anne Rowling Regenerative Neurology Clinic, University of Edinburgh, 49 Little France Crescent, Edinburgh EH16 4SB, UK; Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK.
| | - Peter Foley
- Anne Rowling Regenerative Neurology Clinic, University of Edinburgh, 49 Little France Crescent, Edinburgh EH16 4SB, UK; Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK.
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Merola J, Chiou A, During E, Costanzo A, Foley P, Ardeleanu M, Liu M, Ozturk Z. 417 Dupilumab Significantly Improves Sleep Disturbance in Adults with Moderate-to-Severe Atopic Dermatitis: Results of the DUPISTAD study. J Invest Dermatol 2022. [DOI: 10.1016/j.jid.2022.09.430] [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: 11/19/2022]
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21
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Foley P, Kerdraon YA, Hogden JP, Shumack S, Spelman L, Sebaratnam DF, Su CS, Katelaris CH. Dupilumab-associated ocular surface disease: An interdisciplinary decision framework for prescribers in the Australian setting. Australas J Dermatol 2022; 63:421-436. [PMID: 36125089 PMCID: PMC9826507 DOI: 10.1111/ajd.13924] [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: 05/26/2022] [Revised: 08/23/2022] [Accepted: 08/30/2022] [Indexed: 01/11/2023]
Abstract
BACKGROUND/OBJECTIVES Dupilumab-associated ocular surface disease (DAOSD) is of particular relevance in patients with atopic dermatitis (AD). Guidance on DAOSD assessment and management in the Australian setting is needed to reduce its impact and minimise disruption to treatment. METHODS A systematic review of the literature was undertaken to identify data pertaining to the incidence, pathophysiology, risk factors and management of DAOSD. A critical review of this literature was used to inform a decision framework for dupilumab-prescribers and develop a graded severity scoring tool to guide appropriate management options. RESULTS DAOSD typically emerges within 4 months of commencing dupilumab and the occurrence of new events diminishes over time. The reported incidence varies widely depending on the nature and source of the data: 8.6-22.1% (clinical trials programme), 0.5-70% (real-world data; differences in study size, duration of follow-up, ophthalmologist intervention, use of prophylaxis). Occurrence increases with AD severity and in patients with prior history of ocular disease; pathophysiology is still to be fully characterised. Management options have evolved over time and include lubricants/artificial tears, corticosteroids, calcineurin inhibitors, antihistamines, anti-inflammatory agents and antimicrobial agents. Current therapies aim to resolve symptoms or reduce severity to levels sufficiently tolerable to enable continuation of dupilumab therapy. CONCLUSIONS Recommendations for DAOSD assessment and management include identification of high-risk patients, vigilance for red flags (keratoconus, herpetic and bacterial keratitis), regular assessment of symptom severity (before and during dupilumab therapy), conservative management of mild DAOSD by the prescribing physician and ophthalmologist referral for collaborative care of moderate-severe DAOSD and high-risk patients.
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Affiliation(s)
- Peter Foley
- Department of DermatologySt Vincent’s Hospital MelbourneFitzroyVictoriaAustralia,Department of MedicineThe University MelbourneMelbourneVictoriaAustralia,Skin Health InstituteMelbourneVictoriaAustralia
| | - Yves A. Kerdraon
- Save Sight Institute, Sydney Medical SchoolThe University of SydneySydneyNew South WalesAustralia
| | | | - Stephen Shumack
- Sydney Medical SchoolUniversity of SydneySydneyNew South WalesAustralia,Department of DermatologyRoyal North Shore HospitalSydneyNew South WalesAustralia
| | - Lynda Spelman
- Specialist Connect ServicesBrisbaneQueenslandAustralia,Queensland Institute of DermatologyBrisbaneQueenslandAustralia
| | - Deshan F. Sebaratnam
- Department of DermatologyLiverpool HospitalLiverpoolNew South WalesAustralia,Faculty of MedicineUniversity of New South WalesSydneyNew South WalesAustralia
| | - Charles S. Su
- Orbit, Plastic and Lacrimal UnitRoyal Victorian Eye and Ear HospitalMelbourneVictoriaAustralia,Victoria Parade Surgery CentreMelbourneVictoriaAustralia
| | - Constance H. Katelaris
- Clinical Immunology and Allergy UnitWestern Sydney University, Campbelltown HospitalSydneyNew South WalesAustralia
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Felmingham C, Pan Y, Kok Y, Kelly J, Gin D, Nguyen J, Goh M, Chamberlain A, Oakley A, Tucker S, Berry W, Darling M, Jobson D, Robinson A, de Menezes S, Wang C, Willems A, McLean C, Cranwell W, Adler N, Wada M, Foley P, Brack J, Cumming S, Byars G, Bowling A, Ge Z, Haskett M, Wolfe R, Mar V, Chew C, Chivers S, Chong A, Davenport R, Gupta A, Hiscutt E, Honigman A, Howard M, Jerjen R, Kim M, Li J, Liu W, Lolatgis H, Low ZM, McDonald P, Mumford B, Norris D, Roberts H, Smithson S, Wee E, Wong GN, Yan M, Zallmann M. Improving skin cancer management with ARTificial intelligence: A pre-post intervention trial of an artificial intelligence system used as a diagnostic aid for skin cancer management in a real-world specialist dermatology setting. J Am Acad Dermatol 2022; 88:1138-1142. [PMID: 36306873 DOI: 10.1016/j.jaad.2022.10.038] [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] [Received: 07/07/2022] [Revised: 10/04/2022] [Accepted: 10/09/2022] [Indexed: 03/06/2023]
Affiliation(s)
- Claire Felmingham
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia; Victorian Melanoma Service, Alfred Health, Melbourne, Victoria, Australia; Skin Health Institute, Carlton, Victoria, Australia
| | - Yan Pan
- Victorian Melanoma Service, Alfred Health, Melbourne, Victoria, Australia; Central Clinical School, Monash University Faculty of Medicine, Melbourne, Victoria, Australia
| | - Yonatan Kok
- Victorian Melanoma Service, Alfred Health, Melbourne, Victoria, Australia
| | - John Kelly
- Victorian Melanoma Service, Alfred Health, Melbourne, Victoria, Australia; Central Clinical School, Monash University Faculty of Medicine, Melbourne, Victoria, Australia
| | - Douglas Gin
- Victorian Melanoma Service, Alfred Health, Melbourne, Victoria, Australia; Central Clinical School, Monash University Faculty of Medicine, Melbourne, Victoria, Australia
| | - Jennifer Nguyen
- Victorian Melanoma Service, Alfred Health, Melbourne, Victoria, Australia
| | - Michelle Goh
- Skin Health Institute, Carlton, Victoria, Australia
| | - Alex Chamberlain
- Victorian Melanoma Service, Alfred Health, Melbourne, Victoria, Australia; Central Clinical School, Monash University Faculty of Medicine, Melbourne, Victoria, Australia
| | - Amanda Oakley
- Waikato District Health Board, Department of Dermatology, Hamilton, New Zealand; Faculty of Medical and Health Sciences, Medicine, University of Auckland, Auckland, New Zealand
| | - Simon Tucker
- Cairns Skin Centre, Manoora, Queensland, Australia; Gold Coast Dermatology Clinic, Mermaid Waters, Queensland, Australia
| | - William Berry
- Victorian Melanoma Service, Alfred Health, Melbourne, Victoria, Australia
| | - Mark Darling
- Skin Health Institute, Carlton, Victoria, Australia
| | - Dale Jobson
- Victorian Melanoma Service, Alfred Health, Melbourne, Victoria, Australia
| | | | | | - Charlie Wang
- Victorian Melanoma Service, Alfred Health, Melbourne, Victoria, Australia
| | | | - Catriona McLean
- Anatomical Pathology, Alfred Health, Melbourne, Victoria, Australia
| | - William Cranwell
- Victorian Melanoma Service, Alfred Health, Melbourne, Victoria, Australia
| | - Nikki Adler
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Miki Wada
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Peter Foley
- Skin Health Institute, Carlton, Victoria, Australia
| | - Jane Brack
- Victorian Melanoma Service, Alfred Health, Melbourne, Victoria, Australia
| | - Simon Cumming
- Melanoma and Skin Cancer Trials Group Research Centre, Monash University, Melbourne, Victoria, Australia
| | - Gabrielle Byars
- Melanoma and Skin Cancer Trials Group Research Centre, Monash University, Melbourne, Victoria, Australia
| | | | - Zongyuan Ge
- Monash eResearch Centre, Monash University, Clayton, Victoria, Australia; Department of Electrical and Computer Systems Engineering, Monash University Faculty of Engineering, Clayton, Victoria, Australia
| | | | - Rory Wolfe
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Victoria Mar
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia; Victorian Melanoma Service, Alfred Health, Melbourne, Victoria, Australia.
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Brown F, Glasmacher S, Taylor D, Jenkins R, Chandran S, Gillespie D, Foley P. 114 Pain and objectively measured cognitive performance in adults with multiple sclerosis: a systematic review. J Neurol Psychiatry 2022. [DOI: 10.1136/jnnp-2022-abn2.158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BackgroundPain and cognition are important symptoms in multiple sclerosis (MS). Cognitive processes contributing to pain experience are increasingly documented. Any relationship between pain and objectively measured cognitive performance (OMCP) in MS, including potential mediating factors such as fatigue and medication, remains unclear. Understanding this relationship may facilitate targeted treatment strategies.ObjectiveDetermine the relationship between pain and OMCP in MS.MethodsWe conducted a systematic review, following a pre-registered protocol, of clinical studies examining relationships between pain and OMCP in MS. We searched MEDLINE, Embase and PsychInfo. We assessed confounders and described findings using neuropsychologist-assigned cognitive domains. Risk of bias was assessed using a modified Newcastle-Ottawa Scale.Results10 studies were included. Eight studies identified a relationship between pain and OMCP. In six studies, worse pain scores were associated with worse cognition. However, no evidence was available for several cognitive domains. Studies infrequently controlled for confounders. Most studies were judged to be at risk of bias.ConclusionsWhile several studies suggest that pain in MS is related to worse objective cognitive perfor- mance, conclusions are limited by study design and limited evidence in many cognitive domains. Future studies should better establish this relationship and delineate the neurological substrate underpinning it.
