251
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Vangipuram R, Alikhan A. Apremilast for the management of moderate to severe plaque psoriasis. Expert Rev Clin Pharmacol 2017; 10:349-360. [PMID: 28276777 DOI: 10.1080/17512433.2017.1293519] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
INTRODUCTION Psoriasis is a chronic inflammatory skin disease characterized by erythematous plaques on extensor surfaces, scalp, and back. Current therapies for psoriasis are limited by route of administration, side effects, and cost. Apremilast is the first oral phosphodiesterase inhibitor approved for moderate-to-severe plaque psoriasis. It is a small molecule inhibitor of phosphodiesterase-4, and decreases the inflammatory activity associated with psoriasis. Areas covered: This review will discuss the pharmacology of apremilast, mechanism of action, results from key clinical trials, and its use in managing psoriasis. Currently approved treatments are also discussed. Expert commentary: The advantages of apremilast include convenient oral administration and dosing, a favorable safety and tolerability profile, and significant efficacy in moderate-to-severe plaque psoriasis.
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Affiliation(s)
- Ramya Vangipuram
- a Dermatology Clinical Research Fellow , Center for Clinical Studies , Webster , TX , USA
| | - Ali Alikhan
- b Department of Dermatology , University of Cincinnati Medical Center , Cincinnati , OH , USA
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252
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Olivera P, Danese S, Peyrin-Biroulet L. JAK inhibition in inflammatory bowel disease. Expert Rev Clin Immunol 2017; 13:693-703. [DOI: 10.1080/1744666x.2017.1291342] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- Pablo Olivera
- Gastroenterology Section, Department of Internal Medicine, Centro de Educación Médica e Investigaciones Clínicas (CEMIC), Buenos Aires, Argentina
- INSERM U954 and Department of Hepatogastroenterology, Nancy University Hospital, Université de Lorraine, Vandoeuvre-lès-Nancy, France
| | - Silvio Danese
- Department of Gastroenterology, IBD Center, Humanitas Clinical and Research Center, Milan, Italy
| | - Laurent Peyrin-Biroulet
- INSERM U954 and Department of Hepatogastroenterology, Nancy University Hospital, Université de Lorraine, Vandoeuvre-lès-Nancy, France
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253
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Deng Y, Chang C, Lu Q. The Inflammatory Response in Psoriasis: a Comprehensive Review. Clin Rev Allergy Immunol 2017; 50:377-89. [PMID: 27025861 DOI: 10.1007/s12016-016-8535-x] [Citation(s) in RCA: 254] [Impact Index Per Article: 36.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Psoriasis is a chronic inflammatory autoimmune disease characterized by an excessively aberrant hyperproliferation of keratinocytes. The pathogenesis of psoriasis is complex and the exact mechanism remains elusive. However, psoriasis is thought to result from a combination of genetic, epigenetic, and environmental influences. Recent studies have identified that epigenetic factors including dysregulated DNA methylation levels, abnormal histone modification and microRNAs expressions are involved in the development of psoriasis. The interplay of immune cells and cytokines is another critical factor in the pathogenesis of psoriasis. These factors or pathways include Th1/Th2 homeostasis, the Th17/Treg balance and the IL-23/Th17 axis. Th17 is believed particularly important in psoriasis due to its pro-inflammatory effects and its involvement in an integrated inflammatory loop with dendritic cells and keratinocytes, contributing to an overproduction of antimicrobial peptides, inflammatory cytokines, and chemokines that leads to amplification of the immune response. In addition, other pathways and signaling molecules have been found to be involved, including Th9, Th22, regulatory T cells, γδ T cells, CD8(+) T cells, and their related cytokines. Understanding the pathogenesis of psoriasis will allow us to develop increasingly efficient targeted treatment by blocking relevant inflammatory signaling pathways and molecules. There is no cure for psoriasis at the present time, and much of the treatment involves managing the symptoms. The biologics, while lacking the adverse effects associated with some of the traditional medications such as corticosteroids and methotrexate, have their own set of side effects, which may include reactivation of latent infections. Significant challenges remain in developing safe and efficacious novel targeted therapies that depend on a better understanding of the immunological dysfunction in psoriasis.
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Affiliation(s)
- Yaxiong Deng
- Department of Dermatology, Second Xiangya Hospital, Hunan Key Laboratory of Medical Epigenomics, Central South University, Changsha, Hunan, China
| | - Christopher Chang
- Division of Rheumatology, Allergy and Clinical Immunology, University of California at Davis, 451 Health Sciences Drive, Suite 6510, Davis, CA, 95616, USA
| | - Qianjin Lu
- Department of Dermatology, Second Xiangya Hospital, Hunan Key Laboratory of Medical Epigenomics, Central South University, Changsha, Hunan, China. .,Second Xiangya Hospital, Central South University, #139 Renmin Middle Rd, Changsha, Hunan, 410011, China.
