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Bagit A, Maliyar K, Mansour M, Georgakopoulos JR, Rankin B, Lytvyn Y, Zaaroura H, Park YJ, Wang E, Mufti A, Torres T, Le AM, Vender R, Prajapati VH, Yeung J. Real-World Effectiveness and Safety of Risankizumab in Adult Patients with Plaque Psoriasis: A 1-year International Multicenter Retrospective Cohort Study. J Am Acad Dermatol 2024:S0190-9622(24)00654-6. [PMID: 38677338 DOI: 10.1016/j.jaad.2024.03.048] [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: 02/16/2024] [Accepted: 03/23/2024] [Indexed: 04/29/2024]
Affiliation(s)
- A Bagit
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - K Maliyar
- Division of Dermatology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - M Mansour
- Division of Dermatology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - J R Georgakopoulos
- Division of Dermatology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - B Rankin
- Division of Dermatology, Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Y Lytvyn
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; Division of Dermatology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - H Zaaroura
- Division of Dermatology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Y J Park
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - E Wang
- Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - A Mufti
- Division of Dermatology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada; Division of Dermatology, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - T Torres
- Department of Dermatology, Centro Hospitalar de Santo António, 4099-001 Porto, Portugal; Instituto de Ciências Biomédicas Abel Salazar, University of Porto, 4050-313 Porto, Portugal
| | - A M Le
- Department of Dermatology, Centro Hospitalar de Santo António, 4099-001 Porto, Portugal
| | - R Vender
- Dermatrials Research Inc. and Venderm Consulting, Hamilton, Ontario, Canada
| | - V H Prajapati
- Division of Dermatology, Department of Medicine, University of Calgary, Calgary, Alberta, Canada; Dermatology Research Institute, Calgary, Alberta, Canada; Probity Medical Research, Calgary, Alberta, Canada; Skin Health & Wellness Centre, Calgary, Alberta, Canada; Section of Community Pediatrics, University of Calgary, Calgary, Alberta, Canada; Section of Pediatric Rheumatology, Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada
| | - J Yeung
- Division of Dermatology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada; Division of Dermatology, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Division of Dermatology, Women's College Hospital, Toronto, Ontario, Canada; Probity Medical Research, Toronto, Ontario, Canada.
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2
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Rimke A, Sood S, Rankin BD, Abduelmula A, Georgakopoulos JR, Maliyar K, Bagit A, Leung F, Stark LA, Vender R, Yeung J, Prajapati VH. Real-world experience of bimekizumab for adult patients with plaque psoriasis: A 16-week multicenter retrospective study. J Am Acad Dermatol 2024:S0190-9622(24)00642-X. [PMID: 38649098 DOI: 10.1016/j.jaad.2024.04.027] [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: 03/16/2024] [Revised: 03/31/2024] [Accepted: 04/02/2024] [Indexed: 04/25/2024]
Affiliation(s)
| | - Siddhartha Sood
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Brian D Rankin
- Division of Dermatology, Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Abrahim Abduelmula
- Division of Dermatology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Jorge R Georgakopoulos
- Division of Dermatology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Khalad Maliyar
- Division of Dermatology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Ahmed Bagit
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | | | | | - Ronald Vender
- Division of Dermatology, McMaster University, Hamilton, Ontario, Canada; Dermatrials Research Inc. & Venderm Consulting, Hamilton, Ontario, Canada, Canada
| | - Jensen Yeung
- Division of Dermatology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada; Probity Medical Research, Waterloo, Ontario, Canada; Division of Dermatology, Department of Medicine, Women's College Hospital, Toronto, Ontario, Canada; Division of Dermatology, Department of Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Vimal H Prajapati
- Dermatology Research Institute, Calgary, Alberta, Canada; Division of Dermatology, Department of Medicine, University of Calgary, Calgary, Alberta, Canada; Skin Health & Wellness Centre, Calgary, Alberta, Canada; Probity Medical Research, Waterloo, Ontario, Canada; Division of Dermatology, Department of Medicine, University of Calgary, Calgary, Alberta, Canada; Section of Community Pediatrics, Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada; Section of Pediatric Rheumatology, Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada.
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3
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Papp K, Prajapati VH, Maari C, Legault M, Barakat M, Vender R. Efficacy of brodalumab in moderate-to-severe plaque psoriasis after failure of previous biologic therapy: A phase 4, multicenter, open-label study. J Am Acad Dermatol 2024:S0190-9622(24)00125-7. [PMID: 38290619 DOI: 10.1016/j.jaad.2024.01.025] [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: 08/08/2023] [Revised: 01/15/2024] [Accepted: 01/17/2024] [Indexed: 02/01/2024]
Affiliation(s)
- Kim Papp
- Probity Medical Research and Alliance Clinical Trials, Waterloo, Ontario, Canada; University of Toronto, Toronto, Ontario, Canada
| | - Vimal H Prajapati
- Division of Dermatology, Department of Medicine, University of Calgary, Calgary, Alberta, Canada; Section of Community Pediatrics, Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada; Section of Pediatric Rheumatology, Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada; Dermatology Research Institute, Skin Health & Wellness Centre, Calgary, Alberta, Canada; Probity Medical Research, Calgary, Alberta, Canada
| | - Catherine Maari
- Department of Dermatology and Skin Science, University of Montreal, Montreal, Quebec, Canada; Innovaderm Research Inc, Montreal, Quebec, Canada
| | | | | | - Ronald Vender
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada; Dermatrials Research Inc, Hamilton, Ontario, Canada
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Bukhari T, Markovina M, Abduelmula A, Rankin BD, Vender R, Yeung J, Devani AR, Prajapati VH. Spesolimab, A Novel Interleukin-36 Inhibitor for Generalized Pustular Psoriasis Flares in Adult Patients. Skin Therapy Lett 2024; 29:1-4. [PMID: 38271532] [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] [Subscribe] [Scholar Register] [Indexed: 01/27/2024]
Abstract
Generalized pustular psoriasis (GPP) is a rare, immune-mediated inflammatory disease with characteristic cutaneous and systemic manifestations. Mutations in the interleukin-36 receptor antagonist (IL36RN) gene have been implicated in its pathogenesis. Spesolimab is a novel systemic biologic therapy that selectively inhibits interleukin-36. It was recently approved by Health Canada and the US FDA for the treatment of GPP flares in adults. Results from phase 1 and 2 studies have been promising. Herein, we review the efficacy and safety of spesolimab for the treatment of GPP flares, as demonstrated in clinical trials.
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Affiliation(s)
- Tuba Bukhari
- Dermatology Research Institute, Calgary, AB, Canada
| | | | | | - Brian D Rankin
- Division of Dermatology, Department of Medicine, University of Calgary, Calgary, AB, Canada
| | - Ronald Vender
- Department of Dermatology, McMaster University, Hamilton, ON, Canada
- Dermatrials Research Inc. & Venderm Consulting, Hamilton, ON, Canada
| | - Jensen Yeung
- Division of Dermatology, Department of Medicine, University of Toronto, ON, Canada
- Women's College Research Institute, Women's College Hospital, Toronto, ON, Canada
- Sunnybrook Health Sciences Centre, Toronto, ON, Canada
- Probity Medical Research, Waterloo, ON, Canada
| | - Alim R Devani
- Dermatology Research Institute, Calgary, AB, Canada
- Probity Medical Research, Waterloo, ON, Canada
- Skin Health & Wellness Centre, Calgary, AB, Canada
| | - Vimal H Prajapati
- Dermatology Research Institute, Calgary, AB, Canada
- Division of Dermatology, Department of Medicine, University of Calgary, Calgary, AB, Canada
- Probity Medical Research, Waterloo, ON, Canada
- Skin Health & Wellness Centre, Calgary, AB, Canada
- Section of Community Pediatrics, Department of Pediatrics, University of Calgary, Calgary, AB, Canada
- Section of Pediatric Rheumatology, Department of Pediatrics, University of Calgary, Calgary, AB, Canada
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Sood S, Abduelmula A, Maliyar K, Georgakopoulos JR, Mufti A, Vender R, Prajapati VH, Yeung J. Use of Janus Kinase Inhibitor Treatment for Palmoplantar Pustulosis: An Evidence-Based Review. J Cutan Med Surg 2024; 28:86-87. [PMID: 37937880 DOI: 10.1177/12034754231211342] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2023]
Affiliation(s)
- Siddhartha Sood
- Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Abrahim Abduelmula
- Division of Dermatology, Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Khalad Maliyar
- Division of Dermatology, Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Jorge R Georgakopoulos
- Division of Dermatology, Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Asfandyar Mufti
- Division of Dermatology, Department of Medicine, University of Toronto, Toronto, ON, Canada
- Department of Dermatology, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Ronald Vender
- Division of Dermatology, Department of Medicine, McMaster University, Hamilton, ON, Canada
- Dermatrials Research Inc. & Venderm Consulting, Hamilton, ON, Canada, Canada
| | - Vimal H Prajapati
- Division of Dermatology, Department of Medicine, University of Calgary, Calgary, Alberta, Canada
- Dermatology Research Institute, Calgary, Alberta, Canada
- Skin Health & Wellness Centre, Calgary, Alberta, Canada
- Section of Community Pediatrics, Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada
- Section of Pediatric Rheumatology, Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada
- Probity Medical Research, Waterloo, ON, Canada
| | - Jensen Yeung
- Division of Dermatology, Department of Medicine, University of Toronto, Toronto, ON, Canada
- Department of Dermatology, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
- Probity Medical Research, Waterloo, ON, Canada
- Department of Dermatology, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
- Department of Dermatology, Women's College Hospital, Toronto, ON, Canada
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Martinez-Cabriales S, Marcoux D, Liy-Wong C, Prajapati VH, Sibbald C, Cunningham N, Lansang P, Tonkin R, Joseph M, Wong L, Spring S, Gavigan G, Ramien M. Multicenter Canadian case series of pediatric patients less than 12 years of age with moderate-to-severe atopic dermatitis treated with dupilumab. Pediatr Dermatol 2024; 41:5-11. [PMID: 37906120 DOI: 10.1111/pde.15418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Accepted: 08/05/2023] [Indexed: 11/02/2023]
Abstract
BACKGROUND Dupilumab is approved for moderate-severe atopic dermatitis (AD) in patients aged ≥6 months by the US Food and Drug Administration and Health Canada; however, there are little real-world data because providers have limited practical experience with this recently approved therapy. OBJECTIVES To describe the real-world effectiveness and safety in patients aged <12 years with moderate-severe AD currently receiving or previously having received dupilumab. METHODS A multicenter retrospective study was conducted at six Canadian sites. Cases were divided into Group 1 ≤2 years old, Group 2 >2 to <6 years old, and Group 3 ≥6 to <12 years old. Medical history and details of dupilumab treatment were collected. The primary outcome was to measure the improvement in eczema area and severity index. Secondary outcomes examined included the children's dermatology life quality index/infant's dermatitis quality of life, peak pruritus numerical rating scale, and delay to dupilumab access for patients who were considered off-label for dupilumab due to their age. RESULTS Sixty three pediatric patients (37 males) with moderate-to-severe AD were included; the mean age was 6.4 years old (range: 2-11) when dupilumab treatment was started. Overall, 75% (36/48) achieved EASI-75% and 71% (34/48) achieved EASI-90. EASI-75 and EASI-90 were achieved in 90% (17/19) and 73% (12/19) in patients <6 years old, and 76% (22/29) and 59% (17/29) in patients >6 years old, respectively. No serious adverse events were reported. CONCLUSIONS Dupilumab is safe and effective for patients under the age of 12. However, even for experienced providers, access to the medication was challenging.
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Affiliation(s)
- Sylvia Martinez-Cabriales
- Alberta Children's Hospital, Department of Pediatrics, University of Calgary, Calgary, Canada
- Division of Dermatology, Department of Medicine, University of Toronto, Toronto, Canada
| | - Danielle Marcoux
- Division of Dermatology, Department of Pediatrics, Sainte-Justine University Hospital Center, University of Montreal, Montreal, Canada
| | - Carmen Liy-Wong
- Department of Pediatrics, Division of Dermatology and Rheumatology, Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, Canada
| | - Vimal H Prajapati
- Dermatology Research Institute, Calgary, Canada
- Division of Dermatology, Department of Medicine, University of Calgary, Calgary, Canada
- Section of Community Pediatrics, Department of Pediatrics, University of Calgary, Calgary, Canada
- Section of Pediatric Rheumatology, Department of Pediatrics, University of Calgary, Calgary, Canada
- Skin Health & Wellness Centre, Calgary, Canada
- Probity Medical Research, Calgary, Canada
| | - Cathryn Sibbald
- Division of Dermatology, Department of Medicine, University of Toronto, Toronto, Canada
- The Hospital for Sick Children and Department of Pediatrics, University of Toronto, Toronto, Canada
| | - Natalie Cunningham
- Division of Dermatology, Department of Medicine, IWK Health Centre, Dalhousie University, Halifax, Canada
| | - Perla Lansang
- Division of Dermatology, Department of Medicine, University of Toronto, Toronto, Canada
- The Hospital for Sick Children and Department of Pediatrics, University of Toronto, Toronto, Canada
| | - Rochelle Tonkin
- Division of Dermatology, Department of Medicine, University of Calgary, Calgary, Canada
| | - Marissa Joseph
- Division of Dermatology, Department of Medicine, University of Toronto, Toronto, Canada
- The Hospital for Sick Children and Department of Pediatrics, University of Toronto, Toronto, Canada
| | - Lauren Wong
- Faculty of Medicine, University of Alberta, Edmonton, Canada
| | - Shanna Spring
- Department of Pediatrics, Division of Dermatology and Rheumatology, Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, Canada
| | - Genevieve Gavigan
- Department of Pediatrics, Division of Dermatology and Rheumatology, Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, Canada
| | - Michele Ramien
- Alberta Children's Hospital, Department of Pediatrics, University of Calgary, Calgary, Canada
- Division of Dermatology, Department of Medicine, University of Calgary, Calgary, Canada
- Section of Community Pediatrics, Department of Pediatrics, University of Calgary, Calgary, Canada
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Georgakopoulos JR, Sheka D, Rankin B, Maliyar K, Rimke A, Prajapati VH, Yeung J. Real-world effectiveness and safety of upadacitinib for the treatment of atopic dermatitis in adult patients switched from dupilumab: A multicenter retrospective study. J Am Acad Dermatol 2023; 89:1308-1311. [PMID: 37648068 DOI: 10.1016/j.jaad.2023.08.059] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Revised: 08/04/2023] [Accepted: 08/20/2023] [Indexed: 09/01/2023]
Affiliation(s)
- Jorge R Georgakopoulos
- Division of Dermatology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Dropen Sheka
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Brian Rankin
- Division of Dermatology, Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Khalad Maliyar
- Division of Dermatology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | | | - Vimal H Prajapati
- Division of Dermatology, Department of Medicine, University of Calgary, Calgary, Alberta, Canada; Dermatology Research Institute, Calgary, Alberta, Canada; Section of Community Pediatrics, Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada; Section of Pediatric Rheumatology, Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada; Skin Health & Wellness Centre, Calgary, Alberta, Canada; Probity Medical Research, Waterloo, Ontario, Canada
| | - Jensen Yeung
- Division of Dermatology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada; Division of Dermatology, Department of Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Division of Dermatology, Department of Medicine, Women's College Hospital, Toronto, Ontario, Canada; Probity Medical Research, Waterloo, Ontario, Canada.
