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Renert-Yuval Y, Ezzedine K, Grimes P, Rosmarin D, Eichenfield LF, Castelo-Soccio L, Huang V, Desai SR, Walsh S, Silverberg JI, Paller AS, Rodrigues M, Weingarten M, Narla S, Gardner J, Siegel M, Ibad S, Silverberg NB. Expert Recommendations on Use of Topical Therapeutics for Vitiligo in Pediatric, Adolescent, and Young Adult Patients. JAMA Dermatol 2024; 160:453-461. [PMID: 38477910 DOI: 10.1001/jamadermatol.2024.0021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/14/2024]
Abstract
Importance Evidence-based recommendations for the treatment of vitiligo in pediatric, adolescent, and young adult patients in the US are needed. Objective To develop evidence- and consensus-based expert recommendations on the diagnosis and treatment of vitiligo in young patients. Evidence Review A process was developed to produce consensus recommendations addressing questions regarding pediatric vitiligo. A librarian-conducted literature review was performed using articles that met the inclusion criteria: published in English, containing primary data (including meta-analysis) and pediatric-specific data, and analysis of 6 or more patients. Included articles were graded by the Strength of Recommendation Taxonomy criteria and Oxford Centre for Evidence-based Medicine's Levels of Evidence and Grades of Recommendation. Research questions were reviewed on May 9, 2022, through a video conference. One month after the conference, participants participated in an online survey documenting their level of agreement with the generated statements, using a 5-point Likert scale. Findings Articles on topical corticosteroids and/or topical calcineurin inhibitors (n = 50), topical Janus kinase inhibitors (n = 5), pseudocatalase (n = 2), and microdermabrasion (n = 2) met inclusion criteria. Forty-two recommendations were made on the diagnosis of vitiligo and optimal topical therapeutics, with 33 recommendations obtaining a 70% or greater composite agreement and strong agreement. Topical calcineurin inhibitors twice daily, topical corticosteroids with time limitation due to atrophy risk, and topical ruxolitinib, 1.5%, cream-used off-label for patients younger than 12 years and limited to nonsegmental vitiligo-were identified as evidence-based first-line therapies in the management of pediatric and adolescent patients, with specific guidance on age-based data, minimum therapeutic trial of 6 months or greater, prolonged therapy to prevent recurrence, and the positive benefit of coordinated use of UV therapeutic sources. Conclusions and Relevance Evidence supports the use of topical calcineurin inhibitors, topical corticosteroids, and topical Janus kinase inhibitors as effective therapeutics for vitiligo in pediatric, adolescent, and young adult patients, with specific decisions on choice of agent based on factors such as site location, body surface area, and age.
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Affiliation(s)
- Yael Renert-Yuval
- Department of Dermatology and Pediatrics, Icahn School of Medicine at Mount Sinai, New York, New York
- Pediatric Dermatology Unit, Schneider Children's Medical Center of Israel, Petah Tikva, Israel, and Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Khaled Ezzedine
- Hôpital Henri Mondor, Department of Dermatology and Université Paris Est Créteil, Epidemiology in Dermatology and Evaluation of Therapeutics, Créteil, France
| | - Pearl Grimes
- Departments of Dermatology, University of California, Los Angeles
| | - David Rosmarin
- Department of Dermatology, Indiana University School of Medicine, Indianapolis
| | - Lawrence F Eichenfield
- Dermatology and Pediatrics, University of California, San Diego School of Medicine, San Diego
- Pediatrics and Adolescent Dermatology, Rady Children's Hospital, San Diego, California
| | - Leslie Castelo-Soccio
- National Institute of Arthritis and Musculoskeletal and Skin Diseases, US National Institutes of Health, Bethesda, Maryland
| | - Victor Huang
- Department of Dermatology, University of California, Davis
| | - Seemal R Desai
- Department of Dermatology, The University of Texas Southwestern Medical Center, Dallas
- Innovative Dermatology, Plano, Texas
| | | | | | - Amy S Paller
- Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Michele Rodrigues
- Department of Dermatology, The Royal Children's Hospital, Parkville, Victoria, Australia
| | - Mark Weingarten
- Department of Dermatology and Pediatrics, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Shanthi Narla
- Department of Dermatology, St Luke's University Health Network, Easton, Pennsylvania
| | | | - Michael Siegel
- Pediatric Dermatology Research Alliance, Portland, Oregon
| | - Sidra Ibad
- Department of Dermatology and Pediatrics, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Nanette B Silverberg
- Department of Dermatology and Pediatrics, Icahn School of Medicine at Mount Sinai, New York, New York
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Gordon KB, Langley RG, Warren RB, Okubo Y, Rosmarin D, Lebwohl M, Peterson L, Madden C, de Cuyper D, Davies O, Thaçi D. Bimekizumab safety in patients with moderate-to-severe plaque psoriasis: pooled data from up to 3 years of treatment in randomized phase III trials. Br J Dermatol 2024; 190:477-485. [PMID: 37950894 DOI: 10.1093/bjd/ljad429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Revised: 10/16/2023] [Accepted: 10/29/2023] [Indexed: 11/13/2023]
Abstract
BACKGROUND Patients with psoriasis require long-term management; therefore, understanding the long-term safety of new treatments, such as bimekizumab (BKZ), is crucial. OBJECTIVES To evaluate BKZ's 3-year safety profile in patients with moderate-to-severe plaque psoriasis. METHODS Three years of safety data were pooled from three phase III trials (BE VIVID, BE READY and BE SURE) and their ongoing open-label extension (BE BRIGHT). Treatment-emergent adverse events (TEAEs) are reported using exposure-adjusted incidence rates (EAIRs) per 100 patient-years (PY). RESULTS In total, 1495 patients received at least one BKZ dose; total BKZ exposure was 3876.4 PY. The overall EAIR of TEAEs was 175.5/100 PY and decreased with longer exposure to BKZ. The most commonly reported TEAEs were nasopharyngitis, oral candidiasis and upper respiratory tract infection (EAIRs of 15.0/100 PY, 10.1/100 PY and 6.5/100 PY, respectively); 99.3% of oral candidiasis events were mild or moderate in severity, none were serious and few led to discontinuation. EAIRs of other TEAEs of interest were low, including serious infections (1.2/100 PY), adjudicated inflammatory bowel disease (0.2/100 PY) and laboratory elevations in aspartate aminotransferase or alanine aminotransferase (> 5 × upper limit of normal: 0.6/100 PY). CONCLUSIONS In these analyses pooled across 3 years, no new safety signals were observed with longer exposure to BKZ. The vast majority of oral candidiasis events were mild or moderate in severity, as reported previously.
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Affiliation(s)
| | | | - Richard B Warren
- Dermatology Centre, Northern Care Alliance NHS Foundation Trust, Manchester, UK
- NIHR Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | | | - David Rosmarin
- Indiana University School of Medicine, Indianapolis, IN, USA
| | - Mark Lebwohl
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | | | | | | | | | - Diamant Thaçi
- Institute and Comprehensive Center for Inflammation Medicine, University of Lübeck, Lübeck, Germany
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Robinson SN, Kranseler JS, Rosmarin D. Treatment of palmoplantar keratoderma in a patient with ichthyosis with topical tapinarof. JAAD Case Rep 2024; 45:66-67. [PMID: 38389856 PMCID: PMC10882012 DOI: 10.1016/j.jdcr.2024.01.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/24/2024] Open
Affiliation(s)
- Sarah N Robinson
- Department of Dermatology, Tufts Medical Center, Tufts University School of Medicine, Boston, Massachusetts
| | - Julie S Kranseler
- Department of Dermatology, Tufts Medical Center, Tufts University School of Medicine, Boston, Massachusetts
| | - David Rosmarin
- Department of Dermatology, Indiana University School of Medicine, Indianapolis, Indiana
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Yosipovitch G, Lio PA, Rosmarin D, Serra-Baldrich E, Legat FJ, Casillas M, Pierce E, Liu Z, Sun L, Elmaraghy H, Ständer S. Lebrikizumab improved itch and reduced the extent of itch interference on sleep in patients with moderate-to-severe atopic dermatitis: two randomized, placebo-controlled, phase III trials. Br J Dermatol 2024; 190:289-291. [PMID: 37939793 DOI: 10.1093/bjd/ljad435] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2023] [Revised: 10/24/2023] [Accepted: 10/29/2023] [Indexed: 11/10/2023]
Abstract
Itch and sleep loss due to itch are prevalent symptoms of moderate-to-severe atopic dermatitis, significantly impairing patients’ quality of life and wellbeing. First-line topical therapy is insufficient for most patients and there is an unmet need for effective treatments that provide symptom relief and quality of life improvement. In two randomized, placebo-controlled, phase III trials, significantly more patients treated with the novel monoclonal antibody lebrikizumab had ≥ 3-point improvement in Pruritus Numeric Rating Scale by week 16 vs. patients treated with placebo. In addition, significantly more patients treated with lebrikizumab achieved ≥ 1-point improvement in Sleep-Loss Scale score by week 16 vs. placebo. Onset of itch relief was rapid, occurring within the first few days of treatment.
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Affiliation(s)
- Gil Yosipovitch
- University of Miami Miller School of Medicine, Miami, FL , USA
| | - Peter A Lio
- Northwestern University Feinberg School of Medicine, Chicago, IL , USA
- Medical Dermatology Associates of Chicago, Chicago, IL , USA
| | | | | | | | | | | | - Zhuqing Liu
- Eli Lilly and Company, Indianapolis, IN , USA
| | - Luna Sun
- Eli Lilly and Company, Indianapolis, IN , USA
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5
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Marin Dit Bertoud Q, Bertold C, Ezzedine K, Pandya AG, Cherel M, Castillo Martinez A, Seguy MA, Abdallah M, Bae JM, Böhm M, Parsad D, Rosmarin D, Wolkerstorfer A, Bahadoran P, Blaise M, Dugourd PM, Philippo V, Delaval JM, Passeron T. Reliability and agreement testing of a new automated measurement method to determine facial vitiligo extent using standardized ultraviolet images and a dedicated algorithm. Br J Dermatol 2023; 190:62-69. [PMID: 37615581 DOI: 10.1093/bjd/ljad304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 08/08/2023] [Accepted: 08/17/2023] [Indexed: 08/25/2023]
Abstract
BACKGROUND Facial repigmentation is the primary outcome measure for most vitiligo trials. The Facial Vitiligo Area Scoring Index (F-VASI) score is often chosen as the primary outcome measure to assess the efficacy of treatments for facial vitiligo. Although useful, this scoring system remains subjective and has several limitations. OBJECTIVES To assess the agreement and reliability of an algorithmic method to measure the percentage depigmentation of vitiligo on the face. METHODS We developed a dedicated algorithm called Vitil-IA® to assess depigmentation on standardized facial ultraviolet (UV) pictures. We then conducted a cross-sectional study using the framework of the ERASE trial (NCT04843059) in 22 consecutive patients attending a tertiary care centre for vitiligo. Depigmentation was analysed before any treatment and, for 7 of them, after 3 and 6 months of narrowband UVB treatment combined with 16 mg methylprednisolone, both used twice weekly. Interoperator and interacquisition repeatability measures were assessed for the algorithm. The results of the algorithmic measurement were then compared with the F-VASI and the percentage of depigmented skin scores assessed by 13 raters, including 7 experts in the grading of vitiligo lesions. RESULTS Thirty-one sets of pictures were analysed with the algorithmic method. Internal validation showed excellent reproducibility, with a variation of < 3%. The percentage of depigmentation assessed by the system showed high agreement with the percentage of depigmentation assessed by raters [mean error (ME) -11.94 and mean absolute error (MAE) 12.71 for the nonexpert group; ME 0.43 and MAE 5.57 for the expert group]. The intraclass correlation coefficient (ICC) for F-VASI was 0.45 [95% confidence interval (CI) 0.29-0.62] and 0.52 (95% CI 0.37-0.68) for nonexperts and experts, respectively. When the results were analysed separately for homogeneous and heterogeneous depigmentation, the ICC for homogeneous depigmentation was 0.47 (95% CI 0.31-0.77) and 0.85 (95% CI 0.72-0.94) for nonexperts and experts, respectively. When grading heterogeneous depigmentation, the ICC was 0.19 (95% CI 0.05-0.43) and 0.38 (95% CI 0.20-0.62) for nonexperts and experts, respectively. CONCLUSIONS We demonstrated that the Vitil-IA algorithm provides a reliable assessment of facial involvement in vitiligo. The study underlines the limitations of the F-VASI score when performed by nonexperts for homogeneous vitiligo depigmentation, and in all raters when depigmentation is heterogeneous.
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Affiliation(s)
| | - Clémence Bertold
- Université Côte d'Azur, CHU Nice, Department of Dermatology, Nice, France
| | - Khaled Ezzedine
- Department of Dermatology, AP-HP, Henri Mondor University Hospital, Créteil, France
- Université Paris Est (UPEC), EpiDermE Research Unit, Paris, France
| | - Amit G Pandya
- Palo Alto Foundation Medical Group, Sunnyvale, CA, USA
- Department of Dermatology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Marie Cherel
- Newtone Technologies, Research and Development, Lyon, France
| | | | | | - Marwa Abdallah
- Department of Dermatology, Andrology and Venereology, Ain Shams University, Cairo, Egypt
| | - Jung Min Bae
- Department of Dermatology, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Markus Böhm
- Department of Dermatology, University of Münster, Münster, Germany
| | - Davinder Parsad
- Department of Dermatology, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - David Rosmarin
- Department of Dermatology, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Albert Wolkerstorfer
- Department of Dermatology, Netherlands Institute for Pigment Disorders, Amsterdam University Medical Centers, Amsterdam, the Netherlands
| | - Philippe Bahadoran
- Université Côte d'Azur, CHU Nice, Department of Dermatology, Nice, France
| | - Manon Blaise
- Université Côte d'Azur, CHU Nice, Department of Dermatology, Nice, France
| | | | - Valérie Philippo
- Université Côte d'Azur, CHU Nice, Department of Dermatology, Nice, France
| | | | - Thierry Passeron
- Université Côte d'Azur, CHU Nice, Department of Dermatology, Nice, France
- Université Côte d'Azur, INSERM, U1065, C3M, Nice, France
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Lee K, Woodbury MJ, Zundell MP, Aguero R, Yousif J, Williams SC, Rosmarin D, Silverberg N, Thiboutot D, Larocca C, Shinohara MM, Mostaghimi A, Stander S, Martorell A, Jaleel T, Torbeck RL, Siegel DM, Perez-Chada L, Strand V, Armstrong AW, Merola JF, Gottlieb AB. International Dermatology Outcome Measures (IDEOM) - Report from the 2022 Annual Meeting. J Drugs Dermatol 2023; 22:1153-1159. [PMID: 38051841 DOI: 10.36849/jdd.7615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/07/2023]
Abstract
BACKGROUND The International Dermatology Outcome Measures (IDEOM) is a non-profit organization dedicated to the advancement of evidence-based, consensus-driven outcome measures in dermatological diseases. Researchers and stakeholders from various backgrounds collaborate to develop these objective benchmark metrics to further advance treatment and management of dermatological conditions. SUMMARY The 2022 IDEOM Annual Meeting was held on June 17-18, 2022. Leaders and stakeholders from the hidradenitis suppurativa, acne, vitiligo, actinic keratosis, alopecia areata, itch, cutaneous lymphoma, and psoriatic disease workgroups discussed the progress of their respective outcome-measures research. This report summarizes each workgroup's updates from 2022 and their next steps as established during the 2022 IDEOM Annual Meeting. J Drugs Dermatol. 2023;22(12):1153-1159 doi:10.36849/JDD.7615.