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254
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Olivera P, Danese S, Peyrin-Biroulet L. Next generation of small molecules in inflammatory bowel disease. Gut 2017; 66:199-209. [PMID: 27856614 DOI: 10.1136/gutjnl-2016-312912] [Citation(s) in RCA: 99] [Impact Index Per Article: 14.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2016] [Revised: 10/03/2016] [Accepted: 10/24/2016] [Indexed: 12/11/2022]
Affiliation(s)
- Pablo Olivera
- Gastroenterology Section, Department of Internal Medicine, Centro de Educación Médica e Investigaciones Clínicas (CEMIC), Buenos Aires, Argentina.,INSERM U954 and Department of Gastroenterology, Nancy University Hospital, Université de Lorraine, Vandoeuvre-lès-Nancy, France
| | | | - Laurent Peyrin-Biroulet
- INSERM U954 and Department of Gastroenterology, Nancy University Hospital, Université de Lorraine, Vandoeuvre-lès-Nancy, France
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255
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van der Heijde D, Deodhar A, Wei JC, Drescher E, Fleishaker D, Hendrikx T, Li D, Menon S, Kanik KS. Tofacitinib in patients with ankylosing spondylitis: a phase II, 16-week, randomised, placebo-controlled, dose-ranging study. Ann Rheum Dis 2017; 76:1340-1347. [PMID: 28130206 PMCID: PMC5738601 DOI: 10.1136/annrheumdis-2016-210322] [Citation(s) in RCA: 239] [Impact Index Per Article: 34.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2016] [Revised: 11/24/2016] [Accepted: 11/26/2016] [Indexed: 12/17/2022]
Abstract
Objectives To compare efficacy and safety of various doses of tofacitinib, an oral Janus kinase inhibitor, with placebo in patients with active ankylosing spondylitis (AS, radiographic axial spondyloarthritis). Methods In this 16-week (12-week treatment, 4-week washout), phase II, multicentre, dose-ranging trial, adult patients with active AS were randomised (N=51, 52, 52, 52, respectively) to placebo or tofacitinib 2, 5 or 10 mg twice daily. The primary efficacy endpoint was Assessment of SpondyloArthritis International Society 20% improvement (ASAS20) response rate at week 12. Secondary endpoints included objective measures of disease activity, patient-reported outcomes and MRI of sacroiliac joints and spine. Safety was monitored. Results Emax model analysis of the primary endpoint predicted a tofacitinib 10 mg twice daily ASAS20 response rate of 67.4%, 27.3% higher than placebo. Supportive normal approximation analysis demonstrated tofacitinib 5 mg twice daily ASAS20 response rate significantly higher than placebo (80.8% vs 41.2%; p<0.001); tofacitinib 2 and 10 mg twice daily demonstrated greater response rate than placebo (51.9% and 55.8%, respectively; not significant). Secondary endpoints generally demonstrated greater improvements with tofacitinib 5 and 10 mg twice daily than placebo. Objective (including MRI) endpoints demonstrated clear dose response. Adverse events were similar across treatment groups with no unexpected safety findings. Dose-dependent laboratory outcome changes returned close to baseline by week 16. Conclusions Tofacitinib 5 and 10 mg twice daily demonstrated greater clinical efficacy versus placebo in reducing signs, symptoms and objective endpoints of active AS in adult patients with a similar 12-week safety profile as reported in other indications. Trial registration number NCT01786668.
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Affiliation(s)
| | - Atul Deodhar
- Division of Arthritis and Rheumatic Diseases, Oregon Health & Science University, Portland, Oregon, USA
| | - James C Wei
- Division of Allergy, Immunology and Rheumatology, Chung Shan Medical University Hospital, Graduate Institute of Integrated Medicine, China Medical University, Taichung, Taiwan
| | | | | | | | - David Li
- Pfizer Inc, Collegeville, Pennsylvania, USA
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256
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Samadi A, Ahmad Nasrollahi S, Hashemi A, Nassiri Kashani M, Firooz A. Janus kinase (JAK) inhibitors for the treatment of skin and hair disorders: a review of literature. J DERMATOL TREAT 2017; 28:476-483. [PMID: 28024126 DOI: 10.1080/09546634.2016.1277179] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Janus kinase family (JAKs) has recently attracted the attention of many researchers, and several JAK inhibitor drugs have been developed targeting different members of the JAK family. Tofacitinib and ruxolitinib are US FDA approved drugs in this family for rheumatoid arthritis and myeloproliferative diseases, respectively. Dysregulation of JAK/STAT pathway is also involved in many skin diseases, specifically inflammatory disorders. The JAK/STAT signaling pathway and its involvement in skin diseases are overviewed in this study. We also review clinical studies of JAK inhibitors in field of dermatology, including psoriasis, atopic dermatitis, alopecia areata and vitiligo. Although the available evidence shows promising results, it is still too early to draw a firm conclusion about the place of these drugs in dermatological treatment.