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Gooderham MJ, Bissonnette R, Kalia S, Papp KA, Guenther LC, Gulliver WP, Ho V, Shear NH, Vender R, Gniadecki R, Prajapati VH, Turchin I, Langholff W, Parnell K, Simpson SD, Abbarin N, Lakhani O, Alhusayen R. Baseline Characteristics of Canadian Patients in the Psoriasis Longitudinal Assessment and Registry (PSOLAR). J Cutan Med Surg 2023; 27:594-600. [PMID: 37571829 PMCID: PMC10714709 DOI: 10.1177/12034754231191509] [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: 05/07/2023] [Revised: 07/07/2023] [Accepted: 07/14/2023] [Indexed: 08/13/2023]
Abstract
BACKGROUND The Psoriasis Longitudinal Assessment and Registry (PSOLAR) is a global, prospective, longitudinal, disease-based registry. It serves as a post-marketing safety commitment with a focus on patients with moderate to severe plaque psoriasis who are candidates for systemic therapy. OBJECTIVES To describe the baseline disease demographics and clinical characteristics of a Canadian subgroup of participants enrolled in PSOLAR. METHODS Baseline demographic/disease characteristics, medical histories, and previous psoriasis treatments for Canadian patients in PSOLAR were summarized using descriptive statistics. RESULTS There were 1896 patients analyzed in the Canadian subgroup at 37 clinical sites, accounting for 15.7% of the global PSOLAR population. Baseline disease and clinical characteristics were as expected for a moderate to severe psoriasis population and were generally similar to the global PSOLAR population. Two distinctions were noted in the Canadian subgroup versus those enrolled globally: a higher proportion of patients were overweight/obese (84.7% vs. 80.4%) and male (61.4% vs. 54.7%). In addition, the Canadian subgroup had numerically higher historical peak disease activity (PGA score 3.35 vs. 3.1) and longer disease duration (22.3 years vs. 17.5 years). Canadian PSOLAR patients reported a variety of comorbidities, including psoriatic arthritis (31.5%), hypertension (34.6%), hyperlipidemia (24.3%), mental illness (24.1%), and inflammatory bowel disease (1.6%). CONCLUSION The Canadian subgroup of PSOLAR patients was generally similar to those enrolled globally with respect to baseline disease demographics and clinical characteristics. Multiple comorbidities are noted in the Canadian subgroup, underscoring the need for a holistic approach to the treatment of psoriatic patients.
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Affiliation(s)
- Melinda J. Gooderham
- SKiN Centre for Dermatology and Probity Medical Research, Peterborough, ON, Canada
| | | | - Sunil Kalia
- Department of Dermatology and Skin Science, University of British Columbia and Vancouver Coastal Health Research Institute, Vancouver, BC, Canada
| | - Kim A. Papp
- Probity Medical Research and Alliance Clinical Trials, Waterloo, ON, Canada
| | | | - Wayne P. Gulliver
- Memorial University of Newfoundland and New Lab Life Sciences, St. John’s, NL, Canada
| | - Vincent Ho
- Department of Dermatology and Skin Science, University of British Columbia and Vancouver Coastal Health Research Institute, Vancouver, BC, Canada
| | - Neil H. Shear
- Division of Dermatology, Sunnybrook Health Sciences Centre, University of Toronto, ON, Canada
| | - Ron Vender
- Dermatrials Research Inc., Hamilton, ON, Canada
| | - Robert Gniadecki
- Division of Dermatology, Department of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Vimal H. Prajapati
- Division of Dermatology, Department of Medicine, University of Calgary, Calgary, AB, Canada
- Section of Community Pediatrics, Department of Pediatrics, University of Calgary, Calgary, AB, Canada
- Department of Pediatrics, Section of Pediatric Rheumatology, Calgary, AB, Canada
- Dermatology Research Institute, Calgary, AB, Canada
- Skin Health & Wellness Centre, Calgary, AB, Canada
- Probity Medical Research, Calgary, AB, Canada
| | - Irina Turchin
- Probity Medical Research and Alliance Clinical Trials, Waterloo, ON, Canada
- Brunswick Dermatology Centre, Fredericton, NB, Canada
| | | | - Kim Parnell
- Janssen Scientific Affairs, LLC, Horsham, PA, USA
| | | | | | | | - Raed Alhusayen
- Division of Dermatology, Sunnybrook Health Sciences Centre, University of Toronto, ON, Canada
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Tarride JE, Prajapati VH, Lynde C, Blackhouse G. The burden of palmoplantar pustulosis: A Canadian population-based study of inpatient care, emergency departments, and outpatient clinics. JAAD Int 2023; 12:151-159. [PMID: 37601237 PMCID: PMC10435946 DOI: 10.1016/j.jdin.2023.04.002] [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] [Accepted: 04/06/2023] [Indexed: 08/22/2023] Open
Abstract
Background Not much is known about the burden of palmoplantar pustulosis (PPP). Objectives To document the burden of PPP in Canada, and to compare with psoriasis vulgaris (PV). Methods Adult Canadians (excluding the province of Quebec) hospitalized or visiting an emergency department (ED) or hospital-/community-based clinic between April 1, 2007, and March 31, 2020, with a diagnostic code indicating PPP (ICD-10-CA: L40.3) or PV (ICD10-CA: L40.9 or L40.0) were identified using Canadian administrative data. 10-year prevalent- and 3-year incident-based approaches were conducted. Costs were determined when the most responsible diagnosis (MRD) for the admission was PPP or PV (MRD costs) and for all reasons (all-cause costs). Results In the prevalence analysis, the 10-year mean (standard deviation [SD]) and MRD costs were $544 ($1874) for PPP and $222 ($1828) for PV (P < .01). In the incidence analysis, PPP patients had higher 3-year mean (SD) MRD costs ($1078 [$2705]) than PV ($503 [$2267]) (P < .01). All-cause costs were lower for the PPP cohort in the prevalent and incident analyses. There were no differences in all-cause inpatient mortality between PPP and PV. Limitations Physician and prescription data were not available. Conclusion PPP patients incurred significantly higher MRD costs than PV patients.
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Affiliation(s)
- Jean-Eric Tarride
- Department of Health Research Methods, Evidence and Impact, Faculty of Health Sciences, McMaster University, Hamilton, Canada
- Programs for Assessment of Technology in Health (PATH), The Research Institute of St. Joe’s Hamilton, St. Joseph’s Healthcare, Hamilton, Canada
- Center for Health Economics and Policy Analysis (CHEPA), McMaster University, Hamilton, Canada
| | - Vimal H. Prajapati
- Division of Dermatology, Department of Medicine, University of Calgary, Calgary, Canada; Section of Community Pediatrics, Department of Pediatrics, University of Calgary, Calgary, Canada; Section of Pediatric Rheumatology, Department of Pediatrics, University of Calgary, Calgary, Canada; Skin Health & Wellness Centre, Calgary, Canada; Dermatology Research Institute, Calgary, Canada; Probity Medical Research, Calgary, Canada
| | - Charles Lynde
- Department of Medicine, University of Toronto, Toronto, Canada
| | - Gord Blackhouse
- Department of Health Research Methods, Evidence and Impact, Faculty of Health Sciences, McMaster University, Hamilton, Canada
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10
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Bagit A, Maliyar K, Georgakopoulos JR, Rankin B, Rimke A, Mufti A, Le H, Vender R, Prajapati VH, Yeung J. Real-world effectiveness and safety of risankizumab in patients with plaque psoriasis in whom guselkumab failed recently: A multicenter retrospective study of switching within the interleukin-23 inhibitor class. JAAD Int 2023; 12:136-138. [PMID: 37409313 PMCID: PMC10319311 DOI: 10.1016/j.jdin.2023.05.006] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/07/2023] Open
Affiliation(s)
- Ahmed Bagit
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Khalad Maliyar
- Division of Dermatology, Department of Medicine, University of Toronto, Ontario, Canada
| | | | - Brian Rankin
- Division of Dermatology, Department of Medicine, University of Calgary, Alberta, Canada
| | | | - Asfandyar Mufti
- Division of Dermatology, Department of Medicine, University of Toronto, Ontario, Canada
- Division of Dermatology, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Heather Le
- Dermatrials Research Inc. and Venderm Consulting, Hamilton, Ontario, Canada
| | - Ronald Vender
- Dermatrials Research Inc. and Venderm Consulting, Hamilton, Ontario, Canada
| | - Vimal H. Prajapati
- Division of Dermatology, Department of Medicine, University of Calgary, Alberta, Canada
- Dermatology Research Institute, Calgary, Alberta, Canada
- Section of Community Pediatrics, University of Calgary, Calgary, Alberta, Canada
- Section of Pediatric Rheumatology, Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada
- Skin Health & Wellness Centre, Calgary, Alberta, Canada
- Probity Medical Research, Calgary, Alberta, Canada
| | - Jensen Yeung
- Division of Dermatology, Department of Medicine, University of Toronto, Ontario, Canada
- Division of Dermatology, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Probity Medical Research, Calgary, Alberta, Canada
- Division of Dermatology, Women’s College Hospital, Toronto, Ontario, Canada
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Tarride JE, Prajapati VH, Lynde C, Blackhouse G. The burden associated with generalized pustular psoriasis: A Canadian population-based study of inpatient care, emergency departments, and hospital- or community-based outpatient clinics. JAAD Int 2023; 12:90-98. [PMID: 37325044 PMCID: PMC10265504 DOI: 10.1016/j.jdin.2023.03.012] [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] [Accepted: 03/20/2023] [Indexed: 06/17/2023] Open
Abstract
Background Not much is known about the burden of generalized pustular psoriasis (GPP). Objectives To document the burden of GPP in Canada and to compare it with psoriasis vulgaris (PV). Methods National data were used to identify Canadian adult patients with GPP or PV hospitalized or visiting an emergency department (ED) or hospital-/community-based clinic between April 1, 2007, and March 31, 2020. Analyses of 10-year prevalence and 3-year incidence were conducted. Costs were determined when the most responsible diagnosis (MRD) was GPP or PV (MRD costs) and for all reasons (all-cause costs). Results In the prevalence analysis, 10-year mean (SD) MRD costs were $2393 ($11,410) for patients with GPP and $222 ($1828) for those with PV (P < .01). In the incidence analysis, patients with GPP had higher 3-year mean (SD) MRD costs ($3477 [$14,979] vs $503 [$2267] for PV; P < .01). Higher all-cause costs were also associated with patients with GPP. Inpatient/ED mortality was higher in the GPP group in our 10-year prevalence (9.2% for patients with GPP vs 7.3% for those with PV; P = .01) and 3-year incidence (5.2% for patients with GPP and 2.1% for those with PV; P = .03) analyses. Limitations Physician and prescription drug data were not available. Conclusion Patients with GPP incurred higher costs and mortality than patients with PV.
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Affiliation(s)
- Jean-Eric Tarride
- Department of Health Research Methods, Evidence and Impact, Faculty of Health Sciences, McMaster University, Hamilton, Canada
- Programs for Assessment of Technology in Health (PATH), The Research Institute of St. Joe’s Hamilton, St. Joseph’s Healthcare Hamilton, Hamilton, Canada
- Center for Health Economics and Policy Analysis (CHEPA), McMaster University, Hamilton, Canada
| | - Vimal H. Prajapati
- Division of Dermatology, Department of Medicine; Section of Community Pediatrics, Department of Pediatrics; and Section of Pediatric Rheumatology, Department of Pediatrics, University of Calgary, Calgary, Canada; Skin Health & Wellness Centre, Calgary, Canada; Dermatology Research Institute, Calgary, Canada; and Probity Medical Research, Calgary, Canada
| | - Charles Lynde
- Department of Medicine, University of Toronto, Toronto, Canada
| | - Gord Blackhouse
- Department of Health Research Methods, Evidence and Impact, Faculty of Health Sciences, McMaster University, Hamilton, Canada
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12
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Blauvelt A, Ladizinski B, Prajapati VH, Laquer V, Fischer A, Eisman S, Hu X, Wu T, Calimlim BM, Kaplan B, Liu Y, Teixeira HD, Liu J, Eyerich K. Efficacy and safety of switching from dupilumab to upadacitinib versus continuous upadacitinib in moderate-to-severe atopic dermatitis: Results from an open-label extension of the phase 3, randomized, controlled trial (Heads Up). J Am Acad Dermatol 2023; 89:478-485. [PMID: 37230366 DOI: 10.1016/j.jaad.2023.05.033] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Revised: 04/18/2023] [Accepted: 05/10/2023] [Indexed: 05/27/2023]
Abstract
BACKGROUND Characterization of upadacitinib use and switching from dupilumab to upadacitinib among patients with moderate-to-severe atopic dermatitis (AD) is needed. OBJECTIVE To evaluate the long-term safety and efficacy of continuous upadacitinib 30 mg and switching to upadacitinib after 24 weeks of dupilumab. METHODS Adults who completed the phase 3b clinical trial of oral upadacitinib 30 mg vs injectable dupilumab 300 mg (Heads Up) and entered a 52-week open-label extension (OLE) (NCT04195698) were included. All patients received 30-mg upadacitinib during the open-label period. We report results of a prespecified interim OLE 16-week analysis. RESULTS Patients (n = 239) continuing upadacitinib maintained high levels of skin and itch response. Patients (n = 245) switching from dupilumab experienced additional incremental improvements in clinical responses within 4 weeks of starting upadacitinib. Most patients who did not achieve adequate clinical responses with dupilumab did so with upadacitinib. The safety profile of upadacitinib up to 40 weeks (week 16 of OLE) was consistent with previous phase 3 AD studies, with no new safety risks observed. LIMITATIONS Open-label study design. CONCLUSIONS Clinical responses are maintained with continuous upadacitinib through 40 weeks and patients regardless of prior dupilumab response experienced improved outcomes when switched to upadacitinib. No new safety risks were observed.
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Affiliation(s)
| | | | - Vimal H Prajapati
- Division of Dermatology, Department of Medicine, University of Calgary, Calgary, Alberta, Canada; Section of Community Pediatrics, Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada; Section of Pediatric Rheumatology, Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada; Skin Health & Wellness Centre, Calgary, Alberta, Canada; Dermatology Research Institute, Calgary, Alberta, Canada; Probity Medical Research, Calgary, Alberta, Canada
| | - Vivian Laquer
- First OC Dermatology Research, Fountain Valley, California
| | - Alison Fischer
- Southside Dermatology, Tulsa, Oklahoma; Oklahoma State University Center for Health Sciences, Tulsa, Oklahoma
| | | | | | | | | | | | | | | | - John Liu
- AbbVie Inc, North Chicago, Illinois
| | - Kilian Eyerich
- Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden; Department of Dermatology and Venerology, School of Medicine, University of Freiburg, Freiburg, Germany
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13
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Papp KA, Melosky B, Sehdev S, Hotte SJ, Beecker JR, Kirchhof MG, Turchin I, Dutz JP, Gooderham MJ, Gniadecki R, Hong CH, Lambert J, Lynde CW, Prajapati VH, Vender RB. Correction to: Use of Systemic Therapies for Treatment of Psoriasis in Patients with a History of Treated Solid Tumours: Inference-Based Guidance from a Multidisciplinary Expert Panel. Dermatol Ther (Heidelb) 2023:10.1007/s13555-023-00949-5. [PMID: 37410207 PMCID: PMC10366052 DOI: 10.1007/s13555-023-00949-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/07/2023] Open
Affiliation(s)
- Kim A Papp
- Probity Medical Research Inc., Waterloo, ON, Canada.
