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Burden AD. Response to: Letter to Editor Regarding "Spesolimab Efficacy and Safety in Patients with Moderate-to-Severe Palmoplantar Pustulosis: A Multicentre, Double-Blind, Randomised, Placebo-Controlled, Phase IIb, Dose-Finding Study". Dermatol Ther (Heidelb) 2024; 14:1067-1069. [PMID: 38578385 PMCID: PMC11052932 DOI: 10.1007/s13555-024-01138-8] [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: 02/20/2024] [Accepted: 03/01/2024] [Indexed: 04/06/2024] Open
Affiliation(s)
- A David Burden
- School of Infection and Immunity, University of Glasgow, Glasgow, UK.
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Burden AD, Bissonnette R, Anatchkova M, Budhiarso I, Skalicky AM, Liberato ACS, Hu N, Thoma C, Gloede T, Kohlmann T, Lebwohl MG. Psychometric validation of the Psoriasis Symptom Scale, Functional Assessment of Chronic Illness Therapy-Fatigue and pain-Visual Analogue Scale in patients with generalized pustular psoriasis. J Eur Acad Dermatol Venereol 2024. [PMID: 38334243 DOI: 10.1111/jdv.19830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Accepted: 01/19/2024] [Indexed: 02/10/2024]
Abstract
BACKGROUND Generalized pustular psoriasis (GPP) is a rare, chronic, inflammatory skin disease associated with considerable patient burden. The Psoriasis Symptom Scale (PSS), Functional Assessment of Chronic Illness Therapy-Fatigue (FACIT-Fatigue) and pain-Visual Analogue Scale (pain-VAS) are patient-reported outcomes (PROs) that have not yet been validated in patients with GPP. OBJECTIVES To evaluate the psychometric properties of the PSS, FACIT-Fatigue and pain-VAS using data from Effisayil 1, a randomised trial of spesolimab in patients with moderate-to-severe GPP. METHODS Inter-item correlations and confirmatory factor analysis (CFA) were performed using Week 1 data. Internal consistency was assessed with Cronbach's α coefficient using baseline and Week 1 data. Test-retest reliability was assessed using intraclass correlation coefficients (ICCs); change data for the GPP Physician Global Assessment total score and pustulation subscore were used to define a stable population. Convergent validity was assessed at baseline and Week 1 using Spearman's rank-order correlations. Known-groups validity was measured by analysis of variance using Week 1 data. Ability to detect change from baseline to Week 1 was evaluated by analysis of covariance. RESULTS Inter-item and item-to-total correlations were moderate or strong for most PSS and FACIT-Fatigue items. CFA demonstrated the unidimensionality of the PSS and FACIT-Fatigue, with high factor loadings for most items (PSS range, 0.75-0.94; FACIT-Fatigue range, 0.11-0.93) and acceptable fit statistics. Both scores demonstrated internal consistency (Cronbach's α, 0.71 and 0.95, respectively). The PSS, FACIT-Fatigue and pain-VAS demonstrated test-retest reliability (ICCs ≥0.70) and good evidence of convergent validity. Furthermore, the PROs could differentiate between known groups of varying symptom severity (range, p < 0.0001-0.0225) and detect changes in symptom severity from baseline to Week 1 (range, p < 0.0001-0.0002). CONCLUSIONS Overall, these results support the reliability, validity and ability to detect change of the PSS, FACIT-Fatigue and pain-VAS as PROs in patients with GPP.
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Affiliation(s)
- A David Burden
- School of Infection and Immunity, University of Glasgow, Glasgow, UK
| | | | | | | | | | | | - Na Hu
- Boehringer Ingelheim (China) Investment Co. Ltd, Shanghai, China
| | | | - Tristan Gloede
- Boehringer Ingelheim International GmbH, Ingelheim, Germany
| | - Thomas Kohlmann
- Institute for Community Medicine, Medical University Greifswald, Greifswald, Germany
| | - Mark G Lebwohl
- Icahn School of Medicine at Mount Sinai, New York, New York, USA
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Smith CH, Yiu ZZN, Bale T, Burden AD, Coates LC, Eckert E, Longley N, Mahil SK, McGuire A, Murphy R, Nelson-Piercy C, Owen CM, Parslew R, Woolf RT, Mansour Kiaee Z, Constantin AM, Ezejimofor MC, Exton LS, Mohd Mustapa MF. British Association of Dermatologists guidelines for biologic therapy for psoriasis 2023: a pragmatic update. Br J Dermatol 2024; 190:270-272. [PMID: 37740557 DOI: 10.1093/bjd/ljad347] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Indexed: 09/24/2023]
Abstract
The article provides a pragmatic update of the British Association of Dermatologists guidelines for biologic therapy for psoriasis.
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Morita A, Strober B, Burden AD, Choon SE, Anadkat MJ, Marrakchi S, Tsai TF, Gordon KB, Thaçi D, Zheng M, Hu N, Haeufel T, Thoma C, Lebwohl MG. Efficacy and safety of subcutaneous spesolimab for the prevention of generalised pustular psoriasis flares (Effisayil 2): an international, multicentre, randomised, placebo-controlled trial. Lancet 2023; 402:1541-1551. [PMID: 37738999 DOI: 10.1016/s0140-6736(23)01378-8] [Citation(s) in RCA: 17] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 06/28/2023] [Accepted: 06/29/2023] [Indexed: 09/24/2023]
Abstract
BACKGROUND Spesolimab is an anti-interleukin-36 receptor monoclonal antibody approved to treat generalised pustular psoriasis (GPP) flares. We aimed to assess the efficacy and safety of spesolimab for GPP flare prevention. METHODS This multicentre, randomised, placebo-controlled, phase 2b trial was done at 60 hospitals and clinics in 20 countries. Eligible study participants were aged between 12 and 75 years with a documented history of GPP as per the European Rare and Severe Psoriasis Expert Network criteria, with a history of at least two past GPP flares, and a GPP Physician Global Assessment (GPPGA) score of 0 or 1 at screening and random assignment. Patients were randomly assigned (1:1:1:1) to receive subcutaneous placebo, subcutaneous low-dose spesolimab (300 mg loading dose followed by 150 mg every 12 weeks), subcutaneous medium-dose spesolimab (600 mg loading dose followed by 300 mg every 12 weeks), or subcutaneous high-dose spesolimab (600 mg loading dose followed by 300 mg every 4 weeks) over 48 weeks. The primary objective was to demonstrate a non-flat dose-response curve on the primary endpoint, time to first GPP flare. FINDINGS From June 8, 2020, to Nov 23, 2022, 157 patients were screened, of whom 123 were randomly assigned. 92 were assigned to receive spesolimab (30 high dose, 31 medium dose, and 31 low dose) and 31 to placebo. All patients were either Asian (79 [64%] of 123) or White (44 [36%]). Patient groups were similar in sex distribution (76 [62%] female and 47 [38%] male), age (mean 40·4 years, SD 15·8), and GPP Physician Global Assessment score. A non-flat dose-response relationship was established on the primary endpoint. By week 48, 35 patients had GPP flares; seven (23%) of 31 patients in the low-dose spesolimab group, nine (29%) of 31 patients in the medium-dose spesolimab group, three (10%) of 30 patients in the high-dose spesolimab group, and 16 (52%) of 31 patients in the placebo group. High-dose spesolimab was significantly superior versus placebo on the primary outcome of time to GPP flare (hazard ratio [HR]=0·16, 95% CI 0·05-0·54; p=0·0005) endpoint. HRs were 0·35 (95% CI 0·14-0·86, nominal p=0·0057) in the low-dose spesolimab group and 0·47 (0·21-1·06, p=0·027) in the medium-dose spesolimab group. We established a non-flat dose-response relationship for spesolimab compared with placebo, with statistically significant p values for each predefined model (linear p=0·0022, emax1 p=0·0024, emax2 p=0·0023, and exponential p=0·0034). Infection rates were similar across treatment arms; there were no deaths and no hypersensitivity reactions leading to discontinuation. INTERPRETATION High-dose spesolimab was superior to placebo in GPP flare prevention, significantly reducing the risk of a GPP flare and flare occurrence over 48 weeks. Given the chronic nature of GPP, a treatment for flare prevention is a significant shift in the clinical approach, and could ultimately lead to improvements in patient morbidity and quality of life. FUNDING Boehringer Ingelheim.
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Affiliation(s)
- Akimichi Morita
- Department of Geriatric and Environmental Dermatology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Bruce Strober
- Department of Dermatology, Yale University School of Medicine, New Haven, CT, USA; Central Connecticut Dermatology, Cromwell, CT, USA
| | - A David Burden
- School of Infection and Immunity, University of Glasgow, Glasgow, UK
| | - Siew Eng Choon
- Department of Dermatology, Hospital Sultanah Aminah, and Clinical School Johor Bahru, Monash University Malaysia, Malaysia
| | - Milan J Anadkat
- Division of Dermatology, Washington University School of Medicine, St Louis, MO, USA
| | - Slaheddine Marrakchi
- Department of Dermatology, Hedi Chaker Hospital, University of Sfax, Sfax, Tunisia
| | - Tsen-Fang Tsai
- Department of Dermatology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Kenneth B Gordon
- Department of Dermatology, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Diamant Thaçi
- Comprehensives Center for Inflammation Medicine, University of Lübeck, Lübeck, Germany
| | - Min Zheng
- Department of Dermatology, Second Affiliated Hospital, Zhejiang University, School of Medicine, Hangzhou, Zhejiang, China
| | - Na Hu
- Boehringer Ingelheim (China) Investment Co, Shanghai, China
| | | | | | - Mark G Lebwohl
- Icahn School of Medicine at Mount Sinai, New York, NY, USA.
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Burden AD, Bissonnette R, Navarini AA, Murakami M, Morita A, Haeufel T, Ye B, Baehner F, Terui T. Spesolimab Efficacy and Safety in Patients with Moderate-to-Severe Palmoplantar Pustulosis: A Multicentre, Double-Blind, Randomised, Placebo-Controlled, Phase IIb, Dose-Finding Study. Dermatol Ther (Heidelb) 2023; 13:2279-2297. [PMID: 37731086 PMCID: PMC10539230 DOI: 10.1007/s13555-023-01002-1] [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: 06/23/2023] [Accepted: 08/02/2023] [Indexed: 09/22/2023] Open
Abstract
INTRODUCTION We evaluated the anti-interleukin-36 receptor antibody spesolimab in patients with moderate-to-severe palmoplantar pustulosis (PPP). METHODS This phase IIb trial comprised a loading dose period to week (W) 4, then maintenance dosing to W52. Patients were randomised 2:1:1:1:2 to subcutaneous spesolimab 3000 mg to W4 then 600 mg every 4 weeks (q4w), spesolimab 3000 mg to W4 then 300 mg q4w, spesolimab 1500 mg to W4 then 600 mg q4w, spesolimab 1500 mg to W4, 300 mg q4w to W16 then 300 mg every 8 weeks (q8w), or placebo switching to spesolimab 600 mg q4w at W16. The primary efficacy endpoint was percentage change from baseline in Palmoplantar Pustular Area and Severity Index (PPP ASI) at W16. Secondary endpoints included a Palmoplantar Pustular Physician's Global Assessment (PPP PGA) score of 0/1. Safety (including adverse events [AEs], local tolerability) was assessed. RESULTS 152 patients were treated. The primary endpoint was not met; mean differences for spesolimab versus placebo ranged from - 14.6% (95% confidence interval [CI]: - 31.5%, 2.2%) to - 5.3% (95% CI: - 19.1%, 8.6%); none reached significance. At W16, 23 (21.1%) and two (4.7%) patients in the combined spesolimab and placebo groups, respectively, achieved PPP PGA 0/1 (mean difference 16.4%; 95% CI: 3.8%, 25.7%), increasing to 59 (54.1%; combined spesolimab) and 12 (27.9%; placebo switch to spesolimab) patients at W52. Non-Asian patients had significant improvements in the primary endpoint (mean difference - 17.7%; nominal P = 0.0394) and PPP PGA 0/1 at W16 with spesolimab versus placebo. Rates of AEs and AE-related discontinuations were similar for spesolimab and placebo. Local tolerability events and injection-site reactions were more frequent with spesolimab than placebo. CONCLUSION The primary objective to demonstrate a non-flat dose-response relationship and proof-of-concept was not achieved; improvements with spesolimab occurred in secondary endpoints and in non-Asian patients, indicating potential modest benefits. Spesolimab was generally well tolerated (ClinicalTrials.gov NCT04015518).
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Affiliation(s)
- A David Burden
- School of Infection and Immunity, University of Glasgow, Glasgow, UK.
| | | | | | - Masamoto Murakami
- Department of Dermatology, Ehime University Graduate School of Medicine, Ehime, Japan
| | - Akimichi Morita
- Department of Geriatric and Environmental Dermatology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Thomas Haeufel
- Boehringer Ingelheim International GmbH, Ingelheim, Germany
| | - Binqi Ye
- Boehringer Ingelheim (China) Investment Corporation Limited, Shanghai, People's Republic of China
| | - Frank Baehner
- Boehringer Ingelheim International GmbH, Ingelheim, Germany
| | - Tadashi Terui
- Division of Cutaneous Science, Department of Dermatology, Nihon University School of Medicine, Tokyo, Japan
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Burden AD, Okubo Y, Zheng M, Thaçi D, van de Kerkhof P, Hu N, Quaresma M, Thoma C, Choon SE. Efficacy of spesolimab for the treatment of generalized pustular psoriasis flares across pre-specified patient subgroups in the Effisayil 1 study. Exp Dermatol 2023; 32:1279-1283. [PMID: 37140190 DOI: 10.1111/exd.14824] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [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: 01/31/2023] [Revised: 04/13/2023] [Accepted: 04/19/2023] [Indexed: 05/05/2023]
Abstract
Effisayil 1 was a multicentre, randomized, double-blind, placebo-controlled study of the anti-interleukin (IL)-36 receptor monoclonal antibody, spesolimab, in patients presenting with a generalized pustular psoriasis (GPP) flare. Previously published data from this study revealed that within 1 week, rapid pustular and skin clearance were observed in patients receiving spesolimab versus placebo. In this pre-specified subgroup analysis, the efficacy of spesolimab was evaluated according to patient demographic and clinical characteristics at baseline in patients receiving spesolimab (n = 35) or placebo (n = 18) on Day 1. Efficacy was by assessed by achievement of primary endpoint (Generalized Pustular Psoriasis Physician Global Assessment [GPPGA] pustulation subscore of 0 at Week 1) and key secondary endpoint (GPPGA total score of 0 or 1 at Week 1). Safety was assessed at Week 1. Spesolimab was found to be efficacious and had a consistent and favourable safety profile in patients presenting with a GPP flare, regardless of patient demographics and clinical characteristics at baseline.
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Affiliation(s)
- A D Burden
- School of Infection and Immunity, University of Glasgow, Glasgow, UK
| | - Y Okubo
- Department of Dermatology, Tokyo Medical University, Tokyo, Japan
| | - M Zheng
- Department of Dermatology, Second Affiliated Hospital, Zhejiang University, School of Medicine, Hangzhou, Zhejiang, China
| | - D Thaçi
- Institute and Comprehensive Center for Inflammation Medicine, University of Lübeck, Lübeck, Germany
| | - P van de Kerkhof
- Department of Dermatology, Radboud University, Nijmegen, The Netherlands
| | - N Hu
- Boehringer Ingelheim (China) Investment Co., Ltd, Shanghai, China
| | - M Quaresma
- Boehringer Ingelheim International GmbH, Ingelheim, Germany
| | - C Thoma
- Boehringer Ingelheim International GmbH, Biberach, Germany
| | - S E Choon
- Department of Dermatology, Hospital Sultanah Aminah, Clinical School Johor Bahru, Monash University Malaysia, Subang Jaya, Malaysia
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Burden AD, Bachelez H, Choon SE, Marrakchi S, Tsai TF, Turki H, Morita A, Lebwohl MG, Bissonnette R, Zheng M, Anadkat MJ, Alexander AN, Tang M, Thoma C, Duffin KC. The Generalized Pustular Psoriasis Physician Global Assessment (GPPGA) score: online assessment and validation study of a specific measure of GPP disease activity. Br J Dermatol 2023:7131301. [PMID: 37075220 DOI: 10.1093/bjd/ljad071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 03/02/2023] [Accepted: 04/08/2023] [Indexed: 04/21/2023]
Abstract
Generalized pustular psoriasis (GPP), a rare and potentially life-threatening neutrophilic skin disease, is characterised by recurrent flares of pustulation on non-acral skin with associated erythema, crusting and scaling.1,2 There are no agreed or validated measurements for assessing GPP severity or symptom improvement; clinically validated endpoints that incorporate key manifestations of GPP, and are meaningful and reliable for the evaluation of treatment response, are needed.
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Affiliation(s)
- A David Burden
- Institute of Infection, Immunity and Inflammation, University of Glasgow, Glasgow, UK
| | - Hervé Bachelez
- Service de Dermatologie, Assistance Publique-Hôpitaux de Paris Hôpital Saint-Louis, Paris, France
- INSERM U1163, Imagine Institute for Genetics of Human Diseases, Université Paris Cité, Paris, France
| | - Siew Eng Choon
- Department of Dermatology, Hospital Sultanah Aminah, Clinical School Johor Bahru, Monash University Malaysia, Subang Jaya, Malaysia
| | - Slaheddine Marrakchi
- Department of Dermatology, Hedi Chaker Hospital, University of Sfax, Sfax, Tunisia
| | - Tsen-Fang Tsai
- Department of Dermatology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Hamida Turki
- Department of Dermatology, Hedi Chaker Hospital, University of Sfax, Sfax, Tunisia
| | - Akimichi Morita
- Department of Geriatric and Environmental Dermatology, Nagoya City University, Graduate School of Medical Sciences, Nagoya, Japan
| | - Mark G Lebwohl
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | | | - Min Zheng
- Department of Dermatology, Second Affiliated Hospital, Zhejiang University, School of Medicine, Hangzhou, Zhejiang, China
| | - Milan J Anadkat
- Washington University School of Medicine, Division of Dermatology, St Louis, MO, USA
| | | | - Ming Tang
- Boehringer Ingelheim (China) Investment CO., Ltd, Shanghai, China
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Abstract
INTRODUCTION Generalized pustular psoriasis (GPP), is a rare cutaneous and systemic inflammatory disease which is characterized by flares of widespread painful pustulation of the skin, often associated with fever and elevated inflammatory markers. Although it has historically been regarded as a severe variant of plaque psoriasis, genetic and immunological developments over the past decade have revealed that it is a distinct auto-inflammatory entity, in which over-activity of the interleukin-36 signaling pathway is fundamental. Treatments targeting the IL-36 pathway are under investigation, and in 2022 spesolimab, a monoclonal antibody against the IL-36 receptor, was licensed for treating flares of GPP. AREAS COVERED In this review I discuss the epidemiology, clinical features, genetics, patho-mechanisms and current treatment options for GPP. I describe the results of clinical trials that led to the licensing of spesolimab for flares of GPP. EXPERT OPINION The marked efficacy of spesolimab in GPP opens a new era of highly effective, scientifically-rational and evidence-based treatment for this orphan disease, and has implications for other diseases in which interleukin 36 signaling is involved.
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Affiliation(s)
- A David Burden
- School of Infection and Immunity, College of Medical, Veterinary and Life Sciences, Sir Graeme Davies Building, 120 University Place, Glasgow G12 8TA, Scotland
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Burden AD, Bissonnette R, Lebwohl MG, Gloede T, Anatchkova M, Budhiarso I, Hu N, Thoma C, Skalicky AM, Bachelez H. Psychometric validation of the generalized pustular psoriasis physician global assessment (GPPGA) and generalized pustular psoriasis area and severity index (GPPASI). J Eur Acad Dermatol Venereol 2023. [PMID: 36854864 DOI: 10.1111/jdv.18999] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Accepted: 02/15/2023] [Indexed: 03/02/2023]
Abstract
BACKGROUND Generalized pustular psoriasis (GPP) is a rare and life-threatening skin disease often accompanied by systemic inflammation. There are currently no standardized or validated GPP-specific measures for assessing severity. OBJECTIVE To evaluate the reliability, validity and responder definitions of the Generalized Pustular Psoriasis Physician Global Assessment (GPPGA) and Generalized Pustular Psoriasis Area and Severity Index (GPPASI). METHODS The GPPGA and GPPASI were validated using outcome data from Week 1 of the Effisayil™ 1 study. The psychometric analyses performed included confirmatory factor analysis, item-to-item/item-to-total correlations, internal consistency reliability, test-retest reliability, convergent validity, known-groups validity, responsiveness analysis and responder definition analysis. RESULTS Using data from this patient cohort (N = 53), confirmatory factor analysis demonstrated unidimensionality of the GPPGA total score (root mean square error of approximation <0.08), and GPPGA item-to-item and item-to-total correlations ranged from 0.58 to 0.90. The GPPGA total score, pustulation subscore and GPPASI total score all demonstrated good test-retest reliability (intraclass correlation coefficient: 0.70, 0.91 and 0.95 respectively), and good evidence of convergent validity. In anchor-based analyses, all three scores were able to detect changes in symptom and disease severity over time; reductions of -1.4, -2.2 and - 12.0 were suggested as clinically meaningful improvement thresholds for the GPPGA total score, GPPGA pustulation subscore and GPPASI total score respectively. Anchor-based analyses also supported the GPPASI 50 as a clinically meaningful threshold for improvement. CONCLUSIONS Overall, our findings indicate that the GPPGA and GPPASI are valid, reliable and responsive measures for the assessment of GPP disease severity, and support their use in informing clinical endpoints in trials in GPP.
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Affiliation(s)
- A David Burden
- School of Infection and Immunity, University of Glasgow, Glasgow, UK
| | | | - Mark G Lebwohl
- Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Tristan Gloede
- Boehringer Ingelheim Pharmaceuticals, Inc., Ridgefield, Connecticut, USA
| | | | | | - Na Hu
- Boehringer Ingelheim (China) Investment Co. Ltd, Shanghai, China
| | | | | | - Hervé Bachelez
- Service de Dermatologie, Assistance Publique-Hôpitaux de Paris Hôpital Saint-Louis, and INSERM Unité 1163, Imagine Institute of Genetic Diseases, Université Paris Cité, Paris, France
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Tsakok T, Saklatvala J, Rispens T, Loeff FC, de Vries A, Allen MH, Barbosa IA, Baudry D, Dasandi T, Duckworth M, Meynell F, Russell A, Chapman A, McBride S, McKenna K, Perera G, Ramsay H, Ramesh R, Sands K, Shipman A, Burden AD, Griffiths CE, Reynolds NJ, Warren RB, Mahil S, Barker J, Dand N, Smith C, Simpson MA. Development of antidrug antibodies against adalimumab maps to variation within the HLA-DR peptide-binding groove. JCI Insight 2023; 8:e156643. [PMID: 36810251 PMCID: PMC9977494 DOI: 10.1172/jci.insight.156643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Accepted: 01/13/2023] [Indexed: 02/23/2023] Open
Abstract
Targeted biologic therapies can elicit an undesirable host immune response characterized by the development of antidrug antibodies (ADA), an important cause of treatment failure. The most widely used biologic across immune-mediated diseases is adalimumab, a tumor necrosis factor inhibitor. This study aimed to identify genetic variants that contribute to the development of ADA against adalimumab, thereby influencing treatment failure. In patients with psoriasis on their first course of adalimumab, in whom serum ADA had been evaluated 6-36 months after starting treatment, we observed a genome-wide association with ADA against adalimumab within the major histocompatibility complex (MHC). The association signal mapped to the presence of tryptophan at position 9 and lysine at position 71 of the HLA-DR peptide-binding groove, with both residues conferring protection against ADA. Underscoring their clinical relevance, these residues were also protective against treatment failure. Our findings highlight antigenic peptide presentation via MHC class II as a critical mechanism in the development of ADA against biologic therapies and downstream treatment response.