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7
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Howell MD, Kuo FI, Rumberger B, Boarder E, Sun K, Butler K, Harris JE, Grimes P, Rosmarin D. Baseline Levels of Circulating Inflammatory Biomarkers Stratify Patients with Vitiligo Who Significantly Repigment after Treatment with Ruxolitinib Cream. JID Innov 2023; 3:100230. [PMID: 37840766 PMCID: PMC10568564 DOI: 10.1016/j.xjidi.2023.100230] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Revised: 06/21/2023] [Accepted: 07/06/2023] [Indexed: 10/17/2023] Open
Abstract
BACKGROUND Efficacy of ruxolitinib cream, a topical Jak1/Jak2 inhibitor, was demonstrated in a phase 2 trial in patients with vitiligo. OBJECTIVE This study aimed to characterize circulating inflammatory biomarker profiles in patients who demonstrated ≥50% improvement in facial Vitiligo Area Scoring Index scores by week 24 (group 1) and those who did not (group 2). DESIGN This was a posthoc analysis of a multicenter, randomized, double-blind, vehicle-controlled, phase 2 study in which screening was conducted between June 7, 2017 and March 21, 2018. POPULATION Patients aged between 18 and 75 years with vitiligo, including depigmentation affecting ≥0.5% of body surface area on the face and ≥3% of body surface area on nonfacial areas, were eligible. INTERVENTION Patients applied 1.5% ruxolitinib cream to lesions once or twice daily for 52 weeks. MAIN OUTCOMES AND MEASURES Patients were grouped by achievement of ≥50% improvement in facial Vitiligo Area Scoring Index at week 24. Proteomic analysis was performed on baseline serum samples. RESULTS Mean ± standard error facial Vitiligo Area Scoring Index in group 1 (n = 30) versus group 2 (n = 27) improved by 79.9 ± 4.0% versus 1.1 ± 7.3% and 91.9 ± 1.5% versus 25.1 ± 13.4% at weeks 24 and 52, respectively. Broad proteomic analysis revealed 76 proteins (of 1,104 tested) that were differentially expressed between groups 1 and 2 at baseline (P < 0.05). Ten distinct proteins were upregulated in group 1; 64 were elevated in group 2. CONCLUSION This analysis identified potential differences between patients who achieved ≥50% improvement in facial Vitiligo Area Scoring Index at 24 weeks and those who did not that require deeper scientific interrogation and may be important in stratifying therapeutic benefit for patients with vitiligo. TRIAL REGISTRATION The original study was registered at ClinicalTrials.gov, NCT03099304.
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Affiliation(s)
| | | | | | | | - Kang Sun
- Incyte, Wilmington, Delaware, USA
| | | | - John E. Harris
- Department of Dermatology, University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | - Pearl Grimes
- Vitiligo and Pigmentation Institute of Southern California, Los Angeles, California, USA
| | - David Rosmarin
- Department of Dermatology, Indiana University School of Medicine, Indianapolis, Indiana, USA
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van Geel N, Speeckaert R, Taïeb A, Ezzedine K, Lim HW, Pandya AG, Passeron T, Wolkerstorfer A, Abdallah M, Alomar A, Bae JM, Bekkenk M, Benzekri L, Böhm M, Eleftheriadou V, Esmat S, Ghia D, Goh BK, Grimes P, Gupta S, Hamzavi IH, Harris JE, Oh SH, Huggins R, Katayama I, Lan E, Lee AY, Leone G, Le Poole C, Lui H, Maquignon N, Meurant JM, Monteiro P, Oiso N, Parsad D, Pliszewski G, Raboobee N, Rodrigues M, Rosmarin D, Suzuki T, Tanemura A, Thng S, Xiang F, Zhou Y, Picardo M, Seneschal J. Worldwide expert recommendations for the diagnosis and management of vitiligo: Position statement from the International Vitiligo Task Force Part 1: towards a new management algorithm. J Eur Acad Dermatol Venereol 2023; 37:2173-2184. [PMID: 37746876 DOI: 10.1111/jdv.19451] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Accepted: 08/04/2023] [Indexed: 09/26/2023]
Abstract
BACKGROUND The treatment of vitiligo can be challenging and depends on several factors such as the subtype, disease activity, vitiligo extent, and treatment goals. Vitiligo usually requires a long-term approach. To improve the management of vitiligo worldwide, a clear and up-to-date guide based on international consensus with uniform stepwise recommendations is needed. OBJECTIVES To reach an international consensus on the nomenclature and to develop a management algorithm for the diagnosis, assessment, and treatment of vitiligo. METHODS In this consensus statement, a consortium of 42 international vitiligo experts and four patient representatives participated in online and live meetings to develop a consensus management strategy for vitiligo. At least two vitiligo experts summarized the evidence of topics included in the algorithms. A survey was utilized to resolve remaining issues among a core group of eight experts. Subsequently, the unanimous recommendations were finalized and validated based on further input from the entire group during two live meetings. RESULTS The algorithms highlight the importance of shared decision-making. Dermatologists are encouraged to provide patients with detailed explanations of the prognosis and expected therapeutic outcomes based on clinical examination. The treatment goal should be discussed and clearly emphasized to patients given the different approaches for disease stabilization and repigmentation. The evaluation of disease activity remains a cornerstone in the tailor-made approach to vitiligo patients. CONCLUSIONS These new treatment algorithms are intended to guide clinical decision-making in clinical practice. Promising novel therapies for vitiligo are on the horizon, further highlighting the need for reliable outcome measurement instruments and greater emphasis on shared decision-making.
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Affiliation(s)
- Nanja van Geel
- Department of Dermatology, Ghent University Hospital, Ghent, Belgium
| | | | - Alain Taïeb
- Department of Dermatology and Pediatric Dermatology, National Reference Center for Rare Skin Disorders, Hospital Saint-André, BRIC, UMR 1312, Inserm, University Bordeaux, Bordeaux, France
| | - Khaled Ezzedine
- Department of Dermatology, University Hospital Henri Mondor, EpiDermE EA 7379, Université Paris-Est Créteil Val de Marne, Créteil, France
| | - Henry W Lim
- Department of Dermatology, Henry Ford Health, Detroit, Michigan, USA
| | - Amit G Pandya
- Department of Dermatology, The University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Thierry Passeron
- Department of Dermatology, University Hospital of Nice, Nice, France
| | - Albert Wolkerstorfer
- Department of Dermatology, Ghent University Hospital, Ghent, Belgium
- Department of Dermatology, Netherlands Institute for Pigment Disorders, Amsterdam University Medical Centers, Amsterdam Institute for Infection and Immunity, University of Amsterdam, Amsterdam, The Netherlands
| | - Marwa Abdallah
- Dermatology, Andrology, and Venereology Department, Ain Shams University, Cairo, Egypt
| | - Augustin Alomar
- Department of Dermatology, Clinica Dermatologica Moragas, Barcelona, Spain
| | - Jung Min Bae
- Department of Dermatology, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Marcel Bekkenk
- Department of Dermatology, Netherlands Institute for Pigment Disorders, Amsterdam University Medical Centers, Amsterdam Institute for Infection and Immunity, VU University, Amsterdam, The Netherlands
| | - Laila Benzekri
- Department of Dermatology, Ibn Sina University Hospital, Mohammed V University, Rabat, Morocco
| | - Markus Böhm
- Department of Dermatology, University Hospital Münster, Münster, Germany
| | | | - Samia Esmat
- Department of Dermatology, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Deepti Ghia
- Department of Dermatology, Jaslok Hospital and Research Hospital and South Mumbai Dermatology Clinic, Mumbai, India
| | - Boon Kee Goh
- Skin Physicians Pte Ltd, Mount Elizabeth Medical Centre, Singapore City, Singapore
| | - Pearl Grimes
- Vitiligo & Pigmentation Institute of Southern California, Los Angeles, California, USA
| | - Somesh Gupta
- Department of Dermatology and Venereology, All India Institute of Medical Sciences, New Delhi, India
| | - Iltefat H Hamzavi
- Department of Dermatology, Henry Ford Health, Detroit, Michigan, USA
| | - John E Harris
- Department of Dermatology, University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA
| | - Sang Ho Oh
- Department of Dermatology, Severance Hospital, Cutaneous Biology Research Institute, Yonsei University College of Medicine, Seoul, South Korea
| | - Richard Huggins
- Department of Dermatology, Henry Ford Health, Detroit, Michigan, USA
| | - Ichiro Katayama
- Pigmentation Research and Therapeutics, Osaka Metropolitan University, Osaka, Japan
| | - Eric Lan
- Department of Dermatology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Ai-Young Lee
- Department of Dermatology, College of Medicine, Dongguk University Ilsan Hospital, Goyang, Korea
| | - Giovanni Leone
- Photodermatology and Vitiligo Treatment Unit, Israelite Hospital, Roma, Italy
| | - Caroline Le Poole
- Departments of Dermatology, Microbiology and Immunology, Robert H. Lurie Comprehensive Cancer Center Northwestern University, Chicago, Illinois, USA
| | - Harvey Lui
- Department of Dermatology and Skin Science, University of British Columbia, Vancouver, British Columbia, Canada
| | | | | | | | - Naoki Oiso
- Department of Dermatology, Kindai University Nara Hospital, Ikoma, Japan
| | - Davinder Parsad
- Department of Dermatology, Venereology & Leprology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | | | - Noufal Raboobee
- Department of Dermatology, Westville Hospital, Durban, South Africa
| | - Michelle Rodrigues
- Chroma Dermatology, Pigment and Skin of Colour Centre, Parkville, Victoria, Australia
- Department of Dermatology, The Royal Children's Hospital, Parkville, Victoria, Australia
| | - David Rosmarin
- Department of Dermatology, Tufts University School of Medicine, Boston, Massachusetts, USA
| | - Tamio Suzuki
- Department of Dermatology, Yamagata University Faculty of Medicine, Yamagata, Japan
| | - Atsushi Tanemura
- Department of Dermatology Integrated Medicine, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Steven Thng
- Skin Research Institute of Singapore, ASTAR, Singapore City, Singapore
| | - Flora Xiang
- Department of Dermatology, Huashan Hospital, Fudan University, Shanghai, China
| | - Youwen Zhou
- Department of Dermatology and Skin Science, University of British Columbia, Vancouver, British Columbia, Canada
| | | | - Julien Seneschal
- Department of Dermatology and Pediatric Dermatology, National Reference Center for Rare Skin disorders, Hospital Saint-André, University of Bordeaux, CNRS UMR 5164, ImmunoConcept, Bordeaux, France
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Seneschal J, Speeckaert R, Taïeb A, Wolkerstorfer A, Passeron T, Pandya AG, Lim HW, Ezzedine K, Zhou Y, Xiang F, Thng S, Tanemura A, Suzuki T, Rosmarin D, Rodrigues M, Raboobee N, Pliszewski G, Parsad D, Oiso N, Monteiro P, Meurant JM, Maquignon N, Lui H, Le Poole C, Leone G, Lee AY, Lan E, Katayama I, Huggins R, Oh SH, Harris JE, Hamzavi IH, Gupta S, Grimes P, Goh BK, Ghia D, Esmat S, Eleftheriadou V, Böhm M, Benzekri L, Bekkenk M, Bae JM, Alomar A, Abdallah M, Picardo M, van Geel N. Worldwide expert recommendations for the diagnosis and management of vitiligo: Position statement from the international Vitiligo Task Force-Part 2: Specific treatment recommendations. J Eur Acad Dermatol Venereol 2023; 37:2185-2195. [PMID: 37715487 DOI: 10.1111/jdv.19450] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [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: 02/13/2023] [Accepted: 08/04/2023] [Indexed: 09/17/2023]
Abstract
BACKGROUND The treatment of vitiligo can be challenging. Up-to-date agreed consensus recommendations on the use of topical and systemic therapies to facilitate the clinical management of vitiligo are currently lacking. OBJECTIVES To develop internationally agreed-upon expert-based recommendations for the treatment of vitiligo. METHODS In this consensus statement, a consortium of 42 international vitiligo experts and four patient representatives participated in different online and live meetings to develop a consensus management strategy for vitiligo. At least two vitiligo experts summarized the evidence for different topics included in the algorithms. A survey was then given to a core group of eight experts to resolve the remaining issues. Subsequently, the recommendations were finalized and validated based on further input from the entire group during two live meetings. RESULTS The recommendations provided summarize the latest evidence regarding the use of topical therapies (steroids, calcineurin inhibitors and Jak-inhibitors) and systemic therapies, including steroids and other systemic immunomodulating or antioxidant agents. The different modalities of phototherapies (NB-UVB, photochemotherapy, excimer devices and home phototherapy), which are often combined with other therapies, are also summarized. Interventional approaches as well as depigmentation strategies are presented for specific indications. Finally, the status of innovative and targeted therapies under development is discussed. CONCLUSIONS This international consensus statement culminated in expert-based clinical practice recommendations for the treatment of vitiligo. The development of new therapies is ongoing in vitiligo, and this will likely improve the future management of vitiligo, a disease that still has many unmet needs.