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Armstrong A, Foley P, Liu Y, Yang YW, Miller M, Teneralli RE, Bewley A, Gordon KB, Han C. 33028 Direct and indirect treatment effect of guselkumab on anxiety and depression in patients with psoriasis by adjusting for Psoriasis Area and Severity Index (PASI) – A mediation analysis. J Am Acad Dermatol 2022. [DOI: 10.1016/j.jaad.2022.06.663] [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: 11/24/2022]
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Thaci D, Foley P, Richardson C, Shi Y, Fang J, Augustin M. 33991 Predictors of response to secukinumab in patients with moderate to severe plaque psoriasis with special area involvement in real-world clinical setting: A pooled analysis of prospective observational studies PROSPECT, SERENA, and REALIA. J Am Acad Dermatol 2022. [DOI: 10.1016/j.jaad.2022.06.803] [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: 10/14/2022]
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Stoffel M, Greene DN, Beal SG, Foley P, Killeen AA, Shafi H, Terrazas E. Direct-to-Consumer Testing for Routine Purposes. Clin Chem 2022; 68:1121-1127. [PMID: 35971633 DOI: 10.1093/clinchem/hvac106] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Accepted: 06/08/2022] [Indexed: 11/14/2022]
Affiliation(s)
- Michelle Stoffel
- Assistant Professor, Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis, MN, USA.,Associate CMIO for Laboratory Medicine and Pathology, MHealth Fairview, Minneapolis, MN, USA
| | - Dina N Greene
- Clinical Associate Professor, Department of Laboratory Medicine and Pathology, UW Medicine, Seattle, WA, USA.,Associate Laboratory Director, LetsGetChecked Laboratories, Monrovia, CA, USA
| | - Stacy G Beal
- Laboratory Director, LetsGetChecked, Monrovia, CA, USA.,Associate Professor, Department of Pathology, Immunology, and Laboratory Medicine, University of Florida College of Medicine, Gainesville, FL, USA
| | - Peter Foley
- Founder and Chief Executive Officer, LetsGetChecked Laboratories, Dublin, Ireland
| | - Anthony A Killeen
- Ellis S. Benson Professor and Vice-Chair, Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis, MN, USA
| | - Hedyeh Shafi
- Medical Director, Clinical Laboratory, Kaiser-Permanente, Los Angeles Medical Center, Los Angeles, CA, USA
| | - Enrique Terrazas
- Senior Medical Director, Medical Quality, Quest Diagnostics, West Hills, CA, USA
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Reich K, Gordon KB, Strober B, Langley RG, Miller M, Yang YW, Shen YK, You Y, Zhu Y, Foley P, Blauvelt A. Super-Response to Guselkumab Treatment in Patients With Moderate-to-Severe Psoriasis: Age, Body Weight, Baseline Psoriasis Area and Severity Index, and Baseline Investigator's Global Assessment Scores Predict Complete Skin Clearance. J Eur Acad Dermatol Venereol 2022; 36:2393-2400. [PMID: 35920762 DOI: 10.1111/jdv.18474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Accepted: 07/12/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND Psoriasis is a chronic immune-mediated inflammatory skin disease that often leads to a diminished quality of life. Goals of treating patients with psoriasis have shifted with more focus on achieving near or complete clearance of the skin. Guselkumab, a fully human monoclonal antibody targeting interleukin-23, is effective in treating moderate-to-severe psoriasis. OBJECTIVE To describe the baseline characteristics of patients with moderate-to-severe psoriasis achieving super-response (Psoriasis Area and Severity Index [PASI] 100 response at Weeks 20 and 28) after commencing guselkumab treatment. METHODS Pooled data from VOYAGE-1 and VOYAGE-2 studies identified super-response; baseline demographic, disease, and pharmacokinetic characteristics were compared with non-super-response. A stepwise logistic regression analysis identified which factors were potentially predictive of super-response status, with significance level of 0.1. RESULTS A subset of patients randomized to guselkumab comprised this post hoc analysis (n=664); 271 patients achieved super-response vs 393 with non-super-response. Patient age at study entry and baseline body weight (≤90 kg vs >90 kg), PASI, and Investigator's Global Assessment (IGA) score were significant predictors of super-response status, with odds ratios (95% confidence intervals) of 0.98 (0.967-0.993; p=0.003), 1.42 (1.026-1.977; p=0.034), 0.97 (0.955-0.993; p=0.007), and 0.66 (0.433-0.997; p=0.048), respectively. More patients with super-response achieved an early response: Week 2 PASI 75 (5.5% vs 1.8%) and Week 8 PASI 100 (22.5% vs 3.3%) vs non-super-response. Median serum guselkumab concentrations through Week 28 were slightly greater in patients with super-response vs non-super-response. CONCLUSION Guselkumab was more likely to achieve early clinical responses (complete skin clearance) in younger patients, less obese patients, and patients with less severe psoriasis.
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Affiliation(s)
- K Reich
- Translational Research in Inflammatory Skin Diseases, Institute for Health Services Research in Dermatology and Nursing, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - K B Gordon
- Medical College of Wisconsin, Milwaukee, WI, USA
| | - B Strober
- Yale University, New Haven, CT, USA.,Central Connecticut Dermatology Research, Cromwell, CT, USA
| | - R G Langley
- Dalhousie University, Halifax, Nova Scotia, Canada
| | - M Miller
- Janssen Research & Development, LLC, Spring House, PA, USA
| | - Y-W Yang
- Immunology Global Medical Affairs, Janssen Pharmaceutical Companies of Johnson & Johnson, LLC , Horsham, PA, USA
| | - Y-K Shen
- Janssen Research & Development, LLC, Spring House, PA, USA
| | - Y You
- Janssen Research & Development, LLC, Spring House, PA, USA
| | - Y Zhu
- Janssen Research & Development, LLC, Spring House, PA, USA
| | - P Foley
- The University of Melbourne, St. Vincent's Hospital Melbourne, Fitzroy, VIC, Australia.,Probity Medical Research Inc., Skin Health Institute, Carlton, VIC, Australia
| | - A Blauvelt
- Oregon Medical Research Center, Portland, OR, USA
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Merola J, Chiou A, Foley P, Ardeleanu M, Wu J, Ozturk Z. 298 Sleep improvement with dupilumab in adults with moderate-to-severe atopic dermatitis: Results of the DUPISTAD study. J Invest Dermatol 2022. [DOI: 10.1016/j.jid.2022.05.306] [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: 10/17/2022]
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Foley P, Spelman L, Murrell DF, Mate E, Tronnberg R, Lowe PM. Secukinumab treatment showed improved quality of life in patients with chronic plaque psoriasis in Australia: Results from the HOPE study. Australas J Dermatol 2022; 63:312-320. [PMID: 35816576 PMCID: PMC9542143 DOI: 10.1111/ajd.13893] [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] [Received: 03/22/2022] [Revised: 06/17/2022] [Accepted: 06/23/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Psoriasis imposes a disease burden that can have a profound negative impact on patients' quality of life (QoL). HOPE was the first non-interventional study conducted in patients with severe chronic plaque psoriasis in Australia that evaluated health-related QoL in response to treatment with secukinumab. METHODS HOPE was a prospective, open-label, single-arm, multicentre, non-interventional, exploratory study in patients with severe chronic plaque psoriasis in Australia. The study investigated the change in QoL, using the Dermatology Life Quality Index (DLQI), Assessment Quality of Life-8 Dimension questionnaire (AQoL-8D) and Psoriasis Area and Severity Index (PASI), and safety profile in response to treatment with secukinumab 300 mg SC weekly for 4 weeks followed by monthly maintenance for 58 weeks. RESULTS At Week 14, the mean percentage reduction in total DLQI score from baseline was -82.4% (n = 65), which indicates a substantial improvement in QoL. This level of improvement was sustained up to Week ≥58, with a mean percentage change of -87.4%. The mean percentage change from baseline for AQoL-8D weighted total score decreased from Week 14 (41.1%) to Week 58 (35.2%), indicating an improvement in patients' QoL. A high proportion of patients achieved PASI 75/90/100 responses at Week 14 (97.0%/71.2%/34.8%), with rates sustained up to Week ≥58 (100%/87.9%/43.1%). The safety profile of secukinumab was favourable, with no cumulative or unexpected safety concerns. CONCLUSION Secukinumab treatment demonstrated a striking improvement in patients' QoL in the HOPE study, the first real-world study in patients with severe chronic plaque psoriasis in the Australian clinical setting.
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Affiliation(s)
- Peter Foley
- Skin Health Institute Inc., Carlton, Victoria, Australia.,St Vincent's Department of Medicine (Dermatology), St Vincent's Hospital Melbourne, The University of Melbourne, Fitzroy, Australia
| | - Lynda Spelman
- Veracity Clinical Research Pty. Ltd., Woolloongabba, Queensland, Australia
| | - Dedee F Murrell
- Department of Dermatology, University of New South Wales, Sydney, New South Wales, Australia
| | - Eric Mate
- Novartis Pharmaceuticals, Australia Pty. Ltd., Macquarie Park, New South Wales, Australia
| | - Rebecca Tronnberg
- Novartis Pharmaceuticals, Australia Pty. Ltd., Macquarie Park, New South Wales, Australia
| | - Patricia M Lowe
- Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
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Foley P, Manuelpillai N, Dolianitis C, Cains GD, Mate E, Tronnberg R, Baker C. Secukinumab treatment demonstrated high drug survival and sustained effectiveness in patients with severe chronic plaque psoriasis: 21-month analysis in Australian routine clinical practice (SUSTAIN study). Australas J Dermatol 2022; 63:303-311. [PMID: 35809080 PMCID: PMC9543110 DOI: 10.1111/ajd.13895] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 05/29/2022] [Accepted: 06/25/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND Drug survival measures the rate and duration of adherence to a given therapeutic agent and evaluates its long-term effectiveness, safety, and real-world utility. The SUSTAIN study sought to establish the drug survival and effectiveness of secukinumab for patients with severe chronic plaque psoriasis (CPP) in the Australian clinical setting. METHODS Data of all patients (aged ≥18 years) from Australasian Psoriasis Registry (APR) treated with secukinumab were analysed. The primary objective was to describe the drug survival of secukinumab at 9 months. Key secondary objectives included drug survival of secukinumab at 3, 6, 15, and 21 months, stratified by biologic-naïve vs biologic-experienced patients; proportion of patients achieving Psoriasis Area and Severity Index (PASI) 75/90/100 responses; and changes in health-related quality of life over time utilising the Dermatology Life Quality Index (DLQI). RESULTS Of 294 patients included in this analysis, 110 (37.4%) were biologic-naïve and 184 (62.6%) biologic-experienced. Kaplan-Meїer drug survival rates in biologic-naïve vs biologic-experienced patients were 0.92 vs. 0.86 (9 months) and 0.82 vs. 0.68 (21 months), respectively. The proportion of patients with PASI 75/90/100 responses for biologic-naïve vs. biologic-experienced was 100/87.7/38.4 vs 98.5/61.5/27.2 (9 months) and 100/81.0/41.7 vs. 98.4/62.0/24.2 (21 months), respectively. The mean (standard deviation [SD]) DLQI in biologic-naïve vs. experienced patients was 2.2 (4.1) vs. 3.1 (5.2) (9 months) and 1.4 (2.5) vs. 3.1 (5.3) (21 months). No new safety signals were observed. CONCLUSIONS Secukinumab demonstrated high drug survival and sustained effectiveness in Australian real-world setting, in biologic-naïve and biologic-experienced patients with severe CPP.