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Affiliation(s)
- Teresa Tsakok
- Department of Medical and Molecular Genetics and
- St John’s Institute of Dermatology, School of Basic & Medical Biosciences, Faculty of Life Sciences & Medicine, King’s College London, London, United Kingdom
- St John’s Institute of Dermatology, Guy’s and St Thomas’ National Health Service Foundation Trust, London, United Kingdom
| | | | - Theo Rispens
- Department of Immunopathology, Sanquin Research and Landsteiner Laboratory, Amsterdam, Netherlands
| | - Floris C. Loeff
- Department of Immunopathology, Sanquin Research and Landsteiner Laboratory, Amsterdam, Netherlands
- Biologics Lab, Sanquin Diagnostic Services, Amsterdam, Netherlands
| | - Annick de Vries
- Biologics Lab, Sanquin Diagnostic Services, Amsterdam, Netherlands
| | - Michael H. Allen
- St John’s Institute of Dermatology, School of Basic & Medical Biosciences, Faculty of Life Sciences & Medicine, King’s College London, London, United Kingdom
| | - Ines A. Barbosa
- St John’s Institute of Dermatology, School of Basic & Medical Biosciences, Faculty of Life Sciences & Medicine, King’s College London, London, United Kingdom
| | - David Baudry
- St John’s Institute of Dermatology, School of Basic & Medical Biosciences, Faculty of Life Sciences & Medicine, King’s College London, London, United Kingdom
| | - Tejus Dasandi
- St John’s Institute of Dermatology, Guy’s and St Thomas’ National Health Service Foundation Trust, London, United Kingdom
| | - Michael Duckworth
- St John’s Institute of Dermatology, School of Basic & Medical Biosciences, Faculty of Life Sciences & Medicine, King’s College London, London, United Kingdom
| | - Freya Meynell
- St John’s Institute of Dermatology, School of Basic & Medical Biosciences, Faculty of Life Sciences & Medicine, King’s College London, London, United Kingdom
| | - Alice Russell
- St John’s Institute of Dermatology, School of Basic & Medical Biosciences, Faculty of Life Sciences & Medicine, King’s College London, London, United Kingdom
| | - Anna Chapman
- Department of Dermatology, Queen Elizabeth Hospital, London, United Kingdom
| | - Sandy McBride
- Department of Dermatology, Royal Free London National Health Service Foundation Trust, London, United Kingdom
| | - Kevin McKenna
- Department of Dermatology, Belfast Health and Social Care Trust, Belfast, United Kingdom
| | - Gayathri Perera
- Department of Dermatology, Chelsea and Westminster Hospital National Health Service Foundation Trust, London, United Kingdom
| | - Helen Ramsay
- Department of Dermatology, Sheffield Teaching Hospitals National Health Service Foundation Trust, Sheffield, United Kingdom
| | - Raakhee Ramesh
- Department of Dermatology, Sandwell and West Birmingham National Health Service Trust, Birmingham, United Kingdom
| | - Kathleen Sands
- Department of Dermatology, East Kent Hospitals University National Health Service Foundation Trust, Kent, United Kingdom
| | - Alexa Shipman
- Department of Dermatology, Portsmouth Hospitals National Health Service Trust, Portsmouth, United Kingdom
| | | | - A. David Burden
- Institute of Infection, Immunity and Inflammation, University of Glasgow, Glasgow, United Kingdom
| | - Christopher E.M. Griffiths
- Dermatology Centre, Salford Royal National Health Service Foundation Trust, Manchester, United Kingdom
- The University of Manchester, Manchester Academic Health Science Centre, National Institute for Health Research Manchester Biomedical Research Centre, Manchester, United Kingdom
| | - Nick J. Reynolds
- Department of Dermatology, Royal Victoria Infirmary, Newcastle upon Tyne NHS Hospitals National Health Service Foundation Trust, Newcastle upon Tyne, United Kingdom
- Institute of Translational and Clinical Medicine, Faculty of Medical Sciences, Framlington Place, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Richard B. Warren
- Dermatology Centre, Salford Royal National Health Service Foundation Trust, Manchester, United Kingdom
- The University of Manchester, Manchester Academic Health Science Centre, National Institute for Health Research Manchester Biomedical Research Centre, Manchester, United Kingdom
| | - Satveer Mahil
- St John’s Institute of Dermatology, School of Basic & Medical Biosciences, Faculty of Life Sciences & Medicine, King’s College London, London, United Kingdom
- St John’s Institute of Dermatology, Guy’s and St Thomas’ National Health Service Foundation Trust, London, United Kingdom
| | - Jonathan Barker
- St John’s Institute of Dermatology, School of Basic & Medical Biosciences, Faculty of Life Sciences & Medicine, King’s College London, London, United Kingdom
- St John’s Institute of Dermatology, Guy’s and St Thomas’ National Health Service Foundation Trust, London, United Kingdom
| | - Nick Dand
- Department of Medical and Molecular Genetics and
- Health Data Research UK, London, United Kingdom
| | - Catherine Smith
- St John’s Institute of Dermatology, School of Basic & Medical Biosciences, Faculty of Life Sciences & Medicine, King’s College London, London, United Kingdom
- St John’s Institute of Dermatology, Guy’s and St Thomas’ National Health Service Foundation Trust, London, United Kingdom
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Choon SE, Lebwohl MG, Turki H, Zheng M, Burden AD, Li L, Quaresma M, Thoma C, Bachelez H. Clinical Characteristics and Outcomes of Generalized Pustular Psoriasis (GPP) Flares. Dermatology 2023:000529274. [PMID: 36796336 DOI: 10.1159/000529274] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2022] [Accepted: 12/25/2022] [Indexed: 02/18/2023] Open
Abstract
BACKGROUND Generalized pustular psoriasis (GPP) is a rare, neutrophilic skin disease that can become life-threatening if flares are untreated. There are limited data describing the characteristics and clinical course of GPP disease flares with current treatment options. OBJECTIVE To describe the characteristics and outcomes of GPP flares using historical medical information from patients enrolled in the Effisayil™ 1 trial. METHODS Investigators collected retrospective medical data characterizing patients' GPP flares prior to clinical trial enrollment. Data on overall historical flares were collected, as well as information on patients' typical, most severe, and longest past flares. This included data on systemic symptoms, flare duration, treatment, hospitalization, and time to clearance of skin lesions. RESULTS In this cohort (N=53), patients with GPP experienced a mean of 3.4 flares per year. Flares were painful, associated with systemic symptoms, and often triggered by stress, infections, or treatment withdrawal. Resolution of flares was longer than 3 weeks in 57.1%, 71.0%, and 85.7% of documented (or identified) typical, most severe, and longest flares, respectively. GPP flares led to patient hospitalization in 35.1%, 74.2%, and 64.3% of patients for their typical, most severe, and longest flares, respectively. For the majority of patients, pustules took up to 2 weeks to clear for a typical flare and 3-8 weeks to clear for the most severe and longest flares. CONCLUSION Our findings highlight that current treatment options are slow to control GPP flares and provide context for assessing the efficacy of new therapeutic strategies in patients with a GPP flare.
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Morita A, Choon SE, Bachelez H, Anadkat MJ, Marrakchi S, Zheng M, Tsai TF, Turki H, Hua H, Rajeswari S, Thoma C, Burden AD. Design of Effisayil™ 2: A Randomized, Double-Blind, Placebo-Controlled Study of Spesolimab in Preventing Flares in Patients with Generalized Pustular Psoriasis. Dermatol Ther (Heidelb) 2022; 13:347-359. [PMID: 36333618 PMCID: PMC9823166 DOI: 10.1007/s13555-022-00835-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Accepted: 10/11/2022] [Indexed: 11/06/2022] Open
Abstract
INTRODUCTION Generalized pustular psoriasis (GPP) is a rare autoinflammatory skin disease characterized by flares of widespread erythema with sterile pustules, and can be relapsing with recurrent flares, or persistent with intermittent flares. Spesolimab, a humanized anti-interleukin-36 (IL-36) receptor monoclonal antibody, targets the key IL-36 pathogenetic pathway in GPP. A previous study showed that spesolimab treatment led to rapid pustular and skin clearance in patients with GPP flares, which was sustained for up to 12 weeks. This study investigates the long-term effects of spesolimab on GPP flares, for which no specific treatments are currently available. The Effisayil™ 2 study will assess whether maintenance treatment with subcutaneous spesolimab prevents the occurrence of GPP flares and determine the optimal dosing regimen to achieve this aim. METHODS Patients will have a documented history of GPP with a Generalized Pustular Psoriasis Physician Global Assessment (GPPGA) score of 0 or 1 (clear or almost clear) at screening and randomization. Patients will be randomized 1:1:1:1 to three groups receiving a 600-mg subcutaneous loading dose of spesolimab followed by a 300-mg maintenance dose administered every 4 or 12 weeks, or a 300-mg loading dose followed by a 150-mg maintenance dose administered every 12 weeks, and one group receiving placebo, for 48 weeks. The primary endpoint is time to first GPP flare. If a patient experiences a GPP flare during the randomized maintenance treatment period, an open-label intravenous dose of 900-mg spesolimab will be administered, with an option for a second intravenous dose after 1 week. CONCLUSIONS Effisayil™ 2 is the first placebo-controlled study in patients with GPP to investigate whether maintenance treatment with spesolimab can prevent flares and provide sustained disease control. This study will provide valuable insights on the long-term management of patients with this potentially life-threatening skin disease. TRIAL REGISTRATION NUMBER NCT04399837.
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Affiliation(s)
- Akimichi Morita
- Department of Geriatric and Environmental Dermatology, Graduate School of Medical Sciences, Nagoya City University, Nagoya, Japan.
| | - Siew Eng Choon
- Department of Dermatology, Clinical School Johor Bahru, Hospital Sultanah Aminah, Monash University Malaysia, Johor Bahru, Malaysia
| | - Hervé Bachelez
- Service de Dermatologie, Assistance Publique-Hôpitaux de Paris Hôpital Saint-Louis, Paris, France
- INSERM U1163, Imagine Institute of Genetics Diseases, Université Paris Cité, Paris, France
| | - Milan J Anadkat
- Division of Dermatology, Washington University School of Medicine, St Louis, MO, USA
| | - Slaheddine Marrakchi
- Department of Dermatology, Hedi Chaker Hospital, University of Sfax, Sfax, Tunisia
| | - Min Zheng
- Department of Dermatology, School of Medicine, Second Affiliated Hospital, Zhejiang University, Hangzhou, Zhejiang, China
| | - Tsen-Fang Tsai
- Department of Dermatology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Hamida Turki
- Department of Dermatology, Hedi Chaker Hospital, University of Sfax, Sfax, Tunisia
| | - Harry Hua
- Boehringer Ingelheim Investment Co. Ltd., Shanghai, China
| | | | | | - A David Burden
- Institute of Infection, Immunity and Inflammation, University of Glasgow, Glasgow, UK
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13
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Bachelez H, Barker J, Burden AD, Navarini AA, Krueger JG. Generalized pustular psoriasis is a disease distinct from psoriasis vulgaris: evidence and expert opinion. Expert Rev Clin Immunol 2022; 18:1033-1047. [PMID: 36062811 DOI: 10.1080/1744666x.2022.2116003] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Generalized pustular psoriasis (GPP) is a rare, severe, clinically heterogeneous disease characterized by flares of widespread, non-infectious, macroscopically visible pustules that occur with or without systemic inflammation, and are associated with significant morbidity and mortality. Historically, GPP has been classified as a variant of psoriasis vulgaris (PV, or plaque psoriasis); however, accumulating evidence indicates that these are distinct conditions, requiring different treatment approaches. AREAS COVERED In this perspectives article we review evidence that supports the classification of GPP as distinct from PV. EXPERT OPINION The histopathologic and clinical appearance of GPP is distinct from that of PV and fundamental differences exist between the two conditions in terms of genetic causes and expression-related mechanisms of disease development. GPP results from dysregulation of the innate immune system, with disruption of the interleukin (IL)-36 inflammatory pathway, induction of inflammatory keratinocyte responses, and recruitment of neutrophils. PV is driven by the adaptive immune system, with a key role played by IL-17. Considering GPP as a separate disease will enable greater focus on its specific pathogenesis and the needs of patients. Many treatments for PV have insufficient efficacy in GPP and a therapeutic approach developed specifically for GPP might lead to better patient outcomes.
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Affiliation(s)
- Hervé Bachelez
- Service de Dermatologie, Assistance Publique-Hôpitaux de Paris Hôpital Saint-Louis, Paris, France.,INSERM Unité 1163, Imagine Institute of Genetic Diseases, Université Paris Cité, Paris, France
| | - Jonathan Barker
- St John's Institute of Dermatology, Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - A David Burden
- Institute of Infection, Inflammation and Immunity, University of Glasgow, Glasgow, UK
| | | | - James G Krueger
- Laboratory for Investigative Dermatology, The Rockefeller University, New York, NY, USA
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14
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Burden AD, Bissonnette R, Navarini AA, Murakami M, Morita A, Mozzicato S, Ye B, Baehner F, Terui T. 32923 A multicenter, double-blind, randomized, placebo-controlled, phase IIb dose-finding study to evaluate efficacy and safety of spesolimab in patients with moderate-to-severe palmoplantar pustulosis. J Am Acad Dermatol 2022. [DOI: 10.1016/j.jaad.2022.06.558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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15
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Burden AD, Mrowietz U, Skalicky AM, Rentz AM, Esser D, Gloede T, Thoma C, Menter A. Symptom Experience and Content Validity of the Psoriasis Symptom Scale (PSS) in Patients with Generalized Pustular Psoriasis (GPP). Dermatol Ther (Heidelb) 2022; 12:1367-1381. [PMID: 35590037 PMCID: PMC9209619 DOI: 10.1007/s13555-022-00736-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Accepted: 04/15/2022] [Indexed: 11/13/2022] Open
Abstract
Introduction We sought to understand key symptoms of generalized pustular psoriasis (GPP) and to confirm the relevance to patients and content validity of the Psoriasis Symptom Scale (PSS) in GPP. Methods A targeted literature review and clinical expert interviews were conducted as background research. Patients were interviewed individually (involving concept elicitation and cognitive interviews), and a separate patient workshop was conducted to determine disease-specific symptoms of importance. Results Seven participants with moderate (n = 4), severe (n = 2), and mild (n = 1) GPP and clinician diagnosis were interviewed. During concept elicitation, all participants indicated that pustules may underlie other symptoms. Symptoms reported by all patients were pain, redness, itch, burning, and discomfort. The PSS symptoms of pain, itching, burning, and redness were reported by ≥ 86% of patients as most frequently experienced. Upon debriefing, the PSS was well understood. Relevance and importance of these symptoms was confirmed in the GPP patient workshop. Conclusion Participant feedback found the PSS measure to be relevant and easy to understand. The symptoms included in the instrument, pain, redness, itch, and burning, were most frequently reported, important, and well understood by patients. Study results provided support for the content validity of the PSS for use as endpoints in GPP clinical trials. Generalized pustular psoriasis (GPP) is a severe rare disease, including redness and boils that sometimes come with fever and other general symptoms. This study asked patients with GPP about their key symptoms, and whether the Psoriasis Symptom Scale (PSS) is relevant to them as patients. The PSS is a questionnaire with the symptoms pain, itching, burning, and redness. We searched the literature and interviewed clinical experts to guide the patient interviews. Patients were recruited through clinical sites and the National Psoriasis Foundation (NPF). The interviews discussed GPP symptoms and the PSS questionnaire. Patients with GPP were also asked about commonly experienced symptoms in a workshop. Most patients had moderate to severe GPP. Patients in both the interviews and workshop described experiencing pain, redness, itch, burning, and discomfort with their boils. During interviews, the patients said the PSS questionnaire was easy to understand. Patients in the workshop also found the PSS to be relevant and easy to understand. Patients agreed the symptoms in the PSS, pain, redness, itch, and burning, were common and important. Study results support the PSS for use with patients in clinical trials.
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Affiliation(s)
- A David Burden
- Institute of Infection Immunity and Inflammation, University of Glasgow, Glasgow, UK
| | - Ulrich Mrowietz
- Psoriasis-Center at the Department of Dermatology, University Medical Center Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | | | | | - Dirk Esser
- Boehringer Ingelheim International GmbH, Ingelheim am Rhein, Germany
| | - Tristan Gloede
- Boehringer Ingelheim International GmbH, Ingelheim am Rhein, Germany
| | | | - Alan Menter
- Baylor Scott & White Health, Dallas, TX, USA
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McCluskey D, Benzian-Olsson N, Mahil SK, Hassi NK, Wohnhaas CT, Burden AD, Griffiths CE, Ingram JR, Levell NJ, Parslew R, Pink AE, Reynolds NJ, Warren RB, Visvanathan S, Baum P, Barker JN, Smith CH, Capon F. Single-cell analysis implicates Th17 to Th2 cell plasticity in the pathogenesis of palmoplantar pustulosis. J Allergy Clin Immunol 2022; 150:882-893. [PMID: 35568077 DOI: 10.1016/j.jaci.2022.04.027] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [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: 10/20/2021] [Revised: 03/04/2022] [Accepted: 04/20/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND Palmoplantar pustulosis (PPP) is a severe inflammatory skin disorder, characterised by eruptions of painful, neutrophil-filled pustules on the palms and soles. While PPP has a profound effect on quality of life, it remains poorly understood and notoriously difficult to treat. OBJECTIVE We sought to investigate the immune pathways that underlie the pathogenesis of PPP. METHODS We applied bulk- and single-cell RNA-sequencing methods to the analysis of skin biopsies and peripheral blood mononuclear cells. We validated our results by flow cytometry and immune fluorescence microscopy RESULTS: Bulk RNA-sequencing of patient skin detected an unexpected signature of T-cell activation, with a significant overexpression of several Th2 genes typically upregulated in atopic dermatitis. To further explore these findings, we carried out single-cell RNA-sequencing in peripheral blood mononuclear cells of healthy and affected individuals. We found that the memory CD4+T-cells of PPP patients were skewed towards a Th17 phenotype, a phenomenon that was particularly significant among CLA+ skin-homing cells. We also identified a subset of memory CD4+ T-cells which expressed both Th17 (KLRB1/CD161) and Th2 (GATA3) markers, with pseudo-time analysis suggesting that the population was the result of Th17 to Th2 plasticity. Interestingly, the GATA3+/CD161+ cells were over-represented among the PBMCs of affected individuals, both in the scRNA-seq dataset and in independent flow-cytometry experiments. Dual positive cells were also detected in patient skin by means of immune fluorescence microscopy. CONCLUSIONS These observations demonstrate that PPP is associated with complex T-cell activation patterns and may explain why biologics that target individual T-helper populations have shown limited therapeutic efficacy. CLINICAL IMPLICATIONS The simultaneous activation of Th17 and Th2 responses in PPP supports the therapeutic use of agents that inhibit multiple T-cell pathways.
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Affiliation(s)
- Daniel McCluskey
- Department of Medical and Molecular Genetics, Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - Natashia Benzian-Olsson
- Department of Medical and Molecular Genetics, Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - Satveer K Mahil
- St John's Institute of Dermatology, Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - Nina Karoliina Hassi
- Department of Medical and Molecular Genetics, Faculty of Life Sciences and Medicine, King's College London, London, UK
| | | | | | - A David Burden
- Institute of Infection Immunity and Inflammation, University of Glasgow, Glasgow, UK
| | - Christopher Em Griffiths
- Dermatology Centre, Salford Royal NHS Foundation Trust, NIHR Manchester Biomedical Research Centre, University of Manchester, Manchester, UK
| | - John R Ingram
- Department of Dermatology, Division of Infection & Immunity, Cardiff University, Cardiff, UK
| | - Nick J Levell
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - Richard Parslew
- Department of Dermatology, Royal Liverpool Hospitals, Liverpool, UK
| | - Andrew E Pink
- St John's Institute of Dermatology, Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - Nick J Reynolds
- Translational and Clinical Research Institute, Newcastle University and Department of Dermatology and NIHR Newcastle Biomedical Research Centre, Newcastle Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Richard B Warren
- Dermatology Centre, Salford Royal NHS Foundation Trust, NIHR Manchester Biomedical Research Centre, University of Manchester, Manchester, UK
| | | | - Patrick Baum
- Boehringer Ingelheim Pharma GmbH & Co. KG, Biberach, Germany
| | - Jonathan N Barker
- St John's Institute of Dermatology, Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - Catherine H Smith
- St John's Institute of Dermatology, Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - Francesca Capon
- Department of Medical and Molecular Genetics, Faculty of Life Sciences and Medicine, King's College London, London, UK.
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Abstract
Generalized pustular psoriasis (GPP) is a rare neutrophilic skin condition characterized by episodes of widespread eruption of sterile macroscopic pustules that can be associated with systemic inflammation. The rarity of GPP and its heterogeneous cutaneous and extracutaneous symptoms pose considerable challenges to the development and adoption of comprehensive accurate disease measures for the routine clinical assessment of disease severity and the evaluation of new treatments in clinical trials. Psoriasis disease measures remain among the most commonly used methods for evaluating patients with GPP, despite their limitations owing to a lack of assessment of pustules (a hallmark of GPP), systemic inflammation, and disease symptoms. The adaptation of psoriasis disease measures and the development of assessment tools specific for GPP severity will enable more effective and accurate monitoring of patients with GPP and enhance the clinical development of new therapies. Further clinical validation of recently developed modified assessment tools, such as the Generalized Pustular Psoriasis Physician Global Assessment and the Generalized Pustular Psoriasis Area and Severity Index, and international consensus on using quantitative tools and patient-reported outcome measures in the development of new treatments are needed to advance patient care.
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Affiliation(s)
- A David Burden
- Institute of Infection, Immunity and Inflammation, University of Glasgow, Glasgow, UK
| | - Siew Eng Choon
- Hospital Sultanah Aminah Johor Bahru, Clinical School Johor Bahru, Monash University Malaysia, Johor Bahru, Malaysia
| | | | | | - Richard B Warren
- Dermatology Centre, Salford Royal NHS Foundation Trust, Manchester NIHR Biomedical Research Centre, University of Manchester, Manchester, M6 8HD, UK.