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Affiliation(s)
- Julien Seneschal
- Department of Dermatology and Pediatric Dermatology, National Reference Center for Rare Skin Disorders, Hospital Saint-André, ImmunoConcept, CNRS UMR 5164, Bordeaux University, Bordeaux, France
| | | | - Alain Taïeb
- Department of Dermatology and Pediatric Dermatology, National Reference Center for Rare Skin Disorders, Hospital Saint-André, BRIC, UMR 1312, Inserm, University Bordeaux, Bordeaux, France
| | - Albert Wolkerstorfer
- Department of Dermatology, Netherlands Institute for Pigment Disorders, Amsterdam University Medical Centers, Amsterdam Institute for Infection and Immunity, University of Amsterdam, Amsterdam, The Netherlands
| | - Thierry Passeron
- Department of Dermatology, University Hospital of Nice, Nice, France
| | - Amit G Pandya
- Department of Dermatology, The University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Henry W Lim
- Department of Dermatology, Henry Ford Health, Detroit, Michigan, USA
| | - Khaled Ezzedine
- Department of Dermatology, University Hospital Henri Mondor, EpiDermE EA 7379, Université Paris-Est Créteil Val de Marne, Créteil, France
| | - Youwen Zhou
- Department of Dermatology and Skin Science, University of British Columbia, Vancouver, British Columbia, Canada
| | - Flora Xiang
- Department of Dermatology, Huashan Hospital, Fudan University, Shanghai, China
| | - Steven Thng
- Skin Research Institute of Singapore, ASTAR, Singapore, Singapore
| | - Atsushi Tanemura
- Department of Dermatology Integrated Medicine, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Tamio Suzuki
- Department of Dermatology, Yamagata University Faculty of Medicine, Yamagata, Japan
| | - David Rosmarin
- Department of Dermatology, Tufts University School of Medicine, Boston, Massachusetts, USA
| | - Michelle Rodrigues
- Chroma Dermatology, Pigment and Skin of Colour Centre, Wheelers Hill, Victoria, Australia
- Department of Dermatology, The Royal Children's Hospital, Parkville, Victoria, Australia
| | - Noufal Raboobee
- Department of Dermatology, Westville Hospital, Durban, South Africa
| | | | - Davinder Parsad
- Department of Dermatology, Venereology & Leprology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Naoki Oiso
- Department of Dermatology, Kindai University Nara Hospital, Ikoma, Japan
| | | | | | | | - Harvey Lui
- Department of Dermatology and Skin Science, University of British Columbia, Vancouver, British Columbia, Canada
| | - Caroline Le Poole
- Department of Dermatology, Microbiology and Immunology, Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, Illinois, USA
| | - Giovanni Leone
- Photodermatology and Vitiligo Treatment Unit, Israelite Hospital, Roma
| | - Ai-Young Lee
- Department of Dermatology, College of Medicine, Dongguk University Ilsan Hospital, Goyang, Korea
| | - Eric Lan
- Department of Dermatology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Ichiro Katayama
- Pigmentation Research and Therapeutics, Osaka Metropolitan University, Osaka, Japan
| | - Richard Huggins
- Department of Dermatology, Henry Ford Health, Detroit, Michigan, USA
| | - Sang Ho Oh
- Department of Dermatology, Severance Hospital, Cutaneous Biology Research Institute, Yonsei University College of Medicine, Seoul, South Korea
| | - John E Harris
- Department of Dermatology, University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA
| | - Iltefat H Hamzavi
- Department of Dermatology, Henry Ford Health, Detroit, Michigan, USA
| | - Somesh Gupta
- Department of Dermatology and Venereology, All India Institute of Medical Sciences, New Delhi, India
| | - Pearl Grimes
- Vitiligo & Pigmentation Institute of Southern California, Los Angeles, California, USA
| | | | - Deepti Ghia
- Department of Dermatology, Jaslok Hospital and Research Hospital and South Mumbai Dermatology Clinic, Mumbai, India
| | - Samia Esmat
- Department of Dermatology, Faculty of Medicine Cairo University, Cairo, Egypt
| | | | - Markus Böhm
- Department of Dermatology, University Hospital Münster, Münster, Germany
| | - Laila Benzekri
- Department of Dermatology, Mohammed V University, Ibn Sina University Hospital, Rabat, Morocco
| | - Marcel Bekkenk
- Department of Dermatology, Netherlands Institute for Pigment Disorders, Amsterdam University Medical Centers, Amsterdam Institute for Infection and Immunity, VU University, Amsterdam, The Netherlands
| | - Jung Min Bae
- Department of Dermatology, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Augustin Alomar
- Department of Dermatology, Clinica Dermatologica Moragas, Barcelona, Spain
| | - Marwa Abdallah
- Dermatology, Andrology, and Venereology Department, Ain Shams University, Cairo, Egypt
| | | | - Nanja van Geel
- Department of Dermatology, Ghent University Hospital, Ghent, Belgium
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Rosmarin D, Soliman AM, Li C. Correction to: Real-World Treatment Patterns in Patients with Vitiligo in the United States. Dermatol Ther (Heidelb) 2023; 13:2925. [PMID: 37658969 PMCID: PMC10613157 DOI: 10.1007/s13555-023-01020-z] [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: 09/05/2023] Open
Affiliation(s)
- David Rosmarin
- Department of Dermatology, Indiana University School of Medicine, 545 Barnhill Drive, Emerson Hall 139, Indianapolis, IN, 46202, USA.
| | | | - Chao Li
- AbbVie Inc., North Chicago, IL, USA
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Cunningham KN, Alsukait S, Learned C, Deverapalli S, Aninos A, Rosmarin D. Demographics of Vitiligo in the DataDerm Database. J Cutan Med Surg 2023; 27:529-530. [PMID: 37522738 DOI: 10.1177/12034754231188327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/01/2023]
Affiliation(s)
| | - Sarah Alsukait
- Department of Dermatology, Tufts Medical Center, Boston, MA, USA
| | | | | | - Arik Aninos
- American Academy of Dermatology, Rosemont, IL, USA
| | - David Rosmarin
- Department of Dermatology, Indiana University School of Medicine, Indianapolis, IN, USA
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12
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Rosmarin D, Soliman AM, Li C. Real-World Treatment Patterns in Patients with Vitiligo in the United States. Dermatol Ther (Heidelb) 2023; 13:2079-2091. [PMID: 37548877 PMCID: PMC10442304 DOI: 10.1007/s13555-023-00983-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Accepted: 07/13/2023] [Indexed: 08/08/2023] Open
Abstract
INTRODUCTION Vitiligo is an autoimmune disorder resulting in skin depigmentation, with limited approved treatment options. This study evaluated medication utilization and treatment patterns among patients in the first year following vitiligo diagnosis. METHODS This retrospective analysis of claims data from the Merative® MarketScan Research Databases included patients aged ≥ 12 years newly diagnosed with vitiligo. Patients were identified between October 1, 2016, and April 30, 2021, and had ≥ 12 months of continuous enrollment pre- and post-vitiligo diagnosis. Medication use, treatment line of therapy, time to and number of medication claims, and length of therapy were reported in the 12 months post-vitiligo diagnosis. Results are reported separately for treatment initiators post-vitiligo diagnosis, patients with moderate-to-severe vitiligo, and adolescents (aged 12-17 years). RESULTS A total of 19,335 patients were included in the analysis, with half (N = 9648, 49.9%) not receiving any treatment during the 12-month follow-up. Switching was minimal among treatment initiators (N = 5845) in the 12 months post-vitiligo diagnosis, with the most frequent first-line treatments being high-potency topical corticosteroids (25.4%), oral corticosteroids (23.1%), and topical calcineurin inhibitors (TCI, 14.7%). Adolescents initiating treatment (N = 486) most frequently received TCI (30.9%) as first-line therapy. Patients with moderate-to-severe vitiligo (N = 3462) were very likely to receive treatment during follow-up, with only 1.5% not receiving treatment. Among patients with no vitiligo treatment prior to diagnosis, time to first medication claim ranged from 51.9 days (standard deviation [SD], 84.0) for TCI to 178.6 days (SD 116.0) for systemic immunosuppressants; mean total days supplied ranged from 14.4 days (SD 27.1) for oral corticosteroids to 121.0 (SD 114.0) for immunosuppressants. CONCLUSION In this real-world study, a high proportion of patients did not receive any treatment. Among those receiving treatment, most were unlikely to switch or use a combination of treatments within the first year of vitiligo diagnosis.
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Affiliation(s)
- David Rosmarin
- Department of Dermatology, Indiana University School of Medicine, 545 Barnhill Drive, Emerson Hall 139, Indianapolis, IN, 46202, USA.
| | | | - Chao Li
- AbbVie Inc., North Chicago, IL, USA
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Cunningham KN, Moody K, Alorainy M, Rosmarin D. Use of topical clascoterone for the treatment of hidradenitis suppurativa. JAAD Case Rep 2023; 36:38-39. [PMID: 37215295 PMCID: PMC10196707 DOI: 10.1016/j.jdcr.2023.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/24/2023] Open
Affiliation(s)
| | - Katherine Moody
- Department of Dermatology, Tufts Medical Center, Boston, Massachusetts
| | - May Alorainy
- Department of Dermatology, Tufts Medical Center, Boston, Massachusetts
| | - David Rosmarin
- Department of Dermatology, Indiana University School of Medicine, Indianapolis, Indiana
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14
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Learned C, Cohen SR, Cunningham K, Alsukait S, Santiago S, Lu J, Rothe M, Nichols A, Rosmarin D. Long-term treatment outcomes and safety of dupilumab as a therapy for bullous pemphigoid: A multicenter retrospective review. J Am Acad Dermatol 2023:S0190-9622(23)00525-X. [PMID: 37115111 DOI: 10.1016/j.jaad.2023.03.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 03/15/2023] [Accepted: 03/23/2023] [Indexed: 04/29/2023]
Affiliation(s)
- Christine Learned
- Department of Dermatology, Tufts Medical Center, Boston, Massachusetts
| | - Stephanie R Cohen
- Department of Dermatology, Tufts Medical Center, Boston, Massachusetts
| | | | - Sarah Alsukait
- Department of Dermatology, Tufts Medical Center, Boston, Massachusetts
| | - Sueheidi Santiago
- Department of Dermatology, University of Connecticut Health Center, Farmington, Connecticut
| | - Jun Lu
- Department of Dermatology, University of Connecticut Health Center, Farmington, Connecticut
| | - Marti Rothe
- Department of Dermatology, University of Connecticut Health Center, Farmington, Connecticut
| | - Anna Nichols
- Department of Dermatology, Univeristy of Miami Health Systems, Miami, Florida
| | - David Rosmarin
- Department of Dermatology, Indiana University School of Medicine, Indianapolis, Indiana.
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Alsukait S, Learned C, Rosmarin D. Open-Label Phase 2 Pilot Study of Oral Tofacitinib in Adult Subjects With Discoid Lupus Erythematosus (DLE). J Drugs Dermatol 2023; 22:425-427. [PMID: 37026882 DOI: 10.36849/jdd.7098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/08/2023]
Abstract
CITATION Alsukait S, Learned C, Rosmarin D. Open-label phase 2 pilot study of oral tofacitinib in adult subjects with Discoid Lupus Erythematosus (DLE). J Drugs Dermatol. 2023;22(4): 425-427. doi:10.36849/JDD.7098.
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Blauvelt A, Thyssen JP, Guttman-Yassky E, Bieber T, Serra-Baldrich E, Simpson E, Rosmarin D, Elmaraghy H, Meskimen E, Natalie CR, Liu Z, Xu C, Pierce E, Morgan-Cox M, Garcia Gil E, Silverberg JI. Efficacy and safety of lebrikizumab in moderate-to-severe atopic dermatitis: 52-week results of two randomized double-blinded placebo-controlled phase III trials. Br J Dermatol 2023; 188:740-748. [PMID: 36994947 DOI: 10.1093/bjd/ljad022] [Citation(s) in RCA: 15] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 01/02/2023] [Accepted: 01/23/2023] [Indexed: 03/31/2023]
Abstract
BACKGROUND Lebrikizumab is a novel, high-affinity monoclonal antibody that selectively binds to interleukin (IL)-13. OBJECTIVES To evaluate the efficacy and safety of lebrikizumab monotherapy in adolescent and adult patients with moderate-to-severe atopic dermatitis (AD) over 52 weeks of treatment in ADvocate1 (NCT04146363) and ADvocate2 (NCT04178967). METHODS Patients who responded to lebrikizumab 250 mg every 2 weeks (Q2W) at the end of the 16-week induction period were re-randomized 2 : 2 : 1 to receive lebrikizumab Q2W, lebrikizumab 250 mg every 4 weeks (Q4W) or placebo Q2W (lebrikizumab withdrawal) for 36 additional weeks. Response at week 16 was defined as achieving a 75% reduction in Eczema Area Severity Index (EASI 75) or an Investigator's Global Assessment (IGA) of 0 or 1, with a ≥ 2-point improvement and no rescue medication use. Multiple imputation was used to handle missing data. Intermittent use of topical therapy was permitted during the maintenance period. RESULTS After 52 weeks, an IGA of 0 or 1 with a ≥ 2 point improvement was maintained by 71.2% of patients treated with lebrikizumab Q2W, 76.9% of patients treated with lebrikizumab Q4W and 47.9% of patients in the lebrikizumab withdrawal arm. EASI 75 was maintained by 78.4% of patients treated with lebrikizumab Q2W, 81.7% of patients treated with lebrikizumab Q4W and 66.4% of patients in the lebrikizumab withdrawal arm at week 52. Across treatment arms, proportions of patients using any rescue therapy were 14.0% (ADvocate1) and 16.4% (ADvocate2). During the combined induction and maintenance periods of ADvocate1 and ADvocate2, 63.0% of lebrikizumab-treated patients reported any treatment emergent adverse event, with most events (93.1%) being mild or moderate in severity. CONCLUSIONS After a 16-week induction period with lebrikizumab Q2W, lebrikizumab Q2W and Q4W maintained similar improvement of the signs and symptoms of moderate-to-severe AD, with a safety profile consistent with previously published data.