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Affiliation(s)
- Peter Foley
- Skin Health Institute, Carlton, Victoria, Australia.,The University of Melbourne, St Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia
| | | | - Con Dolianitis
- The University of Melbourne, St Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia.,Royal Melbourne Hospital, Parkville, Victoria, Australia
| | | | - Eric Mate
- Novartis Pharmaceuticals, Australia Pty Limited, Macquarie Park, New South Wales, Australia
| | - Rebecca Tronnberg
- Novartis Pharmaceuticals, Australia Pty Limited, Macquarie Park, New South Wales, Australia
| | - Christopher Baker
- Skin Health Institute, Carlton, Victoria, Australia.,The University of Melbourne, St Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia
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Glasmacher SA, Kearns PK, Hassan Z, Connick P, Tauber S, Reetz K, Foley P, Chandran S. The influence of disease-modifying therapy on hidden disability burden in people with newly diagnosed relapsing-remitting multiple sclerosis. Mult Scler Relat Disord 2022; 63:103837. [PMID: 35576728 DOI: 10.1016/j.msard.2022.103837] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Revised: 04/02/2022] [Accepted: 04/28/2022] [Indexed: 12/01/2022]
Abstract
BACKGROUND In addition to motor disability, "hidden disability" such as depression, anxiety, fatigue, sleep disturbance, cognitive impairment and pain is a major complaint of people with multiple sclerosis. We explored changes in hidden disability burden in the early post-diagnostic period and examined the hypothesis that disease modifying therapies have a beneficial effect on hidden disability burden. METHODS Adults with recently diagnosed (< 6 months) relapsing-remitting multiple sclerosis (n = 440, mean age 37.4 ± 10.4, 76% female), from a national multicentre cohort study (FutureMS) underwent testing with clinical and neuropsychological instruments as well as brain MRI at baseline and after 12-months. Disease modifying therapies were only started after baseline assessment and were classified into injectables (n = 70, interferons, glatiramer acetate), other DMTs (n = 215) and no DMT (n = 117, reference). Sensitivity analyses were undertaken using alternative classifications (disease modifying therapy vs none, and a 3-category system). We performed latent transition analysis with hidden disability burden as the latent variable including propensity score weights. RESULTS We identified three classes with low (58%), moderate (25%) and high (17%) hidden disability burden. 70% did not transition ("unchanged", reference), 26% transitioned into a lower burden class ("improvement") and 4% transitioned into a higher burden class ("worsening"). Median treatment duration was 11 months (IQR 9-12). Injectables [OR 1.3 (95%CIs 0.7, 2.3); P = 0.4] and other DMTs [OR 1.4 (95%CIs 0.9, 2.1); P = 0.2] were not associated with significant change in hidden disability burden in either direction ("improvement" or "worsening"). In the alternative 3-category classification, category 2 treatment (fingolimod, cladribine, n = 22) was associated with improvement [OR 4.3 (2.6, 7.0); P < 0.001]. CONCLUSION Hidden disability was present in most newly diagnosed people with multiple sclerosis. The majority remained unchanged and approximately a quarter improved over the immediate post-diagnostic period. Disease modifying therapy had no significant influence on hidden disability burden in the study period of one year following diagnosis. The trend towards favourable outcomes with fingolimod and cladribine should be interpreted with caution due to the small sample size. Our exploratory data are observational, with scope for attendant biases, but highlight the need for further study including longer-term evaluation as well as randomised trials for non-motor disability.
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Affiliation(s)
- Stella A Glasmacher
- Anne Rowling Regenerative Neurology Clinic, Chancellor's Building, University of Edinburgh, Edinburgh, UK; Centre for Clinical Brain Sciences, Chancellor's Building, University of Edinburgh, Edinburgh, UK; RWTH Aachen University, Department of Neurology, Aachen, Germany
| | - Patrick Ka Kearns
- Anne Rowling Regenerative Neurology Clinic, Chancellor's Building, University of Edinburgh, Edinburgh, UK; Centre for Clinical Brain Sciences, Chancellor's Building, University of Edinburgh, Edinburgh, UK; MRC Human Genetics Unit, Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, UK
| | - Zackary Hassan
- Anne Rowling Regenerative Neurology Clinic, Chancellor's Building, University of Edinburgh, Edinburgh, UK; Centre for Clinical Brain Sciences, Chancellor's Building, University of Edinburgh, Edinburgh, UK
| | - Peter Connick
- Anne Rowling Regenerative Neurology Clinic, Chancellor's Building, University of Edinburgh, Edinburgh, UK; Centre for Clinical Brain Sciences, Chancellor's Building, University of Edinburgh, Edinburgh, UK
| | - Simone Tauber
- RWTH Aachen University, Department of Neurology, Aachen, Germany
| | - Kathrin Reetz
- RWTH Aachen University, Department of Neurology, Aachen, Germany; JARA-BRAIN Institute Molecular Neuroscience and Neuroimaging, Forschungszentrum Jülich GmbH, Jülich, Germany
| | - Peter Foley
- Anne Rowling Regenerative Neurology Clinic, Chancellor's Building, University of Edinburgh, Edinburgh, UK; Centre for Clinical Brain Sciences, Chancellor's Building, University of Edinburgh, Edinburgh, UK
| | - Siddharthan Chandran
- Anne Rowling Regenerative Neurology Clinic, Chancellor's Building, University of Edinburgh, Edinburgh, UK; Centre for Clinical Brain Sciences, Chancellor's Building, University of Edinburgh, Edinburgh, UK; Euan MacDonald Centre for Motor Neurone Disease Research, Chancellor's Building, University of Edinburgh, Edinburgh, UK; UK Dementia Research Institute at University of Edinburgh, Chancellor's Building, Edinburgh, UK.
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32
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Foley P, Parker RA, de Angelis F, Connick P, Chandran S, Young C, Weir CJ, Chataway J. Efficacy of Fluoxetine, Riluzole and Amiloride in treating neuropathic pain associated with secondary progressive multiple sclerosis. Pre-specified analysis of the MS-SMART double-blind randomised placebo-controlled trial. Mult Scler Relat Disord 2022; 63:103925. [PMID: 35671671 DOI: 10.1016/j.msard.2022.103925] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Revised: 05/20/2022] [Accepted: 05/27/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND Evidence-based treatment of pain in people with MS presents a major unmet need. OBJECTIVE We aimed to establish if use of Fluoxetine, Riluzole or Amiloride improved neuropathic pain outcomes in comparison to placebo, in adults with secondary progressive MS participating in a trial of these putative neuroprotectants. METHODS In pre-specified secondary analyses of the MS SMART phase-2b double-blind randomised controlled trial (NCT01910259), we analyzed reports of neuropathic pain, overall pain, and pain interference. Multivariate analyses included adjustment for baseline pain severity. Additionally, we explored associations of pain severity with clinical and MRI brain imaging variables. RESULTS 445 Participants were recruited from 13 UK neuroscience centres. We found no statistically significant benefit of active intervention on any rating of neuropathic pain, or pain overall. Compared to placebo, adjusted mean difference in pain intensity was 0.38 (positive values favouring placebo, 95%CI -0.30 to 1.07, p = 0.27) for Amiloride; 0.52 (-0.17 to 1.22, p = 0.14) for Fluoxetine; and 0.40 (-0.30 to 1.10, p = 0.26) for Riluzole. Pain severity was positively correlated with depressive symptoms (Spearman correlation 0.19, 95%CI 0.10-0.28) and fatigue (Rho 0.30, 95%CI 0.20-0.39). CONCLUSION Use of Fluoxetine, Riluzole or Amiloride was not associated with improvement in neuropathic pain symptoms, in comparison to placebo.
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Affiliation(s)
- Peter Foley
- Anne Rowling Regenerative Neurology Clinic, Chancellor's Building, University of Edinburgh, 49 Little France Crescent, Edinburgh EH16 4SB, United Kingdom.
| | - Richard A Parker
- Edinburgh Clinical Trials Unit, Usher Institute, University of Edinburgh, Edinburgh, United Kingdom
| | - Floriana de Angelis
- Queen Square Multiple Sclerosis Centre, Department of Neuroinflammation, University College London, London, United Kingdom
| | - Peter Connick
- Anne Rowling Regenerative Neurology Clinic, Chancellor's Building, University of Edinburgh, 49 Little France Crescent, Edinburgh EH16 4SB, United Kingdom
| | - Siddharthan Chandran
- Anne Rowling Regenerative Neurology Clinic, Chancellor's Building, University of Edinburgh, 49 Little France Crescent, Edinburgh EH16 4SB, United Kingdom
| | - Carolyn Young
- Walton Centre NHS Foundation Trust, Lower Lane, Fazakerley, Liverpool L9 7LJ, United Kingdom
| | - Christopher J Weir
- Edinburgh Clinical Trials Unit, Usher Institute, University of Edinburgh, Edinburgh, United Kingdom
| | - Jeremy Chataway
- Queen Square Multiple Sclerosis Centre, Department of Neuroinflammation, University College London, London, United Kingdom
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Kearns PKA, Martin SJ, Chang J, Meijboom R, York EN, Chen Y, Weaver C, Stenson A, Hafezi K, Thomson S, Freyer E, Murphy L, Harroud A, Foley P, Hunt D, McLeod M, O'Riordan J, Carod-Artal FJ, MacDougall NJJ, Baranzini SE, Waldman AD, Connick P, Chandran S. FutureMS cohort profile: a Scottish multicentre inception cohort study of relapsing-remitting multiple sclerosis. BMJ Open 2022; 12:e058506. [PMID: 35768080 PMCID: PMC9244691 DOI: 10.1136/bmjopen-2021-058506] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
PURPOSE Multiple sclerosis (MS) is an immune-mediated, neuroinflammatory disease of the central nervous system and in industrialised countries is the most common cause of progressive neurological disability in working age persons. While treatable, there is substantial interindividual heterogeneity in disease activity and response to treatment. Currently, the ability to predict at diagnosis who will have a benign, intermediate or aggressive disease course is very limited. There is, therefore, a need for integrated predictive tools to inform individualised treatment decision making. PARTICIPANTS Established with the aim of addressing this need for individualised predictive tools, FutureMS is a nationally representative, prospective observational cohort study of 440 adults with a new diagnosis of relapsing-remitting MS living in Scotland at the time of diagnosis between May 2016 and March 2019. FINDINGS TO DATE The study aims to explore the pathobiology and determinants of disease heterogeneity in MS and combines detailed clinical phenotyping with imaging, genetic and biomarker metrics of disease activity and progression. Recruitment, baseline assessment and follow-up at year 1 is complete. Here, we describe the cohort design and present a profile of the participants at baseline and 1 year of follow-up. FUTURE PLANS A third follow-up wave for the cohort has recently begun at 5 years after first visit and a further wave of follow-up is funded for year 10. Longer-term follow-up is anticipated thereafter.