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18
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Bachelez H, Choon SE, Marrakchi S, Burden AD, Tsai TF, Morita A, Navarini AA, Zheng M, Xu J, Turki H, Anadkat MJ, Rajeswari S, Hua H, Vulcu SD, Hall D, Tetzlaff K, Thoma C, Lebwohl MG. Trial of Spesolimab for Generalized Pustular Psoriasis. N Engl J Med 2021; 385:2431-2440. [PMID: 34936739 DOI: 10.1056/nejmoa2111563] [Citation(s) in RCA: 120] [Impact Index Per Article: 40.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Generalized pustular psoriasis (GPP) is a rare, life-threatening, inflammatory skin disease characterized by widespread eruption of sterile pustules. Interleukin-36 signaling is involved in the pathogenesis of this disorder. Spesolimab, a humanized anti-interleukin-36 receptor monoclonal antibody, is being studied for the treatment of GPP flares. METHODS In a phase 2 trial, we randomly assigned patients with a GPP flare in a 2:1 ratio to receive a single 900-mg intravenous dose of spesolimab or placebo. Patients in both groups could receive an open-label dose of spesolimab on day 8, an open-label dose of spesolimab as a rescue medication after day 8, or both and were followed to week 12. The primary end point was a Generalized Pustular Psoriasis Physician Global Assessment (GPPGA) pustulation subscore of 0 (range, 0 [no visible pustules] to 4 [severe pustulation]) at the end of week 1. The key secondary end point was a GPPGA total score of 0 or 1 (clear or almost clear skin) at the end of week 1; scores range from 0 to 4, with higher scores indicating greater disease severity. RESULTS A total of 53 patients were enrolled: 35 were assigned to receive spesolimab and 18 to receive placebo. At baseline, 46% of the patients in the spesolimab group and 39% of those in the placebo group had a GPPGA pustulation subscore of 3, and 37% and 33%, respectively, had a pustulation subscore of 4. At the end of week 1, a total of 19 of 35 patients (54%) in the spesolimab group had a pustulation subscore of 0, as compared with 1 of 18 patients (6%) in the placebo group (difference, 49 percentage points; 95% confidence interval [CI], 21 to 67; P<0.001). A total of 15 of 35 patients (43%) had a GPPGA total score of 0 or 1, as compared with 2 of 18 patients (11%) in the placebo group (difference, 32 percentage points; 95% CI, 2 to 53; P = 0.02). Drug reactions were reported in 2 patients who received spesolimab, in 1 of them concurrently with a drug-induced hepatic injury. Among patients assigned to the spesolimab group, infections occurred in 6 of 35 (17%) through the first week; among patients who received spesolimab at any time in the trial, infections had occurred in 24 of 51 (47%) at week 12. Antidrug antibodies were detected in 23 of 50 patients (46%) who received at least one dose of spesolimab. CONCLUSIONS In a phase 2 randomized trial involving patients with GPP, the interleukin-36 receptor inhibitor spesolimab resulted in a higher incidence of lesion clearance at 1 week than placebo but was associated with infections and systemic drug reactions. Longer and larger trials are warranted to determine the effect and risks of spesolimab in patients with pustular psoriasis. (Funded by Boehringer Ingelheim; Effisayil 1 ClinicalTrials.gov number, NCT03782792.).
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Affiliation(s)
- Hervé Bachelez
- From Service de Dermatologie, Assistance Publique-Hôpitaux de Paris Hôpital Saint-Louis, and INSERM Unité 1163, Imagine Institute of Genetic Diseases, Université de Paris - both in Paris (H.B.); the Department of Dermatology, Hospital Sultanah Aminah Johor Bahru, Clinical School Johor Bahru, Monash University Malaysia, Subang Jaya, Malaysia (S.-E.C.); the Dermatology Department, Hedi Chaker University Hospital, Sfax, Tunisia (S.M., H.T.); the Institute of Infection, Immunity, and Inflammation, University of Glasgow, Glasgow, United Kingdom (A.D.B.); the Department of Dermatology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan (T.-F.T.); the Department of Geriatric and Environmental Dermatology, Nagoya City University, Graduate School of Medical Sciences, Nagoya, Japan (A.M.); the Department of Dermatology, University Hospital Basel, Basel, Switzerland (A.A.N.); the Department of Dermatology, Second Affiliated Hospital, Zhejiang University, School of Medicine, Hangzhou (M.Z.), and the Department of Dermatology, Huashan Hospital, Fudan University (J.X.), and Boehringer Ingelheim (China) Investment Company (H.H.), Shanghai - all in China; Washington University School of Medicine, Division of Dermatology, St. Louis (M.J.A.); Boehringer Ingelheim Pharmaceuticals, Ridgefield, CT (S.R., D.H.); Boehringer Ingelheim International, Ingelheim (S.D.V., K.T.), the Medical Clinic, Department of Sports Medicine, University of Tuebingen, Tuebingen (K.T.), and Boehringer Ingelheim International, Biberach (C.T.) - all in Germany; and the Icahn School of Medicine at Mount Sinai, New York (M.G.L.)
| | - Siew-Eng Choon
- From Service de Dermatologie, Assistance Publique-Hôpitaux de Paris Hôpital Saint-Louis, and INSERM Unité 1163, Imagine Institute of Genetic Diseases, Université de Paris - both in Paris (H.B.); the Department of Dermatology, Hospital Sultanah Aminah Johor Bahru, Clinical School Johor Bahru, Monash University Malaysia, Subang Jaya, Malaysia (S.-E.C.); the Dermatology Department, Hedi Chaker University Hospital, Sfax, Tunisia (S.M., H.T.); the Institute of Infection, Immunity, and Inflammation, University of Glasgow, Glasgow, United Kingdom (A.D.B.); the Department of Dermatology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan (T.-F.T.); the Department of Geriatric and Environmental Dermatology, Nagoya City University, Graduate School of Medical Sciences, Nagoya, Japan (A.M.); the Department of Dermatology, University Hospital Basel, Basel, Switzerland (A.A.N.); the Department of Dermatology, Second Affiliated Hospital, Zhejiang University, School of Medicine, Hangzhou (M.Z.), and the Department of Dermatology, Huashan Hospital, Fudan University (J.X.), and Boehringer Ingelheim (China) Investment Company (H.H.), Shanghai - all in China; Washington University School of Medicine, Division of Dermatology, St. Louis (M.J.A.); Boehringer Ingelheim Pharmaceuticals, Ridgefield, CT (S.R., D.H.); Boehringer Ingelheim International, Ingelheim (S.D.V., K.T.), the Medical Clinic, Department of Sports Medicine, University of Tuebingen, Tuebingen (K.T.), and Boehringer Ingelheim International, Biberach (C.T.) - all in Germany; and the Icahn School of Medicine at Mount Sinai, New York (M.G.L.)
| | - Slaheddine Marrakchi
- From Service de Dermatologie, Assistance Publique-Hôpitaux de Paris Hôpital Saint-Louis, and INSERM Unité 1163, Imagine Institute of Genetic Diseases, Université de Paris - both in Paris (H.B.); the Department of Dermatology, Hospital Sultanah Aminah Johor Bahru, Clinical School Johor Bahru, Monash University Malaysia, Subang Jaya, Malaysia (S.-E.C.); the Dermatology Department, Hedi Chaker University Hospital, Sfax, Tunisia (S.M., H.T.); the Institute of Infection, Immunity, and Inflammation, University of Glasgow, Glasgow, United Kingdom (A.D.B.); the Department of Dermatology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan (T.-F.T.); the Department of Geriatric and Environmental Dermatology, Nagoya City University, Graduate School of Medical Sciences, Nagoya, Japan (A.M.); the Department of Dermatology, University Hospital Basel, Basel, Switzerland (A.A.N.); the Department of Dermatology, Second Affiliated Hospital, Zhejiang University, School of Medicine, Hangzhou (M.Z.), and the Department of Dermatology, Huashan Hospital, Fudan University (J.X.), and Boehringer Ingelheim (China) Investment Company (H.H.), Shanghai - all in China; Washington University School of Medicine, Division of Dermatology, St. Louis (M.J.A.); Boehringer Ingelheim Pharmaceuticals, Ridgefield, CT (S.R., D.H.); Boehringer Ingelheim International, Ingelheim (S.D.V., K.T.), the Medical Clinic, Department of Sports Medicine, University of Tuebingen, Tuebingen (K.T.), and Boehringer Ingelheim International, Biberach (C.T.) - all in Germany; and the Icahn School of Medicine at Mount Sinai, New York (M.G.L.)
| | - A David Burden
- From Service de Dermatologie, Assistance Publique-Hôpitaux de Paris Hôpital Saint-Louis, and INSERM Unité 1163, Imagine Institute of Genetic Diseases, Université de Paris - both in Paris (H.B.); the Department of Dermatology, Hospital Sultanah Aminah Johor Bahru, Clinical School Johor Bahru, Monash University Malaysia, Subang Jaya, Malaysia (S.-E.C.); the Dermatology Department, Hedi Chaker University Hospital, Sfax, Tunisia (S.M., H.T.); the Institute of Infection, Immunity, and Inflammation, University of Glasgow, Glasgow, United Kingdom (A.D.B.); the Department of Dermatology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan (T.-F.T.); the Department of Geriatric and Environmental Dermatology, Nagoya City University, Graduate School of Medical Sciences, Nagoya, Japan (A.M.); the Department of Dermatology, University Hospital Basel, Basel, Switzerland (A.A.N.); the Department of Dermatology, Second Affiliated Hospital, Zhejiang University, School of Medicine, Hangzhou (M.Z.), and the Department of Dermatology, Huashan Hospital, Fudan University (J.X.), and Boehringer Ingelheim (China) Investment Company (H.H.), Shanghai - all in China; Washington University School of Medicine, Division of Dermatology, St. Louis (M.J.A.); Boehringer Ingelheim Pharmaceuticals, Ridgefield, CT (S.R., D.H.); Boehringer Ingelheim International, Ingelheim (S.D.V., K.T.), the Medical Clinic, Department of Sports Medicine, University of Tuebingen, Tuebingen (K.T.), and Boehringer Ingelheim International, Biberach (C.T.) - all in Germany; and the Icahn School of Medicine at Mount Sinai, New York (M.G.L.)
| | - Tsen-Fang Tsai
- From Service de Dermatologie, Assistance Publique-Hôpitaux de Paris Hôpital Saint-Louis, and INSERM Unité 1163, Imagine Institute of Genetic Diseases, Université de Paris - both in Paris (H.B.); the Department of Dermatology, Hospital Sultanah Aminah Johor Bahru, Clinical School Johor Bahru, Monash University Malaysia, Subang Jaya, Malaysia (S.-E.C.); the Dermatology Department, Hedi Chaker University Hospital, Sfax, Tunisia (S.M., H.T.); the Institute of Infection, Immunity, and Inflammation, University of Glasgow, Glasgow, United Kingdom (A.D.B.); the Department of Dermatology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan (T.-F.T.); the Department of Geriatric and Environmental Dermatology, Nagoya City University, Graduate School of Medical Sciences, Nagoya, Japan (A.M.); the Department of Dermatology, University Hospital Basel, Basel, Switzerland (A.A.N.); the Department of Dermatology, Second Affiliated Hospital, Zhejiang University, School of Medicine, Hangzhou (M.Z.), and the Department of Dermatology, Huashan Hospital, Fudan University (J.X.), and Boehringer Ingelheim (China) Investment Company (H.H.), Shanghai - all in China; Washington University School of Medicine, Division of Dermatology, St. Louis (M.J.A.); Boehringer Ingelheim Pharmaceuticals, Ridgefield, CT (S.R., D.H.); Boehringer Ingelheim International, Ingelheim (S.D.V., K.T.), the Medical Clinic, Department of Sports Medicine, University of Tuebingen, Tuebingen (K.T.), and Boehringer Ingelheim International, Biberach (C.T.) - all in Germany; and the Icahn School of Medicine at Mount Sinai, New York (M.G.L.)
| | - Akimichi Morita
- From Service de Dermatologie, Assistance Publique-Hôpitaux de Paris Hôpital Saint-Louis, and INSERM Unité 1163, Imagine Institute of Genetic Diseases, Université de Paris - both in Paris (H.B.); the Department of Dermatology, Hospital Sultanah Aminah Johor Bahru, Clinical School Johor Bahru, Monash University Malaysia, Subang Jaya, Malaysia (S.-E.C.); the Dermatology Department, Hedi Chaker University Hospital, Sfax, Tunisia (S.M., H.T.); the Institute of Infection, Immunity, and Inflammation, University of Glasgow, Glasgow, United Kingdom (A.D.B.); the Department of Dermatology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan (T.-F.T.); the Department of Geriatric and Environmental Dermatology, Nagoya City University, Graduate School of Medical Sciences, Nagoya, Japan (A.M.); the Department of Dermatology, University Hospital Basel, Basel, Switzerland (A.A.N.); the Department of Dermatology, Second Affiliated Hospital, Zhejiang University, School of Medicine, Hangzhou (M.Z.), and the Department of Dermatology, Huashan Hospital, Fudan University (J.X.), and Boehringer Ingelheim (China) Investment Company (H.H.), Shanghai - all in China; Washington University School of Medicine, Division of Dermatology, St. Louis (M.J.A.); Boehringer Ingelheim Pharmaceuticals, Ridgefield, CT (S.R., D.H.); Boehringer Ingelheim International, Ingelheim (S.D.V., K.T.), the Medical Clinic, Department of Sports Medicine, University of Tuebingen, Tuebingen (K.T.), and Boehringer Ingelheim International, Biberach (C.T.) - all in Germany; and the Icahn School of Medicine at Mount Sinai, New York (M.G.L.)
| | - Alexander A Navarini
- From Service de Dermatologie, Assistance Publique-Hôpitaux de Paris Hôpital Saint-Louis, and INSERM Unité 1163, Imagine Institute of Genetic Diseases, Université de Paris - both in Paris (H.B.); the Department of Dermatology, Hospital Sultanah Aminah Johor Bahru, Clinical School Johor Bahru, Monash University Malaysia, Subang Jaya, Malaysia (S.-E.C.); the Dermatology Department, Hedi Chaker University Hospital, Sfax, Tunisia (S.M., H.T.); the Institute of Infection, Immunity, and Inflammation, University of Glasgow, Glasgow, United Kingdom (A.D.B.); the Department of Dermatology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan (T.-F.T.); the Department of Geriatric and Environmental Dermatology, Nagoya City University, Graduate School of Medical Sciences, Nagoya, Japan (A.M.); the Department of Dermatology, University Hospital Basel, Basel, Switzerland (A.A.N.); the Department of Dermatology, Second Affiliated Hospital, Zhejiang University, School of Medicine, Hangzhou (M.Z.), and the Department of Dermatology, Huashan Hospital, Fudan University (J.X.), and Boehringer Ingelheim (China) Investment Company (H.H.), Shanghai - all in China; Washington University School of Medicine, Division of Dermatology, St. Louis (M.J.A.); Boehringer Ingelheim Pharmaceuticals, Ridgefield, CT (S.R., D.H.); Boehringer Ingelheim International, Ingelheim (S.D.V., K.T.), the Medical Clinic, Department of Sports Medicine, University of Tuebingen, Tuebingen (K.T.), and Boehringer Ingelheim International, Biberach (C.T.) - all in Germany; and the Icahn School of Medicine at Mount Sinai, New York (M.G.L.)
| | - Min Zheng
- From Service de Dermatologie, Assistance Publique-Hôpitaux de Paris Hôpital Saint-Louis, and INSERM Unité 1163, Imagine Institute of Genetic Diseases, Université de Paris - both in Paris (H.B.); the Department of Dermatology, Hospital Sultanah Aminah Johor Bahru, Clinical School Johor Bahru, Monash University Malaysia, Subang Jaya, Malaysia (S.-E.C.); the Dermatology Department, Hedi Chaker University Hospital, Sfax, Tunisia (S.M., H.T.); the Institute of Infection, Immunity, and Inflammation, University of Glasgow, Glasgow, United Kingdom (A.D.B.); the Department of Dermatology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan (T.-F.T.); the Department of Geriatric and Environmental Dermatology, Nagoya City University, Graduate School of Medical Sciences, Nagoya, Japan (A.M.); the Department of Dermatology, University Hospital Basel, Basel, Switzerland (A.A.N.); the Department of Dermatology, Second Affiliated Hospital, Zhejiang University, School of Medicine, Hangzhou (M.Z.), and the Department of Dermatology, Huashan Hospital, Fudan University (J.X.), and Boehringer Ingelheim (China) Investment Company (H.H.), Shanghai - all in China; Washington University School of Medicine, Division of Dermatology, St. Louis (M.J.A.); Boehringer Ingelheim Pharmaceuticals, Ridgefield, CT (S.R., D.H.); Boehringer Ingelheim International, Ingelheim (S.D.V., K.T.), the Medical Clinic, Department of Sports Medicine, University of Tuebingen, Tuebingen (K.T.), and Boehringer Ingelheim International, Biberach (C.T.) - all in Germany; and the Icahn School of Medicine at Mount Sinai, New York (M.G.L.)
| | - Jinhua Xu
- From Service de Dermatologie, Assistance Publique-Hôpitaux de Paris Hôpital Saint-Louis, and INSERM Unité 1163, Imagine Institute of Genetic Diseases, Université de Paris - both in Paris (H.B.); the Department of Dermatology, Hospital Sultanah Aminah Johor Bahru, Clinical School Johor Bahru, Monash University Malaysia, Subang Jaya, Malaysia (S.-E.C.); the Dermatology Department, Hedi Chaker University Hospital, Sfax, Tunisia (S.M., H.T.); the Institute of Infection, Immunity, and Inflammation, University of Glasgow, Glasgow, United Kingdom (A.D.B.); the Department of Dermatology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan (T.-F.T.); the Department of Geriatric and Environmental Dermatology, Nagoya City University, Graduate School of Medical Sciences, Nagoya, Japan (A.M.); the Department of Dermatology, University Hospital Basel, Basel, Switzerland (A.A.N.); the Department of Dermatology, Second Affiliated Hospital, Zhejiang University, School of Medicine, Hangzhou (M.Z.), and the Department of Dermatology, Huashan Hospital, Fudan University (J.X.), and Boehringer Ingelheim (China) Investment Company (H.H.), Shanghai - all in China; Washington University School of Medicine, Division of Dermatology, St. Louis (M.J.A.); Boehringer Ingelheim Pharmaceuticals, Ridgefield, CT (S.R., D.H.); Boehringer Ingelheim International, Ingelheim (S.D.V., K.T.), the Medical Clinic, Department of Sports Medicine, University of Tuebingen, Tuebingen (K.T.), and Boehringer Ingelheim International, Biberach (C.T.) - all in Germany; and the Icahn School of Medicine at Mount Sinai, New York (M.G.L.)
| | - Hamida Turki
- From Service de Dermatologie, Assistance Publique-Hôpitaux de Paris Hôpital Saint-Louis, and INSERM Unité 1163, Imagine Institute of Genetic Diseases, Université de Paris - both in Paris (H.B.); the Department of Dermatology, Hospital Sultanah Aminah Johor Bahru, Clinical School Johor Bahru, Monash University Malaysia, Subang Jaya, Malaysia (S.-E.C.); the Dermatology Department, Hedi Chaker University Hospital, Sfax, Tunisia (S.M., H.T.); the Institute of Infection, Immunity, and Inflammation, University of Glasgow, Glasgow, United Kingdom (A.D.B.); the Department of Dermatology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan (T.-F.T.); the Department of Geriatric and Environmental Dermatology, Nagoya City University, Graduate School of Medical Sciences, Nagoya, Japan (A.M.); the Department of Dermatology, University Hospital Basel, Basel, Switzerland (A.A.N.); the Department of Dermatology, Second Affiliated Hospital, Zhejiang University, School of Medicine, Hangzhou (M.Z.), and the Department of Dermatology, Huashan Hospital, Fudan University (J.X.), and Boehringer Ingelheim (China) Investment Company (H.H.), Shanghai - all in China; Washington University School of Medicine, Division of Dermatology, St. Louis (M.J.A.); Boehringer Ingelheim Pharmaceuticals, Ridgefield, CT (S.R., D.H.); Boehringer Ingelheim International, Ingelheim (S.D.V., K.T.), the Medical Clinic, Department of Sports Medicine, University of Tuebingen, Tuebingen (K.T.), and Boehringer Ingelheim International, Biberach (C.T.) - all in Germany; and the Icahn School of Medicine at Mount Sinai, New York (M.G.L.)
| | - Milan J Anadkat
- From Service de Dermatologie, Assistance Publique-Hôpitaux de Paris Hôpital Saint-Louis, and INSERM Unité 1163, Imagine Institute of Genetic Diseases, Université de Paris - both in Paris (H.B.); the Department of Dermatology, Hospital Sultanah Aminah Johor Bahru, Clinical School Johor Bahru, Monash University Malaysia, Subang Jaya, Malaysia (S.-E.C.); the Dermatology Department, Hedi Chaker University Hospital, Sfax, Tunisia (S.M., H.T.); the Institute of Infection, Immunity, and Inflammation, University of Glasgow, Glasgow, United Kingdom (A.D.B.); the Department of Dermatology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan (T.-F.T.); the Department of Geriatric and Environmental Dermatology, Nagoya City University, Graduate School of Medical Sciences, Nagoya, Japan (A.M.); the Department of Dermatology, University Hospital Basel, Basel, Switzerland (A.A.N.); the Department of Dermatology, Second Affiliated Hospital, Zhejiang University, School of Medicine, Hangzhou (M.Z.), and the Department of Dermatology, Huashan Hospital, Fudan University (J.X.), and Boehringer Ingelheim (China) Investment Company (H.H.), Shanghai - all in China; Washington University School of Medicine, Division of Dermatology, St. Louis (M.J.A.); Boehringer Ingelheim Pharmaceuticals, Ridgefield, CT (S.R., D.H.); Boehringer Ingelheim International, Ingelheim (S.D.V., K.T.), the Medical Clinic, Department of Sports Medicine, University of Tuebingen, Tuebingen (K.T.), and Boehringer Ingelheim International, Biberach (C.T.) - all in Germany; and the Icahn School of Medicine at Mount Sinai, New York (M.G.L.)
| | - Sushmita Rajeswari
- From Service de Dermatologie, Assistance Publique-Hôpitaux de Paris Hôpital Saint-Louis, and INSERM Unité 1163, Imagine Institute of Genetic Diseases, Université de Paris - both in Paris (H.B.); the Department of Dermatology, Hospital Sultanah Aminah Johor Bahru, Clinical School Johor Bahru, Monash University Malaysia, Subang Jaya, Malaysia (S.-E.C.); the Dermatology Department, Hedi Chaker University Hospital, Sfax, Tunisia (S.M., H.T.); the Institute of Infection, Immunity, and Inflammation, University of Glasgow, Glasgow, United Kingdom (A.D.B.); the Department of Dermatology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan (T.-F.T.); the Department of Geriatric and Environmental Dermatology, Nagoya City University, Graduate School of Medical Sciences, Nagoya, Japan (A.M.); the Department of Dermatology, University Hospital Basel, Basel, Switzerland (A.A.N.); the Department of Dermatology, Second Affiliated Hospital, Zhejiang University, School of Medicine, Hangzhou (M.Z.), and the Department of Dermatology, Huashan Hospital, Fudan University (J.X.), and Boehringer Ingelheim (China) Investment Company (H.H.), Shanghai - all in China; Washington University School of Medicine, Division of Dermatology, St. Louis (M.J.A.); Boehringer Ingelheim Pharmaceuticals, Ridgefield, CT (S.R., D.H.); Boehringer Ingelheim International, Ingelheim (S.D.V., K.T.), the Medical Clinic, Department of Sports Medicine, University of Tuebingen, Tuebingen (K.T.), and Boehringer Ingelheim International, Biberach (C.T.) - all in Germany; and the Icahn School of Medicine at Mount Sinai, New York (M.G.L.)