- Alliance Clinical Research, Waterloo, ON, Canada.
| | - Barbara Melosky
- Medical Oncology, BC Cancer Vancouver Centre, Vancouver, BC, Canada
- Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Sandeep Sehdev
- Division of Medical Oncology, The Ottawa Hospital, University of Ottawa, Ottawa, ON, Canada
| | - Sebastien J Hotte
- Juravinski Cancer Centre, Hamilton, ON, Canada
- Department of Oncology, McMaster University, Hamilton, ON, Canada
| | - Jennifer R Beecker
- Probity Medical Research Inc., Waterloo, ON, Canada
- University of Ottawa, Ottawa, ON, Canada
- Division of Dermatology, The Ottawa Hospital, Ottawa, ON, Canada
- Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Mark G Kirchhof
- University of Ottawa, Ottawa, ON, Canada
- Division of Dermatology, The Ottawa Hospital, Ottawa, ON, Canada
| | - Irina Turchin
- Probity Medical Research Inc., Waterloo, ON, Canada
- Brunswick Dermatology Centre, Fredericton, NB, Canada
- Department of Medicine, Dalhousie University, Halifax, NS, Canada
| | - Jan P Dutz
- Skin Care Centre, Vancouver, BC, Canada
- Department of Dermatology and Skin Science, University of British Columbia, Vancouver, BC, Canada
- BC Children's Hospital Research Institute, Vancouver, BC, Canada
| | - Melinda J Gooderham
- Probity Medical Research Inc., Waterloo, ON, Canada
- SKiN Centre for Dermatology, Peterborough, ON, Canada
| | - Robert Gniadecki
- Division of Dermatology, Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Chih-Ho Hong
- Probity Medical Research Inc., Waterloo, ON, Canada
- Department of Dermatology and Skin Science, University of British Columbia, Vancouver, BC, Canada
- Dr. Chih-ho Hong Medical Inc., Surrey, BC, Canada
| | - Jo Lambert
- Department of Dermatology, Ghent University Hospital, Ghent, Belgium
- Dermatology Research Unit, Ghent University, Ghent, Belgium
| | - Charles W Lynde
- Probity Medical Research Inc., Waterloo, ON, Canada
- Lynde Institute for Dermatology, Markham, ON, Canada
- Division of Dermatology, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Vimal H Prajapati
- Probity Medical Research Inc., Waterloo, ON, Canada
- Division of Dermatology, Department of Medicine, University of Calgary, Calgary, AB, Canada
- Section of Community Pediatrics, Department of Pediatrics, University of Calgary, Calgary, AB, Canada
- Section of Pediatric Rheumatology, Department of Pediatrics, University of Calgary, Calgary, AB, Canada
- Dermatology Research Institute, Calgary, AB, Canada
- Skin Health & Wellness Centre, Calgary, AB, Canada
| | - Ronald B Vender
- Department of Medicine, McMaster University, Hamilton, ON, Canada
- Dermatrials Research Inc., Hamilton, ON, Canada
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14
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Paller AS, Ladizinski B, Mendes-Bastos P, Siegfried E, Soong W, Prajapati VH, Lio P, Thyssen JP, Simpson EL, Platt AM, Raymundo EM, Liu J, Calimlim BM, Huang X, Gu Y, Hu X, Yang Y, Su JC, Zheng M, Yamamoto-Hanada K, Teixeira HD, Irvine AD. Efficacy and Safety of Upadacitinib Treatment in Adolescents With Moderate-to-Severe Atopic Dermatitis: Analysis of the Measure Up 1, Measure Up 2, and AD Up Randomized Clinical Trials. JAMA Dermatol 2023; 159:526-535. [PMID: 37043227 PMCID: PMC10099102 DOI: 10.1001/jamadermatol.2023.0391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Accepted: 02/01/2023] [Indexed: 04/13/2023]
Abstract
Importance Atopic dermatitis onset usually occurs in childhood. Persistence of disease into adolescence and adulthood is common. It is important to evaluate new treatment options in adolescents because of the high unmet need in this population. Objective To assess the efficacy and safety of upadacitinib to treat moderate-to-severe atopic dermatitis in adolescents. Design, Setting, and Participants Prespecified analysis of adolescents enrolled in 3 randomized, double-blind, placebo-controlled phase 3 clinical trials in more than 20 countries across Europe, North and South America, Oceania, the Middle East, and the Asia-Pacific region from July 2018 through December 2020. Participants were adolescents aged 12 to 17 years with moderate-to-severe atopic dermatitis. Data analysis was performed from April to August 2021. Interventions Patients were randomized (1:1:1) to once-daily oral upadacitinib 15 mg, upadacitinib 30 mg, or placebo alone (Measure Up 1 and Measure Up 2) or with topical corticosteroids (AD Up). Main Outcomes and Measures Safety and efficacy, including at least a 75% improvement in the Eczema Area and Severity Index from baseline and validated Investigator Global Assessment for Atopic Dermatitis score of 0 (clear) or 1 (almost clear) at week 16 (coprimary end points). Results A total of 552 adolescents (290 female; 262 male) were randomized. Mean (SD) age was 15.4 (1.8), 15.5 (1.7), and 15.3 (1.8) years for adolescents in Measure Up 1, Measure Up 2, and AD Up, respectively. In Measure Up 1, Measure Up 2, and AD Up, respectively, a greater proportion of adolescents (% [95% CI]) achieved at least 75% improvement in the Eczema Area and Severity Index at week 16 with upadacitinib 15 mg (73% [63%-84%], 69% [57%-81%], 63% [51%-76%]), and upadacitinib 30 mg (78% [68%-88%], 73% [62%-85%], 84% [75%-94%]), than with placebo (12% [4%-20%], 13% [5%-22%], 30% [19%-42%]; nominal P < .001 for all comparisons vs placebo). Similarly, a greater proportion of adolescents treated with upadacitinib achieved a validated Investigator Global Assessment for Atopic Dermatitis score of 0 or 1 at week 16 and improvements in quality of life with upadacitinib than with placebo. Upadacitinib was generally well tolerated in adolescents. Acne was the most common adverse event, and all acne events were mild or moderate. Conclusions and Relevance In this analysis of 3 randomized clinical trials, upadacitinib was an effective treatment for adolescents with moderate-to-severe atopic dermatitis, with an acceptable safety profile. Trial Registration ClinicalTrials.gov Identifiers: NCT03569293 (Measure Up 1), NCT03607422 (Measure Up 2), and NCT03568318 (AD Up).
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Affiliation(s)
- Amy S. Paller
- Departments of Dermatology and Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | | | | | - Elaine Siegfried
- Department of Pediatrics, Saint Louis University School of Medicine, St Louis, Missouri
| | - Weily Soong
- AllerVie Health–Alabama Allergy and Asthma Center and Clinical Research Center of Alabama, Birmingham
| | - Vimal H. Prajapati
- Division of Dermatology, Department of Medicine, Sections of Community Pediatrics and Pediatric Rheumatology, Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada
- Skin Health & Wellness Centre, Dermatology Research Institute and Probity Medical Research, Calgary, Alberta, Canada
| | - Peter Lio
- Medical Dermatology Associates of Chicago, Chicago, Illinois
| | - Jacob P. Thyssen
- Department of Dermatology, Bispebjerg Hospital, University of Copenhagen, Denmark
| | - Eric L. Simpson
- Department of Dermatology, Oregon Health & Science University, Portland
| | | | | | | | | | | | - Yihua Gu
- AbbVie Inc, North Chicago, Illinois
| | | | | | - John C. Su
- Department of Dermatology, Monash University, Eastern Health and MCRI, University of Melbourne, Melbourne, Australia
| | - Min Zheng
- Department of Dermatology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | | | | | - Alan D. Irvine
- Clinical Medicine, Trinity College Dublin and Wellcome-HRB Clinical Research Facility, St James’s Hospital, Dublin, Ireland
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15
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Abduelmula A, Rankin BD, Sood S, Georgakopoulos JR, Mufti A, Vender R, Yeung J, Prajapati VH. Management of Adult Generalized Pustular Psoriasis Using Biologics: A Systematic Review. J Am Acad Dermatol 2023:S0190-9622(23)00729-6. [PMID: 37100243 DOI: 10.1016/j.jaad.2023.04.031] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 04/15/2023] [Accepted: 04/16/2023] [Indexed: 04/28/2023]
Affiliation(s)
- Abrahim Abduelmula
- Faculty of Medicine, University of Western Ontario, London, Ontario, Canada
| | - Brian D Rankin
- Division of Dermatology, Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Siddhartha Sood
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | | | - Asfandyar Mufti
- Division of Dermatology, Department of Medicine, University of Toronto, Ontario, Canada
| | - Ronald Vender
- Department of Dermatology, McMaster University, Hamilton, Ontario, Canada; Dermatrials Research Inc. & Venderm Innovations in Psoriasis, Hamilton, Ontario, Canada
| | - Jensen Yeung
- Division of Dermatology, Department of Medicine, University of Toronto, Ontario, Canada; Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada; Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Probity Medical Research, Waterloo, Ontario, Canada
| | - Vimal H Prajapati
- Section of Pediatric Rheumatology, Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada; Section of Community Pediatrics, Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada; Division of Dermatology, Department of Medicine, University of Calgary, Calgary, Alberta, Canada; Dermatology Research Institute, Calgary, Alberta, Canada; Skin Health & Wellness Centre, Calgary, Alberta, Canada; Probity Medical Research, Calgary, Alberta, Canada.
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16
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Yeung J, Gooderham MJ, Hong HCH, Lynde C, Prajapati VH, Lansang P, Turchin I, Wiseman M, Jack C, Ramien M, Purdy K, Grewal P. Treat-to-target in the management of moderate-to-severe atopic dermatitis in adults: A Canadian perspective. J Am Acad Dermatol 2023:S0190-9622(23)00520-0. [PMID: 37074241 DOI: 10.1016/j.jaad.2023.01.053] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Revised: 01/20/2023] [Accepted: 01/30/2023] [Indexed: 04/20/2023]
Affiliation(s)
- Jensen Yeung
- Division of Dermatology, Women's College Hospital, Toronto, Ontario, Canada; Department of Medicine, University of Toronto, Toronto, Ontario, Canada; Probity Medical Research Inc, Waterloo, Ontario, Canada; Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Ontario, Canada.
| | - Melinda J Gooderham
- Probity Medical Research Inc, Waterloo, Ontario, Canada; Queen's University, Kingston, Ontario, Canada; Skin Centre for Dermatology, Peterborough, Ontario, Canada
| | - H Chih-Ho Hong
- Probity Medical Research Inc, Waterloo, Ontario, Canada; Department of Dermatology and Skin Science, University of British Columbia, Vancouver, British Columbia, Canada; Dr Chih-Ho Hong Medical Inc, Surrey, British Columbia, Canada; Probity Medical Research Inc, Surrey, British Columbia, Canada
| | - Charles Lynde
- Probity Medical Research Inc, Waterloo, Ontario, Canada; Lynde Institute for Dermatology, Markham, Ontario, Canada
| | - Vimal H Prajapati
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada; Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada; Dermatology Research Institute, Calgary, Alberta, Canada; Skin Health & Wellness Centre, Calgary, Alberta, Canada; Probity Medical Research Inc, Calgary, Alberta, Canada
| | - Perla Lansang
- Division of Dermatology, Women's College Hospital, Toronto, Ontario, Canada; Department of Medicine, University of Toronto, Toronto, Ontario, Canada; Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Ontario, Canada; The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Irina Turchin
- Probity Medical Research Inc, Waterloo, Ontario, Canada; Brunswick Dermatology Center, Fredericton, New Brunswick, Canada; Dalhousie University, Halifax, Nova Scotia, Canada
| | - Marni Wiseman
- Probity Medical Research Inc, Waterloo, Ontario, Canada; SKiNWISE Dermatology, Winnipeg, Manitoba, Canada; Department of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Carolyn Jack
- Department of Medicine, Faculty of Medicine and Health Sciences, McGill University, Montreal, Quebec, Canada; Infectious Diseases and Immunity in Global Health, Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada; Innovaderm Research, Montreal, Quebec, Canada
| | - Michele Ramien
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada; Department of Pediatrics, Alberta Children's Hospital, Calgary, Alberta, Canada
| | - Kerri Purdy
- Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Parbeer Grewal
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada; Rejuvenation Dermatology, Edmonton, Alberta, Canada
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17
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Papp KA, Melosky B, Sehdev S, Hotte SJ, Beecker JR, Kirchhof MG, Turchin I, Dutz JP, Gooderham MJ, Gniadecki R, Hong CH, Lambert J, Lynde CW, Prajapati VH, Vender RB. Use of Systemic Therapies for Treatment of Psoriasis in Patients with a History of Treated Solid Tumours: Inference-Based Guidance from a Multidisciplinary Expert Panel. Dermatol Ther (Heidelb) 2023; 13:867-889. [PMID: 36929121 PMCID: PMC10060504 DOI: 10.1007/s13555-023-00905-3] [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] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Accepted: 02/15/2023] [Indexed: 03/18/2023] Open
Abstract
BACKGROUND Patients with treated solid tumours (TSTs) are a highly heterogeneous population at an increased risk for malignancy compared with the general population. When treating psoriasis in patients with a history of TSTs, clinicians are concerned about the immunosuppressive nature of psoriasis therapies, the possibility of augmenting cancer recurrence/progression, and infectious complications. No direct, high-level evidence exists to address these concerns. OBJECTIVES We aim to provide a structured framework supporting healthcare professional and patient discussions on the risks and benefits of systemic psoriasis therapy in patients with previously TSTs. Our goal was to address the clinically important question, "In patients with TSTs, does therapy with systemic agents used for psoriasis increase the risk of malignancy or malignancy recurrence?" METHODS We implemented an inference-based approach relying on indirect evidence when direct clinical trial and real-world data were absent. We reviewed indirect evidence supporting inferences on the status of immune function in patients with TSTs. Recommendations on systemic psoriasis therapies in patients with TSTs were derived using an inferential heuristic. RESULTS We identified five indirect indicators of iatrogenic immunosuppression informed by largely independent bodies of evidence: (1) overall survival, (2) rate of malignancies with psoriasis and systemic psoriasis therapies, (3) rate of infections with psoriasis and systemic psoriasis therapies, (4) common disease biochemical pathways for solid tumours and systemic psoriasis therapies, and (5) solid organ transplant outcomes. On the basis of review of the totality of this data, we provided inference-based conclusions and ascribed level of support for each statement. CONCLUSIONS Prior to considering new therapies for psoriasis, an understanding of cancer prognosis should be addressed. Patients with TSTs and a good cancer prognosis will have similar outcomes to non-TST patients when treated with systemic psoriasis therapies. For patients with TSTs and a poor cancer prognosis, the quality-of-life benefits of treating psoriasis may outweigh the theoretical risks.
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Affiliation(s)
- Kim A Papp
- Probity Medical Research Inc., Waterloo, ON, Canada.