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Affiliation(s)
- Patrick K A Kearns
- Anne Rowling Regenerative Neurology Clinic, The University of Edinburgh Centre for Clinical Brain Sciences, Edinburgh, UK
- Chromatin Lab, Genome Regulation Section, The University of Edinburgh MRC Human Genetics Unit, Edinburgh, UK
- Department of Clinical Neurosciences, Royal Infirmary of Edinburgh, Edinburgh, UK
- Centre for Clinical Brain Sciences, The University of Edinburgh, Edinburgh, UK
- Department of Neurology, Institute of Clinical Neurosciences, NHS Greater Glasgow and Clyde, Glasgow, UK
- Institute of Genetics and Cancer, The University of Edinburgh, Edinburgh, UK
| | - Sarah J Martin
- Centre for Clinical Brain Sciences, The University of Edinburgh, Edinburgh, UK
- Department of Neurology, Institute of Clinical Neurosciences, NHS Greater Glasgow and Clyde, Glasgow, UK
| | - Jessie Chang
- Anne Rowling Regenerative Neurology Clinic, The University of Edinburgh Centre for Clinical Brain Sciences, Edinburgh, UK
- Centre for Clinical Brain Sciences, The University of Edinburgh, Edinburgh, UK
| | - Rozanna Meijboom
- Centre for Clinical Brain Sciences, The University of Edinburgh, Edinburgh, UK
| | - Elizabeth N York
- Centre for Clinical Brain Sciences, The University of Edinburgh, Edinburgh, UK
| | - Yingdi Chen
- Anne Rowling Regenerative Neurology Clinic, The University of Edinburgh Centre for Clinical Brain Sciences, Edinburgh, UK
| | - Christine Weaver
- Anne Rowling Regenerative Neurology Clinic, The University of Edinburgh Centre for Clinical Brain Sciences, Edinburgh, UK
- Centre for Clinical Brain Sciences, The University of Edinburgh, Edinburgh, UK
| | - Amy Stenson
- Anne Rowling Regenerative Neurology Clinic, The University of Edinburgh Centre for Clinical Brain Sciences, Edinburgh, UK
- Centre for Clinical Brain Sciences, The University of Edinburgh, Edinburgh, UK
| | | | - Stacey Thomson
- Institute of Genetics and Cancer, The University of Edinburgh, Edinburgh, UK
| | - Elizabeth Freyer
- Institute of Genetics and Cancer, The University of Edinburgh, Edinburgh, UK
| | - Lee Murphy
- Wellcome Trust Clinical Research Facility, Edinburgh, UK
| | - Adil Harroud
- Department of Neurology, Weill Institute of Clinical Neuroscience, San Francisco, California, USA
| | - Peter Foley
- Anne Rowling Regenerative Neurology Clinic, The University of Edinburgh Centre for Clinical Brain Sciences, Edinburgh, UK
- Centre for Clinical Brain Sciences, The University of Edinburgh, Edinburgh, UK
| | - David Hunt
- Anne Rowling Regenerative Neurology Clinic, The University of Edinburgh Centre for Clinical Brain Sciences, Edinburgh, UK
- Centre for Clinical Brain Sciences, The University of Edinburgh, Edinburgh, UK
| | - Margaret McLeod
- Department of Neurology, Aberdeen Royal Infirmary, Aberdeen, UK
| | - Jonathon O'Riordan
- Tayside Centre for Clinical Neurosciences, University of Dundee Division of Neuroscience, Dundee, UK
| | | | - Niall J J MacDougall
- Anne Rowling Regenerative Neurology Clinic, The University of Edinburgh Centre for Clinical Brain Sciences, Edinburgh, UK
- Department of Neurology, Wishaw General Hospital, Wishaw, UK
| | - Sergio E Baranzini
- Department of Neurology, Weill Institute of Clinical Neuroscience, San Francisco, California, USA
| | - Adam D Waldman
- Centre for Clinical Brain Sciences, The University of Edinburgh, Edinburgh, UK
| | - Peter Connick
- Centre for Clinical Brain Sciences, The University of Edinburgh, Edinburgh, UK
| | - Siddharthan Chandran
- Anne Rowling Regenerative Neurology Clinic, The University of Edinburgh Centre for Clinical Brain Sciences, Edinburgh, UK
- Centre for Clinical Brain Sciences, The University of Edinburgh, Edinburgh, UK
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Baker C, James A, Supranowicz M, Spelman L, Shumack S, Cole J, Weightman W, Sinclair R, Foley P. Method of Assessing Skin Cancerization and Keratoses TM (MASCK™): development and photographic validation in multiple anatomical sites of a novel assessment tool intended for clinical evaluation of patients with extensive skin field cancerization. Clin Exp Dermatol 2022; 47:1144-1153. [PMID: 35150158 PMCID: PMC9313559 DOI: 10.1111/ced.15136] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2021] [Revised: 02/06/2022] [Accepted: 02/07/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND A range of 'field-directed' treatments is available for the management of extensive skin field cancerization (ESFC), but to date, the only validated objective quantitative tools are limited to assessment of actinic keratoses (AKs) affecting the head. AIMS To develop a versatile quantitative instrument for objective clinical assessment of ESFC and perform initial internal validation across multiple anatomical zones. METHODS The study comprised instrument development, pilot testing and instrument refinement and two rounds of reliability and inter-rater validation testing. The study was noninterventional and used a convenience sample of de-identified patient photographs selected based on preset criteria. An expert panel developed the instrument and scoring system via a modified Delphi voting process. A sample of 16 healthcare professionals from multiple specialties undertook the pilot testing, and a panel of seven dermatologists were involved in validation testing. Validation was determined by assessment of overall inter-rater agreement using Gwet chance-corrected agreement coefficients (ACs). RESULTS The instrument produced, called the Method for Assessing Skin Cancer and Keratoses™ (MASCK™), comprises the Skin Field Cancerization Index (SFCIndex), derived from area of skin involvement and AKs (number and thickness), a global assessment score and a cancer-in-zone score, and uses Likert scales for quantitative scoring. The SFCIndex is a composite score comprising the number and thickness of AKs multiplied by area of skin involvement. ACs for the SFCIndex components, the overall SFCIndex score and the global assessment score were > 0.80 (rated 'almost perfect') while the AC for the cancer-in-zone metric was lower (0.33, rated 'fair'). Internal consistency was demonstrated via positive correlation between the overall SFCIndex score and the global assessment score. CONCLUSIONS Our study found near-perfect agreement in inter-rater reliability when using MASCK to assess the severity of ESFC in multiple anatomical sites. Further validation of this novel instrument is planned to specifically assess its reliability, utility and feasibility in clinical practice.
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Affiliation(s)
- Christopher Baker
- Department of DermatologySt Vincent's Hospital MelbourneFitzroyVic.Australia,Department of MedicineThe University MelbourneMelbourneVic.Australia
| | - Amelia James
- Department of DermatologySt Vincent's Hospital MelbourneFitzroyVic.Australia
| | | | | | - Stephen Shumack
- Sydney Medical SchoolUniversity of SydneySydneyNSWAustralia,Department of DermatologyRoyal North Shore HospitalSydneyNSWAustralia
| | - Judith Cole
- Department of DermatologySt John of God HospitalSubiacoWAAustralia
| | - Warren Weightman
- Department of Dermatology Queen Elizabeth HospitalWoodvilleSAAustralia
| | | | - Peter Foley
- Department of DermatologySt Vincent's Hospital MelbourneFitzroyVic.Australia,Department of MedicineThe University MelbourneMelbourneVic.Australia,Probity Medical ResearchSkin Health InstituteMelbourneVic.Australia
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Mease PJ, Foley P, Reich K, Chakravarty SD, Shawi M, Yang YW, Miller M, Kollmeier A, Xu XL, Yu J, Wang Y, Sheng S, You Y, Mcinnes I. AB0892 Targeted Safety Analyses of Guselkumab: Long-Term Results from Randomized Clinical Trials in Patients with Active Psoriatic Arthritis and Moderate to Severe Psoriasis. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.1495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BackgroundGuselkumab (GUS) demonstrated efficacy and a favorable safety profile in active PsA in the Phase (Ph) 21 and Ph3 DISCOVER-1&2 trials2,3 and in moderate-to-severe plaque psoriasis (PsO) in the Ph3 VOYAGE-1&2 trials.4,5ObjectivesTo assess long-term safety of GUS across PsA/PsO trials.MethodsUsing pooled safety data through 2 years (yrs) from PsA trials (N=1229; GUS 100 mg every 4/8 weeks [Q4W/Q8W])1-3 and through 5 yrs from PsO trials (N=1721; GUS 100 mg Q8W),4,5 incidences of serious adverse events (SAEs); gastrointestinal (GI)-related SAEs and other targeted AEs; including candidiasis, uveitis, and opportunistic infections (OIs) were evaluated. Incidence rates (IRs) were calculated as the number of events per 100 pt-yrs (PY) of follow-up with 95% CI. Patients (pts) with an IBD history were not excluded in PsA/PsO trials. Max exposure duration was W100 for PsA trials and W252 for PsO trials.ResultsThe PsA and PsO populations had comparable mean age and BMI. IRs of SAEs and GI-related SAEs were generally similar between GUS- and PBO-treated pts during PBO-controlled periods, and between PsA pts receiving GUS Q4W/Q8W for up to 2 yrs and PsO pts receiving GUS Q8W for up to 5 yrs (Table 1). IRs of other targeted AEs of interest were low. OIs did not occur in PsO pts and were infrequent in PsA pts (Table 1). Candidal infections were infrequent and non-serious. Iridocyclitis was reported in 1 PBO- and 1 GUS Q8W-treated PsA pt. No exacerbations or new onset of IBD or active tuberculosis was reported in GUS-treated PsA/PsO pts.Table 1.Targeted AEs of InterestPooled PsA*Pooled PsOThrough 2 YrsThrough 5 YrsGUS 100 mg Q4W (N=373)GUS 100 mg Q8W (N=475)PBO→GUS 100 mg Q4W (N=352)aPBO→GUS 100 mg Q8W (N=29)aGUS Combined (N=1229)GUS 100 