| | - Hairui Hua
- From Service de Dermatologie, Assistance Publique-Hôpitaux de Paris Hôpital Saint-Louis, and INSERM Unité 1163, Imagine Institute of Genetic Diseases, Université de Paris - both in Paris (H.B.); the Department of Dermatology, Hospital Sultanah Aminah Johor Bahru, Clinical School Johor Bahru, Monash University Malaysia, Subang Jaya, Malaysia (S.-E.C.); the Dermatology Department, Hedi Chaker University Hospital, Sfax, Tunisia (S.M., H.T.); the Institute of Infection, Immunity, and Inflammation, University of Glasgow, Glasgow, United Kingdom (A.D.B.); the Department of Dermatology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan (T.-F.T.); the Department of Geriatric and Environmental Dermatology, Nagoya City University, Graduate School of Medical Sciences, Nagoya, Japan (A.M.); the Department of Dermatology, University Hospital Basel, Basel, Switzerland (A.A.N.); the Department of Dermatology, Second Affiliated Hospital, Zhejiang University, School of Medicine, Hangzhou (M.Z.), and the Department of Dermatology, Huashan Hospital, Fudan University (J.X.), and Boehringer Ingelheim (China) Investment Company (H.H.), Shanghai - all in China; Washington University School of Medicine, Division of Dermatology, St. Louis (M.J.A.); Boehringer Ingelheim Pharmaceuticals, Ridgefield, CT (S.R., D.H.); Boehringer Ingelheim International, Ingelheim (S.D.V., K.T.), the Medical Clinic, Department of Sports Medicine, University of Tuebingen, Tuebingen (K.T.), and Boehringer Ingelheim International, Biberach (C.T.) - all in Germany; and the Icahn School of Medicine at Mount Sinai, New York (M.G.L.)
| | - Sebastian D Vulcu
- From Service de Dermatologie, Assistance Publique-Hôpitaux de Paris Hôpital Saint-Louis, and INSERM Unité 1163, Imagine Institute of Genetic Diseases, Université de Paris - both in Paris (H.B.); the Department of Dermatology, Hospital Sultanah Aminah Johor Bahru, Clinical School Johor Bahru, Monash University Malaysia, Subang Jaya, Malaysia (S.-E.C.); the Dermatology Department, Hedi Chaker University Hospital, Sfax, Tunisia (S.M., H.T.); the Institute of Infection, Immunity, and Inflammation, University of Glasgow, Glasgow, United Kingdom (A.D.B.); the Department of Dermatology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan (T.-F.T.); the Department of Geriatric and Environmental Dermatology, Nagoya City University, Graduate School of Medical Sciences, Nagoya, Japan (A.M.); the Department of Dermatology, University Hospital Basel, Basel, Switzerland (A.A.N.); the Department of Dermatology, Second Affiliated Hospital, Zhejiang University, School of Medicine, Hangzhou (M.Z.), and the Department of Dermatology, Huashan Hospital, Fudan University (J.X.), and Boehringer Ingelheim (China) Investment Company (H.H.), Shanghai - all in China; Washington University School of Medicine, Division of Dermatology, St. Louis (M.J.A.); Boehringer Ingelheim Pharmaceuticals, Ridgefield, CT (S.R., D.H.); Boehringer Ingelheim International, Ingelheim (S.D.V., K.T.), the Medical Clinic, Department of Sports Medicine, University of Tuebingen, Tuebingen (K.T.), and Boehringer Ingelheim International, Biberach (C.T.) - all in Germany; and the Icahn School of Medicine at Mount Sinai, New York (M.G.L.)
| | - David Hall
- From Service de Dermatologie, Assistance Publique-Hôpitaux de Paris Hôpital Saint-Louis, and INSERM Unité 1163, Imagine Institute of Genetic Diseases, Université de Paris - both in Paris (H.B.); the Department of Dermatology, Hospital Sultanah Aminah Johor Bahru, Clinical School Johor Bahru, Monash University Malaysia, Subang Jaya, Malaysia (S.-E.C.); the Dermatology Department, Hedi Chaker University Hospital, Sfax, Tunisia (S.M., H.T.); the Institute of Infection, Immunity, and Inflammation, University of Glasgow, Glasgow, United Kingdom (A.D.B.); the Department of Dermatology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan (T.-F.T.); the Department of Geriatric and Environmental Dermatology, Nagoya City University, Graduate School of Medical Sciences, Nagoya, Japan (A.M.); the Department of Dermatology, University Hospital Basel, Basel, Switzerland (A.A.N.); the Department of Dermatology, Second Affiliated Hospital, Zhejiang University, School of Medicine, Hangzhou (M.Z.), and the Department of Dermatology, Huashan Hospital, Fudan University (J.X.), and Boehringer Ingelheim (China) Investment Company (H.H.), Shanghai - all in China; Washington University School of Medicine, Division of Dermatology, St. Louis (M.J.A.); Boehringer Ingelheim Pharmaceuticals, Ridgefield, CT (S.R., D.H.); Boehringer Ingelheim International, Ingelheim (S.D.V., K.T.), the Medical Clinic, Department of Sports Medicine, University of Tuebingen, Tuebingen (K.T.), and Boehringer Ingelheim International, Biberach (C.T.) - all in Germany; and the Icahn School of Medicine at Mount Sinai, New York (M.G.L.)
| | - Kay Tetzlaff
- From Service de Dermatologie, Assistance Publique-Hôpitaux de Paris Hôpital Saint-Louis, and INSERM Unité 1163, Imagine Institute of Genetic Diseases, Université de Paris - both in Paris (H.B.); the Department of Dermatology, Hospital Sultanah Aminah Johor Bahru, Clinical School Johor Bahru, Monash University Malaysia, Subang Jaya, Malaysia (S.-E.C.); the Dermatology Department, Hedi Chaker University Hospital, Sfax, Tunisia (S.M., H.T.); the Institute of Infection, Immunity, and Inflammation, University of Glasgow, Glasgow, United Kingdom (A.D.B.); the Department of Dermatology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan (T.-F.T.); the Department of Geriatric and Environmental Dermatology, Nagoya City University, Graduate School of Medical Sciences, Nagoya, Japan (A.M.); the Department of Dermatology, University Hospital Basel, Basel, Switzerland (A.A.N.); the Department of Dermatology, Second Affiliated Hospital, Zhejiang University, School of Medicine, Hangzhou (M.Z.), and the Department of Dermatology, Huashan Hospital, Fudan University (J.X.), and Boehringer Ingelheim (China) Investment Company (H.H.), Shanghai - all in China; Washington University School of Medicine, Division of Dermatology, St. Louis (M.J.A.); Boehringer Ingelheim Pharmaceuticals, Ridgefield, CT (S.R., D.H.); Boehringer Ingelheim International, Ingelheim (S.D.V., K.T.), the Medical Clinic, Department of Sports Medicine, University of Tuebingen, Tuebingen (K.T.), and Boehringer Ingelheim International, Biberach (C.T.) - all in Germany; and the Icahn School of Medicine at Mount Sinai, New York (M.G.L.)
| | - Christian Thoma
- From Service de Dermatologie, Assistance Publique-Hôpitaux de Paris Hôpital Saint-Louis, and INSERM Unité 1163, Imagine Institute of Genetic Diseases, Université de Paris - both in Paris (H.B.); the Department of Dermatology, Hospital Sultanah Aminah Johor Bahru, Clinical School Johor Bahru, Monash University Malaysia, Subang Jaya, Malaysia (S.-E.C.); the Dermatology Department, Hedi Chaker University Hospital, Sfax, Tunisia (S.M., H.T.); the Institute of Infection, Immunity, and Inflammation, University of Glasgow, Glasgow, United Kingdom (A.D.B.); the Department of Dermatology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan (T.-F.T.); the Department of Geriatric and Environmental Dermatology, Nagoya City University, Graduate School of Medical Sciences, Nagoya, Japan (A.M.); the Department of Dermatology, University Hospital Basel, Basel, Switzerland (A.A.N.); the Department of Dermatology, Second Affiliated Hospital, Zhejiang University, School of Medicine, Hangzhou (M.Z.), and the Department of Dermatology, Huashan Hospital, Fudan University (J.X.), and Boehringer Ingelheim (China) Investment Company (H.H.), Shanghai - all in China; Washington University School of Medicine, Division of Dermatology, St. Louis (M.J.A.); Boehringer Ingelheim Pharmaceuticals, Ridgefield, CT (S.R., D.H.); Boehringer Ingelheim International, Ingelheim (S.D.V., K.T.), the Medical Clinic, Department of Sports Medicine, University of Tuebingen, Tuebingen (K.T.), and Boehringer Ingelheim International, Biberach (C.T.) - all in Germany; and the Icahn School of Medicine at Mount Sinai, New York (M.G.L.)
| | - Mark G Lebwohl
- From Service de Dermatologie, Assistance Publique-Hôpitaux de Paris Hôpital Saint-Louis, and INSERM Unité 1163, Imagine Institute of Genetic Diseases, Université de Paris - both in Paris (H.B.); the Department of Dermatology, Hospital Sultanah Aminah Johor Bahru, Clinical School Johor Bahru, Monash University Malaysia, Subang Jaya, Malaysia (S.-E.C.); the Dermatology Department, Hedi Chaker University Hospital, Sfax, Tunisia (S.M., H.T.); the Institute of Infection, Immunity, and Inflammation, University of Glasgow, Glasgow, United Kingdom (A.D.B.); the Department of Dermatology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan (T.-F.T.); the Department of Geriatric and Environmental Dermatology, Nagoya City University, Graduate School of Medical Sciences, Nagoya, Japan (A.M.); the Department of Dermatology, University Hospital Basel, Basel, Switzerland (A.A.N.); the Department of Dermatology, Second Affiliated Hospital, Zhejiang University, School of Medicine, Hangzhou (M.Z.), and the Department of Dermatology, Huashan Hospital, Fudan University (J.X.), and Boehringer Ingelheim (China) Investment Company (H.H.), Shanghai - all in China; Washington University School of Medicine, Division of Dermatology, St. Louis (M.J.A.); Boehringer Ingelheim Pharmaceuticals, Ridgefield, CT (S.R., D.H.); Boehringer Ingelheim International, Ingelheim (S.D.V., K.T.), the Medical Clinic, Department of Sports Medicine, University of Tuebingen, Tuebingen (K.T.), and Boehringer Ingelheim International, Biberach (C.T.) - all in Germany; and the Icahn School of Medicine at Mount Sinai, New York (M.G.L.)
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Choon SE, Lebwohl MG, Marrakchi S, Burden AD, Tsai TF, Morita A, Navarini AA, Deng H, Thoma C, Bachelez H. 26590 Design and rationale of Effisayil 1, a Phase II, multicenter, randomized, double-blind, placebo-controlled trial of spesolimab in patients with generalized pustular psoriasis with an acute flare. J Am Acad Dermatol 2021. [DOI: 10.1016/j.jaad.2021.06.453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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O’Shaughnessy EM, Duffy W, Garcia-Vega L, Hussey K, Burden AD, Zamiri M, Martin PE. Dysregulation of Connexin Expression Plays a Pivotal Role in Psoriasis. Int J Mol Sci 2021; 22:ijms22116060. [PMID: 34199748 PMCID: PMC8200029 DOI: 10.3390/ijms22116060] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 05/28/2021] [Accepted: 06/01/2021] [Indexed: 12/13/2022] Open
Abstract
Background: Psoriasis, a chronic inflammatory disease affecting 2–3% of the population, is characterised by epidermal hyperplasia, a sustained pro-inflammatory immune response and is primarily a T-cell driven disease. Previous work determined that Connexin26 is upregulated in psoriatic tissue. This study extends these findings. Methods: Biopsies spanning psoriatic plaque (PP) and non-involved tissue (PN) were compared to normal controls (NN). RNA was isolated and subject to real-time PCR to determine gene expression profiles, including GJB2/CX26, GJB6/CX30 and GJA1/CX43. Protein expression was assessed by immunohistochemistry. Keratinocytes and fibroblasts were isolated and used in 3D organotypic models. The pro-inflammatory status of fibroblasts and 3D cultures was assessed via ELISA and RnD cytokine arrays in the presence or absence of the connexin channel blocker Gap27. Results: Connexin26 expression is dramatically enhanced at both transcriptional and translational level in PP and PN tissue compared to NN (>100x). In contrast, CX43 gene expression is not affected, but the protein is post-translationally modified and accumulates in psoriatic tissue. Fibroblasts isolated from psoriatic patients had a higher inflammatory index than normal fibroblasts and drove normal keratinocytes to adopt a “psoriatic phenotype” in a 3D-organotypic model. Exposure of normal fibroblasts to the pro-inflammatory mediator peptidoglycan, isolated from Staphylococcus aureus enhanced cytokine release, an event protected by Gap27. Conclusion: dysregulation of the connexin26:43 expression profile in psoriatic tissue contributes to an imbalance of cellular events. Inhibition of connexin signalling reduces pro-inflammatory events and may hold therapeutic benefit.
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Affiliation(s)
- Erin M. O’Shaughnessy
- Department of Biological and Biomedical Sciences, School of Health and Life Sciences, Glasgow Caledonian University, Glasgow G4 0BA, UK; (E.M.O.); (L.G.-V.)
| | - William Duffy
- Department of Dermatology, University Hospital Crosshouse, Kilmarnock KA2 0BE, UK; (W.D.); (M.Z.)
| | - Laura Garcia-Vega
- Department of Biological and Biomedical Sciences, School of Health and Life Sciences, Glasgow Caledonian University, Glasgow G4 0BA, UK; (E.M.O.); (L.G.-V.)
| | - Keith Hussey
- Department of Vascular Surgery, Queen Elizabeth University Hospital, Glasgow G51 4TF, UK;
| | - A. David Burden
- Institute of Infection Immunity and Inflammation, University of Glasgow, Glasgow G12 8TA, UK;
| | - Mozheh Zamiri
- Department of Dermatology, University Hospital Crosshouse, Kilmarnock KA2 0BE, UK; (W.D.); (M.Z.)
- Department of Dermatology, Queen Elizabeth University Hospital, Glasgow G51 4TF, UK
| | - Patricia E. Martin
- Department of Biological and Biomedical Sciences, School of Health and Life Sciences, Glasgow Caledonian University, Glasgow G4 0BA, UK; (E.M.O.); (L.G.-V.)
- Correspondence: ; Tel.: +44-141-331-3726
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21
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Jones GT, Macfarlane GJ, Forrest Keenan K, McNamee P, Neilson AR, Siebert S, Burden AD, Kay L, Helliwell PS. The BSR-PsA: study protocol for the British Society for Rheumatology psoriatic arthritis register. BMC Rheumatol 2021; 5:19. [PMID: 33993880 PMCID: PMC8126428 DOI: 10.1186/s41927-021-00189-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Accepted: 03/10/2021] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Psoriatic arthritis (PsA) presents a unique clinical challenge. Affecting joints, skin, nails, and other organs, it is associated with various comorbidities and has a significant impact on quality of life, social participation and working life. While biologic and other targeted synthetic disease modifying anti-rheumatic drugs (bDMARDs and tsDMARDs) have revolutionised therapy, questions remain about the long-term safety of these agents, and their effectiveness and cost-effectiveness in the real-world clinical setting. METHODS/DESIGN The British Society for Rheumatology Psoriatic Arthritis Register (BSR-PsA) is a prospective registry of patients with PsA, recruited from across Great Britain, who are (a) commencing a bDMARD/tsDMARD; or (b) naïve to all bDMARDs/tsDMARDs. Ethical approval was given by the NHS West of Scotland Research Ethics Committee 3 (reference: 18/WS/0126). Clinical data are extracted from participants' medical records, including symptom onset and diagnosis, joint, skin and nail symptoms, dactylitis and enthesitis. Physical measurements (height, weight and 66/68 joint counts) and a detailed drug history are taken. Participants are also asked to complete questionnaires comprising instruments relating to general health and quality of life, axial disease, sleep and fatigue, impact of disease, functional status, mental health, other symptoms, and occupational status. The study duration is 5 years in the first instance, and all participants are followed up annually until the end of the study. Participants commencing a bDMARD/tsDMARD are also followed up three and six months after the start of therapy. Disease activity, including C-reactive protein, is assessed at each visit; and participants from some centres are invited to donate blood and urine samples for the creation of a biobank. DISCUSSION Complementing data from randomised trials, results from this study will contribute to the evidence base underpinning the clinical management of psoriatic arthritis. Various analyses will determine the effectiveness and safety of bDMARDs/tsDMARDs in the real-world, will examine the clinical and biological predictors of treatment response, and will provide real-world data on the cost-effectiveness of these therapies, as well as providing informative data important to patients such as quality of life and occupational outcomes. TRIAL REGISTRATION The full study protocol is registered on the Open Science Framework ( https://osf.io/jzs8n ).
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Affiliation(s)
- Gareth T Jones
- Epidemiology Group, Aberdeen Centre for Arthritis and Musculoskeletal Health, University of Aberdeen, Health Sciences Building, 1st floor, Foresterhill, Aberdeen, AB25 2ZD, UK.
| | - Gary J Macfarlane
- Epidemiology Group, Aberdeen Centre for Arthritis and Musculoskeletal Health, University of Aberdeen, Health Sciences Building, 1st floor, Foresterhill, Aberdeen, AB25 2ZD, UK
| | - Karen Forrest Keenan
- Epidemiology Group, Aberdeen Centre for Arthritis and Musculoskeletal Health, University of Aberdeen, Health Sciences Building, 1st floor, Foresterhill, Aberdeen, AB25 2ZD, UK
| | - Paul McNamee
- Health Economics Research Unit, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, UK
| | - Aileen R Neilson
- Usher Institute, Edinburgh Medical School: Molecular, Genetic and Population Health Sciences, University of Edinburgh, Edinburgh, UK
| | - Stefan Siebert
- Institute of Infection, Immunity and Inflammation, University of Glasgow, Glasgow, UK
| | - A David Burden
- Institute of Infection, Immunity and Inflammation, University of Glasgow, Glasgow, UK
| | - Lesley Kay
- Musculoskeletal Services Directorate, The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle, UK
| | - Philip S Helliwell
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK
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22
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Abstract
Linked Article: Mahil et al. Br J Dermatol 2021; 185:80–90.
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Affiliation(s)
- G Becher
- West Glasgow Ambulatory Care Hospital, Glasgow, UK
| | - A D Burden
- Institute of Infection, Immunity and Inflammation, University of Glasgow, UK
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23
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Mason KJ, Burden AD, Barker JNWN, Lunt M, Ali H, Kleyn CE, McElhone K, Soliman MM, Green AC, Griffiths CEM, Reynolds NJ, Ormerod AD. Risks of basal cell and squamous cell carcinoma in psoriasis patients after treatment with biologic vs non-biologic systemic therapies. J Eur Acad Dermatol Venereol 2021; 35:e496-e498. [PMID: 33866626 DOI: 10.1111/jdv.17282] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Revised: 03/18/2021] [Accepted: 04/09/2021] [Indexed: 11/28/2022]
Affiliation(s)
- K J Mason
- Division of Musculoskeletal and Dermatological Sciences, NIHR Manchester Biomedical Research Centre, The University of Manchester, Manchester, UK.,School of Medicine, Keele University, Staffordshire, UK
| | - A D Burden
- Institute of Infection, Immunity and Inflammation, University of Glasgow, UK
| | - J N W N Barker
- St John's Institute of Dermatology, Faculty of Life Sciences and Medicine, King's College London, UK
| | - M Lunt
- Division of Musculoskeletal and Dermatological Sciences, NIHR Manchester Biomedical Research Centre, The University of Manchester, Manchester, UK
| | - H Ali
- Division of Musculoskeletal and Dermatological Sciences, NIHR Manchester Biomedical Research Centre, The University of Manchester, Manchester, UK
| | - C E Kleyn
- Division of Musculoskeletal and Dermatological Sciences, NIHR Manchester Biomedical Research Centre, The University of Manchester, Manchester, UK.,The Dermatology Centre, Salford Royal NHS Foundation Trust, Salford, UK
| | - K McElhone
- Division of Musculoskeletal and Dermatological Sciences, NIHR Manchester Biomedical Research Centre, The University of Manchester, Manchester, UK
| | - M M Soliman
- Department of Pharmacy Practice, Faculty of Pharmacy, Mansoura University, Mansoura, Egypt
| | - A C Green
- Division of Musculoskeletal and Dermatological Sciences, NIHR Manchester Biomedical Research Centre, The University of Manchester, Manchester, UK.,QIMR Berghofer Medical Research Institute, Brisbane, Qld, Australia.,Molecular Oncology Group, CRUK Manchester Institute, University of Manchester, Manchester, UK
| | - C E M Griffiths
- Division of Musculoskeletal and Dermatological Sciences, NIHR Manchester Biomedical Research Centre, The University of Manchester, Manchester, UK.,The Dermatology Centre, Salford Royal NHS Foundation Trust, Salford, UK
| | - N J Reynolds
- Institute of Translation and Clinical Medicine, Newcastle University, Newcastle upon Tyne, UK.,Newcastle Dermatology, Newcastle Hospitals NHS Trust, Newcastle upon Tyne, UK
| | - A D Ormerod
- Division of Applied Medicine, Aberdeen University, Aberdeen, UK
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- British Association of Dermatologists, London, UK
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24
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Vergnano M, Mockenhaupt M, Benzian-Olsson N, Paulmann M, Grys K, Mahil SK, Chaloner C, Barbosa IA, August S, Burden AD, Choon SE, Cooper H, Navarini AA, Reynolds NJ, Wahie S, Warren RB, Wright A, Huffmeier U, Baum P, Visvanathan S, Barker JN, Smith CH, Capon F, Abraham T, Ali M, August S, Baudry D, Bewley A, Cooper H, Griffiths CE, Ingram J, Kelly S, Korshid M, Ladoyanni E, McKenna J, Meynell F, Parslew R, Patel P, Pushparajah A, Reynolds N, Smith C, Wahie S, Warren R, Wright A. Loss-of-function myeloperoxidase mutations are associated with increased neutrophil counts and pustular skin disease. Am J Hum Genet 2021; 108:757. [PMID: 33798446 PMCID: PMC8059367 DOI: 10.1016/j.ajhg.2021.03.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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25
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Choon SE, Lebwohl MG, Marrakchi S, Burden AD, Tsai TF, Morita A, Navarini AA, Zheng M, Xu J, Turki H, Rajeswari S, Deng H, Tetzlaff K, Thoma C, Bachelez H. Study protocol of the global Effisayil 1 Phase II, multicentre, randomised, double-blind, placebo-controlled trial of spesolimab in patients with generalized pustular psoriasis presenting with an acute flare. BMJ Open 2021; 11:e043666. [PMID: 33785490 PMCID: PMC8011793 DOI: 10.1136/bmjopen-2020-043666] [Citation(s) in RCA: 39] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Generalized pustular psoriasis (GPP) is a rare, potentially life-threatening disease characterised by recurrent flares of widespread neutrophilic aseptic skin pustular eruption. Despite the availability of approved biologics for GPP in Japan, Taiwan and Thailand, associated evidence is largely based on uncontrolled studies in which acute flares were not directly assessed. Therefore, there is a high unmet need to investigate new rapid-acting effective treatments that resolve symptoms associated with acute GPP flares. A prior Phase I proof-of-concept study showed rapid improvements in skin and pustule clearance with a single intravenous dose of spesolimab, a novel anti-interleukin-36 receptor antibody, in patients presenting with an acute GPP flare. Here, we present the design and rationale of Effisayil 1, a global, Phase II, placebo-controlled study to evaluate the efficacy, safety and tolerability of spesolimab in patients presenting with an acute GPP flare. METHODS AND ANALYSIS At least 51 patients with an acute GPP flare will be randomised 2:1 to receive a single 900 mg intravenous dose of spesolimab or placebo and followed for up to 28 weeks. The primary endpoint is a Generalized Pustular Psoriasis Physician Global Assessment (GPPGA) pustulation subscore of 0 (pustule clearance) at Week 1. The key secondary endpoint is a GPPGA score of 0 or 1 (clear or almost clear) at Week 1. Safety will be assessed over the study duration by the occurrence of treatment-emergent adverse events. Blood and skin biopsies will be collected to assess biomarkers. Superiority of spesolimab over placebo in the proportion of patients achieving the primary and key secondary endpoints will be evaluated. ETHICS AND DISSEMINATION The study complies with the ethical principles of the Declaration of Helsinki, the International Council for Harmonisation's Good Clinical Practice and local regulations. Ethics committee approvals have been obtained for each centre from all participating countries and are listed in online supplementary file 1. Primary results will be published in a peer-reviewed journal. TRIAL REGISTRATION DETAILS ClinicalTrials.gov identifier: NCT03782792; Pre-results.
