Benefit-risk profile of tofacitinib in patients with moderate-to-severe chronic plaque psoriasis: pooled analysis across six clinical trials

Background

Although existing psoriasis treatments are effective and well tolerated in many patients, there is still a need for new effective targeted treatment options. Tofacitinib is an oral Janus kinase inhibitor that has been investigated in patients with moderate‐to‐severe chronic plaque psoriasis.

Objectives

To consider the benefits and risks of tofacitinib in patients with moderate‐to‐severe psoriasis.

Methods

Data were pooled from one phase II, four phase III and one long‐term extension study comprising 5204 patient‐years of tofacitinib treatment. Efficacy end points included patients achieving Physician's Global Assessments of ‘clear’ or ‘almost clear’, ≥ 75% and ≥ 90% reduction in Psoriasis Area and Severity Index (coprimary end points) and improvements in Dermatology Life Quality Index score, Hospital Anxiety and Depression Scale depression score and Itch Severity Item score, at weeks 16 and 52. Safety data were summarized for 3 years of tofacitinib exposure.

Results

Tofacitinib 5 and 10 mg twice daily (BID) showed superiority over placebo for all efficacy end points at week 16, with response maintained for 52 weeks of continued treatment. Tofacitinib improved patients’ quality of life and was well tolerated. Rates of safety events of interest (except herpes zoster) were similar to those in the published literature and healthcare databases for other systemic psoriasis therapies. Tofacitinib 10 mg BID demonstrated greater efficacy than 5 mg BID.

Conclusions

Tofacitinib has a benefit–risk profile in moderate‐to‐severe psoriasis consistent with that of other systemic treatments.

What's already known about this topic?

Psoriasis is a chronic, systemic inflammatory disease, which has a significant impact on patients’ health‐related quality of life.

Although several existing psoriasis treatments are efficacious and well tolerated in many patients, some patients require treatment switching, and a proportion of patients remain untreated or undertreated.

Potential challenges to the use of existing therapies include safety issues and limited efficacy in some patients with conventional oral psoriasis treatments, inconvenience of topical treatments and the requirement for parenteral administration of biologics.

What does this study add?

Consistent efficacy and a safety profile consistent with that seen in rheumatoid arthritis, psoriatic arthritis and ulcerative colitis were demonstrated for oral tofacitinib in patients with moderate‐to‐severe psoriasis.

Tofacitinib has a benefit–risk profile in patients with moderate‐to‐severe psoriasis that is consistent with that of other systemic psoriasis treatments.

Linked Comment: Fleming. Br J Dermatol 2019; 180:13–14.

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Nationwide Cancer Control Program in India: 3 Decades of Experience With Fundraising Report

Amount raised: In last decade INR 169,708,369 mobilized through sponsored cancer awareness programs. Background and context: With an eagle's eye our vision of eighties resulted in the incorporation of Cancer Aid Society on 8th of December 1987 at Lucknow. Founders of the Cancer Aid Society perceived the threats early and initiated the fight against cancer by developing a self-sustainable model without external financial assistance unfurling series of events internationally. As of now ours is a holistic model on cancer prevention integrated with NCDs, tobacco and palliative care demonstrating replicability within different communities and scalability across the worlds largest democracy having its own network of branches. Aim: Self-sustainable model prevention and control of tobacco, cancer integrated with other NCDs, palliative care and advocacy. Strategy/Tactics: Sponsored cancer awareness programs are organized free of cost in schools and colleges however we accept voluntary donations from the community if any. As schools have contact with the child and their family from kindergarten to senior secondary, they inculcate the spirit of humanitarianism and work for social amelioration improving the overall health of the citizens strengthening the fight against cancer. It covers the need of the current and future generations on cancer control. Program process: Keeping with the ages old adage “Prevention Is Better Than Cure” thousands of community awareness campaigns are organized in educational Institutions every year by mobilizing a million volunteers who generate awareness among twenty million people all over India on health, hygiene, tobacco abuse including passive smoking, carcinogens, balanced diet, regular exercise, obesity, clean drinking water, pollution of air, water and land etc. This plays an integral part in inculcating healthy lifestyle and keeping children away from tobacco at an age when they are vulnerable and tempted the most further grooming our future generation when they are most receptive and in the process of developing habits. They multiply awareness manifold improving the overall health of the community. Costs and returns: As the program follows an integrated and holistic approach on prevention and control of cancer and other NCDs virtually it lacks any administrative costs and offers 100% returns on investments. In last decade INR 144,968,969 spent in sponsored cancer awareness programs. What was learned: With our 30 years of experience of working at grass root community level all across India in spite of regional complexities in terms of multiple languages, cultures, castes, religions etc. ISO 9001 NGO accreditation has given us teeth since 2004 streamlining our functioning through documentation and continuous improvement program through reporting monitoring and feedback. As of now we are ready to share our experiences at international level.