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Affiliation(s)
| | - Jacob P Thyssen
- Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark
| | | | - Thomas Bieber
- University Hospital Bonn, Bonn, Germany
- Christine Kühne Center for Allergy Research and Education, Davos, Switzerland
| | | | - Eric Simpson
- Oregon Health & Science University, Portland, OR, USA
| | - David Rosmarin
- Indiana University School of Medicine, Indianapolis, IN, USA
| | | | | | | | - Zhuqing Liu
- Eli Lilly and Company, Indianapolis, IN, USA
| | - Chenjia Xu
- Eli Lilly and Company, Indianapolis, IN, USA
| | | | | | | | - Jonathan I Silverberg
- George Washington University School of Medicine and Health Sciences, Washington, DC, USA
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Cunningham KN, Alsukait S, Cohen SR, Learned C, Gao DX, Kachuk C, Dumont N, Zipeto A, Rosmarin D. Apremilast 30 mg twice daily combined with dupilumab for the treatment of recalcitrant moderate-to-severe atopic dermatitis. J Eur Acad Dermatol Venereol 2023; 37:e765-e767. [PMID: 36688247 DOI: 10.1111/jdv.18906] [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: 10/27/2022] [Accepted: 01/16/2023] [Indexed: 01/24/2023]
Affiliation(s)
| | - Sarah Alsukait
- Department of Dermatology, Tufts Medical Center, Massachusetts, Boston, USA
| | - Stephanie R Cohen
- Department of Dermatology, Tufts Medical Center, Massachusetts, Boston, USA
| | - Christine Learned
- Department of Dermatology, Tufts Medical Center, Massachusetts, Boston, USA
| | - David X Gao
- Department of Dermatology, Tufts Medical Center, Massachusetts, Boston, USA
| | - Courtney Kachuk
- Department of Dermatology, Tufts Medical Center, Massachusetts, Boston, USA
| | - Nicole Dumont
- Department of Dermatology, Tufts Medical Center, Massachusetts, Boston, USA
| | - Alysha Zipeto
- Department of Dermatology, Tufts Medical Center, Massachusetts, Boston, USA
| | - David Rosmarin
- Department of Dermatology, Indiana University School of Medicine, Indianapolis, Indiana, USA
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Silverberg N, Weingarten M, Desai S, Huang V, Walsh S, Rosmarin D. A review of the vitiligo literature to standardize the expression of disease severity. Br J Dermatol 2023. [DOI: 10.1093/bjd/ljac106.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Abstract
The literature on vitiligo is extremely heterogeneous with limited standardization in vitiligo disease severity reporting. The IDEOM Vitiligo Workgroup initiated a project to develop an improved understanding of clinical reporting of vitiligo severity and extent. A medical librarian-developed literature review identified 51 English-language clinical trials treating vitiligo topically using topical corticosteroids or topical tacrolimus that included adult and paediatric patients, with 10 or more patients. Grading of studies was performed using SORT criteria. The grading systems used included three studies reporting overall improvement: one as absolute Improvement vs. did not improve (B2), one as marked improvement (C3) and one as improvement, no change or worse (A2). Severity was reported as straight body surface area scoring (BSA) in five trials with grades of (A1, A1, B1, C2 and C3), and two via photography and mapping (A1, A2). Many studies report success as meeting the metric of 50% improvement or clearance (C3). Kanwar et al. further subdivides this into 50% to <75% or >75% (C3). Three studies add the complete clearance metric (A1, A1, B1), with some adding worsening categories. Most studies create a grading system including G0- no change (A1, A1, A2, A2< B2, B2, B3, B3), G1- 1–25%, G2- 26–50%, G3- 51–75%, G4- 75–99% (one study by Lepe et al. reports this as >75%) and G5- 100% re-pigmentation [Bae et al. (C2) report these numbers as 0, 1–24%, 25–49%, 50–74%, 75–99%, 100%]. Variations in response include the meta-analysis by Lee et al. reporting >25%, >50% and >75% re-pigmentation and the combination of G0 and G1 as < or = 25% re-pigmentation, considered a failure (A1, A1, A2. B2, C3, C3, C3). Koopmans-VanDorp (B2) and Kandil (B2) break down re-pigmentation as none, beginning (<25%), good (25–90%) or complete or almost complete (90–100%) or spontaneous re-pigmentation. Success can be defined as G3–G5 or G4–G5. Kathuria classifies <50% as failure (A1). Hu and Farajzadeh (A2) classify >50% as success, Bae (C2) classifies >75% and Kumari (B2) as >90% improvement. Majid further subdivides the score into six subdivisions (A1). Abd-Elazim (A2) reports VASI and Baldo reports DLQI. Sach (C1) and Batchelor (A1) use the vitiligo noticeability scale Baldo, with target patches reported as ‘a lot less noticeable’ or ‘no longer noticeable’ being successful. Ibrahim (A2) uses Patient-Expressed Satisfaction, reporting ‘not satisfied’, ‘slightly satisfied’, ‘satisfied’ or ‘very satisfied’. Batchelor (A1) report percentage re-pigmentation, onset and maintenance of response, treatment burden, QoL, side effects and cost-effectiveness. Body surface area total and quartiles of improvement are the most commonly reported metrics in studies with high-level evidence. The addition of categories of no improvement, complete clearance, spontaneous improvement and worsening appears to enhance information collection. Collection of data using photographs or computer-assisted BSA monitoring enhances data reproducibility. Using 50%, 75% and 90% as thresholds for success appears to be standardized, with a rarer inclusion of 100%. Validated scores like VASI represent a validated alternative collection method, which can be modified to address the 50%, 75% and 90% thresholds. Quality of life has not per se been correlated to clinical response to topical therapeutics, and current scores including patient expression of satisfaction, vitiligo noticeability and satisfaction are not known to reflect topical response at this time.
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Affiliation(s)
- Nanette Silverberg
- Department of Dermatology, Icahn School of Medicine at Mt Sinai , New York, NY , USA
| | - Mark Weingarten
- Department of Dermatology, Icahn School of Medicine at Mt Sinai , New York, NY , USA
| | - Seemal Desai
- Department of Dermatology, University of California , Davis, CA , USA
| | - Victor Huang
- Department of Dermatology, University of Texas Southwestern Medical Center , Dallas, Texas
- Innovative Dermatology , Plano, TX , USA
| | | | - David Rosmarin
- Department of Dermatology, Tufts Medical Center , Boston, MA , USA
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Renert-Yuval Y, Ezzedine K, Grimes P, Rosmarin D, Eichenfield L, Castelo-Soccio L, Huang V, Desai SR, Walsh S, Silverberg JI, Paller AS, Weingarten M, Narla S, Gardner J, Siegel M, Silverberg NB. Vitiligo evidence-based expert consensus recommendations for paediatric and adolescent patients: part I—topical therapeutics. Br J Dermatol 2023. [DOI: 10.1093/bjd/ljac106.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Abstract
No United States paradigm for the treatment of paediatric, adolescent and young adult vitiligo has been developed. To develop evidence and consensus-based expert opinion to promote therapeutic consistency for the diagnosis and treatment of vitiligo. An IRB-exempted process was developed to produce consensus recommendations based on literature review and SORT criteria. Research questions were reviewed on 9 May 2022 in a video-based conference. Forty-two recommendations were made on the diagnosis of vitiligo (5) and optimal topical therapeutics (37). Topical calcineurin inhibitors, topical corticosteroids and topical ruxolitinib 1·5% cream were all identified as potential first-line therapies in the management of paediatric and adolescent patients with specific guidance on age-based data, frequency of application, minimum length of the therapeutic trial and coordinated usage of ultraviolet light therapy. The literature on paediatric and adolescent vitiligo has a heterogeneous methodology and lack of patient-reported outcomes. Children with vitiligo may be effectively managed with a variety of topical agents as first- and second-line therapy. Evidence supports the utility of topical calcineurin inhibitors, topical corticosteroids and topical JAK inhibitors, with limitations based on factors such as location, body surface area and age.
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Affiliation(s)
- Yael Renert-Yuval
- Department of Dermatology and Pediatrics, Icahn School of Medicine at Mt Sinai , New York, NY , USA
| | - Khaled Ezzedine
- Hôpital Henri Mondor, Department of Dermatology and Université Paris Est Créteil (UPEC), Epidemiology in Dermatology and Evaluation of Therapeutics (EpiDermE)—EA 7379 , Créteil , France
| | - Pearl Grimes
- Department of Dermatology, University of California , Los Angeles, CA , USA
| | - David Rosmarin
- Department of Dermatology, Tufts Medical Center , Boston, MA , USA
| | | | - Leslie Castelo-Soccio
- National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health , Bethesda, MD , USA
| | - Victor Huang
- Department of Dermatology, University of California , Davis, CA , USA
| | - Seemal R Desai
- Department of Dermatology, University of Texas Southwestern Medical Center , Dallas, TX , USA
- Innovative Dermatology , Plano, TX , USA
| | | | - Jonathan I Silverberg
- George Washington University School of Medicine and Health Sciences , Washington, DC , USA
| | - Amy S Paller
- Department of Dermatology, Northwestern University Feinberg School of Medicine , Chicago, IL , USA
| | - Mark Weingarten
- Department of Dermatology and Pediatrics, Icahn School of Medicine at Mt Sinai , New York, NY , USA
| | - Shanthi Narla
- Department of Dermatology, St. Luke’s University Health Network , Easton, PA , USA
| | | | - Michael Siegel
- Pediatric Dermatology Research Alliance , Portland, OR , USA
| | - Nanette B Silverberg
- Department of Dermatology and Pediatrics, Icahn School of Medicine at Mt Sinai , New York, NY , USA
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Seneschal J, Wolkerstorfer A, Desai SR, Grimes P, Ezzedine K, Kornacki D, Wei S, Butler K, Rosmarin D. Efficacy and safety of ruxolitinib cream for the treatment of vitiligo by patient demographics and baseline clinical characteristics: Week 52 pooled subgroup analysis from two randomized phase 3 studies. Br J Dermatol 2023. [DOI: 10.1093/bjd/ljac106.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Abstract
Vitiligo is a chronic autoimmune disease that targets melanocytes, causing skin depigmentation. Disease pathogenesis is largely regulated by interferon-γ activation of the Janus kinase (JAK) signalling pathway. A cream formulation of the JAK1/JAK2 inhibitor ruxolitinib demonstrated substantial re-pigmentation in two randomized, double-blind, vehicle-controlled phase 3 studies of adults and adolescents with vitiligo (TruE-V1 and TruE-V2). Pooled 52-week efficacy and safety data based on baseline demographics and clinical characteristics from the TruE-V studies are analysed and reported here. TruE-V1 (NCT04052425) and TruE-V2 (NCT04057573) were conducted in North America and Europe. Patients ≥ 12 years old diagnosed with nonsegmental vitiligo (NSV) with depigmentation covering ≤ 10% total body surface area (BSA), including facial and total Vitiligo Area Scoring Index (F-VASI/T-VASI) scores ≥ 0·5/≥ 3, were eligible for enrolment. Patients were randomized 2 : 1 to twice-daily 1·5% ruxolitinib cream or vehicle for 24 weeks, after which all patients could apply 1·5% ruxolitinib cream through Week 52 (open-label extension). At Week 52, patients who achieved ≥ 75% improvement from baseline in F-VASI (F-VASI75) were evaluated by sex, age group, Fitzpatrick skin type, facial BSA (F-BSA), investigator-assessed disease stability and previous therapy. Safety and tolerability were also assessed. Week 52 data are reported as observed. In total, 674 patients were randomized in the TRuE-V studies (ruxolitinib cream, n = 450; vehicle, n = 224); 673 and 661 patients were included in the safety and efficacy analyses, respectively, and 569 patients continued in the open-label extension (ruxolitinib cream from Day 1, n = 385; crossover from vehicle, n = 184). Mean (SD) age at baseline was 39·5 (15·1) years, and 27·9% of patients had Fitzpatrick skin types IV–VI. Baseline mean F-VASI and T-VASI values were 0·92 and 6·69, respectively. At Week 52, 50·3% of patients who applied ruxolitinib cream from Day 1 achieved F-VASI75. Efficacy by F-VASI75 response was identified in all demographic and clinical characteristic subgroups. Substantive F-VASI75 responses were seen for men [(n = 149), 43·6%] and women [(n = 201), 55·2%], and all age groups [12–17 years (n = 50), 48·0%; 18–64 years (n = 275), 52·0%; ≥ 65 years (n = 25), 36·0%]. F-VASI75 responses were also generally consistent based on skin type [I–III (n = 249), 47·4%; IV–VI (n = 101), 57·4%], F-BSA [<1·5% (n = 283), 49·1%; ≥ 1·5% (n = 67), 55·2%], investigator-assessed disease stability [stable (n = 257), 49·4%; progressive (n = 93), 52·7%] and previous therapy [topical corticosteroids (n = 110), 50·9%; topical calcineurin inhibitors (n = 126), 49·2%; phototherapy (n = 113), 54·0%]. Treatment-related adverse events (AEs) occurred in 13·7% of patients who applied ruxolitinib cream at any time during the study, with generally similar rates among demographic subgroups for patients who applied ruxolitinib cream. Adolescent and adult patients with NSV applying ruxolitinib cream achieved efficacy per F-VASI75 at Week 52 regardless of baseline demographics or clinical characteristics. Ruxolitinib cream was well tolerated, and the incidence of treatment-related AEs was similar across subgroups.
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Affiliation(s)
- Julien Seneschal
- Department of Dermatology and Pediatric Dermatology, National Reference Center for Rare Skin Disorders, Hôpital Saint-André, CNRS, UMR-5164, ImmunoConcEpT , Bordeaux F-33000 , France
| | | | - Seemal R Desai
- University of Texas Southwestern Medical Center , Dallas, TX , USA
- Innovative Dermatology , Plano, TX , USA
| | - Pearl Grimes
- The Vitiligo & Pigmentation Institute of Southern California , Los Angeles, CA , USA
| | - Khaled Ezzedine
- Henri Mondor University Hospital and Université Paris-Est Créteil Val de Marne , Paris , France
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21
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Silverberg NB, Cohen A, Desai S, Francis P, Francis V, Gardner J, Guarino C, Guarino I, Huang V, Rosmarin D. IDEOM vitiligo work group: an update on our first year. Br J Dermatol 2023. [DOI: 10.1093/bjd/ljac106.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Abstract
The new Vitiligo Work Group of IDEOM was created in October 2021 and met at the annual IDEOM meetings of 2021 and 2022. The mission of the workgroup is to develop core outcome measures in vitiligo that meet three criteria: to meet the needs of stakeholders of all types, to be validated for clinical trials and studies, and to be used in all age groups of patients. The Vitiligo Work Group met November 2021 and June 2022, yielding a list of 10 potential core domains for voting. Voting was conducted at the Annual Meeting of IDEOM on 18 June 2022. Voting members of IDEOM included 23 dermatologists, 1 rheumatologist, 3 dermatologists and rheumatologists, 11 industry partners, 9 patients, 8 patient association representatives and 15 researchers. Core domains meeting 75% consensus threshold included: health-related quality of life (95·35%), extent of depigmentation (93·632%), treatment satisfaction including treatment burden (92·86%), location (83·67%), colour matching (82·69%) and maintenance of pigmentation (76·47%). Two domains met 50% threshold including primary diagnosis/comorbidities (59·62%) and trajectory of disease/stabilization (57·45%) and one domain, itch, failed to reach a consensus (38·46%). Using an approach of inclusion of stakeholders from all walks of life, six core domains reached a consensus for inclusion, two achieved partial consensus but required revision to break down the elements (e.g. primary diagnosis and comorbidities should be separated) and itch failed to achieve inclusion. The group continues to work on its core domains set using a broad range of stakeholders to produce a practical set of domains that are of importance to all stakeholders.