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Affiliation(s)
- Siew Eng Choon
- Jeffrey Cheah School of Medicine and Health Sciences, Clinical School Johor Bahru, Monash University Malaysia, Johor Bahru, Johor, Malaysia
| | - Mark G Lebwohl
- Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | | | - A David Burden
- Institute of Infection, Immunity and Inflammation, University of Glasgow, Glasgow, UK
| | - Tsen-Fang Tsai
- Department of Dermatology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Akimichi Morita
- Department of Geriatric and Environmental Dermatology, Nagoya City University, Graduate School of Medical Sciences, Nagoya, Japan
| | | | - Min Zheng
- Department of Dermatology, Second Affiliated Hospital, Zhejiang University, School of Medicine, Hangzhou, China
| | - Jinhua Xu
- Department of Dermatology, Huashan Hospital, Fudan University, Shanghai, China
| | - Hamida Turki
- Dermatology Department, Hedi Chaker University Hospital, Sfax, Tunisia
| | | | - Hongjie Deng
- Boehringer Ingelheim (China), Investment Co Ltd, Shanghai, China
| | - Kay Tetzlaff
- Boehringer Ingelheim International GmbH, Ingelheim, Germany
| | | | - Hervé Bachelez
- Service de Dermatologie, Assistance Publique-Hôpitaux de Paris Hôpital Saint-Louis, Paris, France
- INSERM U1163, Imagine Institute for Genetics of Human Diseases, Université de Paris, Paris, France
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26
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Mason KJ, Burden AD, Barker JNWN, Lunt M, Ali H, Kleyn CE, McElhone K, Soliman MM, Green AC, Griffiths CEM, Reynolds NJ, Ormerod AD. Characteristics and skin cancer risk of psoriasis patients with a history of skin cancer in BADBIR. J Eur Acad Dermatol Venereol 2021; 35:e498-e501. [PMID: 33725378 DOI: 10.1111/jdv.17230] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Accepted: 03/08/2021] [Indexed: 11/26/2022]
Affiliation(s)
- K J Mason
- Division of Musculoskeletal and Dermatological Sciences, NIHR Manchester Biomedical Research Centre, The University of Manchester, Manchester, UK.,School of Medicine, Keele University, Staffordshire, UK
| | - A D Burden
- Institute of Infection, Immunity and Inflammation, University of Glasgow, Glasgow, UK
| | - J N W N Barker
- St John's Institute of Dermatology, Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - M Lunt
- Division of Musculoskeletal and Dermatological Sciences, NIHR Manchester Biomedical Research Centre, The University of Manchester, Manchester, UK
| | - H Ali
- Division of Musculoskeletal and Dermatological Sciences, NIHR Manchester Biomedical Research Centre, The University of Manchester, Manchester, UK
| | - C E Kleyn
- Division of Musculoskeletal and Dermatological Sciences, NIHR Manchester Biomedical Research Centre, The University of Manchester, Manchester, UK.,The Dermatology Centre, Salford Royal NHS Foundation Trust, Salford, UK
| | - K McElhone
- Division of Musculoskeletal and Dermatological Sciences, NIHR Manchester Biomedical Research Centre, The University of Manchester, Manchester, UK
| | - M M Soliman
- Department of Pharmacy Practice, Faculty of Pharmacy, Mansoura University, Mansoura, Egypt
| | - A C Green
- Division of Musculoskeletal and Dermatological Sciences, NIHR Manchester Biomedical Research Centre, The University of Manchester, Manchester, UK.,QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia.,Molecular Oncology Group, CRUK Manchester Institute, University of Manchester, Manchester, UK
| | - C E M Griffiths
- Division of Musculoskeletal and Dermatological Sciences, NIHR Manchester Biomedical Research Centre, The University of Manchester, Manchester, UK.,The Dermatology Centre, Salford Royal NHS Foundation Trust, Salford, UK
| | - N J Reynolds
- Institute of Translation and Clinical Medicine, Newcastle University, Newcastle upon Tyne, UK.,Newcastle Dermatology, Newcastle Hospitals NHS Trust, Newcastle upon Tyne, UK
| | - A D Ormerod
- Division of Applied Medicine, Aberdeen University, Aberdeen, UK
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- British Association of Dermatologists, London, UK
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27
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Mrowietz U, Burden AD, Pinter A, Reich K, Schäkel K, Baum P, Datsenko Y, Deng H, Padula SJ, Thoma C, Bissonnette R. Spesolimab, an Anti-Interleukin-36 Receptor Antibody, in Patients with Palmoplantar Pustulosis: Results of a Phase IIa, Multicenter, Double-Blind, Randomized, Placebo-Controlled Pilot Study. Dermatol Ther (Heidelb) 2021; 11:571-585. [PMID: 33661508 PMCID: PMC8019016 DOI: 10.1007/s13555-021-00504-0] [Citation(s) in RCA: 44] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Accepted: 02/11/2021] [Indexed: 12/22/2022] Open
Abstract
Introduction Palmoplantar pustulosis (PPP) is a chronic, inflammatory skin disease, with high disease burden, that is often refractory to treatment. There is a high unmet clinical need for the treatment of patients with PPP. The objectives of this study were to evaluate the safety and efficacy of spesolimab, a novel anti-interleukin-36 receptor antibody, in patients with PPP. Methods This was a phase IIa, multicenter, double-blind, randomized, placebo-controlled pilot study comparing 900 mg spesolimab (n = 19), 300 mg spesolimab (n = 19), and placebo (n = 21) administered intravenously every 4 weeks until week 12 in patients with PPP. The primary efficacy endpoint was the achievement of Palmoplantar Pustulosis Area and Severity Index 50 (PPP ASI50) at week 16, defined as achieving an ≥ 50% decrease from baseline PPP ASI. Results At week 16, 31.6% of patients in both spesolimab dose groups achieved PPP ASI50 versus 23.8% receiving placebo (risk difference 0.078; 95% confidence interval –0.190, 0.338). Thus, the primary endpoint was not met. Spesolimab was well tolerated with no clinically relevant treatment-emergent safety signals observed. Conclusions PPP severity declined over time in all treatment groups after the start of treatment, with a faster decline in the spesolimab arms than in the placebo arm, indicating a potential treatment effect for spesolimab. Limitations to the study included a small sample size and lower overall disease severity than expected at baseline. It is possible that the primary efficacy endpoint may have coincided with natural disease resolution in some patients. Further effects of the efficacy of spesolimab in PPP are being explored in a phase IIb trial. Supplementary Information The online version contains supplementary material available at 10.1007/s13555-021-00504-0.
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Affiliation(s)
- Ulrich Mrowietz
- Psoriasis-Center at the Department of Dermatology, University Medical Center, Schleswig-Holstein, Campus Kiel, Kiel, Germany.
| | - A David Burden
- Institute of Infection, Immunity and Inflammation, University of Glasgow, Glasgow, UK
| | - Andreas Pinter
- Department of Dermatology, Venereology and Allergology, University Clinic Frankfurt Am Main, Frankfurt am Main, Germany
| | - Kristian Reich
- Center of Translational Research in Inflammatory Skin Diseases, Institute for Health Services Research in Dermatology and Nursing, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Knut Schäkel
- Department of Dermatology, Universitätsklinikum Heidelberg, Heidelberg, Germany
| | - Patrick Baum
- Boehringer Ingelheim International GmbH, Biberach, Germany
| | - Yakov Datsenko
- Boehringer Ingelheim International GmbH, Biberach, Germany
| | - Hongjie Deng
- Boehringer Ingelheim (China) Investment Co. Ltd, Shanghai, China
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28
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Smith CH, Mahil SK, Yiu ZZN, Bale T, Burden AD, Coates LC, McGuire A, Murphy R, Owen CM, Parslew R, Uthman OA, Woolf RT, Manounah L, Ezejimofor MC, Exton LS, Mohd Mustapa MF. Quantitative Evaluation of Biologic Therapy Options for Psoriasis: A Systematic Review and Network Meta-Analysis-Correction. J Invest Dermatol 2020; 141:177-181. [PMID: 33342507 DOI: 10.1016/j.jid.2020.02.048] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Accepted: 02/24/2020] [Indexed: 10/22/2022]
Affiliation(s)
- Catherine H Smith
- St. John's Institute of Dermatology, King's College London, London, United Kingdom.
| | - Satveer K Mahil
- St. John's Institute of Dermatology, King's College London, London, United Kingdom
| | - Zenas Z N Yiu
- Dermatology Centre, Salford Royal NHS Foundation Trust, The University of Manchester, Manchester Academic Health Science Centre, NIHR Manchester Biomedical Research Centre, Manchester, United Kingdom
| | - Tracy Bale
- British Dermatology Nursing Group representative, Aneurin Bevan Health Board, Wales, United Kingdom
| | - A David Burden
- Institute of Infection, Immunity and Inflammation, University of Glasgow, Glasgow, United Kingdom
| | - Laura C Coates
- British Society for Rheumatology, London, United Kingdom; Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, United Kingdom
| | - Arlene McGuire
- Pharmacy Department, Guy's and St. Thomas' Hospitals NHS Trust, London, United Kingdom
| | - Ruth Murphy
- Department of Dermatology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom; Department of Dermatology, Sheffield Children's NHS Foundation Trust, Sheffield, United Kingdom; University of Nottingham, University Park, Nottingham, United Kingdom
| | - Caroline M Owen
- Department of Dermatology, East Lancashire Hospitals NHS Trust, Burnley, United Kingdom
| | - Richard Parslew
- Department of Dermatology, Liverpool University Hospitals NHS Foundation Trust, Liverpool, United Kingdom
| | - Olalekan A Uthman
- Division of Health Sciences, Warwick Centre for Applied Health Research and Delivery, Warwick Medical School, University of Warwick, Coventry, United Kingdom
| | - Richard T Woolf
- St. John's Institute of Dermatology, King's College London, London, United Kingdom
| | - Lina Manounah
- British Association of Dermatologists, London, United Kingdom
| | | | - Lesley S Exton
- British Association of Dermatologists, London, United Kingdom
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29
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Loeff FC, Tsakok T, Dijk L, Hart MH, Duckworth M, Baudry D, Russell A, Dand N, van Leeuwen A, Griffiths CE, Reynolds NJ, Barker J, Burden AD, Warren RB, de Vries A, Bloem K, Wolbink GJ, Smith CH, Rispens T, Barker J, Benham M, Burden D, Evans I, Griffiths C, Hussain S, Kirby B, Lawson L, Mason K, McElhone K, Murphy R, Ormerod A, Owen C, Reynolds N, Smith C, Warren R, Barker JN, Barnes MR, Burden AD, DiMeglio P, Emsley R, Evans A, Griffiths CE, Payne K, Reynolds NJ, Smith CH, Stocken D, Warren RB. Clinical Impact of Antibodies against Ustekinumab in Psoriasis: An Observational, Cross-Sectional, Multicenter Study. J Invest Dermatol 2020; 140:2129-2137. [DOI: 10.1016/j.jid.2020.03.957] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Revised: 02/20/2020] [Accepted: 03/09/2020] [Indexed: 01/07/2023]
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30
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Benzian-Olsson N, Dand N, Chaloner C, Bata-Csorgo Z, Borroni R, Burden AD, Cooper HL, Cornelius V, Cro S, Dasandi T, Griffiths CEM, Kingo K, Koks S, Lachmann H, McAteer H, Meynell F, Mrowietz U, Parslew R, Patel P, Pink AE, Reynolds NJ, Tanew A, Torz K, Trattner H, Wahie S, Warren RB, Wright A, Barker JN, Navarini AA, Smith CH, Capon F. Association of Clinical and Demographic Factors With the Severity of Palmoplantar Pustulosis. JAMA Dermatol 2020; 156:1216-1222. [PMID: 32936291 PMCID: PMC7495329 DOI: 10.1001/jamadermatol.2020.3275] [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] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Accepted: 06/19/2020] [Indexed: 01/10/2023]
Abstract
Importance Although palmoplantar pustulosis (PPP) can significantly impact quality of life, the factors underlying disease severity have not been studied. Objective To examine the factors associated with PPP severity. Design, Setting, and Participants An observational, cross-sectional study of 2 cohorts was conducted. A UK data set including 203 patients was obtained through the Anakinra in Pustular Psoriasis, Response in a Controlled Trial (2016-2019) and its sister research study Pustular Psoriasis, Elucidating Underlying Mechanisms (2016-2020). A Northern European cohort including 193 patients was independently ascertained by the European Rare and Severe Psoriasis Expert Network (2014-2017). Patients had been recruited in secondary or tertiary dermatology referral centers. All patients were of European descent. The PPP diagnosis was established by dermatologists, based on clinical examination and/or published consensus criteria. The present study was conducted from October 1, 2014, to March 15, 2020. Main Outcomes and Measures Demographic characteristics, comorbidities, smoking status, Palmoplantar Pustulosis Psoriasis Area Severity Index (PPPASI), measuring severity from 0 (no sign of disease) to 72 (very severe disease), or Physician Global Assessment (PGA), measuring severity as 0 (clear), 1 (almost clear), 2 (mild), 3 (moderate), and 4 (severe). Results Among the 203 UK patients (43 men [21%], 160 women [79%]; median age at onset, 48 [interquartile range (IQR), 38-59] years), the PPPASI was inversely correlated with age of onset (r = -0.18, P = .01). Similarly, in the 159 Northern European patients who were eligible for inclusion in this analysis (25 men [16%], 134 women [84%]; median age at onset, 45 [IQR, 34-53.3] years), the median age at onset was lower in individuals with a moderate to severe PGA score (41 years [IQR, 30.5-52 years]) compared with those with a clear to mild PGA score (46.5 years [IQR, 35-55 years]) (P = .04). In the UK sample, the median PPPASI score was higher in women (9.6 [IQR, 3.0-16.2]) vs men (4.0 [IQR, 1.0-11.7]) (P = .01). Likewise, moderate to severe PPP was more prevalent among Northern European women (57 of 134 [43%]) compared with men (5 of 25 [20%]) (P = .03). In the UK cohort, the median PPPASI score was increased in current smokers (10.7 [IQR, 4.2-17.5]) compared with former smokers (7 [IQR, 2.0-14.4]) and nonsmokers (2.2 [IQR, 1-6]) (P = .003). Comparable differences were observed in the Northern European data set, as the prevalence of moderate to severe PPP was higher in former and current smokers (51 of 130 [39%]) compared with nonsmokers (6 of 24 [25%]) (P = .14). Conclusions and Relevance The findings of this study suggest that PPP severity is associated with early-onset disease, female sex, and smoking status. Thus, smoking cessation intervention might be beneficial.
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Affiliation(s)
| | - Nick Dand
- Department of Medical and Molecular Genetics, King's College London, London, United Kingdom
- Health Data Research UK, London, United Kingdom
| | - Charlotte Chaloner
- Department of Medical and Molecular Genetics, King's College London, London, United Kingdom
| | - Zsuzsa Bata-Csorgo
- Department of Dermatology and Allergology, University of Szeged, Szeged, Hungary
| | - Riccardo Borroni
- Humanitas Clinical and Research Center, IRCCS, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - A. David Burden
- Institute of Infection, Immunity and Inflammation, University of Glasgow, Glasgow, United Kingdom
| | - Hywel L. Cooper
- Portsmouth Dermatology Unit, Portsmouth Hospitals Trust, Portsmouth, United Kingdom
| | - Victoria Cornelius
- Imperial Clinical Trials Unit, School of Public Health, Imperial College London, London, United Kingdom
| | - Suzie Cro
- Imperial Clinical Trials Unit, School of Public Health, Imperial College London, London, United Kingdom
| | - Tejus Dasandi
- St John's Institute of Dermatology, King's College London, London, United Kingdom
| | - Christopher E. M. Griffiths
- Dermatology Centre, National Institute for Health Research Manchester Biomedical Research Centre, University of Manchester, Manchester, United Kingdom
| | - Külli Kingo
- Dermatology Clinic, Tartu University Hospital, Department of Dermatology, University of Tartu, Tartu, Estonia
| | - Sulev Koks
- Centre for Molecular Medicine and Innovative Therapeutics, Murdoch and Perron Institute for Neurological and Translational Science, Murdoch University, Nedlands, Western Australia, Australia
| | - Helen Lachmann
- National Amyloidosis Centre, University College London, Royal Free Campus, London, United Kingdom
| | - Helen McAteer
- The Psoriasis Association, Northampton, United Kingdom
| | - Freya Meynell
- St John's Institute of Dermatology, King's College London, London, United Kingdom
| | - Ulrich Mrowietz
- Psoriasis Center at the Department of Dermatology, University Medical Center, Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Richard Parslew
- Department of Dermatology, Royal Liverpool Hospitals, Liverpool, United Kingdom
| | - Prakash Patel
- St John's Institute of Dermatology, King's College London, London, United Kingdom
| | - Andrew E. Pink
- St John's Institute of Dermatology, King's College London, London, United Kingdom
| | - Nick J. Reynolds
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
- Department of Dermatology and National Institute for Health Research Newcastle Biomedical Research Centre, Newcastle Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
| | - Adrian Tanew
- Department of Dermatology, Medical University of Vienna, Austria
| | - Kaspar Torz
- Psoriasis Center at the Department of Dermatology, University Medical Center, Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Hannes Trattner
- Department of Dermatology, Medical University of Vienna, Austria
| | - Shyamal Wahie
- Department of Dermatology, University Hospital of North Durham, Durham
| | - Richard B. Warren
- The Dermatology Centre, Salford Royal NHS Foundation Trust, University of Manchester, Manchester Academic Health Science Centre, Manchester, United Kingdom
| | - Andrew Wright
- Department of Dermatology, St Lukes Hospital, Bradford, United Kingdom
| | - Jonathan N. Barker
- St John's Institute of Dermatology, King's College London, London, United Kingdom
| | - Alexander A. Navarini
- Department of Dermatology & Allergy, University Hospital of Basel, Basel, Switzerland
| | - Catherine H. Smith
- St John's Institute of Dermatology, King's College London, London, United Kingdom
| | - Francesca Capon
- Department of Medical and Molecular Genetics, King's College London, London, United Kingdom
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31
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Vergnano M, Mockenhaupt M, Benzian-Olsson N, Paulmann M, Grys K, Mahil SK, Chaloner C, Barbosa IA, August S, Burden AD, Choon SE, Cooper H, Navarini AA, Reynolds NJ, Wahie S, Warren RB, Wright A, Huffmeier U, Baum P, Visvanathan S, Barker JN, Smith CH, Capon F. Loss-of-Function Myeloperoxidase Mutations Are Associated with Increased Neutrophil Counts and Pustular Skin Disease. Am J Hum Genet 2020; 107:539-543. [PMID: 32758448 PMCID: PMC7477255 DOI: 10.1016/j.ajhg.2020.06.020] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Accepted: 06/23/2020] [Indexed: 02/07/2023] Open
Abstract
The identification of disease alleles underlying human autoinflammatory diseases can provide important insights into the mechanisms that maintain neutrophil homeostasis. Here, we focused our attention on generalized pustular psoriasis (GPP), a potentially life-threatening disorder presenting with cutaneous and systemic neutrophilia. Following the whole-exome sequencing of 19 unrelated affected individuals, we identified a subject harboring a homozygous splice-site mutation (c.2031-2A>C) in MPO. This encodes myeloperoxidase, an essential component of neutrophil azurophil granules. MPO screening in conditions phenotypically related to GPP uncovered further disease alleles in one subject with acral pustular psoriasis (c.2031-2A>C;c.2031-2A>C) and in two individuals with acute generalized exanthematous pustulosis (c.1705C>T;c.2031-2A>C and c.1552_1565del;c.1552_1565del). A subsequent analysis of UK Biobank data demonstrated that the c.2031-2A>C and c.1705C>T (p.Arg569Trp) disease alleles were also associated with increased neutrophil abundance in the general population (p = 5.1 × 10-6 and p = 3.6 × 10-5, respectively). The same applied to three further deleterious variants that had been genotyped in the cohort, with two alleles (c.995C>T [p.Ala332Val] and c.752T>C [p.Met251Thr]) yielding p values < 10-10. Finally, treatment of healthy neutrophils with an MPO inhibitor (4-Aminobenzoic acid hydrazide) increased cell viability and delayed apoptosis, highlighting a mechanism whereby MPO mutations affect granulocyte numbers. These findings identify MPO as a genetic determinant of pustular skin disease and neutrophil abundance. Given the recent interest in the development of MPO antagonists for the treatment of neurodegenerative disease, our results also suggest that the pro-inflammatory effects of these agents should be closely monitored.
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Affiliation(s)
- Marta Vergnano
- Department of Medical and Molecular Genetics, School of Basic and Medical Biosciences, King's College London, London SE1 9RT, UK; St John's Institute of Dermatology, School of Basic and Medical Biosciences, King's College London, London SE1 9RT, UK
| | - Maja Mockenhaupt
- Department of Dermatology, Medical Centre-University of Freiburg, Freiburg 79106, Germany
| | - Natashia Benzian-Olsson
- Department of Medical and Molecular Genetics, School of Basic and Medical Biosciences, King's College London, London SE1 9RT, UK
| | - Maren Paulmann
- Department of Dermatology, Medical Centre-University of Freiburg, Freiburg 79106, Germany
| | - Katarzyna Grys
- St John's Institute of Dermatology, School of Basic and Medical Biosciences, King's College London, London SE1 9RT, UK
| | - Satveer K Mahil
- St John's Institute of Dermatology, School of Basic and Medical Biosciences, King's College London, London SE1 9RT, UK
| | - Charlotte Chaloner
- Department of Medical and Molecular Genetics, School of Basic and Medical Biosciences, King's College London, London SE1 9RT, UK
| | - Ines A Barbosa
- St John's Institute of Dermatology, School of Basic and Medical Biosciences, King's College London, London SE1 9RT, UK
| | | | - A David Burden
- Department of Dermatology, University of Glasgow, Glasgow G12 8QQ, UK
| | - Siew-Eng Choon
- Department of Dermatology, Sultanah Aminah Hospital, Clinical School Johor Bahru, Monash University, Malaysia
| | - Hywel Cooper
- Portsmouth Dermatology Centre, St Marys Hospital, Portsmouth PO3 6AD, UK
| | - Alex A Navarini
- Department of Dermatology & Allergy, University Hospital of Basel, Basel 4031, Switzerland
| | - Nick J Reynolds
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne NE2 4HH, UK and Department of Dermatology and NIHR Newcastle Biomedical Research Centre, Newcastle Hospitals NHS Foundation Trust, Newcastle upon Tyne NE2 4LP, UK
| | - Shyamal Wahie
- Department of Dermatology, University Hospital of North Durham, Durham DH1 5TW, UK
| | - Richard B Warren
- Dermatology Centre, Salford Royal NHS Foundation Trust, Manchester NIHR Biomedical Research Centre, University of Manchester, Manchester M6 8HD, UK
| | - Andrew Wright
- Centre for Skin Sciences, St Lukes Hospital, Bradford BD5 0NA, UK
| | - Ulrike Huffmeier
- Institute of Human Genetics, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen 91054, Germany
| | - Patrick Baum
- Boehringer-Ingelheim International GmbH, Biberach 88397, Germany
| | | | - Jonathan N Barker
- St John's Institute of Dermatology, School of Basic and Medical Biosciences, King's College London, London SE1 9RT, UK
| | - Catherine H Smith
- St John's Institute of Dermatology, School of Basic and Medical Biosciences, King's College London, London SE1 9RT, UK
| | - Francesca Capon
- Department of Medical and Molecular Genetics, School of Basic and Medical Biosciences, King's College London, London SE1 9RT, UK.