Advocacy for Early Detection and Treatment of Cervix and Breast Cancer

Background and context: According to ICO Information Centre on HPV and Cancer (HPV Information Centre) 2014 in females with 23.8% breast cancer is highest and at 20.2% cervix cancer comes at number 2 in India. India has a population of 432.20 million women aged 15 years and older who are at risk for developing cervical cancer. Current estimates indicate that every year 122,844 women are diagnosed with cervical cancer and 67,477 die of the disease. Cervical cancer in India ranks as the 2nd most frequent cancer among women between 15 and 44 years of age. Aim: Accessibility for the early detection of cervix and breast cancer for the females in Uttar Pradesh. Strategy/Tactics: Lucknow is the capital city of Uttar Pradesh the most populous State of India having 1/6 of population and equivalent burden of cervical cancer. Any action aimed at an effect in Lucknow shall further have impact in the entire state. Advocacy training was organized at Lucknow on the occasion of “World Cancer Day” (4th February) with material for capacity building of organizations working on cervical cancer and female health. We were able to mobilize 10 different organizations working for cervical cancer and female health issue. Presence of Hon'ble Governor and Principal Health Secretary enabled us in making a dent on the issue from the very beginning. His Excellency the Governor of Uttar Pradesh being a cancer survivor was the best advocate, stressing during the lecture on the need to address the issue. Principal Health Secretary, the ultimate deciding authority for developing the policies assured for full cooperation and early action. Program/Policy process: Principal Health Secretary of Government of Uttar Pradesh announced to establish the screening clinics forscreening of cervical cancer in 23 districts of Uttar Pradesh. Treatment facilities would be provided in all the government medical colleges of Uttar Pradesh. The clinic set up shall be monitored by National Health Mission Unit of Uttar Pradesh. Outcomes: Currently Sampoorna clinics are established in 28 districts of Uttar Pradesh which is for females of age group 15 to 60 years for all kind of screening, advice and treatment. What was learned: For advocacy we need ground work to be done before meeting to any policy maker to influence the policy. Different organization working on the same or related issues has to bring together to strengthen the impact.

Cancer Prevention and Control Through Advocacy on Tobacco Control, Cancer Control by Focusing on Primary and Secondary Prevention on Cancer

Background and context: Cancer Aid Society an ISO 9001 national level social organization working since 1987 for control and prevention of cancer. I am connected with this society from nine years and helping society to reaching his goal to improve the qualities of life of peoples. We are addressing on healthy lifestyle, tobacco abuse, active and passive smoking etc. Our society is working at community level by generating awareness among masses, crowd for the prevention of cancer. As we know cancer is the second biggest killer disease after heart attack and death due to cancer are almost five times more than AIDS. Aim: “Your health is our concern” is our mission and “Quality in cancer control” is our vision. So we are going to community level school, colleges, malls, offices aware peoples for the prevention of cancer. We are also working for palliative care for improving quality of life of cancer patients. Palliative care is care for uncared. We are also covering all the factors of palliative care but mostly focuses on spirituality. Strategy/Tactics: We have eight branches all our the country at Ahmedabad, Bangalore, Chennai, Delhi, Hyderabd, Lucknow, Mumbai, Kolkata these all are the metro cities of India and in branch we have minimum three social workers who all are covering the near by states so it shows our national presence. Having offices and accommodation in these cities save cost of hotels for stay. So in this way we are covering the whole country. Program/Policy process: We allot the areas to each social worker which they have to covered in the given time. In the month mostly minimum each social worker is doing 10 workshops which is organizing free of cost without any charges from institutions. We visit the institution and taking permission from head for conducting cancer awareness workshop. Outcomes: Personally in my nine years of working I have explored more than 24 states of India in which each year I have address more than 1 lac peoples for cancer prevention. Until now I have covered more than 500 institutions in the country and conducted the workshops. And declared more than 800 institutions tobacco free zone under COTPA ACT made by government of India. What was learned: In my work the thing only I learned is serving humanity is a service to God. So I am working for prevention of cancer I feel lucky that Cancer Aid Society give me opportunity for serving society.