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Affiliation(s)
- Nanette B Silverberg
- Department of Dermatology, Icahn School of Medicine at Mt Sinai , New York, NY , USA
| | - Arnon Cohen
- Ben Gurion University , Be’er Sheba , Israel
| | - Seemal Desai
- Department of Dermatology, University of Texas Southwestern Medical Center , Dallas, TX , USA
- Innovative Dermatology , Plano, TX , USA
| | | | | | | | | | | | - Victor Huang
- Department of Dermatology, University of California , San Diego, CA , USA
| | - David Rosmarin
- Department of Dermatology, Tufts Medical Center , Boston, MA , USA
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22
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Passeron T, Harris JE, Pandya AG, Seneschal J, Grimes P, Kornacki D, Wang M, Butler K, Ezzedine K, Rosmarin D. Effect of ruxolitinib cream on achievement of VASI50 by body region: Week 52 pooled analysis of the TRuE-V phase 3 studies. Br J Dermatol 2023. [DOI: 10.1093/bjd/ljac106.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Abstract
Vitiligo is a chronic inflammatory autoimmune disease that targets melanocytes, causing skin de-pigmentation. A cream formulation of the Janus kinase (JAK) 1/JAK2 inhibitor, ruxolitinib demonstrated substantial re-pigmentation in a phase 2 study in adults with vitiligo. In two multinational, randomized, double-blind, vehicle-controlled phase 3 studies of adults and adolescents with vitiligo (TRuE-V1, NCT04052425; TRuE-V2, NCT04057573), ruxolitinib cream was superior to vehicle at Week 24 in the primary and all key secondary endpoints. Pooled results on achievement of ≥ 50% improvement in the Vitiligo Area Scoring Index (VASI50) by body region in TRuE-V1/TRuE-V2 were analysed and are reported herein. Patients ≥ 12 years old with nonsegmental vitiligo (NSV) with de-pigmentation covering ≤ 10% total body surface area, including a total VASI (T-VASI) score ≥ 3, were eligible for enrolment. Patients were randomized 2 : 1 to twice-daily 1·5% ruxolitinib cream or vehicle for 24 weeks, after which all patients could apply twice-daily 1·5% ruxolitinib cream through Week 52 (open-label extension). The percentage of patients achieving VASI50 was calculated for each body region [head and neck (not including face), hands, upper extremities, trunk (including genitals), lower extremities, feet] and total body (excluding face). In total, 674 patients were randomized in the TRuE-V studies (ruxolitinib cream, n = 450; vehicle, n = 224); 661 patients were included in the efficacy analysis (1 site excluded for data quality) and 569 continued in the open-label extension (ruxolitinib cream from Day 1, n = 385; crossover from vehicle, n = 184). At Week 12, more patients who applied 1·5% ruxolitinib cream vs. vehicle achieved VASI50 in the head and neck (28·3% vs. 19·8%), upper extremities (14·1% vs. 11·0%), trunk (15·5% vs. 12·9%) and lower extremities (15·1% vs. 10·9%). At Week 24, more patients who applied 1·5% ruxolitinib cream vs. vehicle achieved VASI50 regardless of body region [head and neck, 45·3% vs. 23·8%; hands, 24·9% vs. 14·4%; upper extremities, 33·2% vs. 8·2%; trunk, 26·4% vs. 12·3%; lower extremities, 29·5% vs. 12·2%; feet, 18·5% vs. 12·5%; total body (excluding face), 20·8% vs. 6·9%]. Similarly at Week 52 more patients who applied ruxolitinib cream from Day 1 achieved VASI50 than those who switched over from vehicle after Week 24 (head and neck, 68·1% vs. 51·0%; hands, 38·2% vs. 29·2%; upper extremities, 56·7% vs. 34·9%; trunk, 48·4% vs. 25·4%; lower extremities, 54·5% vs. 32·3%; feet, 29·3% vs. 22·5%; total body [excluding face], 47·7% vs. 23·3%). Attainment of VASI50 at Week 52 among crossover patients (i.e. after 28 weeks of ruxolitinib cream) was consistent with Week 24 data in patients who applied ruxolitinib cream from Day 1. Adolescents and adults with NSV applying ruxolitinib cream achieved VASI50 in higher percentages compared with vehicle at Week 12 in the head and neck, upper extremities, trunk and lower extremities and at Week 24, regardless of the body region involved. The percentage of patients who achieved VASI50 increased through Week 52, including among patients who switched over from vehicle to ruxolitinib cream after Week 24. In summary, ruxolitinib cream produced a clinically meaningful re-pigmentation of all body regions (including hands and feet that are notoriously difficult to re-pigment) in TRuE-V1/TruE-V2 through Week 52, including among patients who switched over to ruxolitinib cream from vehicle after Week 24.
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Affiliation(s)
- Thierry Passeron
- Centre Hospitalier Universitaire de Nice, Université Côte d’Azur , Nice , France
- INSERM U1065, C3M, Université Côte d’Azur , Nice , France
| | - John E Harris
- University of Massachusetts Medical School , Worcester, MA , USA
| | - Amit G Pandya
- Palo Alto Foundation Medical Group , Mountain View, CA , USA
- University of Texas Southwestern Medical Center , Dallas, TX , USA
| | - Julien Seneschal
- Department of Dermatology and Pediatric Dermatology, National Reference Center for Rare Skin Disorders, Hôpital Saint-André, CNRS, UMR-5164, ImmunoConcEpT , Bordeaux F-33000 , France
| | - Pearl Grimes
- The Vitiligo & Pigmentation Institute of Southern California , Los Angeles, CA , USA
| | | | | | | | - Khaled Ezzedine
- Henri Mondor University Hospital and Université Paris-Est Créteil Val de Marne , Paris , France
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23
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Learned C, Cohen SR, Alsukait S, Deverapalli S, Rosmarin D. Vitiligo adverse events and associated medications as reported in the US Food and Drug Administration's Adverse Event Reporting System from 2016 to 2021. J Am Acad Dermatol 2023; 88:197-199. [PMID: 35427685 DOI: 10.1016/j.jaad.2022.04.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Revised: 03/31/2022] [Accepted: 04/06/2022] [Indexed: 11/26/2022]
Affiliation(s)
- Christine Learned
- Department of Dermatology, Tufts Medical Center, Boston, Massachusetts
| | - Stephanie R Cohen
- Department of Dermatology, Tufts Medical Center, Boston, Massachusetts
| | - Sarah Alsukait
- Department of Dermatology, Tufts Medical Center, Boston, Massachusetts
| | | | - David Rosmarin
- Department of Dermatology, Tufts Medical Center, Boston, Massachusetts.
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Gao DX, Kahn JS, Cohen SR, Dumont N, Yang FC, Rosmarin D. Analysis of patient attitudes and behavior regarding dermatologic care during the COVID-19 pandemic: a survey-based study at a single academic institution. Dermatol Online J 2022; 28. [PMID: 36809108 DOI: 10.5070/d328659738] [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: 12/27/2022] [Accepted: 12/27/2022] [Indexed: 12/30/2022] Open
Affiliation(s)
- D X Gao
- Department of Dermatology, Tufts Medical Center, Boston, Massachusetts, USA
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25
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Deverapalli S, Kahn J, Rosmarin D. A Potential Alternative Treatment for Vitiligo: An Observational Study on Tacrolimus 0.3% Lotion. J Drugs Dermatol 2022; 21:1370-1371. [PMID: 36468953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
Vitiligo is a complex multifactorial disorder of depigmentation affecting 0.5 to 2% of the world's population without specific gender or racial prevalence.1 Though no treatments are FDA approved to repigment vitiligo, topical medications along with phototherapy alone or in combination remain the mainstay of therapy. While Janus Kinase inhibitors and other agents are in development, current topical options are mainly limited to steroid formulations of various potencies or immunomodulatory steroid-sparing agents such as tacrolimus 0.03% or 0.1%.
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26
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Rosmarin D, Passeron T, Pandya AG, Grimes P, Harris JE, Desai SR, Lebwohl M, Ruer-Mulard M, Seneschal J, Wolkerstorfer A, Kornacki D, Sun K, Butler K, Ezzedine K. Two Phase 3, Randomized, Controlled Trials of Ruxolitinib Cream for Vitiligo. N Engl J Med 2022; 387:1445-1455. [PMID: 36260792 DOI: 10.1056/nejmoa2118828] [Citation(s) in RCA: 47] [Impact Index Per Article: 23.5] [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: 01/19/2023]
Abstract
BACKGROUND Vitiligo is a chronic autoimmune disease that causes skin depigmentation. A cream formulation of ruxolitinib (an inhibitor of Janus kinase 1 and 2) resulted in repigmentation in a phase 2 trial involving adults with vitiligo. METHODS We conducted two phase 3, double-blind, vehicle-controlled trials (Topical Ruxolitinib Evaluation in Vitiligo Study 1 [TRuE-V1] and 2 [TRuE-V2]) in North America and Europe that involved patients 12 years of age or older who had nonsegmental vitiligo with depigmentation covering 10% or less of total body-surface area. Patients were randomly assigned in a 2:1 ratio to apply 1.5% ruxolitinib cream or vehicle control twice daily for 24 weeks to all vitiligo areas on the face and body, after which all patients could apply 1.5% ruxolitinib cream through week 52. The primary end point was a decrease (improvement) of at least 75% from baseline in the facial Vitiligo Area Scoring Index (F-VASI; range, 0 to 3, with higher scores indicating a greater area of facial depigmentation), or F-VASI75 response, at week 24. There were five key secondary end points, including improved responses on the Vitiligo Noticeability Scale. RESULTS A total of 674 patients were enrolled, 330 in TRuE-V1 and 344 in TRuE-V2. In TRuE-V1, the percentage of patients with an F-VASI75 response at week 24 was 29.8% in the ruxolitinib-cream group and 7.4% in the vehicle group (relative risk, 4.0; 95% confidence interval [CI], 1.9 to 8.4; P<0.001). In TRuE-V2, the percentages were 30.9% and 11.4%, respectively (relative risk, 2.7; 95% CI, 1.5 to 4.9; P<0.001). The results for key secondary end points showed superiority of ruxolitinib cream over vehicle control. Among patients who applied ruxolitinib cream throughout 52 weeks, adverse events occurred in 54.8% in TRuE-V1 and 62.3% in TRuE-V2; the most common adverse events were application-site acne (6.3% and 6.6%, respectively), nasopharyngitis (5.4% and 6.1%), and application-site pruritus (5.4% and 5.3%). CONCLUSIONS In two phase 3 trials, application of ruxolitinib cream resulted in greater repigmentation of vitiligo lesions than vehicle control through 52 weeks, but it was associated with acne and pruritus at the application site. Larger and longer trials are required to determine the effect and safety of ruxolitinib cream in patients with vitiligo. (Funded by Incyte; TRuE-V1 and TRuE-V2 ClinicalTrials.gov numbers, NCT04052425 and NCT04057573.).
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Affiliation(s)
- David Rosmarin
- From Tufts Medical Center, Boston (D.R.); Centre Hospitalier Universitaire de Nice and Centre Méditerranéen de Médecine Moléculaire, Université Côte d'Azur, Nice (T.P.), the Office of Mireille Ruer-Mulard, M.D., Martiques (M.R.-M.), the Department of Dermatology and Pediatric Dermatology, National Reference Center for Rare Skin Disorders, Hôpital Saint-André, and Centre National de la Recherche Scientifique Unité Mixte de Recherche 5164, ImmunoConcept, Université de Bordeaux, Bordeaux (J.S.), and Henri Mondor University Hospital and Université Paris-Est Créteil Val de Marne, Paris (K.E.) - all in France; Palo Alto Foundation Medical Group, Sunnyvale (A.G.P.), and the Vitiligo and Pigmentation Institute of Southern California, Los Angeles (P.G.) - both in California; the University of Texas Southwestern Medical Center, Dallas (A.G.P., S.R.D.), and Innovative Dermatology, Plano (S.R.D.) - both in Texas; the University of Massachusetts Chan Medical School, Worcester (J.E.H.); Icahn School of Medicine at Mount Sinai, New York (M.L.); Amsterdam University Medical Center, Amsterdam (A.W.); and Incyte, Wilmington, DE (D.K., K.S., K.B.)
| | - Thierry Passeron
- From Tufts Medical Center, Boston (D.R.); Centre Hospitalier Universitaire de Nice and Centre Méditerranéen de Médecine Moléculaire, Université Côte d'Azur, Nice (T.P.), the Office of Mireille Ruer-Mulard, M.D., Martiques (M.R.-M.), the Department of Dermatology and Pediatric Dermatology, National Reference Center for Rare Skin Disorders, Hôpital Saint-André, and Centre National de la Recherche Scientifique Unité Mixte de Recherche 5164, ImmunoConcept, Université de Bordeaux, Bordeaux (J.S.), and Henri Mondor University Hospital and Université Paris-Est Créteil Val de Marne, Paris (K.E.) - all in France; Palo Alto Foundation Medical Group, Sunnyvale (A.G.P.), and the Vitiligo and Pigmentation Institute of Southern California, Los Angeles (P.G.) - both in California; the University of Texas Southwestern Medical Center, Dallas (A.G.P., S.R.D.), and Innovative Dermatology, Plano (S.R.D.) - both in Texas; the University of Massachusetts Chan Medical School, Worcester (J.E.H.); Icahn School of Medicine at Mount Sinai, New York (M.L.); Amsterdam University Medical Center, Amsterdam (A.W.); and Incyte, Wilmington, DE (D.K., K.S., K.B.)