- Alliance Clinical Research, Waterloo, ON, Canada.
| | - Barbara Melosky
- Medical Oncology, BC Cancer Vancouver Centre, Vancouver, BC, Canada
- Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Sandeep Sehdev
- Division of Medical Oncology, The Ottawa Hospital, University of Ottawa, Ottawa, ON, Canada
| | - Sebastien J Hotte
- Juravinski Cancer Centre, Hamilton, ON, Canada
- Department of Oncology, McMaster University, Hamilton, ON, Canada
| | - Jennifer R Beecker
- Probity Medical Research Inc., Waterloo, ON, Canada
- University of Ottawa, Ottawa, ON, Canada
- Division of Dermatology, The Ottawa Hospital, Ottawa, ON, Canada
- Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Mark G Kirchhof
- University of Ottawa, Ottawa, ON, Canada
- Division of Dermatology, The Ottawa Hospital, Ottawa, ON, Canada
| | - Irina Turchin
- Probity Medical Research Inc., Waterloo, ON, Canada
- Brunswick Dermatology Centre, Fredericton, NB, Canada
- Department of Medicine, Dalhousie University, Halifax, NS, Canada
| | - Jan P Dutz
- Skin Care Centre, Vancouver, BC, Canada
- Department of Dermatology and Skin Science, University of British Columbia, Vancouver, BC, Canada
- BC Children's Hospital Research Institute, Vancouver, BC, Canada
| | - Melinda J Gooderham
- Probity Medical Research Inc., Waterloo, ON, Canada
- SKiN Centre for Dermatology, Peterborough, ON, Canada
| | - Robert Gniadecki
- Division of Dermatology, Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Chih-Ho Hong
- Probity Medical Research Inc., Waterloo, ON, Canada
- Department of Dermatology and Skin Science, University of British Columbia, Vancouver, BC, Canada
- Dr. Chih-ho Hong Medical Inc., Surrey, BC, Canada
| | - Jo Lambert
- Department of Dermatology, Ghent University Hospital, Ghent, Belgium
- Dermatology Research Unit, Ghent University, Ghent, Belgium
| | - Charles W Lynde
- Probity Medical Research Inc., Waterloo, ON, Canada
- Lynde Institute for Dermatology, Markham, ON, Canada
- Division of Dermatology, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Vimal H Prajapati
- Probity Medical Research Inc., Waterloo, ON, Canada
- Division of Dermatology, Department of Medicine, University of Calgary, Calgary, AB, Canada
- Section of Community Pediatrics, Department of Pediatrics, University of Calgary, Calgary, AB, Canada
- Section of Pediatric Rheumatology, Department of Pediatrics, University of Calgary, Calgary, AB, Canada
- Dermatology Research Institute, Calgary, AB, Canada
- Skin Health & Wellness Centre, Calgary, AB, Canada
| | - Ronald B Vender
- Department of Medicine, McMaster University, Hamilton, ON, Canada
- Dermatrials Research Inc., Hamilton, ON, Canada
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18
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Zigler CK, Lin L, Ardalan K, Jacobe H, Lane S, Li SC, Luca NJC, Prajapati VH, Schollaert K, Teske N, Torok K. Cross-sectional quantitative validation of the pediatric Localized Scleroderma Quality of Life Instrument (LoSQI): A disease-specific patient-reported outcome measure. J Eur Acad Dermatol Venereol 2023. [PMID: 36950970 DOI: 10.1111/jdv.19059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Accepted: 03/07/2023] [Indexed: 03/24/2023]
Abstract
BACKGROUND The Localized Scleroderma Quality of Life Instrument (LoSQI) is a disease-specific patient-reported outcome (PRO) measure designed for children and adolescents with localized scleroderma (LS; morphea). This tool was developed using rigorous PRO methods and previously cognitively tested in a sample of pediatric patients with LS. OBJECTIVE The purpose of this study was to evaluate the psychometric properties of the LoSQI in a clinical setting. METHODS Cross-sectional data from four specialized clinics in the US and Canada were included in the analysis. Evaluation included reliability of scores, internal structure of the survey, evidence of convergent and divergent validity, and test-retest reliability. RESULTS One-hundred ten patients with LS (age: 8-20 years) completed the LoSQI. Both exploratory and confirmatory factor analysis supported the use of two sub-scores: Pain & Physical Functioning and Body Image & Social Support. Correlations with other PRO measures were consistent with pre-specified hypotheses. LIMITATIONS This study did not evaluate longitudinal validity or responsiveness of scores. CONCLUSION Results from a representative sample of children and adolescents with LS continue to support the validity of the LoSQI when used in a clinical setting. Future work to evaluate the responsiveness is ongoing.
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Affiliation(s)
- C K Zigler
- Duke University School of Medicine, Department of Population Health Sciences, Durham, NC, USA
| | - L Lin
- Duke University School of Medicine, Department of Population Health Sciences, Durham, NC, USA
| | - K Ardalan
- Duke University School of Medicine, Department of Pediatrics, Durham, NC, USA
- Northwestern University Feinberg School of Medicine/Ann & Robert H. Lurie Children's Hospital of Chicago, Departments of Pediatrics and Medical Social Sciences, Chicago, IL, USA
| | - H Jacobe
- UT Southwestern Medical Center, Department of Dermatology, Dallas, TX, USA
| | - S Lane
- University of Pittsburgh, School of Education, Pittsburgh, PA, USA
| | - S C Li
- Joseph M. Sanzari Children's Hospital, Hackensack Meridian School of Medicine, Department of Pediatrics, Hackensack, NJ, USA
| | - N J C Luca
- Alberta Children's Hospital Research Institute, Calgary, AB, Canada
- Section of Pediatric Rheumatology, Department of Pediatrics, Calgary, AB, Canada
| | - V H Prajapati
- Section of Pediatric Rheumatology, Department of Pediatrics, Calgary, AB, Canada
- Section of Community Pediatrics, Department of Pediatrics, University of Calgary, Calgary, AB, Canada
- Division of Dermatology, Department of Medicine, University of Calgary, Calgary, AB, Canada
- Dermatology Research Institute, Calgary, AB, Canada
- Skin Health & Wellness Centre, Calgary, AB, Canada
- Probity Medical Research, Calgary, AB, Canada
| | - K Schollaert
- University of Pittsburgh, School of Medicine, Department of Pediatrics, Pittsburgh, PA, USA
| | - N Teske
- Oregon Health & Science University School of Medicine, Department of Dermatology, OR, USA
| | - K Torok
- University of Pittsburgh, School of Medicine, Department of Pediatrics, Pittsburgh, PA, USA
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19
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Sood S, Heung M, Georgakopoulos JR, Mufti A, Prajapati VH, Yeung J. Use of Janus Kinase Inhibitors for Granulomatous Dermatoses: A Systematic Review. J Am Acad Dermatol 2023:S0190-9622(23)00510-8. [PMID: 36990321 DOI: 10.1016/j.jaad.2023.03.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2023] [Revised: 03/17/2023] [Accepted: 03/21/2023] [Indexed: 03/30/2023]
Affiliation(s)
- Siddhartha Sood
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Martin Heung
- Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Jorge R Georgakopoulos
- Division of Dermatology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Asfandyar Mufti
- Division of Dermatology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada; Department of Dermatology, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Vimal H Prajapati
- Division of Dermatology, Department of Medicine, University of Calgary, Calgary, Alberta, Canada; Dermatology Research Institute, Calgary, Alberta, Canada; Skin Health & Wellness Centre, Calgary, Alberta, Canada; Probity Medical Research, Calgary, Alberta, Canada; Section of Community Pediatrics, Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada; Section of Pediatric Rheumatology, Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada
| | - Jensen Yeung
- Division of Dermatology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada; Department of Dermatology, Sunnybrook Health Sciences Centre, Toronto, ON, Canada; Department of Dermatology, Women's College Hospital, Toronto, ON, Canada; Probity Medical Research, Waterloo, Ontario, Canada.
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20
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Abduelmula A, Rankin BD, Riaz S, Ross N, Luca NJ, Prajapati VH. Management of morphea with systemic immunosuppressive therapies: An evidence-based review. J Am Acad Dermatol 2023; 88:467-469. [PMID: 35716832 DOI: 10.1016/j.jaad.2022.06.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Revised: 05/23/2022] [Accepted: 06/05/2022] [Indexed: 01/17/2023]
Affiliation(s)
- Abrahim Abduelmula
- Faculty of Medicine, University of Western Ontario, London, Ontario, Canada
| | - Brian D Rankin
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Saba Riaz
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Nicholas Ross
- Western School of Business, Department of Business, Edmonton, Alberta
| | - Nadia J Luca
- Alberta Children's Hospital Research Institute, Calgary, Alberta, Canada; Department of Pediatrics, Section of Pediatric Rheumatology, University of Calgary, Calgary, Alberta, Canada
| | - Vimal H Prajapati
- Department of Pediatrics, Section of Community Pediatrics, University of Calgary, Calgary, Alberta, Canada; Division of Dermatology, Department of Medicine, University of Calgary, Calgary, Alberta, Canada; Dermatology Research Institute, Calgary, Alberta, Canada; Skin Health & Wellness Centre, Calgary, Alberta, Canada; Probity Medical Research, Calgary, Alberta, Canada; Probity Medical Research, Calgary, Alberta, Canada.
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21
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Muntyanu A, Gabrielli S, Donovan J, Gooderham M, Guenther L, Hanna S, Lynde C, Prajapati VH, Wiseman M, Netchiporouk E. The burden of alopecia areata: A scoping review focusing on quality of life, mental health and work productivity. J Eur Acad Dermatol Venereol 2023; 37:1490-1520. [PMID: 36708097 DOI: 10.1111/jdv.18926] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Accepted: 01/16/2023] [Indexed: 01/29/2023]
Abstract
Alopecia areata (AA) is a common inflammatory autoimmune disease of the hair which can have a significant negative impact on quality of life (QoL), mental health and productivity. The aim of this scoping review is to elucidate the burden of AA focusing on these three realms. Inclusion criteria included all original manuscripts with no restriction on study type or statistical method written in English (or having an English abstract). For QoL 40 articles were included, 85 for psychiatric comorbidities, and 9 for work/school absenteeism/presenteeism mostly consisting of cross-sectional and observational cohort studies. QoL impairment was detected in over 75% of patients and up to one-third reported extremely severe QoL impairments. Specific QoL dimensions with the greatest impact were embarrassment, social functioning, as well as shopping and/or housework. Cross-sectional studies assessing the psychological burden of adult patients with AA found that the presence of signs of anxiety and/or depression ranged from 30% to 68% and affected all age groups. Rates of work absenteeism and unemployment were significantly higher in AA patients compared to healthy controls. Up to 62% reported making major life decisions including relationships, education and career based on their AA. Additionally, the extensive camouflage techniques and time lost from work led to a strong financial burden for patients and the numerous physician visits added to the healthcare costs. The overall impact of AA stretches much further than simply being an aesthetic concern and can negatively impact every part of an individual's life. An individualized approach and effective treatments will help reduce the psychosocial consequences and distress and return patients to their normal state of health.
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Affiliation(s)
| | | | - Jeffrey Donovan
- Donovan Hair Clinic, Whistler, British Columbia, Canada
- Department of Dermatology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Melinda Gooderham
- SKiN Centre for Dermatology, Peterborough, Ontario, Canada
- Probity Medical Research Inc., Waterloo, Ontario, Canada
- Queen's University, Kingston, Ontario, Canada
- Division of Dermatology, Western University, London, Ontario, Canada
| | - Lyn Guenther
- Division of Dermatology, Western University, London, Ontario, Canada
- Guenther Research Inc., London, Ontario, Canada
| | - Sameh Hanna
- Probity Medical Research Inc., Waterloo, Ontario, Canada
- Dermatology on Bloor, Toronto, Ontario, Canada
| | - Charles Lynde
- Probity Medical Research Inc., Waterloo, Ontario, Canada
- Division of Dermatology, Western University, London, Ontario, Canada
- Lynde Institute for Dermatology, Markham, Ontario, Canada
| | - Vimal H Prajapati
- Probity Medical Research Inc., Waterloo, Ontario, Canada
- Division of Dermatology, Department of Medicine, University of Calgary, Calgary, Alberta, Canada
- Sections of Community Pediatrics and Pediatric Rheumatology, Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada
- Dermatology Research Institute, Calgary, Alberta, Canada
- Skin Health & Wellness Centre, Calgary, Alberta, Canada
| | - Marni Wiseman
- Section of Dermatology, Department of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
- SKiNWISE Dermatology, Winnipeg, Manitoba, Canada
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22
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Adam DN, Gooderham MJ, Beecker JR, Hong CH, Jack CS, Jain V, Lansang P, Lynde CW, Papp KA, Prajapati VH, Turchin I, Yeung J. Expert consensus on the systemic treatment of atopic dermatitis in special populations. J Eur Acad Dermatol Venereol 2023; 37:1135-1148. [PMID: 36695072 DOI: 10.1111/jdv.18922] [Citation(s) in RCA: 20] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Accepted: 01/16/2023] [Indexed: 01/26/2023]
Abstract
With the increasing number of options for the treatment of moderate-to-severe atopic dermatitis, clinicians need guidance on a practical approach to selecting a systemic agent for specific patient populations. We convened an expert panel consisting of 12 members to conduct a literature review and summarize relevant data related to six scenarios of clinical interest: comorbid asthma, ocular surface disease, history of cancer, past and ongoing infections of interest (including herpes simplex virus, herpes zoster, hepatitis B, and tuberculosis), pregnancy and lactation, and the elderly. We performed a literature search and examined each clinical scenario with respect to three major categories of available systemic agents: traditional systemics (azathioprine, cyclosporine A, methotrexate, and mycophenolate mofetil), Janus kinase inhibitors (abrocitinib, baricitinib, and upadacitinib), and biologics (dupilumab, lebrikizumab, and tralokinumab). The expert panel and steering committee met virtually to review the data and discuss the drafted consensus statements. A modified Delphi process was used to arrive at a set of final consensus statements related to the systemic treatment of AD in these specific patient populations. To provide practical guidance on the choice of systemic therapy for atopic dermatitis in these six topics of clinical interest, 25 expert consensus statements and a summary of the supporting data are presented herein.
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Affiliation(s)
- D N Adam
- Division of Dermatology, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.,CCA Medical Research, Ajax, Ontario, Canada.,Probity Medical Research Inc., Waterloo, Ontario, Canada
| | - M J Gooderham
- Probity Medical Research Inc., Waterloo, Ontario, Canada.,SKiN Centre for Dermatology, Peterborough, Ontario, Canada
| | - J R Beecker
- Probity Medical Research Inc., Waterloo, Ontario, Canada.,Division of Dermatology, University of Ottawa, Ottawa, Ontario, Canada.,Division of Dermatology, The Ottawa Hospital, Ottawa, Ontario, Canada.,Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - C H Hong
- Probity Medical Research Inc., Waterloo, Ontario, Canada.,Department of Dermatology and Skin Science, University of British Columbia, Vancouver, British Columbia, Canada.,Dr. Chih-ho Hong Medical Inc., Surrey, British Columbia, Canada
| | - C S Jack
- Division of Dermatology, McGill University, Montreal, Quebec, Canada.,Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
| | - V Jain
- Probity Medical Research Inc., Waterloo, Ontario, Canada.,Division of Clinical Immunology and Allergy, McMaster University, Hamilton, Ontario, Canada
| | - P Lansang
- Division of Dermatology, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.,Division of Dermatology, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.,Division of Dermatology, Women's College Hospital, Toronto, Ontario, Canada
| | - C W Lynde
- Division of Dermatology, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.,Probity Medical Research Inc., Waterloo, Ontario, Canada.,Lynde Institute for Dermatology, Markham, Ontario, Canada
| | - K A Papp
- Probity Medical Research Inc., Waterloo, Ontario, Canada.,K Papp Clinical Research, Waterloo, Ontario, Canada
| | - V H Prajapati
- Probity Medical Research Inc., Waterloo, Ontario, Canada.,Division of Dermatology, Department of Medicine, University of Calgary, Calgary, Alberta, Canada.,Section of Community Pediatrics, Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada.,Section of Pediatric Rheumatology, Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada.,Dermatology Research Institute, Calgary, Alberta, Canada.,Skin Health & Wellness Centre, Calgary, Alberta, Canada
| | - I Turchin
- Probity Medical Research Inc., Waterloo, Ontario, Canada.,Brunswick Dermatology Centre, Fredericton, New Brunswick, Canada.,Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - J Yeung
- Division of Dermatology, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.,Probity Medical Research Inc., Waterloo, Ontario, Canada.,Division of Dermatology, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.,Division of Dermatology, Women's College Hospital, Toronto, Ontario, Canada
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23
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Abduelmula A, Rankin BD, Luca NJ, Prajapati VH. Management of juvenile-onset systemic sclerosis with systemic immunosuppressive therapies: An evidence-based review. J Am Acad Dermatol 2023; 88:234-236. [PMID: 35569591 DOI: 10.1016/j.jaad.2022.05.010] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2022] [Revised: 04/13/2022] [Accepted: 05/05/2022] [Indexed: 11/18/2022]
Affiliation(s)
- Abrahim Abduelmula
- Faculty of Medicine, University of Western Ontario, London, Ontario, Canada
| | - Brian D Rankin
- Cumming School of Medicine, University of Calgary, Alberta, Canada
| | - Nadia J Luca
- Alberta Children's Hospital Research Institute, Calgary, Alberta, Canada; Section of Pediatric Rheumatology, Department of Pediatrics, University of Calgary, Alberta, Canada
| | - Vimal H Prajapati
- Section of Pediatric Rheumatology, Department of Pediatrics, University of Calgary, Alberta, Canada; Section of Community Pediatrics, Department of Pediatrics, University of Calgary, Alberta, Canada; Division of Dermatology, Department of Medicine, University of Calgary, Alberta, Canada; Dermatology Research Institute, Calgary, Alberta, Canada; Skin Health & Wellness Centre, Calgary, Alberta, Canada; Probity Medical Research, Calgary, Alberta, Canada.