Bacillus amyloliquefaciens induces production of a novel blennolide K in coculture of Setophoma terrestris

AIMS

The discovery of known bioactive chemical leads from microbial monocultures hinders the efficiency of drug discovery programmes. Therefore, in recent years, the use of fungal-bacterial coculture experiments has gained considerable attention due to their ability to generate new bioactive leads. In this work, fungal strain Setophoma terrestris was cocultured with Bacillus amyloliquifaciens to discover novel bioactive compounds.

MATERIALS AND METHODS

The bioactive methanolic coculture extract was chosen for the isolation of compounds by chromatographic methods. The isolated compounds were characterized by NMR and mass spectrometric techniques.

CONCLUSION

Coculture extract has resulted in the production of five blennolides. The novel compound, blennolide K was found active against PC-3 (prostate) and MCF-7 (breast) cell lines with an IC₅₀ value of 3·7 ± 0·6 and 4·8 ± 0·4 μmol l^-1 respectively. Furthermore, the nuclear morphology study in PC-3 cells after treatment with blennolide K, demonstrated chromatin condensation, formation of apoptotic bodies and shrinkage of cells.

SIGNIFICANCE AND IMPACT OF THE STUDY

To our knowledge, only few studies have reported the induction of bioactive compounds by coculture having long-distance inhibition morphology. This is principally due to the low occurrences of such morphology. Our study demonstrates the impact of coculture on production of new chemical leads in drug discovery programmes.

Impact of California Fires on Local and Regional Air Quality: The Role of a Low-Cost Sensor Network and Satellite Observations

PM2.5, or fine particulate matter, is a category of air pollutant consisting of particles with effective aerodynamic diameter equal to or less than 2.5 μm. These particles have been linked to human health impacts as well as regional haze, visibility, and climate change issues. Due to cost and space restrictions, the U.S. Environmental Protection Agency monitoring network remains spatially sparse. To increase the spatial resolution of monitoring, previous studies have used satellite data to estimate ground-level PM concentrations, despite these estimates being associated with moderate to large uncertainties when relating a column measure of aerosol (aerosol optical depth) with surface measurements. To this end, we discuss a low-cost air quality monitor (LCAQM) network deployed in California. In this study, we present an application of LCAQM and satellite data for quantifying the impact of wildfires in California during October 2017. The impacts of fires on PM2.5 concentration at varying temporal (hourly, daily, and weekly) and spatial (local to regional) scales have been evaluated. Comparison between low-cost air quality sensors and reference-grade air quality instruments shows expected performance with moderate to high uncertainties. The LCAQM measurements, in the absence of federal equivalent method data, were also found to be very useful in developing statistical models to convert aerosol optical depth into PM2.5 with performance of satellite-derived PM2.5, similar to that obtained using the federal equivalent method data. This paper also highlights challenges associated with both LCAQM and satellite-based PM2.5 measurements, which require further investigation and research.

New cytochalasin from Rosellinia sanctae-cruciana, an endophytic fungus of Albizia lebbeck

AIM

To explore the potential of Rosellinia sanctae-cruciana an endophytic fungus associated with Albizia lebbeck for pharmaceutically important cytotoxic compounds.

METHODS AND RESULTS

One novel cytochalasin, named jammosporin A (1) and four known analogues (2-5) were isolated from the culture of the endophytic fungus R. sanctae-cruciana, harboured from the leaves of the medicinal plant A. lebbeck. Their structures were elucidated by extensive spectroscopic analyses including one-dimensional and two-dimensional nuclear magnetic resonance data along with MS data and by comparison with literature reports. In preliminary screening the ethyl acetate extract of the fungal culture was tested for cytotoxic activity against a panel of four cancer cell lines (MOLT-4, A549, MIA PaCa-2 and MDA-MB-231), and found to be active against MOLT-4 with an IC₅₀ value of 10 μg ml^-1 . Owing to the remarkable cytotoxic activity of the extract the isolated compounds (1-5) were evaluated for their cytototoxicity against the MOLT-4 cell line by MTT assay. Interestingly, compounds 1-2, 4 and 5 showed considerable cytotoxic potential against the human leukaemia cancer cell line (MOLT-4) with IC₅₀ values of 20·0, 10·0, 8·0 and 6·0 μmol l^-1 , respectively, while compound 3 showed an IC₅₀ value of 25 μmol l^-1 . This is the first report of the existence of this class of secondary metabolites in R. sanctae-cruciana fungus.