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Affiliation(s)
- Aniseh Samadi
- a Center for Research & Training in Skin Diseases & Leprosy , Tehran University of Medical Sciences , Tehran , Iran
| | - Saman Ahmad Nasrollahi
- a Center for Research & Training in Skin Diseases & Leprosy , Tehran University of Medical Sciences , Tehran , Iran
| | - Ashkan Hashemi
- a Center for Research & Training in Skin Diseases & Leprosy , Tehran University of Medical Sciences , Tehran , Iran
| | - Mansour Nassiri Kashani
- a Center for Research & Training in Skin Diseases & Leprosy , Tehran University of Medical Sciences , Tehran , Iran
| | - Alireza Firooz
- a Center for Research & Training in Skin Diseases & Leprosy , Tehran University of Medical Sciences , Tehran , Iran
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257
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Fasching P, Stradner M, Graninger W, Dejaco C, Fessler J. Therapeutic Potential of Targeting the Th17/Treg Axis in Autoimmune Disorders. Molecules 2017; 22:E134. [PMID: 28098832 PMCID: PMC6155880 DOI: 10.3390/molecules22010134] [Citation(s) in RCA: 154] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2016] [Revised: 01/05/2017] [Accepted: 01/10/2017] [Indexed: 02/08/2023] Open
Abstract
A disruption of the crucial balance between regulatory T-cells (Tregs) and Th17-cells was recently implicated in various autoimmune disorders. Tregs are responsible for the maintenance of self-tolerance, thus inhibiting autoimmunity, whereas pro-inflammatory Th17-cells contribute to the induction and propagation of inflammation. Distortion of the Th17/Treg balance favoring the pro-inflammatory Th17 side is hence suspected to contribute to exacerbation of autoimmune disorders. This review aims to summarize recent data and advances in targeted therapeutic modification of the Th17/Treg-balance, as well as information on the efficacy of candidate therapeutics with respect to the treatment of autoimmune diseases.
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MESH Headings
- Animals
- Antibodies, Monoclonal/therapeutic use
- Antibodies, Monoclonal, Humanized
- Autoimmune Diseases/drug therapy
- Autoimmune Diseases/genetics
- Autoimmune Diseases/immunology
- Autoimmune Diseases/pathology
- Forkhead Transcription Factors/antagonists & inhibitors
- Forkhead Transcription Factors/genetics
- Forkhead Transcription Factors/immunology
- Gene Expression Regulation
- Humans
- Immunologic Factors/therapeutic use
- Inflammation
- Interleukin-17/antagonists & inhibitors
- Interleukin-17/genetics
- Interleukin-17/immunology
- Nuclear Receptor Subfamily 1, Group F, Member 3/antagonists & inhibitors
- Nuclear Receptor Subfamily 1, Group F, Member 3/genetics
- Nuclear Receptor Subfamily 1, Group F, Member 3/immunology
- Piperidines/therapeutic use
- Pyrimidines/therapeutic use
- Pyrroles/therapeutic use
- Signal Transduction
- T-Lymphocytes, Regulatory/drug effects
- T-Lymphocytes, Regulatory/immunology
- T-Lymphocytes, Regulatory/pathology
- Th17 Cells/drug effects
- Th17 Cells/immunology
- Th17 Cells/pathology
- Ustekinumab/therapeutic use
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Affiliation(s)
- Patrizia Fasching
- Department of Rheumatology and Immunology, Medical University of Graz, Auenbruggerplatz 15, 8036 Graz, Austria.
| | - Martin Stradner
- Department of Rheumatology and Immunology, Medical University of Graz, Auenbruggerplatz 15, 8036 Graz, Austria.
| | - Winfried Graninger
- Department of Rheumatology and Immunology, Medical University of Graz, Auenbruggerplatz 15, 8036 Graz, Austria.
| | - Christian Dejaco
- Department of Rheumatology and Immunology, Medical University of Graz, Auenbruggerplatz 15, 8036 Graz, Austria.
| | - Johannes Fessler
- Department of Rheumatology and Immunology, Medical University of Graz, Auenbruggerplatz 15, 8036 Graz, Austria.