mg Q8W (N=1221)bADA→GUS 100 mg Q8W (N=500)cGUS Combined (N=1721)Total PY645748461171871525419127166Mean PY1.71.61.30.61.54.33.84.2Events/100 PY (95% CI)Overall SAEs4.65(3.14, 6.64)6.42(4.73, 8.51)5.86(3.86, 8.52)0.00(0.00, 17.24)5.61(4.59, 6.79)5.18(4.58, 5.83)4.55(3.64, 5.61)5.01(4.50, 5.56)GI-related SAEs0.46(0.10, 1.36)0.27(0.03, 0.97)0.00 (0.00, 0.65)0.00(0.00, 17.24)0.27(0.09, 0.62)0.44(0.28, 0.66)0.42(0.18, 0.82)0.43(0.29, 0.61)OIsd0.00(0.00, 0.46)0.27(0.03, 0.97)0.22(0.01, 1.21)0.00(0.00, 17.24)0.16(0.03, 0.47)0.00(0.00, 0.06)0.00(0.00, 0.16)0.00(0.00, 0.04)Candida infections0.31(0.04, 1.12)0.00(0.00, 0.40)0.00(0.00, 0.65)0.00(0.00, 17.24)0.11(0.01, 0.39)0.49(0.32, 0.73)0.52(0.25, 0.96)0.50(0.35, 0.70)Non-pathogen specific fungal infections, suspicious for candida0.00(0.00, 0.46)0.27(0.03, 0.97)0.00(0.00, 0.65)0.00(0.00, 17.24)0.11(0.01, 0.39)0.11(0.04, 0.25)0.16(0.03, 0.46)0.13(0.06, 0.24)Uveitis/ Iridocyclitis0.00(0.00, 0.46)0.13(0.00, 0.75)0.00(0.00, 0.65)0.00(0.00, 17.24)0.05(0.00, 0.30)0.00(0.00, 0.06)0.00(0.00, 0.16)0.00(0.00, 0.04)*In PsA Ph2, data after early escape at W16 were excluded. AEs are coded using MedDRA Version 23.1aFor PBO→GUS, data on/after 1st GUS administration were includedbPBO crossover pts were included in GUS column after crossover to GUScEvents prior to GUS (ADA events) were excluded. Only includes pts randomized to ADA at W0 and crossed over to GUS at/after W52 for VOYAGE-1 & W28 for VOYAGE-2dHerpes zoster disseminated, fungal oesophagitis, and meningitis listeria (1 each)ADA=AdalimumabConclusionIRs of SAEs; GI-related SAEs; and AEs of interest including candidiasis, uveitis, and OIs were low, or no cases were reported. No new safety concerns were identified with GUS treatment through 2 yrs and 5 yrs of follow-up in the pooled PsA and PsO trials, respectively, supporting a durable and favorable GUS safety profile consistent between pts with active PsA and moderate-to-severe PsO.References[1]Deodhar A, et al. Lancet. 2018;391:2213-2224.[2]Deodhar A, et al. Lancet. 2020;395:1115-1125.[3]Mease PJ, et al. Lancet. 2020;395:1126-1136.[4]Blauvelt A, et al. J Am Acad Dermatol. 2017;76:405-417.[5]Reich K, et al. J Am Acad Dermatol. 2017;76:418-431.Disclosure of InterestsPhilip J Mease Speakers bureau: AbbVie, Aclaris, Amgen, Bristol-Myers Squibb, Celgene, Eli Lilly, Galapagos, Gilead, GlaxoSmithKline, Celgene, Crescendo Bioscience, Genentech, Inmagene, Janssen, Lilly, Merck, Novartis, Pfizer, SUN Pharma, and UCB, Consultant of: AbbVie, Aclaris, Amgen, Bristol-Myers Squibb, Celgene, Eli Lilly, Galapagos, Gilead, GlaxoSmithKline, Celgene, Crescendo Bioscience, Genentech, Inmagene, Janssen, Lilly, Merck, Novartis, Pfizer, SUN Pharma, and UCB, Grant/research support from: AbbVie, Aclaris, Amgen, Bristol-Myers Squibb, Celgene, Eli Lilly, Galapagos, Gilead, GlaxoSmithKline, Celgene, Crescendo Bioscience, Genentech, Inmagene, Janssen, Lilly, Merck, Novartis, Pfizer, SUN Pharma, and UCB, Peter Foley Speakers bureau: AbbVie, Celgene, Janssen, Eli Lilly, Merck, Novartis, Pfizer, Valeant, Galderma, GlaxoSmithKline, Leo Pharma, and Roche, Paid instructor for: (Advisory boards) AbbVie, Amgen, Aslan, Bristol-Myers Squibb, Boehringer Ingelheim, Celgene, Janssen, Eli Lilly, Merck, Novartis, Pfizer, Sun Pharma, UCB Pharma, Valeant, Galderma, GlaxoSmithKline, Leo Pharma, and Sanofi, Consultant of: Janssen, Eli Lilly, Novartis, Pfizer, UCB Pharma, Bristol-Myers Squibb, Galderma, Leo Pharma, and Roche; investigator for AbbVie, Amgen, AstraZeneca, Arcutis, Aslan, Boehringer Ingelheim, Celgene, Hexima, Janssen, Eli Lilly, Merck, Novartis, Pfizer, Sun Pharma, UCB Pharma, Valeant, Bristol-Myers Squibb, Celtaxsys, CSL, Cutanea, Dermira, Galderma, Genentech, GlaxoSmithKline, Leo Pharma, Regeneron Pharmaceuticals Inc, Reistone, Roche, and Sanofi, Grant/research support from: AbbVie, Amgen, Celgene, Janssen, Leo Pharma, Eli Lilly, Merck, Novartis, Pfizer, Sanofi, and Sun Pharma; travel grants from AbbVie, Janssen, Eli Lilly, Merck, Novartis, Pfizer, Galderma, Leo Pharma, Roche, Sun Pharma, and Sanofi; served as speaker for or received honoraria from AbbVie, Celgene, Janssen, Eli Lilly, Merck, Novartis, Pfizer, Valeant, Galderma, GlaxoSmithKline, Leo Pharma, and Roche, Kristian Reich Speakers bureau: Abbvie, Affibody, Amgen, Biogen, Boehringer Ingelheim Pharma, Bristol Myers Squibb, Celgene, Centocor, Covagen, Eli Lilly, Forward Pharma, Galderma, GlaxoSmithKline, Janssen-Cilag, Leo, Medac, Merck Sharp & Dohme Corp., Novartis, Ocean Pharma, Pfizer, Regeneron, Sanofi, Takeda, UCB Pharma, and Xenoport, Paid instructor for: Abbvie, Affibody, Amgen, Biogen, Boehringer Ingelheim Pharma, Bristol Myers Squibb, Celgene, Centocor, Covagen, Eli Lilly, Forward Pharma, Galderma, GlaxoSmithKline, Janssen-Cilag, Leo, Medac, Merck Sharp & Dohme Corp., Novartis, Ocean Pharma, Pfizer, Regeneron, Sanofi, Takeda, UCB Pharma, and Xenoport, Consultant of: Participated in clinical trials sponsored by Abbvie, Affibody, Amgen, Biogen, Boehringer Ingelheim Pharma, Bristol Myers Squibb, Celgene, Centocor, Covagen, Eli Lilly, Forward Pharma, Galderma, GlaxoSmithKline, Janssen-Cilag, Leo, Medac, Merck Sharp & Dohme Corp., Novartis, Ocean Pharma, Pfizer, Regeneron, Sanofi, Takeda, UCB Pharma, and Xenoport, Soumya D Chakravarty Employee of: Janssen Scientific Affairs, LLC and may own stock or stock options in Johnson & Johnson, May Shawi Employee of: Janssen Global Services, LLC and may own stock or stock options in Johnson & Johnson, Ya-Wen Yang Employee of: Janssen Global Services, LLC and may own stock or stock options in Johnson & Johnson, Megan Miller Employee of: Janssen Research & Development, LLC and may own stock or stock options in Johnson & Johnson, Alexa Kollmeier Employee of: Janssen Research & Development, LLC and may own stock or stock options in Johnson & Johnson, Xie L Xu Employee of: Janssen Research & Development, LLC and may own stock or stock options in Johnson & Johnson, Jenny Yu Employee of: Janssen Research & Development, LLC and may own stock or stock options in Johnson & Johnson, Yanli Wang Employee of: Janssen Research & Development, LLC and may own stock or stock options in Johnson & Johnson, Shihong Sheng Employee of: Janssen Research & Development, LLC and may own stock or stock options in Johnson & Johnson, Yin You Employee of: Janssen Research & Development, LLC and may own stock or stock options in Johnson & Johnson, Iain McInnes Consultant of: AbbVie, Bristol-Myers Squibb, Boehringer-Ingelheim, Celgene, Eli Lilly, Gilead, Janssen, Novartis and UCB., Grant/research support from: Astra Zeneca, Bristol-Myers Squibb, Celgene, Janssen, Lilly, Novartis, and UCB
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Curran WJ, Potter A, Baker C, Shumack S, Sinclair R, Christie D, Wong B, Foley P, Spelman L, O'Brien P. Successful management of Australian patients with extensive skin field cancerization (ESFC) with widefield volumetric arc radiation therapy (VMAT): Report with 12-month follow-up. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.9582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
9582 Background: Non-melanomatous skin cancer (NMSC) diagnoses are associated with a high risk of developing new skin cancers in adjacent areas. Patients with extensive skin field cancerization (ESFC) have large areas (generally ≥50cm2) of compromised skin characterized by pre-cancerous actinic keratoses often requiring repeated interventions. Lesion-directed therapies have excellent cure rates, but therapies targeting a wider region have limited durability, including topical agents such as 5-flurouracil. The development of volumetric modulated arc radiation therapy (VMAT) to precisely target large, curved skin surfaces has generated interest in its application to ESFC. This is a report on the efficacy, safety, and cosmetic outcomes of VMAT in the management of patients with ESFC at facilities across five Australian states. Methods: Sixty-three ESFC zones on 60 patients were prescribed widefield VMAT and prospectively enrolled in the National (Australian) Dermatology Radiation Oncology Registry (NDROR). Over 80% of patients had received up to 4 prior non-radiotherapy interventions. Fields included lower and upper limb, face, scalp, or trunk regions. Total widefield VMAT RT doses ranged from 45-50 Gy delivered in 25-30 daily fractions across 5-7 weeks. 3-, 6-, and 12-month follow-up assessments rated the percentage of disease clearance, cosmesis using the Lovett’s scale, and toxicity based on CTCAE. Results: At 12-month follow-up, 97% of treated zones had achieved and maintained clinical success, defined as > 90% field clearance. Five percent of patients exhibited recurrence of original disease, whereas 10% of patients developed a new actinic keratosis or NMSC. Cosmesis was rated as excellent or good in 98% of patients. Most patients exhibited grade 1-2 radiation-induced dermatitis during therapy, which resolved by 3-month follow-up. Grade 3 dermatitis at end of treatment was exhibited in 7% of the patients, which also resolved. Eight percent of patients discontinued treatment due to acute toxicities. The most common persistent toxicity at 12-month follow-up was localized grade 1 xerosis (dryness) at 43% and/or alopecia at 33%. Conclusions: Widefield VMAT achieved very promising clinical success in patients with ESFC for whom other therapies had failed. VMAT yielded favorable cosmetic outcomes, and treatment-related toxicity was manageable and transient in most patients. While additional follow up is necessary, these results demonstrate that widefield VMAT may be an excellent option for some patients with increasingly unmanageable presentations of ESFC.