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24
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Loo WJ, Turchin I, Prajapati VH, Gooderham MJ, Grewal P, Hong CH, Sauder M, Vender RB, Maari C, Papp KA. Clinical Implications of Targeting the JAK-STAT Pathway in Psoriatic Disease: Emphasis on the TYK2 Pathway. J Cutan Med Surg 2023; 27:3S-24S. [PMID: 36519621 DOI: 10.1177/12034754221141680] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Cytokines in the interleukin (IL)-23/IL-17 axis are central to psoriasis pathogenesis. Janus kinase (JAK) signal transducer and activator of transcription (STAT) regulates intracellular signalling of several cytokines (including IL-12, 23, 22, 6, 17, and interferon (IFN)-γ) in the IL-23/IL-17 axis, and, as a result, has become a therapeutic target for psoriasis treatment. Although several JAK1-3 inhibitors, with varying degrees of selectivity, have been developed for immune-mediated inflammatory diseases, use in psoriasis is limited by a low therapeutic index as anticipated by signals from other disease indications. More selective inhibition of the JAK family is an area of interest. Specifically, selective tyrosine kinase (TYK)2 inhibition suppresses IL-23/IL-17 axis signalling, and at therapeutic doses, has a favorable safety profile compared to therapeutic doses of JAK1-3 inhibitors. Phase III efficacy and safety data for the selective allosteric TYK2-inhibitor, deucravacitinib, in adult patients with moderate-to-severe plaque psoriasis is promising. Furthermore, phase II clinical trials for ropsacitinib (PF-06826647), a selective TYK2 inhibitor, and brepocitinib (PF-06700841), a JAK1/TYK2 inhibitor, have also demonstrated efficacy and an acceptable safety profile in adult patients with moderate-to-severe plaque psoriasis. Other novel TYK2 allosteric inhibitors, NDI-034858 and ESK-001, are currently being investigated in adult patients with plaque psoriasis. This article reviews the details of the JAK-STAT pathway in psoriasis pathophysiology, the rationale for selective targeting of JAKs in the treatment of psoriasis, and provides clinical perspective on clinical trial data for JAK and TYK2 inhibitors.
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Affiliation(s)
- Wei Jing Loo
- DermEffects, London, Ontario, Canada.,468790 Probity Medical Research Inc., Waterloo, ON, Canada
| | - Irina Turchin
- 468790 Probity Medical Research Inc., Waterloo, ON, Canada.,Brunswick Dermatology Center, Fredericton, NB, Canada.,Department of Medicine, Dalhousie University, Halifax, NS, Canada
| | - Vimal H Prajapati
- 70401 Division of Dermatology, Department of Medicine, University of Calgary, Calgary, AB, Canada.,Section of Community Pediatrics, Department of Pediatrics, Calgary, AB, Canada.,Section of Pediatric Rheumatology, Department of Pediatrics, Calgary, AB, Canada.,Skin Health & Wellness Centre, Calgary, AB, Canada.,Dermatology Research Institute, Calgary, AB, Canada.,468790 Probity Medical Research, Calgary, AB, Canada
| | - Melinda J Gooderham
- 468790 Probity Medical Research Inc., Waterloo, ON, Canada.,SKiN Centre for Dermatology, Peterborough, ON, Canada
| | - Parbeer Grewal
- Rejuvenation Dermatology, Edmonton, AB, Canada.,Division of Dermatology, Department of Medicine, University of Alberta, Edmonton, AB, Canada
| | - Chih-Ho Hong
- 468790 Probity Medical Research Inc., Waterloo, ON, Canada.,Department of Dermatology and Skin Science, University of British Columbia, Vancouver, BC, Canada.,Dr. Chih-Ho Hong Medical Inc., Surrey, BC, Canada
| | - Maxwell Sauder
- 468790 Probity Medical Research Inc., Waterloo, ON, Canada.,Division of Dermatology, Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Ronald B Vender
- Dermatrials Research Inc. & Venderm Innovations in Psoriasis, Hamilton, ON, Canada.,Division of Dermatology, Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Catherine Maari
- Innovaderm Research Inc, Montreal, QC, Canada.,10051 Department of Medicine, Division of Dermatology, Montreal University Hospital Center, Montreal, QC, Canada
| | - Kim A Papp
- 468790 Probity Medical Research Inc., Waterloo, ON, Canada.,K Papp Clinical Research, Waterloo, ON, Canada
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25
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Abduelmula A, Rankin BD, Mufti A, Yeung J, Prajapati VH. Tralokinumab for Moderate-to-Severe Atopic Dermatitis in Adults. Skin Therapy Lett 2023; 28:1-6. [PMID: 36657434] [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] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Atopic dermatitis (AD) is a common, chronic, recurrent, immune-mediated inflammatory skin disease. Targeted treatment options remain limited. Tralokinumab (Adtralza®) is a promising, new systemic therapy that inhibits interleukin-13. It was recently approved by Health Canada and the US FDA for the treatment of moderate-to-severe AD in adults and may be used alone or with topical corticosteroids. Herein, we review the efficacy and safety of tralokinumab in adults, as demonstrated in clinical trials.
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Affiliation(s)
| | - Brian D Rankin
- Division of Dermatology, Department of Medicine, University of Calgary, Calgary, AB, Canada
| | - Asfandyar Mufti
- Division of Dermatology, Department of Medicine, University of Toronto, ON, Canada
| | - Jensen Yeung
- Women's College Research Institute, Women's College Hospital, Toronto, ON, Canada.,Sunnybrook Health Sciences Centre, Toronto, ON, Canada.,Probity Medical Research, Waterloo, ON, Canada
| | - Vimal H Prajapati
- Division of Dermatology, Department of Medicine, University of Calgary, Calgary, AB, Canada.,Probity Medical Research, Waterloo, ON, Canada.,Dermatology Research Institute, Calgary, AB, Canada.,Skin Health & Wellness Centre, Calgary, AB, Canada.,Section of Community Pediatrics, Department of Pediatrics, University of Calgary, Calgary, AB, Canada.,Section of Pediatric Rheumatology, Department of Pediatrics, University of Calgary, Calgary, AB, Canada
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26
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Gooderham M, Papp KA, Lynde C, Delorme I, Beecker J, Albrecht L, Dei-Cas I, Brassard D, Prajapati VH, Vieira A, Rihakova L. Sustained Effectiveness of Secukinumab Across Different Body Regions in Patients with Moderate-to-Severe Plaque Psoriasis from the PURE Registry. Dermatol Ther (Heidelb) 2022; 13:535-553. [PMID: 36562944 PMCID: PMC9782282 DOI: 10.1007/s13555-022-00870-3] [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: 10/06/2022] [Accepted: 11/28/2022] [Indexed: 12/24/2022] Open
Abstract
INTRODUCTION The association between physician-reported and patient-reported outcomes in patients with psoriasis is not adequately explored. Trends in PASI scores across body regions and the descriptive correspondence between physician-reported PASI components and patient-reported Psoriasis Symptom Diary are reported here. METHODS PURE is a prospective observational study in adult patients from Canada and Latin America with moderate-to-severe chronic plaque psoriasis. The study enrolled 2362 adult patients treated with secukinumab versus other approved therapies (1:1 ratio). The PASI total score, PASI sub-scores for erythema, thickening, and scaling, and PASI scores for each body region were evaluated and further correlated with disease impact using the Psoriasis Symptom Diary. RESULTS Secukinumab treatment showed early reduction in the PASI total score (mean ± SD) from 13.3 ± 9.02 at baseline to 2.3 ± 3.99 at 3 months; a similar trend was observed for PASI sub-scores for erythema (4.8 ± 3.21 to 0.9 ± 1.44), thickening (4.3 ± 3.00 to 0.7 ± 1.33) and scaling (4.2 ± 3.04 to 0.7 ± 1.30). The reduction in PASI total and sub-scores were sustained up to 36 months. Psoriasis Symptom Diary component scores related to redness, cracking, and scaling showed a similar reduction from baseline at 3 months that was also sustained up to 36 months. PASI regional scores for each body region showed reduction at 3 months with disease in the lower limbs being more treatment resistant. Safety profile of secukinumab was consistent with its established safety profile without any new or unexpected signals. CONCLUSIONS Overall, an early and sustained resolution of erythema, thickening, and scaling was observed. Improvements were evident across all body regions, with the most persistent disease seen in the lower limbs. Trends in disease severity, as assessed by physicians using PASI, broadly reflected the trend in the comparable questions of the Psoriasis Symptom Diary assessed by patients.
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Affiliation(s)
- Melinda Gooderham
- grid.410356.50000 0004 1936 8331SKiN Centre for Dermatology and Probity Medical Research, Peterborough, Queen’s University, Kingston, ON Canada
| | - Kim A. Papp
- grid.415267.3K Papp Clinical Research and Probity Medical Research, Waterloo, ON Canada
| | - Charles Lynde
- grid.17063.330000 0001 2157 2938Lynde Institute for Dermatology, University of Toronto and Probity Medical Research, Markham, ON Canada
| | | | - Jennifer Beecker
- grid.412687.e0000 0000 9606 5108Division of Dermatology, University of Ottawa, Ottawa Hospital Research Institute and Probity Medical Research, Ottawa, ON Canada
| | - Lorne Albrecht
- grid.17091.3e0000 0001 2288 9830Enverus Medical Research, University of British Columbia and Probity Medical Research, Surrey, BC Canada
| | - Ignacio Dei-Cas
- grid.7345.50000 0001 0056 1981Psoriasis BsAs, Hospital Pte Perón, Universidad de Buenos Aires, Buenos Aires, Argentina
| | | | - Vimal H. Prajapati
- grid.22072.350000 0004 1936 7697Division of Dermatology, Department of Medicine, University of Calgary, Calgary, AB Canada ,grid.22072.350000 0004 1936 7697Division of Pediatric Rheumatology, Department of Pediatrics, University of Calgary, Calgary, AB Canada ,grid.22072.350000 0004 1936 7697Division of Community Pediatrics, Department of Pediatrics, University of Calgary, Calgary, AB Canada ,Dermatology Research Institute, Calgary, AB Canada ,Skin Health & Wellness Centre, Calgary, AB Canada ,grid.415267.3Probity Medical Research, Calgary, AB Canada
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27
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Abduelmula A, Mufti A, Mistry J, Sachdeva M, Beecker J, Prajapati VH, Yeung J. Management of Alopecia Areata With Topical JAK Inhibitor Therapy: An Evidence-Based Review. J Cutan Med Surg 2022; 27:73-75. [PMID: 36189927 PMCID: PMC9902965 DOI: 10.1177/12034754221130243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Abrahim Abduelmula
- Faculty of Medicine, University of Western Ontario, London, Ontario, Canada
| | - Asfandyar Mufti
- Division of Dermatology, Department of Medicine, University of Toronto, Ontario, Canada
| | - Jenna Mistry
- Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Muskaan Sachdeva
- Division of Dermatology, Department of Medicine, University of Toronto, Ontario, Canada
| | - Jennifer Beecker
- Probity Medical Research, Waterloo, Ontario, Canada, Division of Dermatology, University of Ottawa, Ottawa, Ontario, Canada
| | - Vimal H. Prajapati
- Division of Dermatology, Department of Medicine, University of Calgary, Calgary, Alberta, Canada,Dermatology Research Institute, Calgary, Alberta, Canada,Skin Health & Wellness Centre, Calgary, Alberta, Canada,Probity Medical Research, Calgary, Alberta, Canada,Section of Community Pediatrics, Department of Pediatrics, University of Calgary, Alberta, Canada,Section of Pediatric Rheumatology, Department of Pediatrics, University of Calgary, Alberta, Canada
| | - Jensen Yeung
- Division of Dermatology, Department of Medicine, University of Toronto, Ontario, Canada,Probity Medical Research, Waterloo, Ontario, Canada,Women’s College Research Institute, Women’s College Hospital, Toronto, Ontario, Canada,Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada,Jensen Yeung, Division of Dermatology, Women’s College Hospital, 76 Grenville St, 5th floor, Toronto, Ontario M5S 1B2, Canada;
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28
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Abduelmula A, Mufti A, Chong DH, Sood S, Prajapati VH, Yeung J. Biologic treatment outcomes in refractory bullous pemphigoid: An evidence-based review. JAAD Int 2022; 9:142-145. [PMID: 36311913 PMCID: PMC9596715 DOI: 10.1016/j.jdin.2022.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Affiliation(s)
- Abrahim Abduelmula
- Faculty of Medicine, University of Western Ontario, London, Ontario, Canada
| | - Asfandyar Mufti
- Division of Dermatology, Department of Medicine, University of Toronto, Ontario, Canada
| | | | - Siddhartha Sood
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Vimal H. Prajapati
- Division of Dermatology, Department of Medicine, University of Calgary, Calgary, Alberta, Canada,Dermatology Research Institute, Calgary, Alberta, Canada,Skin Health & Wellness Centre, Calgary, Alberta, Canada,Probity Medical Research, Calgary, Alberta, Canada,Section of Community Pediatrics, Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada,Section of Pediatric Rheumatology, Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada
| | - Jensen Yeung
- Division of Dermatology, Department of Medicine, University of Toronto, Ontario, Canada,Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada,Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada,Probity Medical Research, Waterloo, Ontario, Canada,Correspondence to: Jensen Yeung, MD, Division of Dermatology, Women’s College Hospital, 76 Grenville St, 5th Floor, Toronto, Ontario, M5S 1B2, Canada
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29
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Yeung J, Bourcier M, Gooderham MJ, Grewal P, Hong C, Lansang P, Lynde C, Maari C, Prajapati VH, Turchin I, Vender R. Management of Moderate‐to‐Severe Plaque Psoriasis with Biologics: A Treat‐to‐Target Position Paper. Dermatol Ther 2022; 35:e15777. [DOI: 10.1111/dth.15777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Revised: 08/04/2022] [Accepted: 08/17/2022] [Indexed: 11/30/2022]
Affiliation(s)
- Jensen Yeung
- Division of Dermatology, Women's College Hospital and the Department of Medicine University of Toronto Toronto ON Canada
- Probity Medical Research, Inc. Waterloo ON Canada
| | - Marc Bourcier
- Faculty of Medicine Université de Sherbrooke, Sherbrooke QC Canada
| | - Melinda J. Gooderham
- Probity Medical Research, Inc. Waterloo ON Canada
- Queen's University Kingston ON Canada
- Skin Centre for Dermatology Peterborough ON Canada
| | - Parbeer Grewal
- Division of Dermatology University of Alberta Edmonton AB Canada
- Rejuvenation Dermatology Edmonton AB Canada
| | - Chih‐Ho Hong
- Department of Dermatology and Skin Science University of British Columbia Vancouver BC Canada
- Probity Medical Research Waterloo ON Canada
- Dr. Chih‐Ho Hong Medical Inc. Surrey BC Canada
| | - Perla Lansang
- Division of Dermatology Women's College Hospital Toronto ON Canada
- Division of Dermatology, Faculty of Medicine University of Toronto Toronto ON Canada
- Division of Dermatology, Department of Medicine, Sunnybrook Health Sciences Centre University of Toronto ON Canada
- The Hospital for Sick Children Toronto ON Canada
| | - Charles Lynde
- Probity Medical Research, Inc. Waterloo ON Canada
- Lynde Institute for Dermatology Markham ON Canada
| | | | - Vimal H. Prajapati
- Division of Dermatology, Department of Medicine University of Calgary Calgary AB Canada
- Section of Community Pediatrics, Department of Pediatrics University of Calgary Calgary AB Canada
- Section of Pediatric Rheumatology, Department of Pediatrics University of Calgary Calgary AB Canada
- Dermatology Research Institute Calgary AB Canada
- Skin Health & Wellness Centre Calgary AB Canada
| | - Irina Turchin
- Probity Medical Research Waterloo ON Canada
- Brunswick Dermatology Center Fredericton NB Canada
- Dalhousie University Halifax NS Canada
| | - Ron Vender
- Department of Medicine, Division of Dermatology McMaster University Hamilton ON Canada
- Dermatrials Research Inc Hamilton ON Canada
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30
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Mendes-Bastos P, Ladizinski B, Guttman-Yassky E, Jiang P, Liu J, Prajapati VH, Simpson EL, Vigna N, Teixeira HD, Barbarot S. Characterization of acne associated with upadacitinib treatment in patients with moderate-to-severe atopic dermatitis: a post hoc integrated analysis of three phase 3 randomized, double-blind, placebo-controlled trials. J Am Acad Dermatol 2022; 87:784-791. [PMID: 35714786 DOI: 10.1016/j.jaad.2022.06.012] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [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: 03/02/2022] [Revised: 05/11/2022] [Accepted: 06/07/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Acne is the most frequent adverse event (AE) associated with upadacitinib treatment in patients with moderate-to-severe atopic dermatitis (AD). OBJECTIVE To characterize the AE of acne associated with upadacitinib. METHODS This was a post hoc integrated analysis of three phase 3 randomized, double-blind, placebo-controlled trials of upadacitinib, alone (NCT03569293 and NCT03607422) or in combination with topical corticosteroids (NCT03568318). Data included were from the 16-week placebo-controlled period. RESULTS Over 16 weeks, 84/857 (9.8%), 131/864 (15.2%), and 19/862 (2.2%) patients randomized to receive upadacitinib 15 mg, upadacitinib 30 mg, and placebo, respectively, experienced acne. All cases of acne, except 1, were mild/moderate in severity; 2 patients discontinued treatment due to moderate acne. Acne occurred at higher rates among younger, female, and non-White patients. Acne required no intervention in 40.5% and 46.6% of patients receiving upadacitinib 15 or 30 mg, respectively; most remaining cases were managed with topical antibiotics, benzoyl peroxide, and/or retinoids. Acne also had no impact on patient-reported outcomes. LIMITATIONS This study was relatively short in duration and had a small patient population. CONCLUSIONS Acne associated with upadacitinib for AD treatment is usually mild/moderate in severity and managed with topical therapies or no intervention.