CONCLUSION

This study discovered a novel compound, named jammosporin A, isolated for the first time from R. sanctae-cruciana, an endophytic fungus of A. lebbeck with anticancer activity against the MOLT-4 cell line.

SIGNIFICANCE AND IMPACT OF THE STUDY

Rosellinia sanctae-cruciana represents an interesting source of a new compound with bioactive potential as a therapeutic agent against a human leukaemia cancer cell line (MOLT-4).

Human epidermal growth factor receptor 2 expression in gastric carcinoma and its association with histopathological parameters in Indian population

INTRODUCTION

Gastric carcinoma is a leading cause of death worldwide with a five year survival of 10-15% even after curative resection. Trastuzumab has emerged as a potential targeted therapy in treatment of Her 2 positive gastric cancer. Her2 positivity ranges from 7-34% in studies across the world. There is a paucity of Indian studies hence a need for determination of Her2 expression in Indian population for better patient management. This study was carried out to determine the frequency of Her 2 expression in gastric carcinoma by immunohistochemistry (IHC) technique and to evaluate its association with histopathological parameters.

MATERIAL AND METHODS

A total of 110 cases of gastric adenocarcinoma diagnosed on histopathological examination from July 2013 to June 2015 were included. Of these, 40 cases were resection specimens and 70 were biopsies. Histological typing of gastric carcinoma was done on the basis of Lauren classification. IHC for Her2 was done in all 110 cases. Her 2 expression was correlated with various histopathological parameters.

RESULTS

Positive Her 2 expression (IHC 3+) was seen in 24.5% cases of gastric carcinoma. Patients in older age group(> 60 years) showed higher Her 2 positivity rate as compared to middle age (40-60 years) and younger population (<40 years). Higher percentage of Her 2 positivity was noted in male patients as compared to female patients. Her 2 positivity was seen more commonly in intestinal type of tumor as compared to diffuse and mixed types. Her 2 positivity was seen more in well differentiated carcinoma and higher stage tumors (pT3 and pT4). However, out of all, a statistically significant association of Her2 expression was found only with (intestinal) type of tumors (p= 0.005) and no significant association was seen with age, gender, site of tumor, tumor stage, lymph node status, lymphovascular, perineural and perinodal invasion or survival.

CONCLUSION

Inspired by promising results of Trastuzumab therapy in Her 2 positive gastric carcinoma worldwide, it is recommended to routinely test all cases of gastric carcinoma for Her 2 expression and to use the targeted therapy with curative intentions in Indian population.

Effect of maternal oxygen inhalation on foetal free radical activity: a prospective, randomized trial

BACKGROUND

Maternal inhalation of 35-40% oxygen concentration has no significant effect on foetal partial pressure of oxygen, and 60-100% produced maternal and foetal hyperoxia with increased free radical activity. The benefit of 50% maternal oxygen inhalation on foetal oxygenation, oxidant stress and total antioxidant status (TAS) during Caesarean section (CS) has not been simultaneously evaluated.

METHODS

In this prospective, randomized, controlled trial 120 ASA physical status I-II, term pregnant women were recruited to elective CS (n = 60) and emergency CS (n = 60) and received either 50% oxygen or air inhalation following subarachnoid block (SAB). Patients and investigators were blinded to the inhaled oxygen concentration. The primary outcome of the study was foetal umbilical artery (UA) malondialdehyde (MDA) at birth.

RESULTS

In both elective and emergency CS, there was no difference in foetal oxidative stress and TAS in spite of increase in maternal PaO2. In elective CS, maternal MDA was higher at delivery in mothers breathing 50% oxygen as compared to their own baseline values (P = 0.04). In emergency CS, maternal TAS at 10 min was lower in mothers inhaling 50% oxygen as compared to air (P = 0.01). The average duration of maternal oxygen supplementation was ~10.3 min in elective and ~7.4 min in emergency CS. Neonatal outcome, episodes of maternal hypotension and oxygen desaturation were similar in both the groups.

CONCLUSION

Brief duration of 50% oxygen maternal inhalation during elective or emergency CS did not significantly affect foetal MDA and TAS under SAB.