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258
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Jones P, Storer RI, Sabnis YA, Wakenhut FM, Whitlock GA, England KS, Mukaiyama T, Dehnhardt CM, Coe JW, Kortum SW, Chrencik JE, Brown DG, Jones RM, Murphy JR, Yeoh T, Morgan P, Kilty I. Design and Synthesis of a Pan-Janus Kinase Inhibitor Clinical Candidate (PF-06263276) Suitable for Inhaled and Topical Delivery for the Treatment of Inflammatory Diseases of the Lungs and Skin. J Med Chem 2017; 60:767-786. [DOI: 10.1021/acs.jmedchem.6b01634] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- Peter Jones
- Medicine Design, ‡Pharmacokinetics, Dynamics and Metabolism, and §Inflammation and
Immunology Research
Unit, Pfizer Inc., 610 Main Street, Cambridge, Massachusetts 02139, United States
- Medicine Design, and ⊥Medicinal Sciences, Pfizer Inc., 445 Eastern Point Road, Groton, Connecticut 06340, United States
- Worldwide Medicinal Chemistry, ∇Structural Biology
and Biophysics, and ○Pharmaceutical
Sciences, Pfizer Ltd., Ramsgate Road, Sandwich, CT13 9NJ, U.K
| | - R. Ian Storer
- Medicine Design, ‡Pharmacokinetics, Dynamics and Metabolism, and §Inflammation and
Immunology Research
Unit, Pfizer Inc., 610 Main Street, Cambridge, Massachusetts 02139, United States
- Medicine Design, and ⊥Medicinal Sciences, Pfizer Inc., 445 Eastern Point Road, Groton, Connecticut 06340, United States
- Worldwide Medicinal Chemistry, ∇Structural Biology
and Biophysics, and ○Pharmaceutical
Sciences, Pfizer Ltd., Ramsgate Road, Sandwich, CT13 9NJ, U.K
| | - Yogesh A. Sabnis
- Medicine Design, ‡Pharmacokinetics, Dynamics and Metabolism, and §Inflammation and
Immunology Research
Unit, Pfizer Inc., 610 Main Street, Cambridge, Massachusetts 02139, United States
- Medicine Design, and ⊥Medicinal Sciences, Pfizer Inc., 445 Eastern Point Road, Groton, Connecticut 06340, United States
- Worldwide Medicinal Chemistry, ∇Structural Biology
and Biophysics, and ○Pharmaceutical
Sciences, Pfizer Ltd., Ramsgate Road, Sandwich, CT13 9NJ, U.K
| | - Florian M. Wakenhut
- Medicine Design, ‡Pharmacokinetics, Dynamics and Metabolism, and §Inflammation and
Immunology Research
Unit, Pfizer Inc., 610 Main Street, Cambridge, Massachusetts 02139, United States
- Medicine Design, and ⊥Medicinal Sciences, Pfizer Inc., 445 Eastern Point Road, Groton, Connecticut 06340, United States
- Worldwide Medicinal Chemistry, ∇Structural Biology
and Biophysics, and ○Pharmaceutical
Sciences, Pfizer Ltd., Ramsgate Road, Sandwich, CT13 9NJ, U.K
| | - Gavin A. Whitlock
- Medicine Design, ‡Pharmacokinetics, Dynamics and Metabolism, and §Inflammation and
Immunology Research
Unit, Pfizer Inc., 610 Main Street, Cambridge, Massachusetts 02139, United States
- Medicine Design, and ⊥Medicinal Sciences, Pfizer Inc., 445 Eastern Point Road, Groton, Connecticut 06340, United States
- Worldwide Medicinal Chemistry, ∇Structural Biology
and Biophysics, and ○Pharmaceutical
Sciences, Pfizer Ltd., Ramsgate Road, Sandwich, CT13 9NJ, U.K
| | - Katherine S. England
- Medicine Design, ‡Pharmacokinetics, Dynamics and Metabolism, and §Inflammation and
Immunology Research
Unit, Pfizer Inc., 610 Main Street, Cambridge, Massachusetts 02139, United States
- Medicine Design, and ⊥Medicinal Sciences, Pfizer Inc., 445 Eastern Point Road, Groton, Connecticut 06340, United States
- Worldwide Medicinal Chemistry, ∇Structural Biology
and Biophysics, and ○Pharmaceutical
Sciences, Pfizer Ltd., Ramsgate Road, Sandwich, CT13 9NJ, U.K
| | - Takasuke Mukaiyama
- Medicine Design, ‡Pharmacokinetics, Dynamics and Metabolism, and §Inflammation and
Immunology Research
Unit, Pfizer Inc., 610 Main Street, Cambridge, Massachusetts 02139, United States
- Medicine Design, and ⊥Medicinal Sciences, Pfizer Inc., 445 Eastern Point Road, Groton, Connecticut 06340, United States
- Worldwide Medicinal Chemistry, ∇Structural Biology
and Biophysics, and ○Pharmaceutical
Sciences, Pfizer Ltd., Ramsgate Road, Sandwich, CT13 9NJ, U.K
| | - Christoph M. Dehnhardt
- Medicine Design, ‡Pharmacokinetics, Dynamics and Metabolism, and §Inflammation and
Immunology Research
Unit, Pfizer Inc., 610 Main Street, Cambridge, Massachusetts 02139, United States
- Medicine Design, and ⊥Medicinal Sciences, Pfizer Inc., 445 Eastern Point Road, Groton, Connecticut 06340, United States
- Worldwide Medicinal Chemistry, ∇Structural Biology