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Affiliation(s)
| | | | - Emma Guttman-Yassky
- Department of Dermatology and the Laboratory for Inflammatory Skin Diseases, Icahn School of Medicine at Mount Sinai, New York
| | | | | | - Vimal H Prajapati
- Division of Dermatology, Department of Medicine, Section of Community Pediatrics, Department of Pediatrics, and Section of Pediatric Rheumatology, Department of Pediatrics, University of Calgary, Calgary, Alberta; and Dermatology Research Institute, Calgary, Alberta, Skin Health & Wellness Centre, Calgary, Alberta, and Probity Medical Research, Calgary, Alberta
| | - Eric L Simpson
- Department of Dermatology, Oregon Health & Science University, Portland
| | | | | | - Sebastien Barbarot
- Dermatology Department, Nantes Université, University Hospital of Nantes, UMR, INRAE, Nantes, France
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31
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Abduelmula A, Rankin BD, Vender R, Yeung J, Devani AR, Prajapati VH. Halobetasol Propionate 0.01% Lotion for Plaque Psoriasis and Corticosteroid-Responsive Dermatoses. Skin Therapy Lett 2022; 27:1-4. [PMID: 35533304] [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] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
A novel topical corticosteroid, halobetasol propionate (HP) 0.01% lotion (Bryhali™), has recently been introduced for the treatment of plaque psoriasis and corticosteroid-responsive dermatoses in adults. Once daily application of HP 0.01% lotion is indicated for use up to 8 weeks. Treatment success for plaque psoriasis in the pivotal phase 3 clinical trials (defined as an Investigator Global Assessment [IGA] of clear/almost clear [IGA 0/1] with ≥2-grade improvement from baseline) occurred in over one-third of patients by week 8. Treatment-emergent adverse events were typically mild-to-moderate in intensity and usually limited to the application site(s). No treatment-related cases of skin atrophy have been reported from the studies. Counselling should be considered to optimize treatment outcomes.
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Affiliation(s)
| | - Brian D Rankin
- Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Ronald Vender
- Department of Dermatology, McMaster University, Hamilton, ON, Canada
- Dermatrials Research Inc. & Venderm Innovations in Psoriasis, Hamilton, ON, Canada
| | - Jensen Yeung
- Division of Dermatology, Department of Medicine, University of Toronto, ON, Canada
- Women's College Research Institute, Women's College Hospital, Toronto, ON, Canada
- Sunnybrook Health Sciences Centre, Toronto, ON, Canada
- Probity Medical Research, Waterloo, ON, Canada
| | - Alim R Devani
- Dermatology Research Institute, Calgary, AB, Canada
- Skin Health & Wellness Centre, Calgary, AB, Canada
- Probity Medical Research, Calgary, AB, Canada
| | - Vimal H Prajapati
- Dermatology Research Institute, Calgary, AB, Canada
- Skin Health & Wellness Centre, Calgary, AB, Canada
- Probity Medical Research, Calgary, AB, Canada
- Division of Dermatology, Department of Medicine, University of Calgary, Calgary, AB, Canada
- Section of Community Pediatrics, Department of Pediatrics, University of Calgary, Calgary, AB, Canada
- Section of Pediatric Rheumatology, Department of Pediatrics, University of Calgary, Calgary, AB, Canada
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32
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Rankin BD, Georgakopoulos JR, Sachdeva M, Mufti A, Devani AR, Gooderham MJ, Hong CH, Jain V, Lansang P, Vender R, Yeung J, Prajapati VH. Incidence and prognosis of COVID-19 in patients with atopic diseases on dupilumab: a multicentre retrospective cohort study. J DERMATOL TREAT 2022; 33:2692-2694. [PMID: 35446185 DOI: 10.1080/09546634.2022.2036673] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Brian D Rankin
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | | | - Muskaan Sachdeva
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Asfandyar Mufti
- Division of Dermatology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Alim R Devani
- Dermatology Research Institute, Calgary, Alberta, Canada.,Skin Health & Wellness Centre, Calgary, Alberta, Canada.,Probity Medical Research, Calgary, Alberta, Canada
| | - Melinda J Gooderham
- Queen's University, Kingston, Ontario, Canada.,SKiN Centre for Dermatology, Peterborough, Ontario, Canada.,Probity Medical Research, Peterborough, Ontario, Canada
| | - Chih-Ho Hong
- Department of Dermatology and Skin Science, University of British Columbia, Vancouver, British Columbia, Canada.,Dr. Chih-Ho Hong Medical Inc, Surrey, British Columbia, Canada
| | - Vipul Jain
- Division of Clinical Immunology and Allergy, McMaster University, Hamilton, Ontario, Canada.,Niagara Region Medical, Niagara Falls, Ontario, Canada.,Allergy Research Canada Inc, Niagara Falls, Ontario, Canada.,Probity Medical Research, Niagara Falls, Ontario, Canada
| | - Perla Lansang
- Division of Dermatology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada.,Division of Dermatology, Department of Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.,Section of Paediatric Dermatology, Department of Paediatric Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Ronald Vender
- Department of Dermatology, McMaster University, Hamilton, Ontario, Canada.,Dermatrials Research Inc. & Venderm Innovations in Psoriasis, Hamilton, Ontario, Canada
| | - Jensen Yeung
- Division of Dermatology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada.,Division of Dermatology, Department of Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.,Section of Paediatric Dermatology, Department of Paediatric Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada.,Probity Medical Research Inc, Waterloo, Ontario, Canada
| | - Vimal H Prajapati
- Dermatology Research Institute, Calgary, Alberta, Canada.,Skin Health & Wellness Centre, Calgary, Alberta, Canada.,Probity Medical Research, Calgary, Alberta, Canada.,Division of Dermatology, Department of Medicine, University of Calgary, Calgary, Alberta, Canada.,Section of Community Pediatrics, Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada.,Section of Pediatric Rheumatology, Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada
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33
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Strober B, Leman J, Mockenhaupt M, Nakano de Melo J, Nassar A, Prajapati VH, Romanelli P, Seneschal J, Tsianakas A, Wei LY, Yasuda M, Yu N, Hernandez Daly AC, Okubo Y. Unmet Educational Needs and Clinical Practice Gaps in the Management of Generalized Pustular Psoriasis: Global Perspectives from the Front Line. Dermatol Ther (Heidelb) 2021; 12:381-393. [PMID: 34904208 PMCID: PMC8850517 DOI: 10.1007/s13555-021-00661-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [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: 10/14/2021] [Accepted: 11/30/2021] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION Generalized pustular psoriasis (GPP) is a rare, potentially life-threatening, neutrophilic, autoinflammatory skin disease characterised by recurrent flares of generalised sterile pustules and associated systemic features. Inconsistent diagnostic criteria and a lack of approved therapies pose serious challenges to GPP management. Our objectives were to discuss the challenges encountered in the care of patients with GPP and identify healthcare provider (HCP) educational needs and clinical practice gaps in GPP management. METHODS On 24 July 2020, 13 dermatologists from 10 countries (Brazil, Canada, China, Egypt, France, Germany, Japan, Malaysia, the UK and the USA) attended a workshop to share experiences in managing patients with GPP. Educational needs and clinical practice gaps grouped according to healthcare system level were discussed and ranked using interactive polling. RESULTS Lack of experience of GPP among HCPs was identified as an important individual HCP-level clinical practice gap. Limited understanding of the presentation and pathogenesis of GPP among non-specialists means misdiagnosis is common, delaying referral and treatment. In countries where patients may present to general practitioners or emergency department HCPs, GPP is often mistaken for an infection. Among dermatologists who can accurately diagnose GPP, limited knowledge of treatments may necessitate referral to a colleague with more experience in GPP. At the organisational level, important needs identified were educating emergency department HCPs to recognise GPP as an autoinflammatory disease and improving communication, cooperation and definitions of roles within multidisciplinary teams supporting patients with GPP. At the regulatory level, robust clinical trial data, clear and consistent treatment guidelines and approved therapies were identified as high priorities. CONCLUSIONS The educational imperative most consistently identified across the participating countries is for HCPs to understand that GPP can be life-threatening if appropriate treatment initiation is delayed, and to recognise when to refer patients to a colleague with more experience of GPP management.
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Affiliation(s)
- Bruce Strober
- Central Connecticut Dermatology Research, 1 Willowbrook Rd, Ste 2, Cromwell, CT, 06520, USA. .,Yale University, New Haven, CT, USA.
| | | | - Maja Mockenhaupt
- Department of Dermatology, Medical Center, University of Freiburg, Freiburg im Breisgau, Germany
| | | | - Ahmed Nassar
- Department of Dermatology and Venereology, Ain Shams University, Cairo, Egypt
| | - Vimal H Prajapati
- Dermatology Research Institute, Calgary, AB, Canada.,Skin Health and Wellness Centre, Calgary, AB, Canada.,Probity Medical Research, Calgary, AB, Canada.,Division of Dermatology, Department of Medicine, University of Calgary, Calgary, AB, Canada.,Section of Community Pediatrics, Department of Pediatrics, University of Calgary, Calgary, AB, Canada.,Section of Pediatric Rheumatology, Department of Pediatrics, University of Calgary, Calgary, AB, Canada
| | - Paolo Romanelli
- Dr. Phillip Frost Department of Dermatology and Dermatopathology, University of Miami, Miami, FL, USA
| | - Julien Seneschal
- Department of Dermatology, National Reference Centre for Rare Skin Diseases, Saint-André Hospital, Bordeaux, France.,University of Bordeaux, Bordeaux, France
| | | | | | - Masahito Yasuda
- Department of Dermatology, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
| | - Ning Yu
- Shanghai Dermatology Hospital, Shanghai, China.,Tongji University School of Medicine, Shanghai, China
| | | | - Yukari Okubo
- Department of Dermatology, Tokyo Medical University, 6-7-1, Nishishinjuku, Shinjuku-ku, Tokyo, 160-0023, Japan.
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34
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Lytvyn Y, Mufti A, Zaaroura H, Sachdeva M, Lu JD, Rankin BD, Prajapati VH, Vender R, Yeung J. Efficacy and safety of risankizumab for moderate-to-severe plaque psoriasis in clinical practice: A 16-week Canadian retrospective multicenter cohort study. JAAD Int 2021; 6:3-5. [PMID: 34816136 PMCID: PMC8592884 DOI: 10.1016/j.jdin.2021.09.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Affiliation(s)
- Yuliya Lytvyn
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Asfandyar Mufti
- Division of Dermatology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Hiba Zaaroura
- Division of Dermatology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Muskaan Sachdeva
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Justin D Lu
- Michael G. DeGroote School of Medicine, Faculty of Medicine, Hamilton, Ontario, Canada
| | - Brian D Rankin
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Vimal H Prajapati
- Division of Dermatology, Department of Medicine, and Divisions of Community Pediatrics and Pediatric Rheumatology, Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada; Dermatology Research Institute, Calgary, Alberta, Canada; Skin Health & Wellness Centre, Calgary, Alberta, Canada; and Probity Medical Research, Calgary, Alberta, Canada
| | - Ronald Vender
- Dermatrials Research Inc., Hamilton, Ontario, Canada.,Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Jensen Yeung
- Division of Dermatology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada.,Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.,Department of Dermatology, Women's College Hospital, Toronto, Ontario, Canada.,Probity Medical Research Inc., Waterloo, Ontario, Canada
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35
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Guenther L, Metelitsa A, Prajapati VH. Fixed Combination Halobetasol Propionate and Tazarotene Lotion for Plaque Psoriasis. Skin Therapy Lett 2021; 26:1-3. [PMID: 34871475] [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] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
A novel fixed combination lotion containing the super-potent corticosteroid halobetasol propionate 0.01% and retinoid tazarotene 0.045% (Duobrii™) has recently been introduced and indicated for the treatment of moderate to severe plaque psoriasis in adults. Studies have shown that there is synergy between the ingredients and that the product can be safely used intermittently for up to 1 year. Treatment success (i.e., Investigator Global Assessment [IGA] of clear/almost clear [IGA 0/1] and at least a 2-grade improvement from baseline) occurred in 58.8% of participants at some point in a 1-year clinical trial. Persistence of treatment success is common after treatment discontinuation. Most treatment-emergent adverse events are application site reactions, mild to moderate in intensity, and occur primarily during the first 12 weeks. Counselling should be considered to optimize treatment outcomes.