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32
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Mahil SK, Ezejimofor MC, Exton LS, Manounah L, Burden AD, Coates LC, de Brito M, McGuire A, Murphy R, Owen CM, Parslew R, Woolf RT, Yiu ZZN, Uthman OA, Mohd Mustapa MF, Smith CH. Comparing the efficacy and tolerability of biologic therapies in psoriasis: an updated network meta-analysis. Br J Dermatol 2020; 183:638-649. [PMID: 32562551 DOI: 10.1111/bjd.19325] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/14/2020] [Indexed: 12/20/2022]
Abstract
BACKGROUND The rapid expansion of psoriasis biologics has led to an urgent need to understand their relative efficacy and tolerability to inform treatment decisions better and, specifically, to inform guideline development. OBJECTIVES To update a 2017 meta-analysis on the comparative efficacy and tolerability of biologic treatments for psoriasis. METHODS We searched the MEDLINE, PubMed, Embase and Cochrane databases for randomized controlled trials (RCTs), published up to 7 September 2018, of 11 licensed, NICE-approved biologics targeting tumour necrosis factor (adalimumab, etanercept, infliximab, certolizumab pegol), interleukin (IL)-12/IL-23p40 (ustekinumab), IL-17A (secukinumab, ixekizumab), IL-17RA (brodalumab) and IL-23p19 (guselkumab, tildrakizumab, risankizumab). A frequentist network meta-analysis ascertained direct or indirect evidence comparing biologics with one another, methotrexate or placebo. This was combined with hierarchical cluster analyses to consider efficacy (≥ 90% improvement in Psoriasis Area and Severity Index (PASI 90) or Physician's Global Assessment 0 or 1; PASI 75; Dermatology Life Quality Index improvement) and tolerability (drug withdrawal due to adverse events) outcomes at 10-16 weeks, followed by assessments of study quality, heterogeneity and inconsistency. RESULTS We identified 62 RCTs presenting data on direct comparisons (31 899 participants). All biologics were efficacious compared with placebo or methotrexate at 10-16 weeks. Hierarchical cluster analyses revealed that adalimumab, brodalumab, certolizumab pegol, guselkumab, risankizumab, secukinumab, tildrakizumab and ustekinumab were comparable with respect to high short-term efficacy and tolerability. Infliximab and ixekizumab clustered together, with high short-term efficacy but relatively lower tolerability than the other agents, although the number of drug withdrawal events across the network was low, so these findings should be treated with caution. CONCLUSIONS Using our methodology we found that most biologics cluster together with respect to short-term efficacy and tolerability, and we did not identify any single agent as 'best'. These data need to be interpreted in the context of longer-term efficacy, effectiveness data, safety, posology and drug acquisition costs when making treatment decisions.
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Affiliation(s)
- S K Mahil
- St John's Institute of Dermatology, Guy's and St Thomas' NHS Foundation Trust, London, SE1 9RT, UK
| | - M C Ezejimofor
- British Association of Dermatologists, London, W1T 5HQ, UK
| | - L S Exton
- British Association of Dermatologists, London, W1T 5HQ, UK
| | - L Manounah
- British Association of Dermatologists, London, W1T 5HQ, UK
| | - A D Burden
- Institute of Infection, Immunity and Inflammation, University of Glasgow, Glasgow, G12 8QQ, UK
| | - L C Coates
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, OX3 7LD, UK
| | - M de Brito
- St John's Institute of Dermatology, Guy's and St Thomas' NHS Foundation Trust, London, SE1 9RT, UK
| | - A McGuire
- St John's Institute of Dermatology, Guy's and St Thomas' NHS Foundation Trust, London, SE1 9RT, UK
| | - R Murphy
- Department of Dermatology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, S10 2JF, UK.,Department of Dermatology, Sheffield Children's NHS Foundation Trust, Sheffield, S10 3FL, UK.,University of Nottingham, University Park, Nottingham, NG7 2RD, UK
| | - C M Owen
- Department of Dermatology, East Lancashire Hospitals NHS Trust, Burnley, BB10 2PQ, UK
| | - R Parslew
- Department of Dermatology, Liverpool University Hospitals NHS Foundation Trust, Liverpool, L7 8XP, UK
| | - R T Woolf
- St John's Institute of Dermatology, Guy's and St Thomas' NHS Foundation Trust, London, SE1 9RT, UK
| | - Z Z N Yiu
- Dermatology Centre, Salford Royal NHS Foundation Trust, The University of Manchester, Manchester Academic Health Science Centre, NIHR Manchester Biomedical Research Centre, Manchester, M13 9PT, UK
| | - O A Uthman
- Warwick Centre for Applied Health Research and Delivery, Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, CV4 7AL, UK
| | | | - C H Smith
- St John's Institute of Dermatology, Guy's and St Thomas' NHS Foundation Trust, London, SE1 9RT, UK
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33
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Smith CH, Yiu ZZN, Bale T, Burden AD, Coates LC, Edwards W, MacMahon E, Mahil SK, McGuire A, Murphy R, Nelson-Piercy C, Owen CM, Parslew R, Uthman OA, Woolf RT, Manounah L, Ezejimofor MC, Exton LS, Mohd Mustapa MF. British Association of Dermatologists guidelines for biologic therapy for psoriasis 2020: a rapid update. Br J Dermatol 2020; 183:628-637. [PMID: 32189327 DOI: 10.1111/bjd.19039] [Citation(s) in RCA: 99] [Impact Index Per Article: 24.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/14/2020] [Indexed: 11/27/2022]
Affiliation(s)
- C H Smith
- St John's Institute of Dermatology, Guy's and St Thomas' NHS Foundation Trust, London, SE1 9RT, UK
| | - Z Z N Yiu
- Dermatology Centre, Salford Royal NHS Foundation Trust, The University of Manchester, Manchester Academic Health Science Centre, NIHR Manchester Biomedical Research Centre, Manchester, M13 9PT, UK
| | - T Bale
- British Dermatology Nursing Group representative, Aneurin Bevan Health Board, Wales, UK
| | - A D Burden
- Institute of Infection, Immunity and Inflammation, University of Glasgow, Glasgow, G12 8QQ, UK
| | - L C Coates
- British Society for Rheumatology, London, EC4Y 8EE, UK.,Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, OX3 7LD, UK
| | - W Edwards
- Patient representative, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, S10 2JF, UK
| | - E MacMahon
- Department of Infectious Diseases, Guy's and St Thomas' NHS Foundation Trust, London, SE1 9RT, UK
| | - S K Mahil
- St John's Institute of Dermatology, Guy's and St Thomas' NHS Foundation Trust, London, SE1 9RT, UK
| | - A McGuire
- Pharmacy Department , Guy's and St Thomas' NHS Foundation Trust, London, SE1 9RT, UK
| | - R Murphy
- Department of Dermatology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, S10 2JF, UK.,Department of Dermatology, Sheffield Children's NHS Foundation Trust, Sheffield, S10 3FL, UK.,University of Nottingham, University Park, Nottingham, NG7 2RD, UK
| | - C Nelson-Piercy
- Women's Health Academic Centre, Guy's and St Thomas' NHS Foundation Trust, London, SE1 9RT, UK
| | - C M Owen
- Department of Dermatology, East Lancashire Hospitals NHS Trust, Burnley, BB10 2PQ, UK
| | - R Parslew
- Department of Dermatology, Liverpool University Hospitals NHS Foundation Trust, Liverpool, L7 8XP, UK
| | - O A Uthman
- Warwick Centre for Applied Health Research and Delivery, Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, CV4 7AL, UK
| | - R T Woolf
- St John's Institute of Dermatology, Guy's and St Thomas' NHS Foundation Trust, London, SE1 9RT, UK
| | - L Manounah
- British Association of Dermatologists, London, W1T 5HQ, UK
| | - M C Ezejimofor
- British Association of Dermatologists, London, W1T 5HQ, UK
| | - L S Exton
- British Association of Dermatologists, London, W1T 5HQ, UK
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34
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Pan S, Tsakok T, Dand N, Lonsdale DO, Loeff FC, Bloem K, de Vries A, Baudry D, Duckworth M, Mahil S, Pushpa-Rajah A, Russell A, Alsharqi A, Becher G, Murphy R, Wahie S, Wright A, Griffiths CEM, Reynolds NJ, Barker J, Warren RB, David Burden A, Rispens T, Standing JF, Smith CH. Using Real-World Data to Guide Ustekinumab Dosing Strategies for Psoriasis: A Prospective Pharmacokinetic-Pharmacodynamic Study. Clin Transl Sci 2020; 13:400-409. [PMID: 31995663 PMCID: PMC7070790 DOI: 10.1111/cts.12725] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Accepted: 10/14/2019] [Indexed: 12/13/2022] Open
Abstract
Variation in response to biologic therapy for inflammatory diseases, such as psoriasis, is partly driven by variation in drug exposure. Real‐world psoriasis data were used to develop a pharmacokinetic/pharmacodynamic (PK/PD) model for the first‐line therapeutic antibody ustekinumab. The impact of differing dosing strategies on response was explored. Data were collected from a UK prospective multicenter observational cohort (491 patients on ustekinumab monotherapy, drug levels, and anti‐drug antibody measurements on 797 serum samples, 1,590 measurements of Psoriasis Area Severity Index (PASI)). Ustekinumab PKs were described with a linear one‐compartment model. A maximum effect (Emax) model inhibited progression of psoriatic skin lesions in the turnover PD mechanism describing PASI evolution while on treatment. A mixture model on half‐maximal effective concentration identified a potential nonresponder group, with simulations suggesting that, in future, the model could be incorporated into a Bayesian therapeutic drug monitoring “dashboard” to individualize dosing and improve treatment outcomes.
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Affiliation(s)
- Shan Pan
- St. John's Institute of Dermatology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Teresa Tsakok
- St. John's Institute of Dermatology, Guy's and St Thomas' NHS Foundation Trust, London, UK.,St. John's Institute of Dermatology, School of Basic & Medical Biosciences, Faculty of Life Sciences & Medicine, King's College London, London, UK
| | - Nick Dand
- Department of Medical & Molecular Genetics, School of Basic & Medical Biosciences, Faculty of Life Sciences & Medicine, King's College London, London, UK
| | - Dagan O Lonsdale
- Institute of Infection and Immunity, St. George's, University of London, London, UK
| | - Floris C Loeff
- Department of Immunopathology, Sanquin Research and Landsteiner Laboratory, Amsterdam, The Netherlands
| | - Karien Bloem
- Biologics Lab, Sanquin Diagnostic Services, Amsterdam, The Netherlands
| | - Annick de Vries
- Biologics Lab, Sanquin Diagnostic Services, Amsterdam, The Netherlands
| | - David Baudry
- St. John's Institute of Dermatology, School of Basic & Medical Biosciences, Faculty of Life Sciences & Medicine, King's College London, London, UK
| | - Michael Duckworth
- St. John's Institute of Dermatology, School of Basic & Medical Biosciences, Faculty of Life Sciences & Medicine, King's College London, London, UK
| | - Satveer Mahil
- St. John's Institute of Dermatology, Guy's and St Thomas' NHS Foundation Trust, London, UK.,St. John's Institute of Dermatology, School of Basic & Medical Biosciences, Faculty of Life Sciences & Medicine, King's College London, London, UK
| | - Angela Pushpa-Rajah
- St. John's Institute of Dermatology, School of Basic & Medical Biosciences, Faculty of Life Sciences & Medicine, King's College London, London, UK
| | - Alice Russell
- St. John's Institute of Dermatology, School of Basic & Medical Biosciences, Faculty of Life Sciences & Medicine, King's College London, London, UK
| | - Ali Alsharqi
- Dermatology Department, Royal Liverpool and Broadgreen University Hospital Trust, Liverpool, UK
| | | | - Ruth Murphy
- Department of Dermatology, Queens Medical Centre, Nottingham University Teaching Hospitals, Nottingham, UK
| | - Shyamal Wahie
- Dermatology Department, University Hospital of North Durham, Durham, UK
| | - Andrew Wright
- Centre for Skin Sciences, University of Bradford, Bradford, UK
| | - Christopher E M Griffiths
- Dermatology Centre, Salford Royal National Health Service Foundation Trust, Manchester, UK.,The University of Manchester, Manchester Academic Health Science Centre, National Institute for Health Research Manchester Biomedical Research Centre, Manchester, UK
| | - Nick J Reynolds
- Dermatological Sciences, Institute of Cellular Medicine, Medical School, Newcastle University, Newcastle upon Tyne, UK.,Department of Dermatology, Royal Victoria Infirmary, Newcastle Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Jonathan Barker
- St. John's Institute of Dermatology, Guy's and St Thomas' NHS Foundation Trust, London, UK.,St. John's Institute of Dermatology, School of Basic & Medical Biosciences, Faculty of Life Sciences & Medicine, King's College London, London, UK
| | - Richard B Warren
- Dermatology Centre, Salford Royal National Health Service Foundation Trust, Manchester, UK
| | - A David Burden
- Institute of Infection, Immunity and Inflammation, University of Glasgow, Glasgow, UK
| | - Theo Rispens
- Department of Immunopathology, Sanquin Research and Landsteiner Laboratory, Amsterdam, The Netherlands
| | - Joseph F Standing
- Infection, Immunity, Inflammation Section, UCL Great Ormond Street Institute of Child Health, London, UK
| | - Catherine H Smith
- St. John's Institute of Dermatology, Guy's and St Thomas' NHS Foundation Trust, London, UK.,St. John's Institute of Dermatology, School of Basic & Medical Biosciences, Faculty of Life Sciences & Medicine, King's College London, London, UK
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35
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Warren RB, Barker JNWB, Finlay AY, Burden AD, Kirby B, Armendariz Y, Williams R, Hatchard C, Khare S, Griffiths CEM. Secukinumab for patients failing previous tumour necrosis factor-α inhibitor therapy: results of a randomized open-label study (SIGNATURE). Br J Dermatol 2019; 183:60-70. [PMID: 31628677 DOI: 10.1111/bjd.18623] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/17/2019] [Indexed: 12/19/2022]
Abstract
BACKGROUND Efficacy data on therapies for patients with psoriasis who have failed tumour necrosis factor (TNF)-α inhibitor therapy is limited. OBJECTIVES To determine the effectiveness and tolerability of secukinumab, an interleukin (IL)-17A inhibitor, in patients with moderate/severe chronic plaque psoriasis with documented efficacy failure of TNF-α inhibitor therapy (SIGNATURE study). METHODS This was a randomized, open-label, noncomparator study in 53 dermatology centres in the U.K. and Republic of Ireland. Patients were randomized 1 : 1 to receive secukinumab 300 mg or 150 mg subcutaneously every week for 4 weeks, then 4-weekly thereafter. Patients were stratified by their prior efficacy failure with TNF-α inhibitors. Only patients who started and stayed on the same dose at each time point were included for efficacy assessments. RESULTS In total, 233 patients were analysed. The primary end point was met, with a statistically significant improvement in response rates [75% reduction in Psoriasis Area and Severity Index (PASI 75)] from baseline to week 16 in both secukinumab 300 mg and 150 mg dose groups [77 of 118 patients (65·3%) and 51 of 115 patients (44·3%), respectively; P < 0·0001]. After 72 weeks, in patients starting and remaining on 300 mg, 77% (54 of 70) achieved PASI 75. Improvements in Dermatology Life Quality Index from baseline to week 16 occurred and were maintained up to 72 weeks. The safety profile was generally consistent with previous secukinumab studies, although a higher incidence of some adverse events (e.g. candida infections) was observed. CONCLUSIONS This study provides evidence of efficacy and safety of secukinumab for treatment of patients with psoriasis who failed prior TNF-α inhibitor therapy. This study represents a 'real-world' population, providing reassurance that secukinumab is a treatment option in this difficult-to-treat population. What's already known about this topic? Conventional systemic nonbiological and tumour necrosis factor (TNF)-α inhibitor therapies for plaque psoriasis have not fully met patients' needs. There is a lack of data to support the treatment pathways for patients with psoriasis who have inadequate responses to TNF-α inhibitor therapy. Secukinumab, a recombinant high-affinity fully human monoclonal anti-human interleukin-17A antibody of the IgG1/κ-class, has shown excellent safety and efficacy in the treatment of moderate-to-severe psoriasis. What does this study add? This is the first study evaluating treatment with biologics after prior efficacy failure of TNF-α inhibitor therapy as defined by the U.K. National Institute for Health and Care Excellence criteria. Secukinumab is an effective treatment in this difficult-to-treat patient population. This study provides important practical information for clinicians managing psoriasis. Adverse events were consistent with the phase III programme for secukinumab, although some adverse events, e.g. candida, were increased.
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Affiliation(s)
- R B Warren
- Centre for Dermatology Research, University of Manchester, NIHR Manchester Biomedical Research Centre, Manchester, U.K.,Salford Royal NHS Foundation Trust, Manchester, U.K
| | - J N W B Barker
- St John's Institute of Dermatology, King's College London, London, U.K
| | - A Y Finlay
- Division of Infection and Immunity, Cardiff University, Cardiff, U.K
| | - A D Burden
- Centre for Dermatology Research, University of Manchester, NIHR Manchester Biomedical Research Centre, Manchester, U.K.,Institute of Infection, Immunity and Inflammation, University of Glasgow, Glasgow, U.K
| | - B Kirby
- St Vincent's University Hospital and the Charles Institute, University College Dublin, Dublin, Ireland
| | | | - R Williams
- Novartis Pharmaceuticals U.K. Ltd, Frimley, U.K
| | - C Hatchard
- Novartis Pharmaceuticals U.K. Ltd, Frimley, U.K
| | - S Khare
- Novartis Pharmaceuticals U.K. Ltd, Frimley, U.K
| | - C E M Griffiths
- Centre for Dermatology Research, University of Manchester, NIHR Manchester Biomedical Research Centre, Manchester, U.K.,Salford Royal NHS Foundation Trust, Manchester, U.K
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36
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Rungapiromnan W, Mason KJ, Lunt M, McElhone K, Burden AD, Rutter MK, Warren RB, Griffiths CEM, Ashcroft DM. Risk of major cardiovascular events in patients with psoriasis receiving biologic therapies: a prospective cohort study. J Eur Acad Dermatol Venereol 2019; 34:769-778. [PMID: 31633837 PMCID: PMC7155017 DOI: 10.1111/jdv.16018] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Accepted: 09/30/2019] [Indexed: 12/21/2022]
Abstract
Background The cardiovascular safety profile of biologic therapies used for psoriasis is unclear. Objectives To compare the risk of major cardiovascular events (CVEs; acute coronary syndrome, unstable angina, myocardial infarction and stroke) in patients with chronic plaque psoriasis treated with adalimumab, etanercept or ustekinumab in a large prospective cohort. Methods Prospective cohort study examining the comparative risk of major CVEs was conducted using the British Association of Dermatologists Biologics and Immunomodulators Register. The main analysis compared adults with chronic plaque psoriasis receiving ustekinumab with tumour necrosis‐α inhibitors (TNFi: etanercept and adalimumab), whilst the secondary analyses compared ustekinumab, etanercept or methotrexate against adalimumab. Hazard ratios (HRs) with 95% confidence intervals (CIs) were calculated using overlap weights by propensity score to balance baseline covariates among comparison groups. Results We included 5468 biologic‐naïve patients subsequently exposed (951 ustekinumab; 1313 etanercept; and 3204 adalimumab) in the main analysis. The secondary analyses also included 2189 patients receiving methotrexate. The median (p25–p75) follow‐up times for patients using ustekinumab, TNFi, adalimumab, etanercept and methotrexate were as follows: 2.01 (1.16–3.21), 1.93 (1.05–3.34), 1.94 (1.09–3.32), 1.92 (0.93–3.45) and 1.43 (0.84–2.53) years, respectively. Ustekinumab, TNFi, adalimumab, etanercept and methotrexate groups had 7, 29, 23, 6 and 9 patients experiencing major CVEs, respectively. No differences in the risk of major CVEs were observed between biologic therapies [adjusted HR for ustekinumab vs. TNFi: 0.96 (95% CI 0.41–2.22); ustekinumab vs. adalimumab: 0.81 (0.30–2.17); etanercept vs. adalimumab: 0.81 (0.28–2.30)] and methotrexate against adalimumab [1.05 (0.34–3.28)]. Conclusions In this large prospective cohort study, we found no significant differences in the risk of major CVEs between three different biologic therapies and methotrexate. Additional studies, with longer term follow‐up, are needed to investigate the potential effects of biologic therapies on incidence of major CVEs. Linked Commentary: K. Kridin and A.D. Cohen. J Eur Acad Dermatol Venereol 2020; 34: 668–669. https://doi.org/10.1111/jdv.16345.