and Biophysics, and ○Pharmaceutical
Sciences, Pfizer Ltd., Ramsgate Road, Sandwich, CT13 9NJ, U.K
| | - Jotham W. Coe
- Medicine Design, ‡Pharmacokinetics, Dynamics and Metabolism, and §Inflammation and
Immunology Research
Unit, Pfizer Inc., 610 Main Street, Cambridge, Massachusetts 02139, United States
- Medicine Design, and ⊥Medicinal Sciences, Pfizer Inc., 445 Eastern Point Road, Groton, Connecticut 06340, United States
- Worldwide Medicinal Chemistry, ∇Structural Biology
and Biophysics, and ○Pharmaceutical
Sciences, Pfizer Ltd., Ramsgate Road, Sandwich, CT13 9NJ, U.K
| | - Steve W. Kortum
- Medicine Design, ‡Pharmacokinetics, Dynamics and Metabolism, and §Inflammation and
Immunology Research
Unit, Pfizer Inc., 610 Main Street, Cambridge, Massachusetts 02139, United States
- Medicine Design, and ⊥Medicinal Sciences, Pfizer Inc., 445 Eastern Point Road, Groton, Connecticut 06340, United States
- Worldwide Medicinal Chemistry, ∇Structural Biology
and Biophysics, and ○Pharmaceutical
Sciences, Pfizer Ltd., Ramsgate Road, Sandwich, CT13 9NJ, U.K
| | - Jill E. Chrencik
- Medicine Design, ‡Pharmacokinetics, Dynamics and Metabolism, and §Inflammation and
Immunology Research
Unit, Pfizer Inc., 610 Main Street, Cambridge, Massachusetts 02139, United States
- Medicine Design, and ⊥Medicinal Sciences, Pfizer Inc., 445 Eastern Point Road, Groton, Connecticut 06340, United States
- Worldwide Medicinal Chemistry, ∇Structural Biology
and Biophysics, and ○Pharmaceutical
Sciences, Pfizer Ltd., Ramsgate Road, Sandwich, CT13 9NJ, U.K
| | - David G. Brown
- Medicine Design, ‡Pharmacokinetics, Dynamics and Metabolism, and §Inflammation and
Immunology Research
Unit, Pfizer Inc., 610 Main Street, Cambridge, Massachusetts 02139, United States
- Medicine Design, and ⊥Medicinal Sciences, Pfizer Inc., 445 Eastern Point Road, Groton, Connecticut 06340, United States
- Worldwide Medicinal Chemistry, ∇Structural Biology
and Biophysics, and ○Pharmaceutical
Sciences, Pfizer Ltd., Ramsgate Road, Sandwich, CT13 9NJ, U.K
| | - Rhys M. Jones
- Medicine Design, ‡Pharmacokinetics, Dynamics and Metabolism, and §Inflammation and
Immunology Research
Unit, Pfizer Inc., 610 Main Street, Cambridge, Massachusetts 02139, United States
- Medicine Design, and ⊥Medicinal Sciences, Pfizer Inc., 445 Eastern Point Road, Groton, Connecticut 06340, United States
- Worldwide Medicinal Chemistry, ∇Structural Biology
and Biophysics, and ○Pharmaceutical
Sciences, Pfizer Ltd., Ramsgate Road, Sandwich, CT13 9NJ, U.K
| | - John R. Murphy
- Medicine Design, ‡Pharmacokinetics, Dynamics and Metabolism, and §Inflammation and
Immunology Research
Unit, Pfizer Inc., 610 Main Street, Cambridge, Massachusetts 02139, United States
- Medicine Design, and ⊥Medicinal Sciences, Pfizer Inc., 445 Eastern Point Road, Groton, Connecticut 06340, United States
- Worldwide Medicinal Chemistry, ∇Structural Biology
and Biophysics, and ○Pharmaceutical
Sciences, Pfizer Ltd., Ramsgate Road, Sandwich, CT13 9NJ, U.K
| | - Thean Yeoh
- Medicine Design, ‡Pharmacokinetics, Dynamics and Metabolism, and §Inflammation and
Immunology Research
Unit, Pfizer Inc., 610 Main Street, Cambridge, Massachusetts 02139, United States
- Medicine Design, and ⊥Medicinal Sciences, Pfizer Inc., 445 Eastern Point Road, Groton, Connecticut 06340, United States
- Worldwide Medicinal Chemistry, ∇Structural Biology
and Biophysics, and ○Pharmaceutical
Sciences, Pfizer Ltd., Ramsgate Road, Sandwich, CT13 9NJ, U.K
| | - Paul Morgan
- Medicine Design, ‡Pharmacokinetics, Dynamics and Metabolism, and §Inflammation and
Immunology Research
Unit, Pfizer Inc., 610 Main Street, Cambridge, Massachusetts 02139, United States
- Medicine Design, and ⊥Medicinal Sciences, Pfizer Inc., 445 Eastern Point Road, Groton, Connecticut 06340, United States
- Worldwide Medicinal Chemistry, ∇Structural Biology
and Biophysics, and ○Pharmaceutical
Sciences, Pfizer Ltd., Ramsgate Road, Sandwich, CT13 9NJ, U.K
| | - Iain Kilty
- Medicine Design, ‡Pharmacokinetics, Dynamics and Metabolism, and §Inflammation and
Immunology Research
Unit, Pfizer Inc., 610 Main Street, Cambridge, Massachusetts 02139, United States
- Medicine Design, and ⊥Medicinal Sciences, Pfizer Inc., 445 Eastern Point Road, Groton, Connecticut 06340, United States
- Worldwide Medicinal Chemistry, ∇Structural Biology
and Biophysics, and ○Pharmaceutical