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Affiliation(s)
- Lyn Guenther
- Western University, London, ON, Canada
- The Guenther Dermatology Research Centre, London, ON, Canada
| | - Andrei Metelitsa
- Beacon Dermatology, Calgary, AB, Canada
- Division of Dermatology, Department of Medicine, University of Calgary, Calgary, AB, Canada
- Probity Medical Research, Calgary, AB, Canada
| | - Vimal H Prajapati
- Division of Dermatology, Department of Medicine, University of Calgary, Calgary, AB, Canada
- Probity Medical Research, Calgary, AB, Canada
- Skin Health & Wellness Centre, Calgary, AB, Canada
- Dermatology Research Institute, Calgary, AB, Canada
- Section of Community Pediatrics, Department of Pediatrics, University of Calgary, Calgary, AB, Canada
- Section of Pediatric Rheumatology, Department of Pediatrics, University of Calgary, Calgary, AB, Canada
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36
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Lytvyn Y, Georgakopoulos JR, Mufti A, Devani AR, Gooderham MJ, Jain V, Lansang P, Vender R, Prajapati VH, Yeung J. Incidence and prognosis of COVID-19 in patients with psoriasis on apremilast: a multicentre retrospective cohort study. J Eur Acad Dermatol Venereol 2021; 36:e94-e95. [PMID: 34657332 PMCID: PMC8656447 DOI: 10.1111/jdv.17749] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Accepted: 10/14/2021] [Indexed: 01/02/2023]
Affiliation(s)
- Y Lytvyn
- Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - J R Georgakopoulos
- Division of Dermatology, Department of Medicine, University of Toronto, ON, Canada
| | - A Mufti
- Division of Dermatology, Department of Medicine, University of Toronto, ON, Canada
| | - A R Devani
- Dermatology Research Institute, Calgary, AB, Canada.,Skin Health & Wellness Centre, Calgary, AB, Canada.,Probity Medical Research, Calgary, AB, Canada
| | - M J Gooderham
- Queen's University, Kingston, ON, Canada.,SKiN Centre for Dermatology, Peterborough, ON, Canada.,Probity Medical Research, Peterborough, ON, Canada
| | - V Jain
- Clinal Immunology and Allergy, McMaster University, Hamilton, ON, Canada.,Probity Medical Research, Hamilton, ON, Canada
| | - P Lansang
- Division of Dermatology, Department of Medicine, University of Toronto, ON, Canada.,Division of Dermatology, Department of Medicine, Sunnybrook Health Sciences Centre, Toronto, ON, Canada.,Section␣of Paediatric Dermatology, Department of Paediatric Medicine, The Hospital for Sick Children, Toronto, ON, Canada
| | - R Vender
- Department of Dermatology, McMaster University, Hamilton, ON, Canada.,Dermatrials Research Inc. & Venderm Innovations in Psoriasis, Hamilton, ON, Canada
| | - V H Prajapati
- Skin Health & Wellness Centre, Calgary, AB, Canada.,Probity Medical Research, Calgary, AB, Canada.,Division of Dermatology, Department of Medicine, University of Calgary, Calgary, AB, Canada.,Section␣of Community Pediatrics, Department of Pediatrics, University of Calgary, Calgary, AB, Canada.,Section␣of Pediatric Rheumatology, Department of Pediatrics, University of Calgary, Calgary, AB, Canada
| | - J Yeung
- Division of Dermatology, Department of Medicine, University of Toronto, ON, Canada.,Department of Dermatology, McMaster University, Hamilton, ON, Canada.,Department of Dermatology, Women's College Hospital, Toronto, ON, Canada.,Probity Medical Research Inc, Waterloo, ON, Canada
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37
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Abduelmula A, Georgakopoulos JR, Mufti A, Devani AR, Gooderham MJ, Hong CH, Jain V, Lansang P, Vender R, Prajapati VH, Yeung J. Incidence of COVID-19 in Patients With Chronic Idiopathic Urticaria and Asthma on Omalizumab: A Multicentre Retrospective Cohort Study. J Cutan Med Surg 2021; 26:319-320. [PMID: 34587789 DOI: 10.1177/12034754211049707] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
| | | | - Asfandyar Mufti
- 7938 Division of Dermatology, Department of Medicine, University of Toronto, ON, Canada
| | | | | | - Chih-Ho Hong
- Department of Dermatology and Skin Science, University of British Columbia, Vancouver, BC, Canada
| | - Vipul Jain
- 3710 Division of Clinical Immunology and Allergy, McMaster University, Hamilton, ON, Canada
| | - Perla Lansang
- Division of Dermatology, Department of Medicine, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Ronald Vender
- Department of Dermatology, McMaster University, Hamilton, ON, Canada
| | - Vimal H Prajapati
- 70401 Division of Dermatology, Department of Medicine, University of Calgary, AB, Canada
| | - Jensen Yeung
- Department of Dermatology, Women's College Hospital, Toronto, ON, Canada
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38
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Simpson EL, de Bruin-Weller MS, Prajapati VH, Calimlim BM, Teixeira HD, Zeng J, Liu M, Silverberg JI. 25511 Effects of upadacitinib on the patient-reported impact of atopic dermatitis: Atopic Dermatitis Impact Scale (ADerm-IS) results from two pivotal phase 3 studies (MEASURE UP 1 and MEASURE UP 2). J Am Acad Dermatol 2021. [DOI: 10.1016/j.jaad.2021.06.266] [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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39
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Blauvelt A, Teixeira HD, Simpson EL, Costanzo A, De Bruin-Weller M, Barbarot S, Prajapati VH, Lio P, Hu X, Wu T, Liu J, Ladizinski B, Chu AD, Eyerich K. Efficacy and Safety of Upadacitinib vs Dupilumab in Adults With Moderate-to-Severe Atopic Dermatitis: A Randomized Clinical Trial. JAMA Dermatol 2021; 157:1047-1055. [PMID: 34347860 PMCID: PMC8340015 DOI: 10.1001/jamadermatol.2021.3023] [Citation(s) in RCA: 200] [Impact Index Per Article: 66.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Accepted: 06/26/2021] [Indexed: 12/16/2022]
Abstract
IMPORTANCE Atopic dermatitis (AD) is a chronic, recurrent, inflammatory skin disease with an unmet need for treatments that provide rapid and high levels of skin clearance and itch improvement. OBJECTIVE To assess the safety and efficacy of upadacitinib vs dupilumab in adults with moderate-to-severe AD. DESIGN, SETTING, AND PARTICIPANTS Heads Up was a 24-week, head-to-head, phase 3b, multicenter, randomized, double-blinded, double-dummy, active-controlled clinical trial comparing the safety and efficacy of upadacitinib with dupilumab among 692 adults with moderate-to-severe AD who were candidates for systemic therapy. The study was conducted from February 21, 2019, to December 9, 2020, at 129 centers located in 22 countries across Europe, North and South America, Oceania, and the Asia-Pacific region. Efficacy analyses were conducted in the intent-to-treat population. INTERVENTIONS Patients were randomized 1:1 and treated with oral upadacitinib, 30 mg once daily, or subcutaneous dupilumab, 300 mg every other week. MAIN OUTCOMES AND MEASURES The primary end point was achievement of 75% improvement in the Eczema Area and Severity Index (EASI75) at week 16. Secondary end points were percentage change from baseline in the Worst Pruritus Numerical Rating Scale (NRS) (weekly average), proportion of patients achieving EASI100 and EASI90 at week 16, percentage change from baseline in Worst Pruritus NRS at week 4, proportion of patients achieving EASI75 at week 2, percentage change from baseline in Worst Pruritus NRS (weekly average) at week 1, and Worst Pruritus NRS (weekly average) improvement of 4 points or more at week 16. End points at week 24 included EASI75, EASI90, EASI100, and improvement of 4 points or more in Worst Pruritus NRS from baseline (weekly average). Safety was assessed as treatment-emergent adverse events in all patients receiving 1 or more dose of either drug. RESULTS Of 924 patients screened, 348 (183 men [52.6%]; mean [SD] age, 36.6 [14.6] years) were randomized to receive upadacitinib and 344 were randomized to receive dupilumab (194 men [56.4%]; mean [SD] age, 36.9 [14.1] years); demographic and disease characteristics were balanced among treatment groups. At week 16, 247 patients receiving upadacitinib (71.0%) and 210 patients receiving dupilumab (61.1%) achieved EASI75 (P = .006). All ranked secondary end points also demonstrated the superiority of upadacitinib vs dupilumab, including improvement in Worst Pruritus NRS as early as week 1 (mean [SE], 31.4% [1.7%] vs 8.8% [1.8%]; P < .001), achievement of EASI75 as early as week 2 (152 [43.7%] vs 60 [17.4%]; P < .001), and achievement of EASI100 at week 16 (97 [27.9%] vs 26 [7.6%]; P < .001). Rates of serious infection, eczema herpeticum, herpes zoster, and laboratory-related adverse events were higher for patients who received upadacitinib, whereas rates of conjunctivitis and injection-site reactions were higher for patients who received dupilumab. CONCLUSIONS AND RELEVANCE During 16 weeks of treatment, upadacitinib demonstrated superior efficacy vs dupilumab in patients with moderate-to-severe AD, with no new safety signals. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT03738397.
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Affiliation(s)
| | | | - Eric L. Simpson
- Department of Dermatology, Oregon Health & Science University, Portland
| | - Antonio Costanzo
- Dermatology Unit, Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy
- Humanitas Clinical and Research Center, Scientific Institute for Research, Hospitalization and Healthcare, Rozzano, Italy
| | - Marjolein De Bruin-Weller
- Department of Dermatology and Allergology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Sebastien Barbarot
- Department of Dermatology, Nantes Université, Centre Hospitalier Universitaire de Nantes, Nantes, France
| | - Vimal H. Prajapati
- Division of Dermatology, Department of Medicine, University of Calgary, Calgary, Alberta, Canada
- Division of Community Pediatrics, Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada
- Division of Pediatric Rheumatology, Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada
- Skin Health & Wellness Centre, Calgary, Alberta, Canada
- Dermatology Research Institute, Calgary, Alberta, Canada
- Probity Medical Research, Calgary, Alberta, Canada
| | - Peter Lio
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
- Medical Dermatology Associates of Chicago, Chicago, Illinois
| | | | | | - John Liu
- AbbVie Inc, North Chicago, Illinois
| | | | | | - Kilian Eyerich
- Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
- Department of Dermatology and Allergy, Technical University of Munich, Munich, Germany
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40
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Milovanova K, Adly M, Lethebe BC, Stevenson R, Prajapati VH, Luca NJC. Predictors of family impact of juvenile localized scleroderma. Pediatr Dermatol 2021; 38:1137-1142. [PMID: 34263473 DOI: 10.1111/pde.14683] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To measure the impact juvenile localized scleroderma (jLS) has on family quality of life and to identify predictors of family impact in this population which may inform the development of tailored resources to enhance family functioning for patients with jLS. METHODS A retrospective cohort study of pediatric patients with jLS and their families was conducted. Five questionnaires were administered at each visit: Pediatric Quality of Life Inventory Family Impact Module (PedsQL-FIM), PedsQL 4.0 Generic Core Scales (PedsQL-Generic), PedsQL Rheumatology Module (PedsQL-RM), Child Health Assessment Questionnaire (CHAQ), and Children's Dermatology Life Quality Index (CDLQI). Linear mixed models with random intercepts for each patient were used to find relationships between family impact scores and clinically relevant variables over time. Variables of interest included disease activity status, methotrexate use, jLS distribution, and scores for PedsQL-Generic and PedsQL-RM. RESULTS The median baseline PedsQL-FIM total score was 80.9 (IQR = 76.6-97.4). Adjusting for age and sex, the most significant predictors of family impact were PedsQL-Generic scores and four of five PedsQL-RM dimensions (all P < .001); methotrexate use had borderline significance (P = .06). Family impact increased more significantly over time in older patients. In multivariable modeling, PedsQL-Generic total score and jLS "other" distribution were significant for predicting an increased PedsQL-FIM score (P = .003 and P = .03, respectively). CONCLUSIONS JLS has a moderate family impact. Family impact is predicted by patients' general and disease-specific health-related quality of life (HRQL) and their jLS subtype. There is a trend toward increased family impact with methotrexate treatment. This study emphasizes the importance of family-centered care in jLS.
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Affiliation(s)
- Katia Milovanova
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Merna Adly
- Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Brendan C Lethebe
- Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Rebeka Stevenson
- Section of Pediatric Rheumatology, Department of Pediatrics, University of Calgary, Calgary, AB, Canada
| | - Vimal H Prajapati
- Section of Pediatric Rheumatology, Department of Pediatrics, University of Calgary, Calgary, AB, Canada.,Section of Community Pediatrics, Department of Pediatrics, University of Calgary, Calgary, AB, Canada.,Division of Dermatology, Department of Medicine, University of Calgary, Calgary, AB, Canada.,Dermatology Research Institute, Calgary, AB, Canada.,Skin Health & Wellness Centre, Calgary, AB, Canada
| | - Nadia J C Luca
- Section of Pediatric Rheumatology, Department of Pediatrics, University of Calgary, Calgary, AB, Canada
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41
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Heck E, Rankin BD, Schneider M, Prajapati VH. Flagellate purpura associated with COVID-19 vaccination. J Eur Acad Dermatol Venereol 2021; 36:e33-e34. [PMID: 34416052 PMCID: PMC8656622 DOI: 10.1111/jdv.17609] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 06/06/2021] [Accepted: 08/12/2021] [Indexed: 02/03/2023]
Affiliation(s)
- E Heck
- Division of Dermatology, Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - B D Rankin
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - M Schneider
- Department of Pathology and Laboratory Medicine, University of Calgary, Calgary, Alberta, Canada
| | - V H Prajapati
- Division of Dermatology, Department of Medicine, University of Calgary, Calgary, Alberta, Canada.,Dermatology Research Institute, Calgary, Alberta, Canada.,Skin Health & Wellness Centre, Calgary, Alberta, Canada.,Probity Medical Research, Calgary, Alberta, Canada.,Section of Community Pediatrics, Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada.,Section of Pediatric Rheumatology, Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada
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42
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Georgakopoulos JR, Mufti A, Vender R, Prajapati VH, Yeung J. Incidence and prognosis of COVID-19 in psoriasis patients on biologic therapy: a multicentre retrospective cohort study. J Eur Acad Dermatol Venereol 2021; 35:e485-e487. [PMID: 33872431 PMCID: PMC8250560 DOI: 10.1111/jdv.17279] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Accepted: 04/13/2021] [Indexed: 10/28/2022]
Affiliation(s)
- J R Georgakopoulos
- Division of Dermatology, Department of Medicine, University of Toronto, ON, Canada
| | - A Mufti
- Division of Dermatology, Department of Medicine, University of Toronto, ON, Canada
| | - R Vender
- Department of Dermatology, McMaster University, Hamilton, ON, Canada.,Dermatrials Research Inc. & Venderm Innovations in Psoriasis, Hamilton, ON, Canada
| | - V H Prajapati
- Division of Dermatology, Department of Medicine, University of Calgary, Calgary, AB, Canada.,Division of Community Pediatrics, Department of Pediatrics, University of Calgary, Calgary, AB, Canada.,Division of Pediatric Rheumatology, Department of Pediatrics, University of Calgary, Calgary, AB, Canada.,Dermatology Research Institute, Calgary, AB, Canada.,Skin Health & Wellness Centre, Calgary, AB, Canada.,Probity Medical Research Inc, Calgary, AB, Canada
| | - J Yeung
- Division of Dermatology, Department of Medicine, University of Toronto, ON, Canada.,Sunnybrook Health Sciences Centre, Toronto, ON, Canada.,Women's College Hospital, Toronto, ON, Canada.,Probity Medical Research Inc, Waterloo, ON, Canada
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43
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Lewinson RT, Prajapati VH, Luca NJ. Cerebellar Atrophy in Craniofacial Morphea: A Report of 2 Cases with 1-year Neuroimaging Followup. J Rheumatol 2020; 47:1452-1453. [PMID: 32541079 DOI: 10.3899/jrheum.190808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
- Ryan T Lewinson
- Division of Dermatology, Department of Medicine, University of Calgary
| | - Vimal H Prajapati
- Division of Dermatology, Department of Medicine, Section of Community Pediatrics, Section of Pediatric Rheumatology, Department of Pediatrics, University of Calgary, Dermatology Research Institute
| | - Nadia J Luca
- Section of Pediatric Rheumatology, Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada.