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Affiliation(s)
| | | | | | | | - Robert Sinclair
- Queensland Institute of Dermatology, Brisbane, QLD, Australia
| | | | | | - Peter Foley
- St. Vincent's Hospital, Melbourne, VIC, Australia
| | - Lynda Spelman
- Veracity Clinical Research, Woolloongabba, QLD, Australia
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Gordon K, Merola JF, Foley P, Choi O, Chan D, Miller M, You Y, Shen YK, Yang YW, Blauvelt A. AB1473 EFFICACY RESPONSES ACROSS DISEASE SEVERITY AND TREATMENT HISTORY SUBGROUPS OF PATIENTS WITH MODERATE TO SEVERE PLAQUE PSORIASIS TREATED WITH GUSELKUMAB: POOLED RESULTS FROM VOYAGE-1 AND VOYAGE-2 THROUGH 5 YEARS. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.1530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BackgroundThe VOYAGE-1 and VOYAGE-2 phase 3 studies evaluated efficacy and safety of guselkumab (GUS) in patients with moderate-to-severe plaque psoriasis.ObjectivesTo assess the five-year efficacy of GUS by baseline disease characteristics and treatment history.MethodsThis study evaluated 1829 patients randomized to GUS, placebo (PBO)→GUS, and adalimumab (ADA) →GUS from the VOYAGE-1 and VOYAGE-2 trials. All patients received open-label GUS 100 mg every 8 weeks (Q8W) during Week (W) 52 to W252 in VOYAGE-1 and during W76 to W252 in VOYAGE-2. The proportions of combined GUS patients (including PBO→GUS and ADA→GUS) achieving Investigator’s Global Assessment of cleared or minimal (IGA-0/1) and Psoriasis Area and Severity Index (PASI) 90 response were evaluated from W100 to W252 by baseline PASI (<20/≥20) and IGA (<4/=4) scores, body surface area (BSA; <20%/≥20%), and prior psoriasis treatments. Analysis was performed using observed data after applying treatment failure rules.ResultsAt W252, proportions of combined GUS patients achieving IGA 0/1 or PASI 90, respectively, were comparable or numerically greater for patients with baseline PASI < 20 (85.4%; 81.1%) vs PASI ≥ 20 (81.4%; 83.8%); IGA < 4 (85.1%; 82.7%) vs IGA = 4 (78.9%; 81.1%); BSA < 20% (85.1%; 82.7%) vs BSA ≥ 20% (82.6%; 82.0%); no prior phototherapy (83.3%; 84.0%) vs prior phototherapy (83.8%; 81.1%); no prior non-biologic systemic therapy (84.5%; 83.0%) vs prior non-biologic systemic therapy (83.2%; 82.0%); and no prior biologics (85.3%; 83.8%) vs prior biologics (76.7%; 76.3%). This trend was consistent at each timepoint evaluated from W100 to W252.ConclusionThis analysis demonstrated that the high degree of efficacy of GUS treatment is durable through 5 years among broad subpopulations of patients with varying disease severity characteristics and previous psoriasis treatments.ReferencesNoneDisclosure of InterestsKenneth Gordon Grant/research support from: AbbVie, Almirall, Amgen, BMS, Celgene, Dermira, Dermavant, Eli Lilly, Janssen, LEO Pharma, Novartis, Ortho Dermatologics, Pfizer, Sun Pharma, and UCB Pharma, Joseph F. Merola Consultant of: AbbVie, Arena, Avotres, Biogen, Bristol-Myers Squibb, Celgene, Dermavant, Eli Lilly, EMD Sorono, Janssen, Leo Pharma, Merck, Novartis, Pfizer, Regeneron, Sanofi, Sun Pharma, and UCB pharma, Peter Foley Speakers bureau: AbbVie, Celgene, Eli Lilly, Galderma, GSK, Janssen, Leo Pharma, Merck, Novartis, Pfizer, Roche, and Valeant, Consultant of: AbbVie, Amgen, Arcutis, Aslan, AstraZeneca, BMS, Boehringer Ingelheim, Celgene, Celtaxsys, CSL, Cutanea, Dermira, Eli Lilly, Galderma, Genentech, GSK, Hexima, Janssen, Leo Pharma, Merck, Novartis, Pfizer, Regeneron Pharmaceuticals Inc, Reistone, Roche, Sanofi, Sun Pharma, UCB Pharma, and Valeant, Grant/research support from: grant/research support from AbbVie, Amgen, Celgene, Eli Lilly, Janssen, Leo Pharma, Merck, Novartis, Pfizer, Sanofi, and Sun Pharma; and travel grants from AbbVie, Eli Lilly, Galderma, Janssen, Leo Pharma, Merck, Novartis, Pfizer, Roche, Sanofi, and Sun Pharma, Olivia Choi Shareholder of: may own stock or stock options in Johnson & Johnson, Employee of: Janssen Scientific Affairs, LLC, Daphne Chan Shareholder of: may own stock or stock options in Johnson & Johnson, Employee of: Janssen Scientific Affairs, LLC, Megan Miller Shareholder of: may own stock or stock options in Johnson & Johnson, Employee of: Janssen Research & Development, LLC, Yin You Shareholder of: may own stock or stock options in Johnson & Johnson, Employee of: Janssen Research & Development, LLC, Yaung-Kaung Shen Shareholder of: may own stock or stock options in Johnson & Johnson, Employee of: Janssen Research & Development, LLC, Ya-Wen Yang Shareholder of: may own stock or stock options in Johnson & Johnson, Employee of: Immunology Global Medical Affairs, Janssen Pharmaceutical Companies of Johnson & Johnson, Andrew Blauvelt Speakers bureau: AbbVie, Almirall, Arena, Athenex, Boehringer Ingelheim, Bristol-Myers Squibb, Dermavant, Eli Lilly, Evommune, Forte, Galderma, Incyte, Janssen, Leo Pharma, Novartis, Pfizer, Rapt, Regeneron, Sandoz, Sanofi Genzyme, Sun Pharma, and UCB Pharma, Consultant of: AbbVie, Almirall, Arena, Athenex, Boehringer Ingelheim, Bristol-Myers Squibb, Dermavant, Eli Lilly, Evommune, Forte, Galderma, Incyte, Janssen, Leo Pharma, Novartis, Pfizer, Rapt, Regeneron, Sandoz, Sanofi Genzyme, Sun Pharma, and UCB Pharma
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Potter AE, Baker C, Shumack S, Sinclair R, Curran WJ, Christie D, Wong B, Foley P, O’Brien P, Spelman L. Preliminary efficacy and safety analysis: 12-month results in 83 patients using a novel approach of widefield radiation therapy for extensive skin field cancerization with or without keratinocyte cancers. J DERMATOL TREAT 2022; 33:2634-2642. [DOI: 10.1080/09546634.2022.2067814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Affiliation(s)
| | - Christopher Baker
- Department of Dermatology, St Vincent’s Hospital Melbourne, Fitzroy, Australia
- Department of Medicine, The University Melbourne, Melbourne, Australia
| | - Stephen Shumack
- Sydney Medical School, University of Sydney, Sydney, Australia
- Department of Dermatology, Royal North Shore Hospital, St Leonards, Australia
| | - Robert Sinclair
- Queensland Institute of Dermatology, Brisbane, Australia
- Specialist Connect Services, Brisbane, Australia
| | - Walter J. Curran
- Oncology, GenesisCare, Fort Myers, FL, USA
- Emory University, Atlanta, GA, USA
| | - David Christie
- GenesisCare, Gold Coast, QLD, Australia
- School of Medicine, Bond University, Gold Coast, QLD, Australia
| | - Bradley Wong
- GenesisCare Radiation Oncology, Buderim, QLD, Australia
| | - Peter Foley
- Department of Dermatology, St Vincent’s Hospital Melbourne, Fitzroy, Australia
- Department of Medicine, The University Melbourne, Melbourne, Australia
- Probity Medical Research, Skin Health Institute, Melbourne, Australia
| | - Peter O’Brien
- GenesisCare Radiation Oncology, Newcastle, NSW, Australia
| | - Lynda Spelman
- Queensland Institute of Dermatology, Brisbane, Australia
- Specialist Connect Services, Brisbane, Australia
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Zegard A, Okafor O, Foley P, Umar F, Taylor R, Marshall H, Stegemann B, Moody W, Steeds R, Halliday B, Hammersley D, Jones R, Prasad S, Qiu T, Leyva F. Myocardial fibrosis predicts ventricular arrhythmias and sudden death after cardiac electronic device implantation. Europace 2022. [DOI: 10.1093/europace/euac053.384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: Private grant(s) and/or Sponsorship. Main funding source(s): Unrestricted educational grants
Background
Increasing evidence supports a link between myocardial fibrosis (MF) and ventricular arrhythmias. We sought to determine whether presence of MF on visual assessment (MFVA) and gray zone fibrosis (GZF) mass predicts SCD and ventricular fibrillation / sustained ventricular tachycardia after cardiac implantable electronic device (CIED) implantation.
Methods
In this prospective study, total fibrosis and GZF mass, quantified using cardiovascular magnetic resonance, was assessed in relation to the primary endpoint of sudden cardiac death (SCD) and the secondary, arrhythmic endpoint of SCD or ventricular arrhythmias after CIED implantation.
Results
Among 700 patients (age 68.0 ± 12.0yrs [mean ± SD]), 27 (3.85%) experienced a SCD and 121 (17.3%) met the arrhythmic endpoint over 6.93 yrs (median; interquartile range 5.82-9.32). MFVA predicted SCD (hazard ratio [HR]: HR:26.3 [95% confidence interval [CI] 3.70-3337]; negative predictive value: 100%). In competing risks analyses, MFVA also predicted the arrhythmic endpoint (subdistribution [sHR]: 19.9 [95% CI 6.40-61.9]; negative predictive value:98.6%). Compared with no MFVA, a GZF mass measured with the 5SD method (GZF5SD) > 17 g was associated with highest risk of SCD (HR: 44.6;95% CI 6.12-5685) and the arrhythmic endpoint (sHR: 30.3 [95% CI 9.60-95.8]). Adding GZF5SD mass to MFVA led to reclassification of 39% for SCD and 50.2% for the arrhythmic endpoint. In contrast, LVEF did not predict either endpoint.
Conclusions
In CIED recipients, MFVA excluded patients at risk of SCD and virtually excluded ventricular arrhythmias. Quantified GZF5SD mass added predictive value in relation to SCD and the arrhythmic endpoint.