Sciences, Pfizer Ltd., Ramsgate Road, Sandwich, CT13 9NJ, U.K
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259
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Pathogenesis and immunotherapy in cutaneous psoriasis: what can rheumatologists learn? Curr Opin Rheumatol 2017; 29:71-78. [DOI: 10.1097/bor.0000000000000358] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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260
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Goswami R, Kaplan M. STAT Transcription Factors in T Cell Control of Health and Disease. INTERNATIONAL REVIEW OF CELL AND MOLECULAR BIOLOGY 2017; 331:123-180. [DOI: 10.1016/bs.ircmb.2016.09.012] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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261
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Ferreira P, Melo A, Jesus J, Paixão T, Macieira J, Océa R, Vechi M, Dias B, Carvalho L. USO DE TOFACITINIBE NO TRATAMENTO DA ALOPECIA AREATA UNIVERSAL EM PACIENTE COM ARTRITE REUMATOIDE. REVISTA BRASILEIRA DE REUMATOLOGIA 2017. [DOI: 10.1016/j.rbr.2017.06.076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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262
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Vesely MD, Imaeda S, King BA. Tofacitinib citrate for the treatment of refractory, severe chronic actinic dermatitis. JAAD Case Rep 2017; 3:4-6. [PMID: 28050588 PMCID: PMC5192094 DOI: 10.1016/j.jdcr.2016.09.008] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
| | | | - Brett A. King
- Department of Dermatology, Yale School of Medicine, New Haven, Connecticut
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263
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Maharaj AB, Chandran V. Treatment of psoriatic arthritis with traditional DMARD’s and novel therapies: approaches and recommendations. Expert Rev Clin Immunol 2016; 13:319-331. [DOI: 10.1080/1744666x.2017.1257939] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Affiliation(s)
- Ajesh B. Maharaj
- Department of Internal Medicine, Prince Mshiyeni Memorial Hospital, Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa
- Department of Clinical Immunology and Rheumatology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Vinod Chandran
- Psoriatic Arthritis Program, Centre for Prognosis Studies in the Rheumatic Diseases, Krembil Research Institute, University Health Network, Toronto, Canada
- Division of Rheumatology, Department of Medicine, University of Toronto, Toronto, Canada
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Canada
- Institute of Medical Science, University of Toronto, Toronto Western Hospital, Toronto, Canada
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264
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Hirahara K, Schwartz D, Gadina M, Kanno Y, O'Shea JJ. Targeting cytokine signaling in autoimmunity: back to the future and beyond. Curr Opin Immunol 2016; 43:89-97. [PMID: 27821272 DOI: 10.1016/j.coi.2016.10.001] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2016] [Accepted: 10/10/2016] [Indexed: 12/16/2022]
Abstract
Cytokines represent structurally diverse soluble factors with critical roles in normal immune function and the pathogenesis of autoimmunity. The emergence of many successful biological therapies targeting cytokines and cytokine receptors exemplifies the importance of cytokines in driving human autoimmune disease; unsurprisingly, there is no paucity of reviews on this subject. Nonetheless, many patients with autoimmune disease do not respond to biologicals, and cure remains an unmet goal. Thus, targeting the intracellular pathways employed by cytokines provides new therapeutic opportunities. A subset of cytokines utilizes the Janus kinase-signal transducer of activators of transcription (JAK-STAT) pathway as a mode of signal transduction. First generation JAK inhibitors (jakinibs) are used to treat rheumatologic disease, and second-generation jakinibs are being developed. Simultaneously, rapid advances are being made in our understanding of the genomic and epigenomic impact of cytokines. In this review, we will briefly review the role of JAK-STAT-dependent cytokines in immune-mediated disease, the current status of Jakinibs, and future possibilities for therapeutic intervention using genomic insights.