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44
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Ladha MA, Edgerton B, Levy J, Mahmood MN, Devani AR, Grewal PS, Prajapati VH. Methotrexate-induced cutaneous ulceration and necrosis in chronic atopic dermatitis. JAAD Case Rep 2020; 6:864-867. [PMID: 32904188 PMCID: PMC7452306 DOI: 10.1016/j.jdcr.2020.02.028] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Affiliation(s)
- Malika A. Ladha
- Division of Dermatology, Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Bryn Edgerton
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Jonathan Levy
- Division of Dermatology, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Muhammad N. Mahmood
- Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, Alberta, Canada
| | - Alim R. Devani
- Dermatology Research Institute, Calgary, Alberta, Canada
| | - Parbeer S. Grewal
- Division of Dermatology, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Vimal H. Prajapati
- Division of Dermatology, Department of Medicine, University of Calgary, Calgary, Alberta, Canada
- Dermatology Research Institute, Calgary, Alberta, Canada
- Division of Community Pediatrics, Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada
- Division of Pediatric Rheumatology, Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada
- Correspondence to: Vimal H. Prajapati, MD, Dermatology Research Institute, Meadows Mile Professional Building, 330-8500 Blackfoot Trail S.E., Calgary, Alberta, Canada T2J 7E1.
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45
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Stephenson C, Prajapati VH, Hunter C, Miettunen P. Novel use of Autoinflammatory Diseases Activity Index (AIDAI) captures skin and extracutaneous features to help manage pediatric DITRA: A case report and a proposal for a modified disease activity index in autoinflammatory keratinization disorders. Pediatr Dermatol 2020; 37:670-676. [PMID: 32301172 DOI: 10.1111/pde.14155] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Revised: 01/30/2020] [Accepted: 03/03/2020] [Indexed: 12/26/2022]
Abstract
Generalized pustular psoriasis (GPP) is a severe form of psoriasis, which is rare in pediatric and adult patients. It is characterized by sterile pustular lesions that appear on erythematous skin, associated with systemic features. A recent identification of mutations in the IL36RN gene in some GPP patients has led to a diagnosis of new autoinflammatory disease, interleukin-36-receptor antagonist deficiency (DITRA). DITRA represents an emerging group of autoinflammatory diseases with hyperkeratotic skin involvement, called autoinflammatory keratinization diseases (AIKD). DITRA diagnosis and management are challenging as neither DITRA-specific clinical assessment tools nor treatment trials exist. Autoinflammatory Diseases Activity Index (AIDAI) is a validated tool originally developed to evaluate disease activity and treatment response in other inherited autoinflammatory diseases with systemic and skin involvement. We report the first use of AIDAI in a pediatric DITRA patient with the following goals: (a) to describe the contribution of AIDAI to our patient's management; (b) to identify potential limitations of AIDAI in DITRA; (c) to review literature for current psoriasis assessment tools; and (d) to propose a preliminary DITRA/AIKD disease activity index (DITRA/AIDAI) to be validated in future studies.
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Affiliation(s)
- Chloe Stephenson
- Department of Paediatrics, University of Calgary, Calgary, AB, Canada
| | - Vimal H Prajapati
- Division of Dermatology, Department of Medicine, University of Calgary, Calgary, AB, Canada.,Division of Community Paediatrics, Department of Paediatrics, University of Calgary, Calgary, AB, Canada.,Division of Paediatric Rheumatology, Department of Paediatrics, University of Calgary, Calgary, AB, Canada
| | - Charlene Hunter
- Department of Pathology, University of Calgary, Calgary, AB, Canada
| | - Paivi Miettunen
- Department of Paediatrics, University of Calgary, Calgary, AB, Canada.,Division of Paediatric Rheumatology, Department of Paediatrics, University of Calgary, Calgary, AB, Canada
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46
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Lansang P, Lara-Corrales I, Bergman JN, Hong CH, Joseph M, Kim VHD, Lam JM, Landells I, Marcoux D, Prajapati VH, Ramien ML, Spring S. Approach to the Assessment and Management of Pediatric Patients With Atopic Dermatitis: A Consensus Document. Section IV: Consensus Statements on the Assessment and Management of Pediatric Atopic Dermatitis. J Cutan Med Surg 2020; 23:32S-39S. [PMID: 31692378 DOI: 10.1177/1203475419882654] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This document is intended to provide practical guidance to physicians treating pediatric atopic dermatitis (AD), especially dermatologists, pediatricians, allergists, and other health-care professionals. The recommendations contained here were formalized based on a consensus of 12 Canadian pediatric dermatologists, dermatologists, pediatricians, and pediatric allergists with extensive experience managing AD in the pediatric population. A modified Delphi process was adopted with iterative voting on a 5-point Likert scale, with a prespecified agreement cutoff of 75%. Topic areas addressed in the 17 consensus statements reflect areas of practical management, including counselling, assessment, comorbidity management, and therapy.
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Affiliation(s)
- Perla Lansang
- Division of Dermatology, Sunnybrook Health Sciences Centre, Toronto, ON, Canada.,Division of Dermatology, Faculty of Medicine, University of Toronto, ON, Canada.,Section of Dermatology, Division of Paediatric Medicine, The Hospital for Sick Children, Toronto, ON, Canada
| | - Irene Lara-Corrales
- Section of Dermatology, Division of Paediatric Medicine, The Hospital for Sick Children, Toronto, ON, Canada.,Department of Pediatrics, Faculty of Medicine, University of Toronto, ON, Canada
| | - James N Bergman
- Department of Dermatology and Skin Science, University of British Columbia, Vancouver, Canada
| | - Chih-Ho Hong
- Department of Dermatology and Skin Science, University of British Columbia, Vancouver, Canada.,Dr. Chih-ho Hong Medical Inc., Surrey, BC, Canada.,Probity Medical Research, Waterloo, ON, Canada
| | - Marissa Joseph
- Section of Dermatology, Division of Paediatric Medicine, The Hospital for Sick Children, Toronto, ON, Canada.,Department of Pediatrics, Faculty of Medicine, University of Toronto, ON, Canada.,Division of Dermatology, Women's College Hospital, Toronto, ON, Canada
| | - Vy H D Kim
- Department of Pediatrics, Faculty of Medicine, University of Toronto, ON, Canada.,Division of Immunology & Allergy, Department of Paediatrics, The Hospital for Sick Children, Toronto, ON, Canada
| | - Joseph M Lam
- Department of Dermatology and Skin Science, University of British Columbia, Vancouver, Canada.,Department of Pediatrics, University of British Columbia, Vancouver, Canada
| | - Ian Landells
- Division of Dermatology, Departments of Medicine and Pediatrics, Memorial University, St. John's, NL, Canada.,Nexus Clinical Research, St. John's, NL, Canada
| | - Danielle Marcoux
- Division of Dermatology, Department of Pediatrics, University of Montreal and CHU Sainte-Justine University Hospital Center, Montreal, QC, Canada
| | - Vimal H Prajapati
- Division of Dermatology, Department of Medicine, University of Calgary, AB, Canada.,Division of Community Pediatrics, Department of Pediatrics, University of Calgary, AB, Canada.,Division of Pediatric Rheumatology, Department of Pediatrics, University of Calgary, AB, Canada.,Dermatology Research Institute, Calgary, AB, Canada
| | - Michele L Ramien
- Division of Dermatology, Department of Medicine, University of Calgary, AB, Canada.,Division of Community Pediatrics, Department of Pediatrics, University of Calgary, AB, Canada
| | - Shanna Spring
- Division of Dermatology and Rheumatology, Children's Hospital of Eastern Ontario, Ottawa, Canada.,Department of Pediatrics, University of Ottawa, ON, Canada.,Division of Dermatology, Department of Medicine, University of Ottawa, ON, Canada
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47
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Lansang P, Bergman JN, Fiorillo L, Joseph M, Lara-Corrales I, Marcoux D, McCuaig C, Pope E, Prajapati VH, Li SZ, Landells I. Management of pediatric plaque psoriasis using biologics. J Am Acad Dermatol 2020; 82:213-221. [DOI: 10.1016/j.jaad.2019.05.056] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Revised: 05/21/2019] [Accepted: 05/23/2019] [Indexed: 12/31/2022]
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48
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Lansang P, Lam JM, Marcoux D, Prajapati VH, Spring S, Lara-Corrales I. Approach to the Assessment and Management of Pediatric Patients With Atopic Dermatitis: A Consensus Document. Section III: Treatment Options for Pediatric Atopic Dermatitis. J Cutan Med Surg 2019; 23:19S-31S. [PMID: 31692376 DOI: 10.1177/1203475419882647] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Because atopic dermatitis (AD) is a chronic, relapsing disease, treatment requires the use of both active therapy to control flares and preventative maintenance therapy to promote integrity of the skin barrier. In this third of four sections, important clinical considerations for the treatment of pediatric AD are reviewed. Emerging therapies in development for pediatric AD are introduced.
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Affiliation(s)
- Perla Lansang
- Division of Dermatology, Sunnybrook Health Sciences Centre, Toronto, ON, Canada.,Division of Dermatology, Faculty of Medicine, University of Toronto, ON, Canada.,Division of Paediatric Medicine, Section of Dermatology, The Hospital for Sick Children, Toronto, ON, Canada
| | - Joseph M Lam
- Department of Dermatology and Skin Science, University of British Columbia, Vancouver, Canada.,Department of Pediatrics, University of British Columbia, Vancouver, Canada
| | - Danielle Marcoux
- Division of Dermatology, Department of Paediatrics, Sainte-Justine University Hospital Center, University of Montreal, QC, Canada
| | - Vimal H Prajapati
- Division of Dermatology, Department of Medicine, University of Calgary, AB, Canada.,Division of Community Pediatrics, Department of Pediatrics, University of Calgary, AB, Canada.,Division of Pediatric Rheumatology, Department of Pediatrics, University of Calgary, AB, Canada.,Dermatology Research Institute, Calgary, AB, Canada
| | - Shanna Spring
- Division of Dermatology and Rheumatology, Children's Hospital of Eastern Ontario, Ottawa, Canada.,Department of Pediatrics, University of Ottawa, ON, Canada.,Division of Dermatology, Department of Medicine, University of Ottawa, ON, Canada
| | - Irene Lara-Corrales
- Division of Paediatric Medicine, Section of Dermatology, The Hospital for Sick Children, Toronto, ON, Canada.,Department of Pediatrics, Faculty of Medicine, University of Toronto, ON, Canada
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49
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Edgerton B, Ladha MA, Hunter C, Devani AR, Prajapati VH. Successful treatment of multinucleate cell angiohistiocytoma in an adult male patient with potassium-titanyl-phosphate laser in combination with intralesional corticosteroids. JAAD Case Rep 2019; 5:880-882. [PMID: 31681826 PMCID: PMC6818368 DOI: 10.1016/j.jdcr.2019.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Affiliation(s)
- Bryn Edgerton
- Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Malika A Ladha
- Division of Dermatology, Department of Medicine, University of Calgary, Calgary, Canada
| | - Charlene Hunter
- Department of Pathology and Laboratory Medicine, University of Calgary, Calgary, Canada
| | | | - Vimal H Prajapati
- Division of Dermatology, Department of Medicine, University of Calgary, Calgary, Canada.,Dermatology Research Institute, Calgary, Canada.,Division of Community Pediatrics, Department of Pediatrics, University of Calgary, Calgary, Canada.,Division of Pediatric Rheumatology, Department of Pediatrics, University of Calgary, Calgary, Canada
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50
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Andriescu EC, Coughlin CC, Cheng CE, Prajapati VH, Huang JT, Schmidt BA, Degar BA, Aplenc R, Pillai V, Yan AC, Liang MG. Pediatric leukemia cutis: A case series. Pediatr Dermatol 2019; 36:658-663. [PMID: 31273836 DOI: 10.1111/pde.13864] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND Pediatric leukemia cutis (LC) is often difficult to diagnose due to similarity in appearance to other dermatologic diseases. Several case reports and smaller case series have been published in the medical literature, but studies on larger cohorts of children with LC are lacking. OBJECTIVE This study aimed to better characterize the clinical features, course, and prognosis of LC in the pediatric population. METHODS We performed a retrospective case series of 31 patients diagnosed with LC at Boston Children's Hospital and the Children's Hospital of Philadelphia. RESULTS The number and morphology of LC lesions varied among patients, with the head and lower extremities being the most common sites of involvement. Leukemia cutis presented concomitantly with systemic leukemia in the majority of cases. Most cases of LC arose during initial leukemia episodes, rather than with relapsed leukemia. Acute myeloid leukemia was the subtype most frequently associated with LC, followed by acute lymphoblastic leukemia. Diagnosis altered treatment timing and therapeutic decisions. CONCLUSION Children most often present concomitantly with LC and systemic leukemia. Since the morphology and distribution of LC varies, physicians must maintain a high index of suspicion for this diagnosis, as the presence of LC may change the management of systemic leukemia.
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Affiliation(s)
| | - Carrie C Coughlin
- Division of Dermatology, Departments of Medicine and Pediatrics, Washington University School of Medicine, St. Louis, Missouri
| | - Carol E Cheng
- Division of Dermatology, Department of Medicine, University of California, Los Angeles, Los Angeles, California
| | - Vimal H Prajapati
- Division of Dermatology, Department of Medicine, University of Calgary, Calgary, Alberta, Canada.,Division of Pediatric Rheumatology, Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada.,Division of Community Pediatrics, Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada.,Dermatology Research Institute, Calgary, Alberta, Canada
| | - Jennifer T Huang
- Department of Dermatology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Birgitta A Schmidt
- Department of Pathology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Barbara A Degar
- Department of Pediatric Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Richard Aplenc
- Division of Oncology, Center for Pediatric Clinical Effectiveness, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.,Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Vinodh Pillai
- Department of Pathology and Laboratory Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.,University of Pennsylvania, Philadelphia, Pennsylvania
| | - Albert C Yan
- Section of Pediatric Dermatology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.,Departments of Pediatrics and Dermatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Marilyn G Liang
- Department of Dermatology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
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