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Affiliation(s)
- A Zegard
- Aston University, Birmingham, United Kingdom of Great Britain & Northern Ireland
| | - O Okafor
- Queen Elizabeth Hospital Birmingham, Birmingham, United Kingdom of Great Britain & Northern Ireland
| | - P Foley
- The Great Western Hospital, Swindon, United Kingdom of Great Britain & Northern Ireland
| | - F Umar
- Ottawa Cardiovascular Centre, The Ottawa Hospital, Ottawa, Canada
| | - R Taylor
- Worcestershire Acute Hospitals NHS trust, Alexandra Hospital, Worcestershire, United Kingdom of Great Britain & Northern Ireland
| | - H Marshall
- Queen Elizabeth Hospital Birmingham, Birmingham, United Kingdom of Great Britain & Northern Ireland
| | - B Stegemann
- Aston University, Birmingham, United Kingdom of Great Britain & Northern Ireland
| | - W Moody
- Queen Elizabeth Hospital Birmingham, Birmingham, United Kingdom of Great Britain & Northern Ireland
| | - R Steeds
- Queen Elizabeth Hospital Birmingham, Birmingham, United Kingdom of Great Britain & Northern Ireland
| | - B Halliday
- Royal Brompton Hospital and National Heart and Lung Institute, Imperial College, London, United Kingdom of Great Britain & Northern Ireland
| | - D Hammersley
- Royal Brompton Hospital and National Heart and Lung Institute, Imperial College, London, United Kingdom of Great Britain & Northern Ireland
| | - R Jones
- Royal Brompton Hospital and National Heart and Lung Institute, Imperial College, London, United Kingdom of Great Britain & Northern Ireland
| | - S Prasad
- Royal Brompton Hospital and National Heart and Lung Institute, Imperial College, London, United Kingdom of Great Britain & Northern Ireland
| | - T Qiu
- Queen Elizabeth Hospital Birmingham, Birmingham, United Kingdom of Great Britain & Northern Ireland
| | - F Leyva
- Aston University, Birmingham, United Kingdom of Great Britain & Northern Ireland
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Jameson M, Batumalai V, Woods A, Twentyman T, Sproule V, Christiansen J, Kennedy N, Marney M, Barooshian K, Plit M, Lynch J, Jagavkar R, Ormandy H, Christodouleas J, Pietzsch F, de Leon J, Foley P. PO-1064 A Registry for Analysis of Data to Advance Personalised Therapy with MR-Linac (ADAPT-MRL). Radiother Oncol 2022. [DOI: 10.1016/s0167-8140(22)03028-6] [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: 11/24/2022]
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Thomas H, Plummer C, Wright IJ, Foley P, Turley AJ. Guidelines for the peri‐operative management of people with cardiac implantable electronic devices. Anaesthesia 2022; 77:808-817. [DOI: 10.1111/anae.15728] [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] [Received: 01/10/2022] [Revised: 02/22/2022] [Accepted: 03/16/2022] [Indexed: 12/13/2022]
Affiliation(s)
- H. Thomas
- Department of Cardiology Northumbria Healthcare NHS Foundation Trust Northumberland UK
| | - C. Plummer
- Department of Cardiology Newcastle upon Tyne NHS Foundation Trust Newcastle upon Tyne UK
| | - I. J. Wright
- Department of Cardiology Imperial College Healthcare NHS Foundation Trust London UK
| | - P. Foley
- Department of Cardiology Great Western Hospitals NHS Foundation Trust Swindon UK
| | - A. J. Turley
- Department of Cardiology South Tees NHS Foundation Trust Middlesbrough UK
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Foley P, Tsai TF, Rodins K, Hamadah IR, Ammoury A, Dayem HA, Abdallah M, Crowe S, Haas S, Pournara E, Jagiello P, Huang YH. Effectiveness and Safety of Secukinumab for Psoriasis in a Real-World Clinical Setting in the Asia-Pacific and Middle East Regions: Results from the REALIA Study. Dermatol Ther (Heidelb) 2022; 12:511-527. [PMID: 35038128 PMCID: PMC8850524 DOI: 10.1007/s13555-021-00675-w] [Citation(s) in RCA: 6] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Accepted: 12/24/2021] [Indexed: 12/31/2022] Open
Abstract
INTRODUCTION Secukinumab has demonstrated sustained long-term efficacy with a favourable safety profile in various manifestations of psoriatic disease. We investigated effectiveness and safety of secukinumab, other biologics and conventional systemic therapies in patients with chronic plaque psoriasis in a real-world setting. METHODS REALIA was a non-interventional, multicentre, prospective, parallel group study. Eligible patients were ≥ 18 years old with chronic plaque psoriasis commencing a new treatment with a biologic agent or conventional systemic therapies. RESULTS At baseline, 541 patients were divided into three cohorts based on treatment initiated: conventional systemics (173), secukinumab (184) and other biologics (184). A significantly higher proportion of patients achieved almost clear to clear skin based on physician's judgement in secukinumab versus conventional systemics at month 3 (64.7% versus 22.8%, P < 0.001) and month 6 (61.8% versus 20.8%, P < 0.001). At month 12, clear to almost clear skin was achieved by 52.1% of the patients in secukinumab versus 35.8% in conventional systemics (P = 0.066). The proportion of patients achieving Psoriasis Area Severity Index (PASI) 90 on conventional systemics, secukinumab and other biologics was 18.8%, 59.7% and 40.0% at month 3 and 35.3%, 60.8% and 50.0% at month 12, respectively. Secukinumab patients showed significantly higher change in PASI total score from baseline versus conventional systemics at month 3 {least squares [LS] mean [standard error (SE)]: -14.49 [0.648] versus -8.48 [1.149], P < 0.001} and numerically higher [LS mean (SE): -13.60 (0.475) versus -10.84 (1.733), P = 0.122] at month 12. The proportion of patients with Dermatology Life Quality Index 0/1 score on conventional systemics, secukinumab and other biologics was 22.6%, 65.0% and 41.6% at month 3 and 32.0%, 63.5% and 41.3% at month 12, respectively. Safety profile was comparable across cohorts. CONCLUSIONS Secukinumab is effective and well tolerated in patients with chronic plaque psoriasis in a real-world setting in an Asia-Pacific and Middle East population, and these results are in agreement with clinical outcomes of secukinumab reported in randomised clinical trials. TRIAL REGISTRATION NUMBER 170803-001645.
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Affiliation(s)
- Peter Foley
- Skin Health Institute, Carlton, Victoria, Australia
| | | | - Karl Rodins
- Northern Dermatology, Chermside, Queensland, Australia
| | | | - Alfred Ammoury
- Saint George Hospital University Medical Center, Beirut, Lebanon
| | | | - Mahmoud Abdallah
- Department of Dermatology and Venereology, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | | | | | | | | | - Yu-Huei Huang
- Chang Gung Memorial Hospital Linkou and Chang Gung University, Tao-yuan, Taiwan.
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Foley P, Kong Y, Dirvanskiene R, Valdes-Hernandez M, Bastiani M, Murnane J, Sellar R, Roberts N, Pernet C, Weir C, Bak T, Colvin L, Chandran S, Fallon M, Tracey I. Coupling cognitive and brainstem dysfunction in multiple sclerosis-related chronic neuropathic limb pain. Brain Commun 2022; 4:fcac124. [PMID: 35663383 PMCID: PMC9155950 DOI: 10.1093/braincomms/fcac124] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [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: 01/04/2021] [Revised: 04/01/2022] [Accepted: 05/13/2022] [Indexed: 11/12/2022] Open
Abstract
Chronic pain in multiple sclerosis is common and difficult to treat. Its mechanisms remain incompletely understood. Dysfunction of the descending pain modulatory system is known to contribute to human chronic pain conditions. However, it is not clear how alterations in executive function influence this network, despite healthy volunteer studies linking function of the descending pain modulatory system, to cognition. In adults with multiple sclerosis-associated chronic neuropathic limb pain, compared to those without pain, we hypothesized altered functional connectivity of the descending pain modulatory system, coupled to executive dysfunction. Specifically we hypothesized reduced mental flexibility, because of potential importance in stimulus reappraisal. To investigate these hypotheses, we conducted a case-control cross-sectional study of 47 adults with relapsing remitting multiple sclerosis (31 with chronic neuropathic limb pain, 16 without pain), employing clinical, neuropsychological, structural, and functional MRI measures. We measured brain lesions and atrophy affecting descending pain modulatory system structures. Both cognitive and affective dysfunctions were confirmed in the chronic neuropathic limb pain group, including reduced mental flexibility (Delis Kaplan Executive Function System card sorting tests P < 0.001). Functional connectivity of rostral anterior cingulate and ventrolateral periaqueductal gray, key structures of the descending pain modulatory system, was significantly lower in the group experiencing chronic neuropathic pain. There was no significant between-group difference in whole-brain grey matter or lesion volumes, nor lesion volume affecting white matter tracts between rostral anterior cingulate and periaqueductal gray. Brainstem-specific lesion volume was higher in the chronic neuropathic limb pain group (P = 0.0017). Differential functional connectivity remained after correction for brainstem-specific lesion volume. Gabapentinoid medications were more frequently used in the chronic pain group. We describe executive dysfunction in people with multiple sclerosis affected by chronic neuropathic pain, along with functional and structural MRI evidence compatible with dysfunction of the descending pain modulatory system. These findings extend understanding of close inter-relationships between cognition, function of the descending pain modulatory system, and chronic pain, both in multiple sclerosis and more generally in human chronic pain conditions. These findings could support application of pharmacological and cognitive interventions in chronic neuropathic pain associated with multiple sclerosis.
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Affiliation(s)
- Peter Foley
- Anne Rowling Regenerative Neurology Clinic, University of Edinburgh, 49 Little France Crescent, Edinburgh EH16 4SB, UK
| | - Yazhuo Kong
- CAS Key Laboratory of Behavioural Science, Institute of Psychology, Chinese Academy of Sciences, Beijing, China.,Department of Psychology, University of Chinese Academy of Sciences, Beijing, China
| | - Ramune Dirvanskiene
- Anne Rowling Regenerative Neurology Clinic, University of Edinburgh, 49 Little France Crescent, Edinburgh EH16 4SB, UK
| | - Maria Valdes-Hernandez
- Dementia Research Institute, University of Edinburgh, Edinburgh, UK.,Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Matteo Bastiani
- Sir Peter Mansfield Imaging Centre, School of Medicine, University of Nottingham, Nottingham, UK.,NIHR Biomedical Research Centre, University of Nottingham, Nottingham, UK.,Wellcome Centre for Integrative Neuroimaging, University of Oxford, Oxford, UK
| | - Jonathan Murnane
- Clinical Research Imaging Centre, Edinburgh University, Edinburgh, UK
| | - Robin Sellar
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Neil Roberts
- Clinical Research Imaging Centre, Edinburgh University, Edinburgh, UK
| | - Cyril Pernet
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Christopher Weir
- Edinburgh Clinical Trials Unit, Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Thomas Bak
- School of Philosophy, Psychology and Language Sciences, University of Edinburgh, Edinburgh, UK
| | - Lesley Colvin
- Division of Population Health and Genomics, University of Dundee, Dundee, UK
| | - Siddharthan Chandran
- Anne Rowling Regenerative Neurology Clinic, University of Edinburgh, 49 Little France Crescent, Edinburgh EH16 4SB, UK.,Dementia Research Institute, University of Edinburgh, Edinburgh, UK.,Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Marie Fallon
- Department of Palliative Medicine, University of Edinburgh, Edinburgh, UK
| | - Irene Tracey
- Wellcome Centre for Integrative Neuroimaging, University of Oxford, Oxford, UK.,Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, University of Oxford, Oxford, UK
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Bourassi E, Savidge C, Foley P, Hartwig S. Serologic and urinary survey of exposure to Leptospira species in a feral cat population of Prince Edward Island, Canada. J Feline Med Surg 2021; 23:1155-1161. [PMID: 33719673 PMCID: PMC8637349 DOI: 10.1177/1098612x211001042] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
OBJECTIVES Recent studies show that cats could play an important role in the transmission of Leptospira species. There are few reports of leptospirosis on Prince Edward Island (PEI) and none in cats. The objective of this study was to determine the prevalence of serum antibodies against Leptospira serovars and of Leptospira DNA in the urine of a population of free-roaming cats. METHODS Paired blood and urine samples were collected from 200 cats brought to a trap-neuter-return program. Antibody titers against six Leptospira serovars (Bratislava, Canicola, Gryppotyphosa, Hardjo, Pomona, Icterohaemorrhagiae) were determined by microscopic agglutination test. PCR was performed on urine samples to identify urine shedding of Leptospira DNA. RESULTS Antibodies were detected in 20/200 cats (10%) for at least one serovar, with titers ranging from 1:50 to 1:6400 (all serovars tested, except Hardjo). Urine samples of 7/200 cats (3.5%) were PCR-positive. CONCLUSIONS AND RELEVANCE Feral cats in PEI had a higher than expected exposure to leptospirosis and can shed DNA from pathogenic Leptospira species in urine. Further studies are needed to determine the prevalence of exposure to leptospirosis in other species on PEI and the potential role of feral cats in transmission of the disease.