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Affiliation(s)
- Kiyoshi Hirahara
- Department of Immunology, Graduate School of Medicine, Chiba University, 1-8-1 Inohana Chuo-ku, Chiba 260-8670, Japan
| | - Daniella Schwartz
- Molecular Immunology and Inflammation Branch, NIAMS, National Institutes of Health, Bethesda, MD 20892, USA
| | - Massimo Gadina
- Translational Immunology Section, Office of Science Technology, NIAMS, National Institutes of Health, Bethesda, MD 20892, USA
| | - Yuka Kanno
- Molecular Immunology and Inflammation Branch, NIAMS, National Institutes of Health, Bethesda, MD 20892, USA
| | - John J O'Shea
- Molecular Immunology and Inflammation Branch, NIAMS, National Institutes of Health, Bethesda, MD 20892, USA.
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265
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Panés J, Su C, Bushmakin AG, Cappelleri JC, Healey P. Direct and Indirect Effects of Tofacitinib on Treatment Satisfaction in Patients with Ulcerative Colitis. J Crohns Colitis 2016; 10:1310-1315. [PMID: 27194530 DOI: 10.1093/ecco-jcc/jjw107] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
BACKGROUND AND AIMS This mediation modelling analysis evaluated direct and indirect effects of tofacitinib, an oral, small molecule Janus kinase inhibitor under investigation for ulcerative colitis, on patient treatment satisfaction. METHODS Data from an 8-week randomized Phase 2 trial [NCT00787202] in adults with moderate-to-severe, active ulcerative colitis receiving twice-daily tofacitinib 0.5-15mg [n=146] or placebo [n=48] were analysed in patient-reported [n=149] and clinician-reported [n=170] outcomes-based mediation models. Binary predictor variable: Treatment [pooled active treatment vs placebo]. Eventual dependent variable: Week 8 patient treatment satisfaction [measured on a five-point Likert scale]. Mediators of treatment effect on satisfaction: Week 8 Inflammatory Bowel Disease Questionnaire domains [Bowel Symptoms, Emotional Health, Social Function and Systemic Symptoms] and Mayo scale domains [Stool Frequency, Rectal Bleeding, Physician's Global Assessment and Endoscopic Disease Activity] for patient-reported and clinician-reported models, respectively. RESULTS Overall tofacitinib indirect effect on satisfaction via Inflammatory Bowel Disease Questionnaire domains was 40.5% [p<0.05] and via Mayo scale domains was 84.0% [p<0.01] for patient-reported and clinician-reported models, respectively. Bowel function had the most important indirect effect: of the total tofacitinib effect on satisfaction, 32.4% [p=0.05] was indirectly mediated via Bowel Symptoms; and 30.0% [p=0.04] via Stool Frequency. In total, 59.5% [p<0.01] and only 16.0% [p=0.56] of tofacitinib's effect on satisfaction was unrelated to Inflammatory Bowel Disease Questionnaire and Mayo scale domains in the patient-reported and clinician-reported models, respectively. CONCLUSIONS Bowel function is an important factor for patient treatment satisfaction with tofacitinib. Treatment effect on patient satisfaction was almost completely mediated via improvement in Mayo scale domains.
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Affiliation(s)
- Julian Panés
- Hospital Clinic de Barcelona, IDIBAPS, CIBERehd, Barcelona, Spain
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266
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Gómez-García F, Epstein D, Isla-Tejera B, Lorente A, Vélez García-Nieto A, Ruano J. Short-term efficacy and safety of new biological agents targeting the interleukin-23-T helper 17 pathway for moderate-to-severe plaque psoriasis: a systematic review and network meta-analysis. Br J Dermatol 2016; 176:594-603. [PMID: 27292159 DOI: 10.1111/bjd.14814] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/23/2016] [Indexed: 12/26/2022]
Abstract
A new generation of biologics targeting the interleukin-23-T helper 17 pathway has been developed. This study aimed to assess the short-term effectiveness and safety of these new agents using a network meta-analysis. Twenty-seven randomized clinical trials (10 629 patients) were identified by a comprehensive systematic literature review (PROSPERO 2015: CRD42015025472). Quality of evidence was assessed following Cochrane-compliant rules and the Grading of Recommendations, Assessment, Development and Evaluations approach. Efficacy and safety outcomes at weeks 10-16 were compared using a random-effects network meta-analysis within a frequentist framework to estimate pooled odds ratios (ORs) of direct and indirect comparisons among the therapeutic options. There were six direct drug-to-drug comparisons in the network, with a high degree of consistency between the direct and indirect evidence. From the available evidence, infliximab 5 mg kg-1 every 8 weeks [OR 118·89, 95% confidence interval (CI) 60·91-232·04] and secukinumab 300 mg every 4 weeks (OR 87·07, 95% CI 55·01-137·82) are shown to be among the most effective short-term treatments, but are ranked as the biologics most likely to produce any adverse event or an infectious adverse event, respectively. Ustekinumab 90 mg every 12 weeks, the third most efficacious treatment (OR 73·67, 95% CI 46·97-115·56), was the only agent that did not show increased risk of adverse events compared with placebo. Treatment recommendations should also consider long-term outcomes and costs.