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Affiliation(s)
- W Rungapiromnan
- Centre for Pharmacoepidemiology and Drug Safety, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - K J Mason
- Division of Musculoskeletal and Dermatological Sciences, School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - M Lunt
- Division of Musculoskeletal and Dermatological Sciences, School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - K McElhone
- Division of Musculoskeletal and Dermatological Sciences, School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - A D Burden
- Institute of Infection, Immunity and Inflammation, University of Glasgow, Glasgow, UK
| | - M K Rutter
- Division of Endocrinology, Diabetes and Gastroenterology, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK.,Manchester Diabetes Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | - R B Warren
- Division of Musculoskeletal and Dermatological Sciences, School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK.,Dermatology Centre, Salford Royal NHS Foundation Trust, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - C E M Griffiths
- Division of Musculoskeletal and Dermatological Sciences, School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK.,Dermatology Centre, Salford Royal NHS Foundation Trust, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - D M Ashcroft
- Centre for Pharmacoepidemiology and Drug Safety, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
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Tsakok T, Wilson N, Dand N, Loeff FC, Bloem K, Baudry D, Duckworth M, Pan S, Pushpa-Rajah A, Standing JF, de Vries A, Alsharqi A, Becher G, Murphy R, Wahie S, Wright A, Griffiths CEM, Reynolds NJ, Barker J, Warren RB, Burden AD, Rispens T, Stocken D, Smith C. Association of Serum Ustekinumab Levels With Clinical Response in Psoriasis. JAMA Dermatol 2019; 155:1235-1243. [PMID: 31532460 PMCID: PMC6751771 DOI: 10.1001/jamadermatol.2019.1783] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Question Can therapeutic drug monitoring for the interleukin-12 and interleukin-23 inhibitor ustekinumab optimize treatment pathways and outcomes in patients with psoriasis? Findings This cohort study of 491 patients with psoriasis found that early serum ustekinumab levels were associated with a subsequent 75% reduction from baseline in Psoriasis Area and Severity Index score, although this association did not hold across other Psoriasis Area and Severity Index outcomes. Drug immunogenicity appeared to be low, with antidrug antibodies detected in only 17 of 490 patients (3.5%). Meaning This study provides evidence that measurement of early ustekinumab levels could be useful to direct treatment strategy in patients with psoriasis; adequate drug exposure early in the treatment cycle may be particularly important in determining clinical outcome. Importance High-cost biologic therapies have transformed the management of immune-mediated inflammatory diseases. To optimize outcomes and reduce costs, dose adjustment informed by measurement of circulating drug levels has been shown to be effective in various settings. However, limited evidence exists for this approach with the interleukin 12 and interleukin 23 inhibitor ustekinumab. Objective To evaluate clinical utility of therapeutic drug monitoring for ustekinumab in patients with psoriasis. Design, Setting, and Participants A prospective observational cohort of 491 adults with psoriasis was recruited to the multicenter Biomarkers of Systemic Treatment Outcomes in Psoriasis study within the British Association of Dermatologists Biologic and Immunomodulators Register from June 2009 to December 2017; samples from some patients were taken between 2009 and 2011 as part of a pilot study with the same inclusion criteria. Exposure Serum ustekinumab level measured at any point during the dosing cycle using an enzyme-linked immunosorbent assay. Main Outcomes and Measures Disease activity measured using the Psoriasis Area and Severity Index (PASI) score. Treatment response outcomes were PASI75 (75% reduction in PASI score from baseline [primary outcome]), PASI90 (90% reduction of PASI score from baseline), and absolute PASI score of 1.5 or less. Results A total of 491 patients (171 women and 320 men; mean [SD] age, 45.7 [12.8] years) had 1 or more serum samples (total, 853 samples obtained 0-56 weeks from start of treatment) and 1 or more PASI scores within the first year of treatment. Antidrug antibodies were detected in only 17 of 490 patients (3.5%). Early measured drug levels (1-12 weeks after starting treatment) were associated with PASI75 response 6 months after starting treatment (odds ratio, 1.38; 95% CI, 1.11-1.71) when adjusted for baseline PASI score, age, and ustekinumab dose. However, this finding was not consistent across the other PASI outcomes (PASI90 and PASI score of ≤1.5). Conclusions and Relevance This real-world study provides evidence that measurement of early serum ustekinumab levels could be useful to direct the treatment strategy for psoriasis. Adequate drug exposure early in the treatment cycle may be particularly important in determining clinical outcome.
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Affiliation(s)
- Teresa Tsakok
- St John's Institute of Dermatology, School of Basic & Medical Biosciences, Faculty of Life Sciences & Medicine, King's College London, London, United Kingdom.,St John's Institute of Dermatology, Guy's and St Thomas' National Health Service Foundation Trust, London, United Kingdom
| | - Nina Wilson
- Institute of Health and Society, Faculty of Medical Sciences, Newcastle University, Newcastle-upon-Tyne, United Kingdom
| | - Nick Dand
- Department of Medical and Molecular Genetics, School of Basic & Medical Biosciences, Faculty of Life Sciences & Medicine, King's College London, London, United Kingdom
| | - Floris C Loeff
- Department of Immunopathology, Sanquin Research and Landsteiner Laboratory, Amsterdam, the Netherlands
| | - Karien Bloem
- Biologics Lab, Sanquin Diagnostic Services, Amsterdam, the Netherlands
| | - David Baudry
- St John's Institute of Dermatology, School of Basic & Medical Biosciences, Faculty of Life Sciences & Medicine, King's College London, London, United Kingdom
| | - Michael Duckworth
- St John's Institute of Dermatology, School of Basic & Medical Biosciences, Faculty of Life Sciences & Medicine, King's College London, London, United Kingdom
| | - Shan Pan
- Infection, Immunity, Inflammation Section, University College London Great Ormond Street Institute of Child Health, London, United Kingdom
| | - Angela Pushpa-Rajah
- St John's Institute of Dermatology, School of Basic & Medical Biosciences, Faculty of Life Sciences & Medicine, King's College London, London, United Kingdom
| | - Joseph F Standing
- Infection, Immunity, Inflammation Section, University College London Great Ormond Street Institute of Child Health, London, United Kingdom
| | - Annick de Vries
- Biologics Lab, Sanquin Diagnostic Services, Amsterdam, the Netherlands
| | - Ali Alsharqi
- Department of Dermatology, Royal Liverpool and Broadgreen University Hospital Trust, Liverpool, United Kingdom
| | | | - Ruth Murphy
- Department of Dermatology, Queens Medical Centre, Nottingham University Teaching Hospitals, Nottingham, United Kingdom
| | - Shyamal Wahie
- Department of Dermatology, University Hospital of North Durham, Durham, United Kingdom
| | - Andrew Wright
- Centre for Skin Sciences, University of Bradford, Bradford, United Kingdom
| | - Christopher E M Griffiths
- Dermatology Centre, Salford Royal National Health Service Foundation Trust, Manchester, United Kingdom.,The University of Manchester, Manchester Academic Health Science Centre, National Institute for Health Research Manchester Biomedical Research Centre, Manchester, United Kingdom
| | - Nick J Reynolds
- Dermatology Sciences, Institute of Cellular Medicine, Medical School, Newcastle University, Newcastle upon Tyne, United Kingdom.,Department of Dermatology, Royal Victoria Infirmary, Newcastle Hospitals National Health Service Foundation Trust, Newcastle upon Tyne, United Kingdom
| | - Jonathan Barker
- St John's Institute of Dermatology, School of Basic & Medical Biosciences, Faculty of Life Sciences & Medicine, King's College London, London, United Kingdom.,St John's Institute of Dermatology, Guy's and St Thomas' National Health Service Foundation Trust, London, United Kingdom
| | - Richard B Warren
- Dermatology Centre, Salford Royal National Health Service Foundation Trust, Manchester, United Kingdom
| | - A David Burden
- Institute of Infection, Immunity and Inflammation, University of Glasgow, Glasgow, United Kingdom
| | - Theo Rispens
- Department of Immunopathology, Sanquin Research and Landsteiner Laboratory, Amsterdam, the Netherlands
| | - Deborah Stocken
- Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, United Kingdom
| | - Catherine Smith
- St John's Institute of Dermatology, School of Basic & Medical Biosciences, Faculty of Life Sciences & Medicine, King's College London, London, United Kingdom.,St John's Institute of Dermatology, Guy's and St Thomas' National Health Service Foundation Trust, London, United Kingdom
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Catapano M, Vergnano M, Romano M, Mahil SK, Choon SE, Burden AD, Young HS, Carr IM, Lachmann HJ, Lombardi G, Smith CH, Ciccarelli FD, Barker JN, Capon F. IL-36 Promotes Systemic IFN-I Responses in Severe Forms of Psoriasis. J Invest Dermatol 2019; 140:816-826.e3. [PMID: 31539532 PMCID: PMC7097848 DOI: 10.1016/j.jid.2019.08.444] [Citation(s) in RCA: 56] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Revised: 07/24/2019] [Accepted: 08/06/2019] [Indexed: 12/16/2022]
Abstract
Psoriasis is an immune-mediated skin disorder associated with severe systemic comorbidities. Whereas IL-36 is a key disease driver, the pathogenic role of this cytokine has mainly been investigated in skin. Thus, its effects on systemic immunity and extracutaneous disease manifestations remain poorly understood. To address this issue, we investigated the consequences of excessive IL-36 activity in circulating immune cells. We initially focused our attention on generalized pustular psoriasis (GPP), a clinical variant associated with pervasive upregulation of IL-36 signaling. By undertaking blood and neutrophil RNA sequencing, we demonstrated that affected individuals display a prominent IFN-I signature, which correlates with abnormal IL-36 activity. We then validated the association between IL-36 deregulation and IFN-I over-expression in patients with severe psoriasis vulgaris (PV). We also found that the activation of IFN-I genes was associated with extracutaneous morbidity, in both GPP and PV. Finally, we undertook mechanistic experiments, demonstrating that IL-36 acts directly on plasmacytoid dendritic cells, where it potentiates toll-like receptor (TLR)-9 activation and IFN-α production. This effect was mediated by the upregulation of PLSCR1, a phospholipid scramblase mediating endosomal TLR-9 translocation. These findings identify an IL-36/ IFN-I axis contributing to extracutaneous inflammation in psoriasis.
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Affiliation(s)
- Marika Catapano
- Department of Medical and Molecular Genetics, School of Basic & Medical Biosciences, King's College London, London, United Kingdom
| | - Marta Vergnano
- Department of Medical and Molecular Genetics, School of Basic & Medical Biosciences, King's College London, London, United Kingdom
| | - Marco Romano
- Department of Immunobiology, School of Immunology & Microbial Sciences, King's College London, London, United Kingdom
| | - Satveer K Mahil
- St John's Institute of Dermatology, School of Basic & Medical Biosciences, King's College London, London, United Kingdom
| | - Siew-Eng Choon
- Department of Dermatology, Sultanah Aminah Hospital, Johor Bahru, Malaysia
| | - A David Burden
- Department of Dermatology, University of Glasgow, Glasgow, United Kingdom
| | - Helen S Young
- Division of Musculoskeletal and Dermatological Sciences, University of Manchester, Manchester, United Kingdom
| | - Ian M Carr
- School of Medicine, University of Leeds, Leeds, United Kingdom
| | - Helen J Lachmann
- National Amyloidosis Centre and Centre for Acute Phase Proteins, Division of Medicine, University College London, London, United Kingdom
| | - Giovanna Lombardi
- Department of Immunobiology, School of Immunology & Microbial Sciences, King's College London, London, United Kingdom
| | - Catherine H Smith
- St John's Institute of Dermatology, School of Basic & Medical Biosciences, King's College London, London, United Kingdom
| | - Francesca D Ciccarelli
- Cancer Systems Biology Laboratory, The Francis Crick Institute, London, United Kingdom; School of Cancer & Pharmaceutical Sciences, King's College London, London, United Kingdom
| | - Jonathan N Barker
- St John's Institute of Dermatology, School of Basic & Medical Biosciences, King's College London, London, United Kingdom
| | - Francesca Capon
- Department of Medical and Molecular Genetics, School of Basic & Medical Biosciences, King's College London, London, United Kingdom.
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Mahil SK, Wilson N, Dand N, Reynolds NJ, Griffiths CEM, Emsley R, Marsden A, Evans I, Warren RB, Stocken D, Barker JN, Burden AD, Smith CH. Psoriasis treat to target: defining outcomes in psoriasis using data from a real-world, population-based cohort study (the British Association of Dermatologists Biologics and Immunomodulators Register, BADBIR). Br J Dermatol 2019; 182:1158-1166. [PMID: 31286471 PMCID: PMC7317460 DOI: 10.1111/bjd.18333] [Citation(s) in RCA: 69] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/05/2019] [Indexed: 12/16/2022]
Abstract
Background The ‘treat to target’ paradigm improves outcomes and reduces costs in chronic disease management but is not yet established in psoriasis. Objectives To identify treatment targets in psoriasis using two common measures of disease activity: Psoriasis Area and Severity Index (PASI) and Physician's Global Assessment (PGA). Methods Data from a multicentre longitudinal U.K. cohort of patients with psoriasis receiving systemic or biologic therapies (British Association of Dermatologists Biologics and Immunomodulators Register, BADBIR) were used to identify absolute PASI thresholds for 90% (PASI 90) and 75% (PASI 75) improvements in baseline disease activity, using receiver operating characteristic curves. The relationship between PGA (clear, almost clear, mild, moderate, moderate–severe, severe) and PASI (range 0–72) was described, and the concordance between absolute and relative definitions of response was determined. The same approach was used to establish treatment response and eligibility definitions based on PGA. Results Data from 13 422 patients were available (58% male, 91% white ethnicity, mean age 44·9 years), including over 23 000 longitudinal PASI and PGA scores. An absolute PASI ≤ 2 was concordant with PASI 90 and an absolute PASI ≤ 4 was concordant with PASI 75 in 90% and 88% of cases, respectively. These findings were robust to subgroups of timing of assessment, baseline disease severity and treatment modality. PASI and PGA were strongly correlated (Spearman's rank correlation coefficient 0·92). The median PASI increased from 0 (interquartile range 0–0, range 0–23) to 19 (interquartile range 15–25, range 0–64) for PGA clear to severe, respectively. PGA clear/almost clear was concordant with PASI ≤ 2 in 90% of cases, and PGA moderate–severe severe was concordant with the National Institute for Health and Care Excellence PASI eligibility criteria for biologics in 81% of cases. Conclusions An absolute PASI ≤ 2 and PGA clear/almost clear represent relevant disease end points to inform treat‐to‐target management strategies in psoriasis. What's already known about this topic? The most commonly used relative disease activity measure in psoriasis is ≥ 90% improvement in Psoriasis Area and Severity Index (PASI 90); however, it has several limitations including dependency on a baseline severity assessment. Defining an absolute target disease activity end point in psoriasis has the potential to improve patient outcomes and reduce costs, as demonstrated by treat‐to‐target approaches in other chronic diseases such as hypertension and diabetes. The Physician's Global Assessment (PGA) is a popular alternative measure of psoriasis severity in daily practice; however, its utility has not been formally assessed with respect to PASI.
What does this study add? An absolute PASI ≤ 2 corresponds with PASI 90 response and is a relevant disease end point for treat‐to‐target approaches in psoriasis. There is a strong correlation between PASI and PGA. PGA moderate–severe/severe may serve as an alternative eligibility criterion for biologics to PASI‐based definitions, and PGA clear/almost clear is an appropriate alternative absolute treatment end point.
What are the clinical implications of this work? Absolute PASI ≤ 2 and PGA clear/almost clear represent relevant disease end points to inform treat‐to‐target management strategies in psoriasis.
Linked Editorial: Takeshita. Br J Dermatol 2020; 182:1075–1076.
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Affiliation(s)
- S K Mahil
- St John's Institute of Dermatology, Guy's and St Thomas' NHS Foundation Trust, London, U.K
| | - N Wilson
- Institute of Health and Society, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, U.K
| | - N Dand
- Department of Medical and Molecular Genetics, King's College London, London, U.K
| | - N J Reynolds
- Dermatological Sciences, Institute of Cellular Medicine, Medical School, Newcastle University, Newcastle upon Tyne, U.K.,Department of Dermatology, Royal Victoria Infirmary, Newcastle Hospitals NHS Foundation Trust, Newcastle upon Tyne, U.K
| | - C E M Griffiths
- Dermatology Centre, Salford Royal NHS Foundation Trust, University of Manchester, Manchester Academic Health Science Centre, NIHR Manchester Biomedical Research Centre, Manchester, U.K
| | - R Emsley
- Department of Biostatistics & Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, U.K
| | - A Marsden
- Centre for Biostatistics, School of Health Sciences, University of Manchester, Manchester Academic Health Science Centre, Manchester, U.K
| | - I Evans
- Dermatology Centre, Salford Royal NHS Foundation Trust, University of Manchester, Manchester Academic Health Science Centre, NIHR Manchester Biomedical Research Centre, Manchester, U.K
| | - R B Warren
- Dermatology Centre, Salford Royal NHS Foundation Trust, University of Manchester, Manchester Academic Health Science Centre, NIHR Manchester Biomedical Research Centre, Manchester, U.K
| | - D Stocken
- Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, U.K
| | - J N Barker
- St John's Institute of Dermatology, Guy's and St Thomas' NHS Foundation Trust, London, U.K
| | - A D Burden
- Institute of Infection, Immunity and Inflammation, University of Glasgow, Glasgow, U.K
| | - C H Smith
- St John's Institute of Dermatology, Guy's and St Thomas' NHS Foundation Trust, London, U.K
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40
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Gardner R, Burden AD. How do you determine the optimal biologic treatment for psoriasis? Br J Dermatol 2019; 181:247-248. [PMID: 31318044 DOI: 10.1111/bjd.13593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- R Gardner
- Department of Dermatology, Western Infirmary, Glasgow, G11 6NT, U.K
| | - A D Burden
- Department of Dermatology, Western Infirmary, Glasgow, G11 6NT, U.K
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41
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Dand N, Duckworth M, Baudry D, Russell A, Curtis CJ, Lee SH, Evans I, Mason KJ, Alsharqi A, Becher G, Burden AD, Goodwin RG, McKenna K, Murphy R, Perera GK, Rotarescu R, Wahie S, Wright A, Reynolds NJ, Warren RB, Griffiths CE, Smith CH, Simpson MA, Barker JN, Benham M, Hussain S, Kirby B, Lawson L, McElhone K, Ormerod A, Owen C, Barnes MR, Di Meglio P, Emsley R, Evans A, Payne K, Stocken D. HLA-C*06:02 genotype is a predictive biomarker of biologic treatment response in psoriasis. J Allergy Clin Immunol 2019; 143:2120-2130. [DOI: 10.1016/j.jaci.2018.11.038] [Citation(s) in RCA: 61] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Revised: 11/13/2018] [Accepted: 11/27/2018] [Indexed: 01/28/2023]
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Mason KJ, Barker JNWN, Smith CH, Hampton PJ, Lunt M, McElhone K, Warren RB, Yiu ZZN, Griffiths CEM, Burden AD. Comparison of Drug Discontinuation, Effectiveness, and Safety Between Clinical Trial Eligible and Ineligible Patients in BADBIR. JAMA Dermatol 2019; 154:581-588. [PMID: 29590279 DOI: 10.1001/jamadermatol.2018.0183] [Citation(s) in RCA: 65] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Importance Patients with psoriasis enrolled in clinical trials of biologics may not be representative of the real-world population. There is evidence that patients ineligible for such trials have a greater risk of serious adverse events (SAEs), but the effect on drug discontinuation and effectiveness are unknown. Objective To determine whether (1) drug discontinuation, (2) effectiveness, and (3) rates of SAEs differ in patients with psoriasis categorized as eligible or ineligible for clinical trials. Design, Setting, and Participants An observational study using 157 dermatology centers in the United Kingdom and Republic of Ireland was carried out wherein we applied the eligibility criteria of clinical trials of biologic therapies for psoriasis to patients who were being followed up in the British Association of Dermatologists Biologic Interventions Register (BADBIR) and being prescribed biologics as part of standard clinical care. Patients with psoriasis registered to BADBIR who were taking etanercept (enbrel only; n = 1509), adalimumab (n = 4000), and ustekinumab (n = 1627) with at least 1 follow-up visit. Eligibility criteria were extracted from phase 3 licensing trials for etanercept, adalimumab, and ustekinumab for the treatment of moderate to severe psoriasis. Patients in BADBIR with a missing baseline Psoriasis Area and Severity Index (PASI) or baseline PASI value less than 10 (etanercept) or less than 12 (adalimumab; ustekinumab) but who would otherwise be eligible were investigated separately. Eligibility categories applied to BADBIR included: eligible, ineligible, insufficient baseline PASI only, and missing baseline PASI only. Main Outcomes and Measures (1) Drug discontinuation: cumulative incidence at 12 months by stop reason per eligibility category and drug; (2) effectiveness: linear regression of absolute change in PASI from baseline to 6 and 12 months; and (3) SAEs: incidence rate ratio (IRR) at 12 months between eligibility categories per drug. Results The mean (SD) age of the 7136 patients included in the analysis was 45 (13) years and 2924 (41%) were women and 4212 (59%) were men. Of 7136 patients, 839 (56%) etanercept, 2219 (56%) adalimumab, and 754 (46%) ustekinumab registrations were categorized as eligible. The most common reasons for ineligibility were diabetes (etanercept, 143 [9%]; ustekinumab, 201 [12%]) and nonchronic plaque psoriasis (adalimumab, 157 [4%]). Patients categorized as ineligible (etanercept, 367 [24%]; adalimumab, 282 [7%]; ustekinumab, 394 [24%]) achieved a smaller absolute change in PASI after 6 and 12 months (adalimumab, ustekinumab), and had significantly higher rates of SAEs compared with the eligible category (etanercept: IRR, 1.9; 95% CI, 1.4-2.6; adalimumab: IRR, 2.0; 95% CI, 1.5-2.6; ustekinumab: IRR, 2.8; 95% CI, 2.1-3.8). No significant differences in drug discontinuation were observed between categories. Conclusions and Relevance Clinical trial effectiveness and safety outcomes are not representative of real-world patients in BADBIR patients categorized as ineligible for such trials.
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Affiliation(s)
- Kayleigh J Mason
- Division of Musculoskeletal and Dermatological Sciences, The University of Manchester, Manchester, United Kingdom
| | - Jonathan N W N Barker
- St John's Institute of Dermatology, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Catherine H Smith
- St John's Institute of Dermatology, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Philip J Hampton
- Newcastle Dermatology, Newcastle Hospitals NHS Trust, Newcastle upon Tyne, United Kingdom
| | - Mark Lunt
- Division of Musculoskeletal and Dermatological Sciences, The University of Manchester, Manchester, United Kingdom
| | - Kathleen McElhone
- Division of Musculoskeletal and Dermatological Sciences, The University of Manchester, Manchester, United Kingdom
| | - Richard B Warren
- Division of Musculoskeletal and Dermatological Sciences, The University of Manchester, Manchester, United Kingdom.,Dermatology Centre, Salford Royal NHS Foundation Trust, Manchester, United Kingdom
| | - Zenas Z N Yiu
- Dermatology Centre, Salford Royal NHS Foundation Trust, Manchester, United Kingdom.,Centre for Pharmacoepidemiology and Drug Safety, The University of Manchester, Manchester, United Kingdom
| | - Christopher E M Griffiths
- Division of Musculoskeletal and Dermatological Sciences, The University of Manchester, Manchester, United Kingdom.,Dermatology Centre, Salford Royal NHS Foundation Trust, Manchester, United Kingdom
| | - A David Burden
- Department of Dermatology, Royal Infirmary of Edinburgh, Edinburgh, United Kingdom
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Mrowietz U, Bachelez H, Burden AD, Rissler M, Sieder C, Orsenigo R, Chaouche-Teyara K. Secukinumab for moderate-to-severe palmoplantar pustular psoriasis: Results of the 2PRECISE study. J Am Acad Dermatol 2019; 80:1344-1352. [DOI: 10.1016/j.jaad.2019.01.066] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2018] [Revised: 01/24/2019] [Accepted: 01/27/2019] [Indexed: 02/08/2023]
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Bachelez H, Choon SE, Marrakchi S, Burden AD, Tsai TF, Morita A, Turki H, Hall DB, Shear M, Baum P, Padula SJ, Thoma C. Inhibition of the Interleukin-36 Pathway for the Treatment of Generalized Pustular Psoriasis. N Engl J Med 2019; 380:981-983. [PMID: 30855749 DOI: 10.1056/nejmc1811317] [Citation(s) in RCA: 180] [Impact Index Per Article: 36.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Hervé Bachelez
- Sorbonne Paris Cité Université Paris Diderot, Paris, France
| | | | | | | | | | | | | | - David B Hall
- Boehringer Ingelheim Pharmaceuticals, Ridgefield, CT
| | - Michael Shear
- Boehringer Ingelheim International, Biberach, Germany
| | - Patrick Baum
- Boehringer Ingelheim International, Biberach, Germany
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45
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Wilkinson N, Tsakok T, Dand N, Bloem K, Duckworth M, Baudry D, Pushpa-Rajah A, Griffiths CEM, Reynolds NJ, Barker J, Warren RB, Burden AD, Rispens T, Stocken D, Smith C. Defining the Therapeutic Range for Adalimumab and Predicting Response in Psoriasis: A Multicenter Prospective Observational Cohort Study. J Invest Dermatol 2019; 139:115-123. [PMID: 30130616 PMCID: PMC6300405 DOI: 10.1016/j.jid.2018.07.028] [Citation(s) in RCA: 49] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Revised: 06/28/2018] [Accepted: 07/15/2018] [Indexed: 12/21/2022]
Abstract
Biologics have transformed management of inflammatory diseases. To optimize outcomes and reduce costs, dose adjustment informed by circulating drug levels has been proposed. We aimed to determine the real-world clinical utility of therapeutic drug monitoring in psoriasis. Within a multicenter (n = 60) prospective observational cohort, 544 psoriasis patients were included who were receiving adalimumab monotherapy and had at least one serum sample and Psoriasis Area and Severity Index (PASI) score available within the first year. We present models giving individualized probabilities of response for any given drug level: a minimally effective drug level of 3.2 μg/ml discriminates responders (PASI75 indicates 75% improvement in baseline PASI) from nonresponders, and gives an estimated PASI75 probability of 65% (95% confidence interval = 60-71). At 7 μg/ml, PASI75 probability is 81% (95% CI = 76-86); beyond 7 μg/ml, the drug level/response curve plateaus. Crucially, drug levels are predictive of response 6 months later, whether sampled early or at steady state. We confirm serum drug level to be the most important factor determining treatment response, highlighting the need to take drug levels into account when searching for biomarkers of response. This real-world study with pragmatic drug level sampling provides evidence to support the proactive measurement of adalimumab levels in psoriasis to direct treatment strategy, and is relevant to other inflammatory diseases.