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Affiliation(s)
- Emilia Bourassi
- Department of Companion Animals, Atlantic Veterinary College, University of Prince Edward Island, Charlottetown, PE, Canada
| | - Christine Savidge
- Department of Companion Animals, Atlantic Veterinary College, University of Prince Edward Island, Charlottetown, PE, Canada
| | - Peter Foley
- Department of Companion Animals, Atlantic Veterinary College, University of Prince Edward Island, Charlottetown, PE, Canada
| | - Sunny Hartwig
- Department of Biomedical Sciences, Atlantic Veterinary College, University of Prince Edward Island, Charlottetown, PE, Canada
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Ryan C, Guenther L, Foley P, Weisman J, Burge RT, Gallo G, See K, McKean-Matthews M, Bertram CC, Merola JF. Ixekizumab provides persistent improvements in health-related quality of life and the sexual impact associated with moderate-to-severe genital psoriasis in adult patients during a 52-week, randomised, placebo-controlled, phase 3 clinical trial. J Eur Acad Dermatol Venereol 2021; 36:e277-e279. [PMID: 34812561 PMCID: PMC9299771 DOI: 10.1111/jdv.17836] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Revised: 11/12/2021] [Accepted: 11/18/2021] [Indexed: 11/29/2022]
Affiliation(s)
- C Ryan
- Charles Institute of Dermatology, University College, Dublin, Ireland.,Institute of Dermatologists, Dublin, Ireland
| | - L Guenther
- Guenther Dermatology Research Centre, London, ON, Canada
| | - P Foley
- Skin Health Institute, Melbourne, VIC, Australia
| | - J Weisman
- Medical Dermatology Specialists, Atlanta, GA, USA
| | - R T Burge
- Eli Lilly and Company, Indianapolis, IN, USA.,University of Cincinnati, Cincinnati, OH, USA
| | - G Gallo
- Eli Lilly and Company, Indianapolis, IN, USA
| | - K See
- Eli Lilly and Company, Indianapolis, IN, USA
| | | | - C C Bertram
- Eli Lilly and Company, Indianapolis, IN, USA
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Silverberg JI, Simpson EL, Boguniewicz M, De Bruin-Weller MS, Foley P, Kataoka Y, Bégo-Le-Bagousse G, Chen Z, Shumel B, Chao J, Rossi AB. Dupilumab Provides Rapid and Sustained Clinically Meaningful Responses in Adults with Moderate-to-severe Atopic Dermatitis. Acta Derm Venereol 2021; 101:adv00585. [PMID: 34618162 PMCID: PMC9455327 DOI: 10.2340/actadv.v101.307] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Optimal management of atopic dermatitis requires a comprehensive assessment of response to treatment in order to inform therapeutic decisions. In a realworld setting, successful response to atopic dermatitis treatment is measured by sustained improvements in signs, symptoms, and quality of life. Post-hoc analyses of a 1-year, randomized, double-blinded, placebo-controlled trial (NCT02260986) of dupilumab with concomitant topical corticosteroids in 421 adults with moderate-to-severe atopic dermatitis (of whom 315/106 received placebo/dupilumab (of whom 315 received placebo and 106 received dupilumab) was performed to assess the proportion of responders to dupilumab through a multidimensional composite endpoint. At 6-months, 80.2% of dupilumab-treated vs 40.0% placebo patients (p < 0.0001) achieved improvement in signs (Eczema Area and Severity Index ≤ 7), symptoms (worst itch score ≤ 4), or quality of life (Dermatology Life Quality Index ≤5), representative of minimal/clear atopic dermatitis. All 3 endpoints, indicative of no/minimal atopic dermatitis, were achieved by 44.3% of dupilumab-treated vs 10.2% placebo patients (p < 0.0001) and sustained through 1 year. Dupilumab treatment provided sustained clinically meaningful improvement in signs, symptoms, and quality of life in adults with moderate-to-severe atopic dermatitis.
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Affiliation(s)
- Jonathan I Silverberg
- George Washington University School of Medicine of Health Sciences, Ross Hall, 300 Eye Street NW, Washington 20037, DC, USA.
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Wang CY, Foley P, Baker C, Rademaker M. Biological Therapy Interruption and Re-Treatment in Chronic Plaque Psoriasis. J Drugs Dermatol 2021; 20:1063-1071. [PMID: 34636525 DOI: 10.36849/jdd.5716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
While biological treatments for chronic plaque psoriasis should be administered continuously to maximize and maintain efficacy, interruptions in therapy may be necessary for a number of reasons. We reviewed the evidence from clinical trials on efficacy, safety and immunogenicity in clinical trials for approved biologic agents for chronic plaque psoriasis. A systematic search of three major medical databases was performed and a total of 35 articles were included into the analysis, including 13 controlled trials. Trials assessing continuous therapy against dosing as-needed therapy (including infliximab, etanercept and secukinumab) have demonstrated superior efficacy for continuous regimes. However, randomized withdrawal trials for etanercept, adalimumab, ixekizumab, brodalumab, guselkumab, risankizumab and tildrakizumab, showed no significant impact on skin clearance rates in patients who are interrupted once and then re-treated. With the possible exception of infliximab, temporary interruption in biologic therapy appears to be safe and most agents will regain efficacy after re-introduction. J Drugs Dermatol. 2021;20(10):1063-1071. doi:10.36849/JDD.5716.
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48
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van Lonkhuizen PJC, Vegt NJH, Meijer E, van Duijn E, de Bot ST, Klempíř J, Frank W, Landwehrmeyer GB, Mühlbäck A, Hoblyn J, Squitieri F, Foley P, Chavannes NH, Heemskerk AW. Study Protocol for the Development of a European eHealth Platform to Improve Quality of Life in Individuals With Huntington's Disease and Their Partners (HD-eHelp Study): A User-Centered Design Approach. Front Neurol 2021; 12:719460. [PMID: 34589047 PMCID: PMC8476232 DOI: 10.3389/fneur.2021.719460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Accepted: 07/26/2021] [Indexed: 12/02/2022] Open
Abstract
Background: Huntington's disease (HD) is an autosomal dominant neurodegenerative disease that affects the quality of life (QoL) of HD gene expansion carriers (HDGECs) and their partners. Although HD expertise centers have been emerging across Europe, there are still some important barriers to care provision for those affected by this rare disease, including transportation costs, geographic distance of centers, and availability/accessibility of these services in general. eHealth seems promising in overcoming these barriers, yet research on eHealth in HD is limited and fails to use telehealth services specifically designed to fit the perspectives and expectations of HDGECs and their families. In the European HD-eHelp study, we aim to capture the needs and wishes of HDGECs, partners of HDGECs, and health care providers (HCPs) in order to develop a multinational eHealth platform targeting QoL of both HDGECs and partners at home. Methods: We will employ a participatory user-centered design (UCD) approach, which focusses on an in-depth understanding of the end-users' needs and their contexts. Premanifest and manifest adult HDGECs (n = 76), partners of HDGECs (n = 76), and HCPs (n = 76) will be involved as end-users in all three phases of the research and design process: (1) Exploration and mapping of the end-users' needs, experiences and wishes; (2) Development of concepts in collaboration with end-users to ensure desirability; (3) Detailing of final prototype with quick review rounds by end-users to create a positive user-experience. This study will be conducted in the Netherlands, Germany, Czech Republic, Italy, and Ireland to develop and test a multilingual platform that is suitable in different healthcare systems and cultural contexts. Discussion: Following the principles of UCD, an innovative European eHealth platform will be developed that addresses the needs and wishes of HDGECs, partners and HCPs. This allows for high-quality, tailored care to be moved partially into the participants' home, thereby circumventing some barriers in current HD care provision. By actively involving end-users in all design decisions, the platform will be tailored to the end-users' unique requirements, which can be considered pivotal in eHealth services for a disease as complex and rare as HD.
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Affiliation(s)
- Pearl J. C. van Lonkhuizen
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, Netherlands
- National eHealth Living Lab, Leiden University Medical Center, Leiden, Netherlands
- Huntington Center Topaz Overduin, Katwijk, Netherlands
| | - Niko J. H. Vegt
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, Netherlands
- National eHealth Living Lab, Leiden University Medical Center, Leiden, Netherlands
| | - Eline Meijer
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, Netherlands
- National eHealth Living Lab, Leiden University Medical Center, Leiden, Netherlands
| | - Erik van Duijn
- Huntington Center Topaz Overduin, Katwijk, Netherlands
- Department of Psychiatry, Leiden University Medical Center, Leiden, Netherlands
| | - Susanne T. de Bot
- Department of Neurology, Leiden University Medical Center, Leiden, Netherlands
| | - Jiří Klempíř
- Department of Neurology and Center of Clinical Neuroscience, 1st Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czechia
| | - Wiebke Frank
- Department of Neurology, University Hospital Ulm, Ulm, Germany
| | | | | | - Jennifer Hoblyn
- Bloomfield Hospital, Trinity College Dublin, Dublin, Ireland
| | - Ferdinando Squitieri
- Huntington and Rare Diseases Unit, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Casa Sollievo della Sofferenza Research Hospital, San Giovanni Rotondo, Italy
| | - Peter Foley
- Department of Clinical Neurosciences, Anne Rowling Regenerative Neurology Clinic, University of Edinburgh, Edinburgh, United Kingdom
| | - Niels H. Chavannes
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, Netherlands
- National eHealth Living Lab, Leiden University Medical Center, Leiden, Netherlands
| | - Anne-Wil Heemskerk
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, Netherlands
- Huntington Center Topaz Overduin, Katwijk, Netherlands
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Ringin S, Baker CS, Foley P, Daniel BS. Pityriasis rubra pilaris treatment options: A retrospective case series from a tertiary hospital. Dermatol Ther 2021; 34:e15128. [PMID: 34505752 DOI: 10.1111/dth.15128] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Revised: 09/06/2021] [Accepted: 09/06/2021] [Indexed: 11/26/2022]
Abstract
Pityriasis rubra pilaris (PRP) is a group of uncommon chronic inflammatory skin conditions with unclear pathophysiology and etiology. To date there is limited published literature and no clinical guidelines for the management of PRP. Infliximab, alone or in combination, is the most widely published successful treatment for adults and etanercept for pediatric populations. We present a case series of patients diagnosed with PRP. Retrospective data were collected from a tertiary Australian dermatology department between January 2010 and December 2019 on patients with PRP. Electronic medical records and pathology database were searched. A total of 13 patients were included. Twelve of the 13 patients used topical agents and three patients attempted narrow-band ultraviolet B phototherapy. All patients received acitretin as first line systemic agent with the dose varying from 10 to 50 mg daily. Six patients treated with acitretin reported adverse events, requiring dose reduction or cessation. Of the nine patients who did not receive a biologic agent, complete clearance of PRP was achieved in five cases. At least one biologic agent was used in four cases with two experiencing a marked improvement. Overall, complete clearance was achieved in six patients. PRP continues to be a challenge to treat with many treatment options used with variable efficacy.
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Affiliation(s)
- Sarah Ringin
- Department of Dermatology, St Vincent's Hospital Melbourne, Fitzroy, Australia
| | - Christopher S Baker
- Department of Dermatology, St Vincent's Hospital Melbourne, Fitzroy, Australia.,Department of Medicine, The University of Melbourne, Melbourne, Australia
| | - Peter Foley
- Department of Dermatology, St Vincent's Hospital Melbourne, Fitzroy, Australia.,Department of Medicine, The University of Melbourne, Melbourne, Australia
| | - Benjamin S Daniel
- Department of Dermatology, St Vincent's Hospital Melbourne, Fitzroy, Australia
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Blauvelt A, Gordon KB, Griffiths CE, Papp KA, Foley P, Song M, Miller M, Shen YK, You Y, Ramachandran P, Reich K. 28095 Long-term safety of guselkumab: Results from the VOYAGE 1 and VOYAGE 2 trials with up to 5 years of treatment. J Am Acad Dermatol 2021. [DOI: 10.1016/j.jaad.2021.06.708] [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: 10/20/2022]
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