| | - Amit G Pandya
- From Tufts Medical Center, Boston (D.R.); Centre Hospitalier Universitaire de Nice and Centre Méditerranéen de Médecine Moléculaire, Université Côte d'Azur, Nice (T.P.), the Office of Mireille Ruer-Mulard, M.D., Martiques (M.R.-M.), the Department of Dermatology and Pediatric Dermatology, National Reference Center for Rare Skin Disorders, Hôpital Saint-André, and Centre National de la Recherche Scientifique Unité Mixte de Recherche 5164, ImmunoConcept, Université de Bordeaux, Bordeaux (J.S.), and Henri Mondor University Hospital and Université Paris-Est Créteil Val de Marne, Paris (K.E.) - all in France; Palo Alto Foundation Medical Group, Sunnyvale (A.G.P.), and the Vitiligo and Pigmentation Institute of Southern California, Los Angeles (P.G.) - both in California; the University of Texas Southwestern Medical Center, Dallas (A.G.P., S.R.D.), and Innovative Dermatology, Plano (S.R.D.) - both in Texas; the University of Massachusetts Chan Medical School, Worcester (J.E.H.); Icahn School of Medicine at Mount Sinai, New York (M.L.); Amsterdam University Medical Center, Amsterdam (A.W.); and Incyte, Wilmington, DE (D.K., K.S., K.B.)
| | - Pearl Grimes
- From Tufts Medical Center, Boston (D.R.); Centre Hospitalier Universitaire de Nice and Centre Méditerranéen de Médecine Moléculaire, Université Côte d'Azur, Nice (T.P.), the Office of Mireille Ruer-Mulard, M.D., Martiques (M.R.-M.), the Department of Dermatology and Pediatric Dermatology, National Reference Center for Rare Skin Disorders, Hôpital Saint-André, and Centre National de la Recherche Scientifique Unité Mixte de Recherche 5164, ImmunoConcept, Université de Bordeaux, Bordeaux (J.S.), and Henri Mondor University Hospital and Université Paris-Est Créteil Val de Marne, Paris (K.E.) - all in France; Palo Alto Foundation Medical Group, Sunnyvale (A.G.P.), and the Vitiligo and Pigmentation Institute of Southern California, Los Angeles (P.G.) - both in California; the University of Texas Southwestern Medical Center, Dallas (A.G.P., S.R.D.), and Innovative Dermatology, Plano (S.R.D.) - both in Texas; the University of Massachusetts Chan Medical School, Worcester (J.E.H.); Icahn School of Medicine at Mount Sinai, New York (M.L.); Amsterdam University Medical Center, Amsterdam (A.W.); and Incyte, Wilmington, DE (D.K., K.S., K.B.)
| | - John E Harris
- From Tufts Medical Center, Boston (D.R.); Centre Hospitalier Universitaire de Nice and Centre Méditerranéen de Médecine Moléculaire, Université Côte d'Azur, Nice (T.P.), the Office of Mireille Ruer-Mulard, M.D., Martiques (M.R.-M.), the Department of Dermatology and Pediatric Dermatology, National Reference Center for Rare Skin Disorders, Hôpital Saint-André, and Centre National de la Recherche Scientifique Unité Mixte de Recherche 5164, ImmunoConcept, Université de Bordeaux, Bordeaux (J.S.), and Henri Mondor University Hospital and Université Paris-Est Créteil Val de Marne, Paris (K.E.) - all in France; Palo Alto Foundation Medical Group, Sunnyvale (A.G.P.), and the Vitiligo and Pigmentation Institute of Southern California, Los Angeles (P.G.) - both in California; the University of Texas Southwestern Medical Center, Dallas (A.G.P., S.R.D.), and Innovative Dermatology, Plano (S.R.D.) - both in Texas; the University of Massachusetts Chan Medical School, Worcester (J.E.H.); Icahn School of Medicine at Mount Sinai, New York (M.L.); Amsterdam University Medical Center, Amsterdam (A.W.); and Incyte, Wilmington, DE (D.K., K.S., K.B.)
| | - Seemal R Desai
- From Tufts Medical Center, Boston (D.R.); Centre Hospitalier Universitaire de Nice and Centre Méditerranéen de Médecine Moléculaire, Université Côte d'Azur, Nice (T.P.), the Office of Mireille Ruer-Mulard, M.D., Martiques (M.R.-M.), the Department of Dermatology and Pediatric Dermatology, National Reference Center for Rare Skin Disorders, Hôpital Saint-André, and Centre National de la Recherche Scientifique Unité Mixte de Recherche 5164, ImmunoConcept, Université de Bordeaux, Bordeaux (J.S.), and Henri Mondor University Hospital and Université Paris-Est Créteil Val de Marne, Paris (K.E.) - all in France; Palo Alto Foundation Medical Group, Sunnyvale (A.G.P.), and the Vitiligo and Pigmentation Institute of Southern California, Los Angeles (P.G.) - both in California; the University of Texas Southwestern Medical Center, Dallas (A.G.P., S.R.D.), and Innovative Dermatology, Plano (S.R.D.) - both in Texas; the University of Massachusetts Chan Medical School, Worcester (J.E.H.); Icahn School of Medicine at Mount Sinai, New York (M.L.); Amsterdam University Medical Center, Amsterdam (A.W.); and Incyte, Wilmington, DE (D.K., K.S., K.B.)
| | - Mark Lebwohl
- From Tufts Medical Center, Boston (D.R.); Centre Hospitalier Universitaire de Nice and Centre Méditerranéen de Médecine Moléculaire, Université Côte d'Azur, Nice (T.P.), the Office of Mireille Ruer-Mulard, M.D., Martiques (M.R.-M.), the Department of Dermatology and Pediatric Dermatology, National Reference Center for Rare Skin Disorders, Hôpital Saint-André, and Centre National de la Recherche Scientifique Unité Mixte de Recherche 5164, ImmunoConcept, Université de Bordeaux, Bordeaux (J.S.), and Henri Mondor University Hospital and Université Paris-Est Créteil Val de Marne, Paris (K.E.) - all in France; Palo Alto Foundation Medical Group, Sunnyvale (A.G.P.), and the Vitiligo and Pigmentation Institute of Southern California, Los Angeles (P.G.) - both in California; the University of Texas Southwestern Medical Center, Dallas (A.G.P., S.R.D.), and Innovative Dermatology, Plano (S.R.D.) - both in Texas; the University of Massachusetts Chan Medical School, Worcester (J.E.H.); Icahn School of Medicine at Mount Sinai, New York (M.L.); Amsterdam University Medical Center, Amsterdam (A.W.); and Incyte, Wilmington, DE (D.K., K.S., K.B.)
| | - Mireille Ruer-Mulard
- From Tufts Medical Center, Boston (D.R.); Centre Hospitalier Universitaire de Nice and Centre Méditerranéen de Médecine Moléculaire, Université Côte d'Azur, Nice (T.P.), the Office of Mireille Ruer-Mulard, M.D., Martiques (M.R.-M.), the Department of Dermatology and Pediatric Dermatology, National Reference Center for Rare Skin Disorders, Hôpital Saint-André, and Centre National de la Recherche Scientifique Unité Mixte de Recherche 5164, ImmunoConcept, Université de Bordeaux, Bordeaux (J.S.), and Henri Mondor University Hospital and Université Paris-Est Créteil Val de Marne, Paris (K.E.) - all in France; Palo Alto Foundation Medical Group, Sunnyvale (A.G.P.), and the Vitiligo and Pigmentation Institute of Southern California, Los Angeles (P.G.) - both in California; the University of Texas Southwestern Medical Center, Dallas (A.G.P., S.R.D.), and Innovative Dermatology, Plano (S.R.D.) - both in Texas; the University of Massachusetts Chan Medical School, Worcester (J.E.H.); Icahn School of Medicine at Mount Sinai, New York (M.L.); Amsterdam University Medical Center, Amsterdam (A.W.); and Incyte, Wilmington, DE (D.K., K.S., K.B.)
| | - Julien Seneschal
- From Tufts Medical Center, Boston (D.R.); Centre Hospitalier Universitaire de Nice and Centre Méditerranéen de Médecine Moléculaire, Université Côte d'Azur, Nice (T.P.), the Office of Mireille Ruer-Mulard, M.D., Martiques (M.R.-M.), the Department of Dermatology and Pediatric Dermatology, National Reference Center for Rare Skin Disorders, Hôpital Saint-André, and Centre National de la Recherche Scientifique Unité Mixte de Recherche 5164, ImmunoConcept, Université de Bordeaux, Bordeaux (J.S.), and Henri Mondor University Hospital and Université Paris-Est Créteil Val de Marne, Paris (K.E.) - all in France; Palo Alto Foundation Medical Group, Sunnyvale (A.G.P.), and the Vitiligo and Pigmentation Institute of Southern California, Los Angeles (P.G.) - both in California; the University of Texas Southwestern Medical Center, Dallas (A.G.P., S.R.D.), and Innovative Dermatology, Plano (S.R.D.) - both in Texas; the University of Massachusetts Chan Medical School, Worcester (J.E.H.); Icahn School of Medicine at Mount Sinai, New York (M.L.); Amsterdam University Medical Center, Amsterdam (A.W.); and Incyte, Wilmington, DE (D.K., K.S., K.B.)
| | - Albert Wolkerstorfer
- From Tufts Medical Center, Boston (D.R.); Centre Hospitalier Universitaire de Nice and Centre Méditerranéen de Médecine Moléculaire, Université Côte d'Azur, Nice (T.P.), the Office of Mireille Ruer-Mulard, M.D., Martiques (M.R.-M.), the Department of Dermatology and Pediatric Dermatology, National Reference Center for Rare Skin Disorders, Hôpital Saint-André, and Centre National de la Recherche Scientifique Unité Mixte de Recherche 5164, ImmunoConcept, Université de Bordeaux, Bordeaux (J.S.), and Henri Mondor University Hospital and Université Paris-Est Créteil Val de Marne, Paris (K.E.) - all in France; Palo Alto Foundation Medical Group, Sunnyvale (A.G.P.), and the Vitiligo and Pigmentation Institute of Southern California, Los Angeles (P.G.) - both in California; the University of Texas Southwestern Medical Center, Dallas (A.G.P., S.R.D.), and Innovative Dermatology, Plano (S.R.D.) - both in Texas; the University of Massachusetts Chan Medical School, Worcester (J.E.H.); Icahn School of Medicine at Mount Sinai, New York (M.L.); Amsterdam University Medical Center, Amsterdam (A.W.); and Incyte, Wilmington, DE (D.K., K.S., K.B.)
| | - Deanna Kornacki
- From Tufts Medical Center, Boston (D.R.); Centre Hospitalier Universitaire de Nice and Centre Méditerranéen de Médecine Moléculaire, Université Côte d'Azur, Nice (T.P.), the Office of Mireille Ruer-Mulard, M.D., Martiques (M.R.-M.), the Department of Dermatology and Pediatric Dermatology, National Reference Center for Rare Skin Disorders, Hôpital Saint-André, and Centre National de la Recherche Scientifique Unité Mixte de Recherche 5164, ImmunoConcept, Université de Bordeaux, Bordeaux (J.S.), and Henri Mondor University Hospital and Université Paris-Est Créteil Val de Marne, Paris (K.E.) - all in France; Palo Alto Foundation Medical Group, Sunnyvale (A.G.P.), and the Vitiligo and Pigmentation Institute of Southern California, Los Angeles (P.G.) - both in California; the University of Texas Southwestern Medical Center, Dallas (A.G.P., S.R.D.), and Innovative Dermatology, Plano (S.R.D.) - both in Texas; the University of Massachusetts Chan Medical School, Worcester (J.E.H.); Icahn School of Medicine at Mount Sinai, New York (M.L.); Amsterdam University Medical Center, Amsterdam (A.W.); and Incyte, Wilmington, DE (D.K., K.S., K.B.)
| | - Kang Sun
- From Tufts Medical Center, Boston (D.R.); Centre Hospitalier Universitaire de Nice and Centre Méditerranéen de Médecine Moléculaire, Université Côte d'Azur, Nice (T.P.), the Office of Mireille Ruer-Mulard, M.D., Martiques (M.R.-M.), the Department of Dermatology and Pediatric Dermatology, National Reference Center for Rare Skin Disorders, Hôpital Saint-André, and Centre National de la Recherche Scientifique Unité Mixte de Recherche 5164, ImmunoConcept, Université de Bordeaux, Bordeaux (J.S.), and Henri Mondor University Hospital and Université Paris-Est Créteil Val de Marne, Paris (K.E.) - all in France; Palo Alto Foundation Medical Group, Sunnyvale (A.G.P.), and the Vitiligo and Pigmentation Institute of Southern California, Los Angeles (P.G.) - both in California; the University of Texas Southwestern Medical Center, Dallas (A.G.P., S.R.D.), and Innovative Dermatology, Plano (S.R.D.) - both in Texas; the University of Massachusetts Chan Medical School, Worcester (J.E.H.); Icahn School of Medicine at Mount Sinai, New York (M.L.); Amsterdam University Medical Center, Amsterdam (A.W.); and Incyte, Wilmington, DE (D.K., K.S., K.B.)
| | - Kathleen Butler
- From Tufts Medical Center, Boston (D.R.); Centre Hospitalier Universitaire de Nice and Centre Méditerranéen de Médecine Moléculaire, Université Côte d'Azur, Nice (T.P.), the Office of Mireille Ruer-Mulard, M.D., Martiques (M.R.-M.), the Department of Dermatology and Pediatric Dermatology, National Reference Center for Rare Skin Disorders, Hôpital Saint-André, and Centre National de la Recherche Scientifique Unité Mixte de Recherche 5164, ImmunoConcept, Université de Bordeaux, Bordeaux (J.S.), and Henri Mondor University Hospital and Université Paris-Est Créteil Val de Marne, Paris (K.E.) - all in France; Palo Alto Foundation Medical Group, Sunnyvale (A.G.P.), and the Vitiligo and Pigmentation Institute of Southern California, Los Angeles (P.G.) - both in California; the University of Texas Southwestern Medical Center, Dallas (A.G.P., S.R.D.), and Innovative Dermatology, Plano (S.R.D.) - both in Texas; the University of Massachusetts Chan Medical School, Worcester (J.E.H.); Icahn School of Medicine at Mount Sinai, New York (M.L.); Amsterdam University Medical Center, Amsterdam (A.W.); and Incyte, Wilmington, DE (D.K., K.S., K.B.)
| | - Khaled Ezzedine
- From Tufts Medical Center, Boston (D.R.); Centre Hospitalier Universitaire de Nice and Centre Méditerranéen de Médecine Moléculaire, Université Côte d'Azur, Nice (T.P.), the Office of Mireille Ruer-Mulard, M.D., Martiques (M.R.-M.), the Department of Dermatology and Pediatric Dermatology, National Reference Center for Rare Skin Disorders, Hôpital Saint-André, and Centre National de la Recherche Scientifique Unité Mixte de Recherche 5164, ImmunoConcept, Université de Bordeaux, Bordeaux (J.S.), and Henri Mondor University Hospital and Université Paris-Est Créteil Val de Marne, Paris (K.E.) - all in France; Palo Alto Foundation Medical Group, Sunnyvale (A.G.P.), and the Vitiligo and Pigmentation Institute of Southern California, Los Angeles (P.G.) - both in California; the University of Texas Southwestern Medical Center, Dallas (A.G.P., S.R.D.), and Innovative Dermatology, Plano (S.R.D.) - both in Texas; the University of Massachusetts Chan Medical School, Worcester (J.E.H.); Icahn School of Medicine at Mount Sinai, New York (M.L.); Amsterdam University Medical Center, Amsterdam (A.W.); and Incyte, Wilmington, DE (D.K., K.S., K.B.)