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Key Words
- ada, anti-drug antibody
- badbir, british association of dermatologists biologic interventions registry
- bstop, biomarkers of systemic treatment outcomes in psoriasis
- ci, confidence interval
- ibd, inflammatory bowel disease
- imid, immune-mediated inflammatory disease
- pasi, psoriasis area and severity index
- pasi75, 75% improvement in baseline psoriasis area and severity index
- pasi90, 90% improvement in baseline psoriasis area and severity index
- ra, rheumatoid arthritis
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Affiliation(s)
- Nina Wilkinson
- Institute of Health and Society, Faculty of Medical Sciences, Newcastle University, Newcastle-upon-Tyne, UK
| | - Teresa Tsakok
- St John's Institute of Dermatology, School of Basic and Medical Biosciences, Faculty of Life Sciences and Medicine, King's College London, London, UK; St. John's Institute of Dermatology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Nick Dand
- St John's Institute of Dermatology, School of Basic and Medical Biosciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - Karien Bloem
- Department of Immunopathology, Sanquin Research and Landsteiner Laboratory, Amsterdam, The Netherlands
| | - Michael Duckworth
- St John's Institute of Dermatology, School of Basic and Medical Biosciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - David Baudry
- St John's Institute of Dermatology, School of Basic and Medical Biosciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - Angela Pushpa-Rajah
- St John's Institute of Dermatology, School of Basic and Medical Biosciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - Christopher E M Griffiths
- Dermatology Centre, Salford Royal NHS Foundation Trust, The University of Manchester, Manchester Academic Health Science Centre, NIHR Manchester Biomedical Research Centre, Manchester, UK
| | - Nick J Reynolds
- Dermatological Sciences, Institute of Cellular Medicine, Medical School, Newcastle University, and Department of Dermatology, Royal Victoria Infirmary, Newcastle Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Jonathan Barker
- St John's Institute of Dermatology, School of Basic and Medical Biosciences, Faculty of Life Sciences and Medicine, King's College London, London, UK; St. John's Institute of Dermatology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Richard B Warren
- Dermatology Centre, Salford Royal NHS Foundation Trust, The University of Manchester, Manchester Academic Health Science Centre, NIHR Manchester Biomedical Research Centre, Manchester, UK
| | - A David Burden
- Institute of Infection, Immunity and Inflammation, University of Glasgow, UK
| | - Theo Rispens
- Department of Immunopathology, Sanquin Research and Landsteiner Laboratory, Amsterdam, The Netherlands
| | - Deborah Stocken
- Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | - Catherine Smith
- St John's Institute of Dermatology, School of Basic and Medical Biosciences, Faculty of Life Sciences and Medicine, King's College London, London, UK; St. John's Institute of Dermatology, Guy's and St Thomas' NHS Foundation Trust, London, UK.
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46
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Petridis C, Navarini AA, Dand N, Saklatvala J, Baudry D, Duckworth M, Allen MH, Curtis CJ, Lee SH, Burden AD, Layton A, Bataille V, Pink AE, Carlavan I, Voegel JJ, Spector TD, Trembath RC, McGrath JA, Smith CH, Barker JN, Simpson MA. Genome-wide meta-analysis implicates mediators of hair follicle development and morphogenesis in risk for severe acne. Nat Commun 2018; 9:5075. [PMID: 30542056 PMCID: PMC6290788 DOI: 10.1038/s41467-018-07459-5] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2018] [Accepted: 10/26/2018] [Indexed: 12/21/2022] Open
Abstract
Acne vulgaris is a highly heritable common, chronic inflammatory disease of the skin for which five genetic risk loci have so far been identified. Here, we perform a genome-wide association study of 3823 cases and 16,144 controls followed by meta-analysis with summary statistics from a previous study, with a total sample size of 26,722. We identify 20 independent association signals at 15 risk loci, 12 of which have not been previously implicated in the disease. Likely causal variants disrupt the coding region of WNT10A and a P63 transcription factor binding site in SEMA4B. Risk alleles at the 1q25 locus are associated with increased expression of LAMC2, in which biallelic loss-of-function mutations cause the blistering skin disease epidermolysis bullosa. These findings indicate that variation affecting the structure and maintenance of the skin, in particular the pilosebaceous unit, is a critical aspect of the genetic predisposition to severe acne. Acne vulgaris is a chronic inflammation of the skin, the genetic basis of which is incompletely understood. Here, Petridis et al. perform GWAS and meta-analysis for acne in 26,722 individuals and identify 12 novel risk loci that implicate structure and maintenance of the skin in severe acne risk.
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Affiliation(s)
- Christos Petridis
- Department of Medical and Molecular Genetics, School of Basic & Medical Biosciences, King's College London, London, SE1 9RT, UK
| | - Alexander A Navarini
- Department of Medical and Molecular Genetics, School of Basic & Medical Biosciences, King's College London, London, SE1 9RT, UK.,Departement of Dermatology, University Hospital of Zurich and University of Zurich, CH-8091, Zurich, Switzerland
| | - Nick Dand
- Department of Medical and Molecular Genetics, School of Basic & Medical Biosciences, King's College London, London, SE1 9RT, UK
| | - Jake Saklatvala
- Department of Medical and Molecular Genetics, School of Basic & Medical Biosciences, King's College London, London, SE1 9RT, UK
| | - David Baudry
- St John's Institute of Dermatology, School of Basic & Medical Biosciences, King's College London, London, SE1 9RT, UK
| | - Michael Duckworth
- St John's Institute of Dermatology, School of Basic & Medical Biosciences, King's College London, London, SE1 9RT, UK
| | - Michael H Allen
- St John's Institute of Dermatology, School of Basic & Medical Biosciences, King's College London, London, SE1 9RT, UK
| | - Charles J Curtis
- NIHR Maudsley Biomedical Research Centre (BRC) at South London and Maudsley NHS Foundation Trust (SLaM) & Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, London, SE5 8AF, UK.,Social Genetic & Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, London, SE5 8AF, UK
| | - Sang Hyuck Lee
- NIHR Maudsley Biomedical Research Centre (BRC) at South London and Maudsley NHS Foundation Trust (SLaM) & Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, London, SE5 8AF, UK.,Social Genetic & Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, London, SE5 8AF, UK
| | - A David Burden
- Institute of Infection, Immunity and Inflammation, University of Glasgow, Glasgow, G12 8TA, UK
| | - Alison Layton
- Department of Dermatology, Harrogate and District Foundation Trust, Harrogate, HG2 7SX, UK
| | - Veronique Bataille
- Twin Research and Genetic Epidemiology Unit, School of Basic & Medical Biosciences, King's College London, London, SE1 7EH, UK
| | - Andrew E Pink
- St John's Institute of Dermatology, School of Basic & Medical Biosciences, King's College London, London, SE1 9RT, UK
| | | | - Isabelle Carlavan
- Research Department, Galderma R&D, Sophia Antipolis, 06410 Biot, France
| | - Johannes J Voegel
- Research Department, Galderma R&D, Sophia Antipolis, 06410 Biot, France
| | - Timothy D Spector
- Twin Research and Genetic Epidemiology Unit, School of Basic & Medical Biosciences, King's College London, London, SE1 7EH, UK
| | - Richard C Trembath
- Department of Medical and Molecular Genetics, School of Basic & Medical Biosciences, King's College London, London, SE1 9RT, UK
| | - John A McGrath
- St John's Institute of Dermatology, School of Basic & Medical Biosciences, King's College London, London, SE1 9RT, UK
| | - Catherine H Smith
- St John's Institute of Dermatology, School of Basic & Medical Biosciences, King's College London, London, SE1 9RT, UK
| | - Jonathan N Barker
- St John's Institute of Dermatology, School of Basic & Medical Biosciences, King's College London, London, SE1 9RT, UK.
| | - Michael A Simpson
- Department of Medical and Molecular Genetics, School of Basic & Medical Biosciences, King's College London, London, SE1 9RT, UK.
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47
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Warren RB, Marsden A, Tomenson B, Mason KJ, Soliman MM, Burden AD, Reynolds NJ, Stocken D, Emsley R, Griffiths CEM, Smith C. Identifying demographic, social and clinical predictors of biologic therapy effectiveness in psoriasis: a multicentre longitudinal cohort study. Br J Dermatol 2018; 180:1069-1076. [PMID: 30155885 PMCID: PMC6519065 DOI: 10.1111/bjd.16776] [Citation(s) in RCA: 54] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/08/2018] [Indexed: 01/28/2023]
Abstract
Background Biologic therapies have revolutionized the treatment of moderate‐to‐severe psoriasis. However, for reasons largely unknown, many patients do not respond or lose response to these drugs. Objectives To evaluate demographic, social and clinical factors that could be used to predict effectiveness and stratify response to biologic therapies in psoriasis. Methods Using a multicentre, observational, prospective pharmacovigilance study (BADBIR), we identified biologic‐naive patients starting biologics with outcome data at 6 (n = 3079) and 12 (n = 3110) months. Associations between 31 putative predictors and outcomes were investigated in univariate and multivariable regression analyses. Potential stratifiers of treatment response were investigated with statistical interactions. Results Eight factors associated with reduced odds of achieving ≥ 90% improvement in Psoriasis Area and Severity Index (PASI 90) at 6 months were identified (described as odds ratio and 95% confidence interval): demographic (female sex, 0·78, 0·66–0·93); social (unemployment, 0·67, 0·45–0·99); unemployment due to ill health (0·62, 0·48–0·82); ex‐ and current smoking (0·81, 0·66–0·99 and 0·79, 0·63–0·99, respectively); clinical factors (high weight, 0·99, 0·99–0·99); psoriasis of the palms and/or soles (0·75, 0·61–0·91); and presence of small plaques only compared with small and large plaques (0·78, 0·62–0·96). White ethnicity (1·48, 1·12–1·97) and higher baseline PASI (1·04, 1·03–1·04) were associated with increased odds of achieving PASI 90. The findings were largely consistent at 12 months. There was little evidence for predictors of differential treatment response. Conclusions Psoriasis phenotype and potentially modifiable factors are associated with poor outcomes with biologics, underscoring the need for lifestyle management. Effect sizes suggest that these factors alone cannot inform treatment selection. What's already known about this topic? Biologic therapy used in the treatment of moderate‐to‐severe psoriasis differs in its effectiveness across patients. Previous research has indicated that patients with a higher body mass index, who smoke or who have smoked, and with a lower baseline Psoriasis Area and Severity Index (PASI) are less likely to have a good outcome with biologic therapy for the treatment of moderate‐to‐severe psoriasis.
What does this study add? This large‐scale study in a real‐world setting confirms that weight, smoking status and baseline PASI are associated with effectiveness of biologic therapy. There is evidence that non‐white ethnicity, female sex, unemployment, psoriasis of the palms and soles and the presence of small chronic plaques are associated with poor outcomes with biologics. There is some evidence that men have a comparatively worse response to etanercept, relative to adalimumab, than women. Otherwise, most factors do not appear to be predictors of differential treatment response.
Respond to this article
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Affiliation(s)
- R B Warren
- Dermatology Centre, Salford Royal NHS Foundation Trust, The University of Manchester, Manchester Academic Health Science Centre, NIHR Manchester Biomedical Research Centre, Manchester, U.K
| | - A Marsden
- Centre for Biostatistics, School of Health Sciences, The University of Manchester, Manchester Academic Health Science Centre, Manchester, U.K
| | - B Tomenson
- Centre for Biostatistics, School of Health Sciences, The University of Manchester, Manchester Academic Health Science Centre, Manchester, U.K
| | - K J Mason
- Division of Musculoskeletal and Dermatological Sciences, The University of Manchester, Manchester, U.K
| | - M M Soliman
- Department of Pharmacy Practice, Faculty of Pharmacy, Mansoura University, Mansoura, Egypt
| | - A D Burden
- Department of Dermatology, Royal Infirmary of Edinburgh, Edinburgh, U.K
| | - N J Reynolds
- Dermatological Sciences, Institute of Cellular Medicine, Medical School, Newcastle University, NIHR Newcastle Biomedical Research Centre and Department of Dermatology, Royal Victoria Infirmary, Newcastle Hospitals NHS Foundation Trust, Newcastle upon Tyne, U.K
| | - D Stocken
- Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, U.K
| | - R Emsley
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, U.K
| | - C E M Griffiths
- Dermatology Centre, Salford Royal NHS Foundation Trust, The University of Manchester, Manchester Academic Health Science Centre, NIHR Manchester Biomedical Research Centre, Manchester, U.K
| | - C Smith
- St John's Institute of Dermatology, Guy's and St Thomas' NHS Foundation Trust, London, U.K
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48
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Smith CH, Jabbar-Lopez ZK, Yiu ZZ, Bale T, Burden AD, Coates LC, Cruickshank M, Hadoke T, MacMahon E, Murphy R, Nelson-Piercy C, Owen CM, Parslew R, Peleva E, Pottinger E, Samarasekera EJ, Stoddart J, Strudwicke C, Venning VA, Warren RB, Exton LS, Mohd Mustapa MF. British Association of Dermatologists guidelines for biologic therapy for psoriasis 2017. Br J Dermatol 2018; 177:628-636. [PMID: 28513835 DOI: 10.1111/bjd.15665] [Citation(s) in RCA: 162] [Impact Index Per Article: 27.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/29/2017] [Indexed: 01/17/2023]
Affiliation(s)
- C H Smith
- St John's Institute of Dermatology, Guy's and St Thomas' NHS Foundation Trust, London, SE1 9RT, U.K
| | - Z K Jabbar-Lopez
- St John's Institute of Dermatology, Guy's and St Thomas' NHS Foundation Trust, London, SE1 9RT, U.K
| | - Z Z Yiu
- The Dermatology Centre, Salford Royal NHS Foundation Trust, The University of Manchester, Manchester Academic Health Science Centre, Manchester, M13 9NT, U.K
| | - T Bale
- British Dermatology Nursing Group representative, Aneurin Bevan Health Board, Wales, U.K
| | - A D Burden
- Department of Dermatology, Royal Infirmary of Edinburgh, Edinburgh, EH3 9HA, U.K
| | - L C Coates
- British Society for Rheumatology, Chapel Allerton Hospital, Leeds, LS7 4SA, U.K.,Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, OX3 7LD, U.K
| | - M Cruickshank
- National Guideline Centre, Royal College of Physicians, London, NW1 4LE, U.K
| | | | - E MacMahon
- Department of Infectious Diseases, Guy's and St Thomas' NHS Foundation Trust, London, SE1 9RT, U.K
| | - R Murphy
- Department of Dermatology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, S10 2JF, U.K
| | - C Nelson-Piercy
- Women's Health Academic Centre, Guy's and St Thomas' NHS Foundation Trust, London, SE1 9RT, U.K
| | - C M Owen
- Department of Dermatology, East Lancashire Hospitals NHS Trust, Burnley, BB10 2PQ, U.K
| | - R Parslew
- Department of Dermatology, Royal Liverpool and Broadgreen University Hospitals NHS Trust, Liverpool, L7 8XP, U.K
| | - E Peleva
- St John's Institute of Dermatology, Guy's and St Thomas' NHS Foundation Trust, London, SE1 9RT, U.K
| | - E Pottinger
- National Guideline Centre, Royal College of Physicians, London, NW1 4LE, U.K
| | - E J Samarasekera
- National Guideline Centre, Royal College of Physicians, London, NW1 4LE, U.K
| | - J Stoddart
- Independent chair, Healthcare Quality Improvement Partnership, London, EC2Y 9AE, U.K
| | | | - V A Venning
- Department of Dermatology, Oxford University Hospitals NHS Foundation Trust, Oxford, OX3 7LE, U.K
| | - R B Warren
- The Dermatology Centre, Salford Royal NHS Foundation Trust, The University of Manchester, Manchester Academic Health Science Centre, Manchester, M13 9NT, U.K
| | - L S Exton
- British Association of Dermatologists, London, W1T 5HQ, U.K
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Shams K, Kurowska-Stolarska M, Schütte F, Burden AD, McKimmie CS, Graham GJ. MicroRNA-146 and cell trauma down-regulate expression of the psoriasis-associated atypical chemokine receptor ACKR2. J Biol Chem 2017; 293:3003-3012. [PMID: 29279330 PMCID: PMC5827444 DOI: 10.1074/jbc.m117.809780] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [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: 08/01/2017] [Revised: 12/11/2017] [Indexed: 11/30/2022] Open
Abstract
Chemokines are the principal regulators of leukocyte migration and are essential for initiation and maintenance of inflammation. Atypical chemokine receptor 2 (ACKR2) binds and scavenges proinflammatory CC-chemokines, regulates cutaneous T-cell positioning, and limits the spread of inflammation in vivo. Altered ACKR2 function has been implicated in several inflammatory disorders, including psoriasis, a common and debilitating T-cell–driven disorder characterized by thick erythematous skin plaques. ACKR2 expression is abnormal in psoriatic skin, with decreased expression correlating with recruitment of T-cells into the epidermis and increased inflammation. However, the molecular mechanisms that govern ACKR2 expression are not known. Here, we identified specific psoriasis-associated microRNAs (miRs) that bind ACKR2, inhibit its expression, and are active in primary cultures of human cutaneous cells. Using both in silico and in vitro approaches, we show that miR-146b and miR-10b directly bind the ACKR2 3′-UTR and reduce expression of ACKR2 transcripts and protein in keratinocytes and lymphatic endothelial cells, respectively. Moreover, we demonstrate that ACKR2 expression is further down-regulated upon cell trauma, an important trigger for the development of new plaques in many psoriasis patients (the Koebner phenomenon). We found that tensile cell stress leads to rapid ACKR2 down-regulation and concurrent miR-146b up-regulation. Together, we provide, for the first time, evidence for epigenetic regulation of an atypical chemokine receptor. We propose a mechanism by which cell trauma and miRs coordinately exacerbate inflammation via down-regulation of ACKR2 expression and provide a putative mechanistic explanation for the Koebner phenomenon in psoriasis.
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Affiliation(s)
- Kave Shams
- Skin Research Group, Leeds Institute of Rheumatic and Musculoskeletal Medicine, National Institute for Health Research Biomedical Research Centre; Department of Dermatology, Chapel Allerton Hospital, Leeds LS7 4SA, United Kingdom; Chemokine Research Group
| | - Mariola Kurowska-Stolarska
- Institute of Infection, Immunity and Inflammation, 120 University Place, University of Glasgow, Glasgow G12 8TA, Scotland, United Kingdom
| | | | - A David Burden
- Institute of Infection, Immunity and Inflammation, 120 University Place, University of Glasgow, Glasgow G12 8TA, Scotland, United Kingdom; Department of Dermatology, Lauriston Building, Edinburgh EH3 9HA, Scotland, United Kingdom
| | - Clive S McKimmie
- Chemokine Research Group; Virus Host Interaction Team, Leeds Institute of Cancer and Pathology, University of Leeds, St. James' University Hospital, Leeds LS9 7TF, United Kingdom
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50
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Pottinger E, Woolf RT, Exton LS, Burden AD, Nelson-Piercy C, Smith CH. Exposure to biological therapies during conception and pregnancy: a systematic review. Br J Dermatol 2017; 178:95-102. [PMID: 28718898 DOI: 10.1111/bjd.15802] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/05/2017] [Indexed: 01/05/2023]
Abstract
BACKGROUND Biological therapies are effective treatments for psoriasis and are often prescribed to women of child-bearing age. OBJECTIVES To evaluate the safety of biological therapy in conception and/or pregnancy. METHODS We performed a systematic review of PubMed, MEDLINE, Embase and Cochrane databases for multivariate-adjusted studies of women exposed to biologics relevant to the treatment of psoriasis during conception and/or pregnancy. RESULTS We identified four population-based cohort studies involving 1300 women exposed to tumour necrosis factor (TNF)-α inhibitors (TNFi) 3 months prior to or during the first 3 months of pregnancy. These studies showed a trend towards drug-specific harm with TNFi exposure in women with different inflammatory diseases, with an increased risk of congenital malformations [three studies; odds ratio (OR) range 1·32-1·64] and preterm birth (one study; OR 1·69, 95% confidence interval 1·10-2·60). This trend did not reach statistical significance in all studies; study heterogeneity, variation across comparator cohorts, inadequate adjustment for important confounding variables such as co-therapy, and an absence of a common constellation of malformations means there is uncertainty about the causal role of TNFi. No studies specifically addressed the effect of TNFi exposure in psoriasis during conception and/or pregnancy, or of interleukin (IL)-17 and IL-12/23 antagonists in any indication. CONCLUSIONS When counselling women these findings must be balanced against the potential impact of untreated severe psoriasis on conception and/or pregnancy and maternal wellbeing; ongoing pharmacovigilance via registries remains essential to address this evidence gap.
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Affiliation(s)
- E Pottinger
- National Guideline Centre, Royal College of Physicians, London, U.K
| | - R T Woolf
- St John's Institute of Dermatology, Division of Genetics and Molecular Medicine, 9th Floor Tower Wing, King's College London, Guy's Hospital, Great Maze Pond, London, SE1 9RT, U.K
| | - L S Exton
- British Association of Dermatologists, London, U.K
| | - A D Burden
- Department of Dermatology, Royal Infirmary of Edinburgh, Edinburgh, U.K
| | - C Nelson-Piercy
- Women's Health Academic Centre, Guy's & St Thomas' NHS Foundation Trust, St Thomas' Hospital, London, U.K
| | - C H Smith
- St John's Institute of Dermatology, Division of Genetics and Molecular Medicine, 9th Floor Tower Wing, King's College London, Guy's Hospital, Great Maze Pond, London, SE1 9RT, U.K
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