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Rosmarin D, Ezzedine K, Desai SR. 34789 Efficacy and safety of ruxolitinib cream for the treatment of vitiligo: Week 24 pooled analysis of the TRuE-V phase 3 studies. J Am Acad Dermatol 2022. [DOI: 10.1016/j.jaad.2022.06.236] [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: 11/30/2022]
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Learned C, Alsukait S, Rosmarin D. Usage of Topical Calcineurin Inhibitors in the Medicare Population from 2013 to 2018. J Drugs Dermatol 2022; 21:912-913. [DOI: 10.36849/jdd.6706] [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: 11/09/2022]
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Zagona-Prizio C, Yousif J, Grant C, Mehta M, Rosmarin D, Silverberg N, Tan J, Larocca C, Shinohara M, Mostaghimi A, Kim B, Gulliver S, Gulliver W, Siegel D, Perez-Chada L, Merola J, Gottlieb A, Armstrong A. International Dermatology Outcome Measures (IDEOM): Report from the 2021 Annual Meeting. J Drugs Dermatol 2022; 21:867-874. [DOI: 10.36849/jdd.6974] [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: 11/09/2022]
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Ujiie H, Rosmarin D, Schön MP, Ständer S, Boch K, Metz M, Maurer M, Thaci D, Schmidt E, Cole C, Amber KT, Didona D, Hertl M, Recke A, Graßhoff H, Hackel A, Schumann A, Riemekasten G, Bieber K, Sprow G, Dan J, Zillikens D, Sezin T, Christiano AM, Wolk K, Sabat R, Kridin K, Werth VP, Ludwig RJ. Unmet Medical Needs in Chronic, Non-communicable Inflammatory Skin Diseases. Front Med (Lausanne) 2022; 9:875492. [PMID: 35755063 PMCID: PMC9218547 DOI: 10.3389/fmed.2022.875492] [Citation(s) in RCA: 47] [Impact Index Per Article: 23.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Accepted: 05/09/2022] [Indexed: 12/15/2022] Open
Abstract
An estimated 20-25% of the population is affected by chronic, non-communicable inflammatory skin diseases. Chronic skin inflammation has many causes. Among the most frequent chronic inflammatory skin diseases are atopic dermatitis, psoriasis, urticaria, lichen planus, and hidradenitis suppurativa, driven by a complex interplay of genetics and environmental factors. Autoimmunity is another important cause of chronic skin inflammation. The autoimmune response may be mainly T cell driven, such as in alopecia areata or vitiligo, or B cell driven in chronic spontaneous urticaria, pemphigus and pemphigoid diseases. Rare causes of chronic skin inflammation are autoinflammatory diseases, or rheumatic diseases, such as cutaneous lupus erythematosus or dermatomyositis. Whilst we have seen a significant improvement in diagnosis and treatment, several challenges remain. Especially for rarer causes of chronic skin inflammation, early diagnosis is often missed because of low awareness and lack of diagnostics. Systemic immunosuppression is the treatment of choice for almost all of these diseases. Adverse events due to immunosuppression, insufficient therapeutic responses and relapses remain a challenge. For atopic dermatitis and psoriasis, a broad spectrum of innovative treatments has been developed. However, treatment responses cannot be predicted so far. Hence, development of (bio)markers allowing selection of specific medications for individual patients is needed. Given the encouraging developments during the past years, we envision that many of these challenges in the diagnosis and treatment of chronic inflammatory skin diseases will be thoroughly addressed in the future.
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Affiliation(s)
- Hideyuki Ujiie
- Department of Dermatology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - David Rosmarin
- Department of Dermatology, Tufts Medical Center, Boston, MA, United States
| | - Michael P Schön
- Department of Dermatology, Venereology and Allergology, University Medical Center Göttingen, Göttingen, Germany.,Lower Saxony Institute of Occupational Dermatology, University Medical Center Göttingen, Göttingen, Germany
| | - Sonja Ständer
- Center for Chronic Pruritus, Department of Dermatology, University Hospital Muenster, Muenster, Germany
| | - Katharina Boch
- Department of Dermatology, University of Lübeck, Lübeck, Germany
| | - Martin Metz
- Institute for Allergology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany.,Fraunhofer Institute for Translational Medicine and Pharmacology (ITMP), Allergology and Immunology, Berlin, Germany
| | - Marcus Maurer
- Institute for Allergology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany.,Fraunhofer Institute for Translational Medicine and Pharmacology (ITMP), Allergology and Immunology, Berlin, Germany
| | - Diamant Thaci
- Institute and Comprehensive Center for Inflammation Medicine, University of Lübeck, Lübeck, Germany
| | - Enno Schmidt
- Department of Dermatology, University of Lübeck, Lübeck, Germany.,Lübeck Institute of Experimental Dermatology and Center for Research on Inflammation of the Skin, University of Lübeck, Lübeck, Germany
| | - Connor Cole
- Division of Dermatology, Rush University Medical Center, Chicago, IL, United States.,Department of Internal Medicine, Rush University Medical Center, Chicago, IL, United States
| | - Kyle T Amber
- Division of Dermatology, Rush University Medical Center, Chicago, IL, United States.,Department of Internal Medicine, Rush University Medical Center, Chicago, IL, United States
| | - Dario Didona
- Department of Dermatology and Allergology, Philipps-Universität, Marburg, Germany
| | - Michael Hertl
- Department of Dermatology and Allergology, Philipps-Universität, Marburg, Germany
| | - Andreas Recke
- Department of Dermatology, University of Lübeck, Lübeck, Germany
| | - Hanna Graßhoff
- Department of Rheumatology and Clinical Immunology, University of Lübeck, Lübeck, Germany
| | - Alexander Hackel
- Department of Rheumatology and Clinical Immunology, University of Lübeck, Lübeck, Germany
| | - Anja Schumann
- Department of Rheumatology and Clinical Immunology, University of Lübeck, Lübeck, Germany
| | - Gabriela Riemekasten
- Department of Rheumatology and Clinical Immunology, University of Lübeck, Lübeck, Germany
| | - Katja Bieber
- Lübeck Institute of Experimental Dermatology and Center for Research on Inflammation of the Skin, University of Lübeck, Lübeck, Germany
| | - Gant Sprow
- Department of Dermatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States.,Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, PA, United States
| | - Joshua Dan
- Department of Dermatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States.,Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, PA, United States
| | - Detlef Zillikens
- Department of Dermatology, University of Lübeck, Lübeck, Germany
| | - Tanya Sezin
- Department of Dermatology, Columbia University Medical Center, New York, NY, United States
| | - Angela M Christiano
- Department of Dermatology, Columbia University Medical Center, New York, NY, United States
| | - Kerstin Wolk
- Psoriasis Research and Treatment Centre, Charité-Universitätsmedizin Berlin, Berlin, Germany.,Interdisciplinary Group Molecular Immunopathology, Dermatology/Medical Immunology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Robert Sabat
- Psoriasis Research and Treatment Centre, Charité-Universitätsmedizin Berlin, Berlin, Germany.,Interdisciplinary Group Molecular Immunopathology, Dermatology/Medical Immunology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Khalaf Kridin
- Lübeck Institute of Experimental Dermatology and Center for Research on Inflammation of the Skin, University of Lübeck, Lübeck, Germany.,Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel
| | - Victoria P Werth
- Department of Dermatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States.,Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, PA, United States
| | - Ralf J Ludwig
- Department of Dermatology, University of Lübeck, Lübeck, Germany.,Lübeck Institute of Experimental Dermatology and Center for Research on Inflammation of the Skin, University of Lübeck, Lübeck, Germany
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Learned C, Alsukait S, Deverapalli S, Elliott E, Moody K, Sobell J, Konnikov N, Ortega M, Rosmarin D. Psoriasis adverse events and associated medications as reported in the US Food and Drug Administration’s Adverse Event Reporting System from 2016 to 2021. JAAD Int 2022; 7:144-145. [PMID: 35497638 PMCID: PMC9043660 DOI: 10.1016/j.jdin.2022.03.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Veerabagu SA, Jia J, Yu Z, Gao D, Kahn JS, Tanner J, Burkemper NM, Friedman AJ, Huang JT, Nord KM, Rosmarin D, Murina AT. Improving dermatology residency program website transparency in the era of preference signaling. Dermatol Online J 2022; 28. [DOI: 10.5070/d328257408] [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] [Received: 05/10/2022] [Accepted: 05/10/2022] [Indexed: 11/08/2022] Open
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Rosmarin D, Fretzin S, Strowd L, Casillas M, DeLozier AM, Dawson Z, Chen S, Lu N, Thyssen JP. Rapid Improvement in Skin Pain Severity and Its Impact on Quality of Life in Adult Patients With Moderate-to-Severe Atopic Dermatitis From a Double-Blind, Placebo-Controlled Baricitinib Phase 3 Study. J Cutan Med Surg 2022; 26:377-385. [PMID: 35354410 DOI: 10.1177/12034754221088542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Skin pain (discomfort/soreness) is a common symptom associated with atopic dermatitis (AD). OBJECTIVE To evaluate rapid changes in skin pain severity with baricitinib, and its impact on patient quality of life (QoL) in adults with moderate-to-severe AD who were inadequate responders to topical therapy. METHODS Adult patients with moderate-to-severe AD who were inadequate responders to topical therapies (N = 440, BREEZE-AD5 [NCT03435081]) were randomized to once-daily placebo, baricitinib 1 mg, or baricitinib 2 mg for 16 weeks. Change in Skin Pain Numeric Rating Scale (NRS) scores were assessed for the randomized population. Skin Pain NRS and Dermatology Life Quality Index (DLQI) scores were assessed for Skin Pain Response groups and patients with Body Surface Area (BSA) 10% to 50%. RESULTS Skin Pain NRS improvement was significant versus placebo by day 1 baricitinib 2 mg (least squares mean [LSM] difference -4.4%, P = .048) and by day 2 for baricitinib 1 mg (-6.7%, P = .011). As measured weekly, improvement was significant starting at Week 1 and remained significant through Week 16 for both doses. At Week 16, 70.9% of Skin Pain NRS responders vs 10.4% of nonresponders had a clinically meaningful improvement in DLQI (P < .0001). At week 16, LSM DLQI change from baseline was -11.1 for all Skin Pain NRS responders versus -3.5 for nonresponders (P < .0001). Patients with BSA 10% to 50% showed similar trends. CONCLUSIONS Patients with moderate-to-severe AD, treated with baricitinib, reported rapid improvements in skin pain severity by day 1 for baricitinib 2 mg and day 2 for baricitinib 1 mg and remained effective through 16 weeks of treatment, which positively impacted patient QoL.
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Affiliation(s)
| | - Scott Fretzin
- Dawes Fretzin Dermatology Group, Indianapolis, IN, USA
| | - Lindsay Strowd
- 528756 Wake Forest School of Medicine, Winston-Salem, NC, USA
| | | | | | - Zach Dawson
- 1539 Eli Lilly and Company, Indianapolis, IN, USA
| | | | - Na Lu
- Precision Statistics Consulting, Woodbury, MN, USA
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Rosmarin D, Casillas M, Chen S, Dawson Z, Pierce E, Zhang H, Bukhalo M, Smith S. Onset of Symptom Relief Reported in Daily Diaries in Patients With Atopic Dermatitis Treated With Baricitinib in a United States Clinical Trial (BREEZE-AD5). J Cutan Med Surg 2022; 26:262-266. [PMID: 35086348 DOI: 10.1177/12034754211073661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Itch and sleep disturbance due to itch are burdensome symptoms associated with atopic dermatitis (AD). Rapid onset of action is important for AD treatments to improve quality of life and relieve suffering. OBJECTIVES This subanalysis evaluated how quickly baricitinib 1-mg and 2-mg reduced itch and associated sleep disturbance during the first 7 days after treatment initiation in a phase 3, double-blind, placebo-controlled trial. METHODS Adult patients with AD were randomized 1:1:1 to placebo (N = 147), baricitinib 1 mg (N = 147) or baricitinib 2 mg (N = 146). Patients kept daily diaries, completing the Itch Numeric Rating Scale (NRS) (itch severity from 0 = no itch to 10 = worst itch imaginable) and the Atopic Dermatitis Sleep Scale (ADSS) to measure sleep disturbance (number of nighttime awakenings because of itch). Mixed model repeated measures analysis was used to analyze change from day 1 to day 7 values. RESULTS Patients receiving either dose of baricitinib had a 9.9% decrease in itch NRS scores from baseline to Day 2 vs 1.5% decrease for placebo (significant between-group least squares mean [LSM] difference: 8.3; 95% CI -12.66 to -3.89; P = .0002). Baricitinib 2 mg reduced nighttime awakenings due to itch (ADSS item 2) at day 2 by 25.2% vs 3.9% in the placebo group (between-group LSM difference: -21.4, P = .0025). Baricitinib 2 mg continued to demonstrate a statistically significant difference from placebo in sleep symptoms at day 7 (LSM difference -23.9; P = .001). CONCLUSIONS Baricitinib 2-mg provided relief from itching and sleep disturbance in patients with AD, beginning the day after taking first dose.Clinical trials at www.clinicaltrials.gov: BREEZE-AD5 (NCT03435081).
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Affiliation(s)
| | | | | | - Zach Dawson
- 1539 Eli Lilly and Company, Indianapolis, IN, USA
| | | | - Hong Zhang
- 142851 TechData Service, King of Prussia, PA, USA
| | | | - Stacy Smith
- California Dermatology and Clinical Research Institute, Encinitas, CA, USA
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Rosenbaum KB, Rosmarin D. The Boundaries of Critiquing a Colleague. J Am Acad Psychiatry Law 2021; 49:470-472. [PMID: 34903577 DOI: 10.29158/jaapl.210098-21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Affiliation(s)
- Karen B Rosenbaum
- Dr. Rosenbaum is Clinical Assistant Professor, Forensic Psychiatry Department, New York University Langone Medical Center, New York, NY, and has a private clinical and forensic practice in New York City, NY. Dr. Rosmarin is the Director of the Forensic Psychiatry Service at McLean Hospital, Harvard Medical School, Boston, MA, and Chair of the Committee on Peer Review of Psychiatric Testimony of AAPL.
| | - David Rosmarin
- Dr. Rosenbaum is Clinical Assistant Professor, Forensic Psychiatry Department, New York University Langone Medical Center, New York, NY, and has a private clinical and forensic practice in New York City, NY. Dr. Rosmarin is the Director of the Forensic Psychiatry Service at McLean Hospital, Harvard Medical School, Boston, MA, and Chair of the Committee on Peer Review of Psychiatric Testimony of AAPL
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Cohen SR, Gao DX, Kahn JS, Rosmarin D. Comparison of constitutional and dermatologic side effects between COVID-19 and non-COVID-19 vaccines: Review of a publicly available database of vaccine side effects. J Am Acad Dermatol 2021; 86:248-249. [PMID: 34592382 PMCID: PMC8482701 DOI: 10.1016/j.jaad.2021.09.044] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Revised: 09/11/2021] [Accepted: 09/18/2021] [Indexed: 11/16/2022]
Affiliation(s)
- Stephanie R Cohen
- Department of Dermatology, Tufts Medical Center, Boston, Massachusetts
| | - David X Gao
- Department of Dermatology, Tufts Medical Center, Boston, Massachusetts
| | - Jared S Kahn
- Department of Dermatology, Tufts Medical Center, Boston, Massachusetts
| | - David Rosmarin
- Department of Dermatology, Tufts Medical Center, Boston, Massachusetts.
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Ghatnekar S, Suhaimi NM, Griffin J, Rosmarin D, Yanovsky R, Sharma P, Yang FC. Using simulation modeling to minimize patient-to-patient contact time while optimizing clinical operations during a pandemic. J Am Acad Dermatol 2021; 85:1662-1664. [PMID: 34509539 PMCID: PMC8463112 DOI: 10.1016/j.jaad.2021.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Revised: 08/17/2021] [Accepted: 09/02/2021] [Indexed: 11/29/2022]
Affiliation(s)
| | - Nurul M Suhaimi
- Department of Mechanical and Industrial Engineering, Northeastern University, Boston, Massachusetts
| | - Jacqueline Griffin
- Department of Mechanical and Industrial Engineering, Northeastern University, Boston, Massachusetts
| | - David Rosmarin
- Department of Dermatology, Tufts Medical Center, Boston, Massachusetts
| | - Rebecca Yanovsky
- Department of Dermatology, Tufts Medical Center, Boston, Massachusetts
| | - Priyank Sharma
- Department of Dermatology, Hofstra School of Medicine/Northwell, Lake Success, New York, New York
| | - F Clarissa Yang
- Department of Dermatology, Tufts Medical Center, Boston, Massachusetts.
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Hamzavi I, Rosmarin D, Butler K, Kuo F, Zhu Z, Sun K. 25486 Correlation of the Vitiligo Area Scoring Index with patient- and physician-reported measures of clinical improvement in a randomized, double-blind phase 2 study. J Am Acad Dermatol 2021. [DOI: 10.1016/j.jaad.2021.06.264] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Rosmarin D, Smith S, Shrom D, Burge R, See K, McKean‐Matthews M, Ridenour T, Lin C, Gorelick J. Clinical outcomes at 1 year in early Psoriasis Area and Severity Index responders compared with non-responders: Subgroup analysis of UNCOVER-3 trial. Skin Health Dis 2021; 1:e43. [PMID: 35663140 PMCID: PMC9060090 DOI: 10.1002/ski2.43] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
| | - S. Smith
- California Dermatology and Clinical Research InstituteEncinitasCaliforniaUSA
| | - D. Shrom
- Eli Lilly and CompanyIndianapolisIndianaUSA
| | - R. Burge
- Eli Lilly and CompanyIndianapolisIndianaUSA
- Division of Pharmaceutical SciencesUniversity of CincinnatiCincinnatiOhioUSA
| | - K. See
- Eli Lilly and CompanyIndianapolisIndianaUSA
| | | | | | - C.‐Y. Lin
- Eli Lilly and CompanyIndianapolisIndianaUSA
| | - J. Gorelick
- California Skin InstituteSan JoseCaliforniaUSA
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Eichenfield LF, Maverakis E, Tan J, Albrecht L, Buchanan A, DeLozier AM, Zhong J, Sun L, Rosmarin D. 25423 Improvements in work productivity following baricitinib treatment in patients with moderate-to-severe atopic dermatitis: Results from BREEZE-AD5. J Am Acad Dermatol 2021. [DOI: 10.1016/j.jaad.2021.06.257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Rosmarin D, Fretzin S, Strowd L, Casillas M, DeLozier A, Dawson Z, Chen S, Lu N, Thyssen JP. 26292 Rapid improvement in skin pain, and its impact on quality of life, in adult patients with moderate-to-severe atopic dermatitis from a double-blind, placebo-controlled baricitinib phase 3 study. J Am Acad Dermatol 2021. [DOI: 10.1016/j.jaad.2021.06.402] [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: 11/15/2022]
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Harris JE, Pandya AG, Lebwohl M, Grimes P, Gottlieb AB, Sofen HL, Moore AY, Butler K, Kuo F, Sun K, Rosmarin D. 27535 Safety and efficacy of ruxolitinib cream for the treatment of vitiligo: 104-week data from a phase 2 study. J Am Acad Dermatol 2021. [DOI: 10.1016/j.jaad.2021.06.165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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43
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Song S, Gao D, Fiumara K, Rosmarin D. 28547 Retrospective review of patients with dupilumab facial and neck redness treated with itraconazole at a single academic medical center. J Am Acad Dermatol 2021. [DOI: 10.1016/j.jaad.2021.06.801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Silverberg JI, Thyssen JP, Rosmarin D, Pink AE, Calimlim BM, Teixeira HD, Hu X, Yang Y, Thaçi D. 25532 Effects of upadacitinib on patient-reported symptoms of atopic dermatitis: Atopic Dermatitis Symptom Scale (ADerm-SS) results from two pivotal phase 3 studies (MEASURE UP 1 and MEASURE UP 2). J Am Acad Dermatol 2021. [DOI: 10.1016/j.jaad.2021.06.055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Pandya AG, Harris JE, Lebwohl M, Hamzavi I, Butler K, Kuo F, Wei S, Rosmarin D. 27636 Addition of narrow-band ultraviolet light B phototherapy to ruxolitinib cream in patients with vitiligo. J Am Acad Dermatol 2021. [DOI: 10.1016/j.jaad.2021.06.645] [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: 11/27/2022]
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46
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Jarell A, Smith S, Gallo G, Renda L, Burge R, Zhu B, Guo J, Blue EK, Rosmarin D. 25805 Ixekizumab provides more durable improvements in skin clearance, itch, and quality of life than guselkumab in patients with moderate-to-severe psoriasis: 24-week results from IXORA-R. J Am Acad Dermatol 2021. [DOI: 10.1016/j.jaad.2021.06.070] [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: 11/30/2022]
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47
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Silverberg JI, de Bruin-Weller M, Bieber T, Soong W, Kabashima K, Costanzo A, Rosmarin D, Lynde C, Liu J, Gamelli A, Zeng J, Ladizinski B, Chu AD, Reich K. Upadacitinib plus topical corticosteroids in atopic dermatitis: week-52 AD Up study results. J Allergy Clin Immunol 2021; 149:977-987.e14. [PMID: 34403658 DOI: 10.1016/j.jaci.2021.07.036] [Citation(s) in RCA: 49] [Impact Index Per Article: 16.3] [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: 03/30/2021] [Revised: 07/09/2021] [Accepted: 07/29/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Primary (week 16) results from the ongoing phase 3, double-blind AD Up study (NCT03568318) demonstrate a positive benefit-risk profile for upadacitinib+TCS in patients with moderate-to-severe AD. OBJECTIVE Evaluate efficacy and safety of UPA+TCS through 52 weeks. METHODS Patients (12-75y) with chronic AD (≥10% of body surface area affected, EASI ≥16, vIGA-AD™ ≥3, and WP-NRS score ≥4) were randomized 1:1:1 to once-daily upadacitinib 15mg+TCS, upadacitinib 30mg+TCS, or PBO+TCS (re-randomized at week 16 to upadacitinib+TCS). Safety and efficacy, including proportion of patients achieving ≥75% improvement in EASI (EASI-75), vIGA-AD of clear/almost clear with improvement ≥2 grades (vIGA-AD 0/1), and WP-NRS improvement ≥4, were assessed through week 52. Missing data were primarily handled by nonresponder imputation incorporating multiple imputation for missing values due to COVID-19. RESULTS Of 901 patients, 300 were randomized to upadacitinib 15mg+TCS, 297 to upadacitinib 30mg+TCS, and 304 to PBO+TCS. For all endpoints, efficacy for upadacitinib 15mg+TCS and upadacitinib 30mg+TCS at week 16 was maintained through week 52. At week 52, the proportions of patients treated with upadacitinib 15mg+TCS and upadacitinib 30mg+TCS who achieved EASI-75 were 50.8% and 69.0%, respectively; 33.5% and 45.2%, respectively, achieved vIGA-AD 0/1; and 45.3% and 57.5%, respectively, achieved WP-NRS improvement ≥4. upadacitinib+TCS was well tolerated through 52 weeks; no new important safety risks beyond the current label were observed. No deaths were reported; events of MACE and VTE were infrequent (≤0.2/100 PY). CONCLUSION Results through 52 weeks demonstrate long-term maintenance of efficacy and a favorable safety profile of upadacitinib+TCS in patients with moderate-to-severe AD.
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Affiliation(s)
- Jonathan I Silverberg
- Department of Dermatology, The George Washington University School of Medicine and Health Sciences, Washington, DC.
| | - Marjolein de Bruin-Weller
- National Expertise Center of Atopic Dermatitis, Department of Dermatology and Allergology, University Medical Center Utrecht, Utrecht, Netherlands
| | - Thomas Bieber
- Department of Dermatology and Allergy, University Hospital of Bonn, Bonn, Germany
| | - Weily Soong
- Alabama Allergy & Asthma Center and Clinical Research Center of Alabama, Birmingham
| | - Kenji Kabashima
- Department of Dermatology, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Antonio Costanzo
- Dermatology Unit, Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - David Rosmarin
- Department of Dermatology, Tufts University School of Medicine, Boston, Mass
| | - Charles Lynde
- Lynde Dermatology, Probity Medical Research, Markham and Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | | | | | | | | | | | - Kristian Reich
- Translational Research in Inflammatory Skin Diseases, Institute for Health Services Research in Dermatology and Nursing, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Kahn JS, Moody K, Rosmarin D. Significant improvement of dermatitis herpetiformis with tofacitinib. Dermatol Online J 2021; 27. [PMID: 34391330 DOI: 10.5070/d327754365] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Accepted: 08/09/2021] [Indexed: 11/08/2022] Open
Abstract
Dermatitis herpetiformis (DH) is a rare autoimmune blistering disorder in which patients with celiac disease, a gluten-sensitive enteropathy, present with a severely pruritic papulovesicular eruption over extensor surfaces such as the knees, elbows, lower back, buttocks, and neck. Patients are instructed to adhere to a gluten-free diet for purposes of improving their skin disease and gluten-sensitive enteropathy; this is the only treatment that lowers risk of enteropathy-associated T cell lymphoma. Patients who adhere to a strict gluten-free diet often have remission of their skin disease over months to years. Dapsone is a rapid and extremely effective first-line treatment option and often used while transitioning to a gluten-free diet. Aside from gluten-free diet and dapsone, second-line treatment options include sulfapyridine, sulfasalazine, and colchicine. Some patients have difficulty adhering to a gluten-free diet or develop intolerable side effects to systemic therapies. Furthermore, there is limited data on the use of the second-line treatments. Recent studies have shed light on the role of JAK-STAT-dependent pathways in the pathogenesis of dermatitis herpetiformis. We present a patient treated with tofacitinib, 5mg twice daily, an oral JAK1/3 inhibitor, who demonstrated clinical improvement of DH and control of new lesion development.
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Affiliation(s)
- Jared S Kahn
- Tufts University School of Medicine, Boston, MA Department of Dermatology, Tufts Medical Center, Boston, MA
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49
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Alzahrani N, Grossman-Kranseler J, Swali R, Fiumara K, Zancanaro P, Tyring S, Rosmarin D. Hailey-Hailey disease treated with dupilumab: a case series. Br J Dermatol 2021; 185:680-682. [PMID: 33971025 DOI: 10.1111/bjd.20475] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Revised: 03/16/2021] [Accepted: 04/22/2021] [Indexed: 11/30/2022]
Affiliation(s)
- N Alzahrani
- King Abdulaziz University, Jeddah, Saudi Arabia
| | | | - R Swali
- Center for Clinical Studies, Houston, TX, USA
| | - K Fiumara
- Clinical Pharmacy, Tufts Medical Center, Boston, MA, USA
| | - P Zancanaro
- Department of Dermatology, Tufts Medical Center, Boston, MA, USA
| | - S Tyring
- McGovern Medical School at University of Texas Health Science Center, Houston, TX, USA
| | - D Rosmarin
- Department of Dermatology, Tufts Medical Center, Boston, MA, USA
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50
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Cohen SR, Kahn JS, Gao DX, Fiumara K, Lam A, Dumont N, Rosmarin D. Continuation and Discontinuation Rates of Biologics in Dermatology Patients During COVID-19 Pandemic. J Cutan Med Surg 2021; 25:646-647. [PMID: 34107794 DOI: 10.1177/12034754211024125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Stephanie R Cohen
- 1867 Department of Dermatology, Tufts Medical Center, Boston, MA, USA
| | - Jared S Kahn
- 1867 Department of Dermatology, Tufts Medical Center, Boston, MA, USA
| | - David X Gao
- 1867 Department of Dermatology, Tufts Medical Center, Boston, MA, USA
| | - Kristin Fiumara
- 12261 Department of Pharmacy, Tufts Medical Center, Boston, MA, USA
| | - Anh Lam
- 12261 Department of Pharmacy, Tufts Medical Center, Boston, MA, USA
| | - Nicole Dumont
- 1867 Department of Dermatology, Tufts Medical Center, Boston, MA, USA
| | - David Rosmarin
- 1867 Department of Dermatology, Tufts Medical Center, Boston, MA, USA
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