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Affiliation(s)
- F Gómez-García
- Department of Dermatology, Hospital Universitario Reina Sofía, Menendez Pidal Ave, 14004, Córdoba, Spain.,Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC)/Hospital Universitario Reina Sofía/Universidad de Córdoba, Córdoba, Spain
| | - D Epstein
- Department of Applied Economics, School of Economics, University of Granada, Granada, Spain
| | - B Isla-Tejera
- Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC)/Hospital Universitario Reina Sofía/Universidad de Córdoba, Córdoba, Spain.,Department of Pharmacy, Hospital Universitario Reina Sofía, Menendez Pidal Ave, 14004, Córdoba, Spain
| | - A Lorente
- Department of Dermatology, Hospital Universitario Reina Sofía, Menendez Pidal Ave, 14004, Córdoba, Spain.,Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC)/Hospital Universitario Reina Sofía/Universidad de Córdoba, Córdoba, Spain
| | - A Vélez García-Nieto
- Department of Dermatology, Hospital Universitario Reina Sofía, Menendez Pidal Ave, 14004, Córdoba, Spain.,Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC)/Hospital Universitario Reina Sofía/Universidad de Córdoba, Córdoba, Spain
| | - J Ruano
- Department of Dermatology, Hospital Universitario Reina Sofía, Menendez Pidal Ave, 14004, Córdoba, Spain.,Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC)/Hospital Universitario Reina Sofía/Universidad de Córdoba, Córdoba, Spain
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267
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Jaleel T, Elmets C, Weinkle A, Kassira S, Elewski B. Secukinumab (AIN-457) for the treatment of Psoriasis. Expert Rev Clin Pharmacol 2016; 9:187-202. [PMID: 26647300 DOI: 10.1586/17512433.2016.1129894] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Secukinumab (also known as AIN-457) is a human monoclonal antibody targeting IL-17A, which has been recently FDA-approved for the treatment of moderate to severe psoriasis and psoriatic arthritis with coexistent moderate to severe plaque psoriasis based on clinical trials demonstrating excellent efficacy. This review will address the rationale for targeting the IL-23/Th17/IL-17 axis, the role of IL-17 and Th17 cells in psoriasis and other chronic inflammatory diseases, and will examine pre-clinical studies, pharmacologic properties, clinical efficacy, and the safety profile of secukinumab.
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Affiliation(s)
- Tarannum Jaleel
- a Department of Dermatology , University of Alabama at Birmingham , Birmingham , AL , USA
| | - Craig Elmets
- a Department of Dermatology , University of Alabama at Birmingham , Birmingham , AL , USA
| | - Allison Weinkle
- c University of California San Diego School of Medicine , La Jolla , CA , USA
| | - Sama Kassira
- b University of Alabama School of Medicine , Birmingham , AL , USA
| | - Boni Elewski
- a Department of Dermatology , University of Alabama at Birmingham , Birmingham , AL , USA
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268
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Alves de Medeiros AK, Speeckaert R, Desmet E, Van Gele M, De Schepper S, Lambert J. JAK3 as an Emerging Target for Topical Treatment of Inflammatory Skin Diseases. PLoS One 2016; 11:e0164080. [PMID: 27711196 PMCID: PMC5053514 DOI: 10.1371/journal.pone.0164080] [Citation(s) in RCA: 125] [Impact Index Per Article: 15.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2016] [Accepted: 09/19/2016] [Indexed: 12/19/2022] Open
Abstract
The recent interest and elucidation of the JAK/STAT signaling pathway created new targets for the treatment of inflammatory skin diseases (ISDs). JAK inhibitors in oral and topical formulations have shown beneficial results in psoriasis and alopecia areata. Patients suffering from other ISDs might also benefit from JAK inhibition. Given the development of specific JAK inhibitors, the expression patterns of JAKs in different ISDs needs to be clarified. We aimed to analyze the expression of JAK/STAT family members in a set of prevalent ISDs: psoriasis, lichen planus (LP), cutaneous lupus erythematosus (CLE), atopic dermatitis (AD), pyoderma gangrenosum (PG) and alopecia areata (AA) versus healthy controls for (p)JAK1, (p)JAK2, (p)JAK3, (p)TYK2, pSTAT1, pSTAT2 and pSTAT3. The epidermis carried in all ISDs, except for CLE, a strong JAK3 signature. The dermal infiltrate showed a more diverse expression pattern. JAK1, JAK2 and JAK3 were significantly overexpressed in PG and AD suggesting the need for pan-JAK inhibitors. In contrast, psoriasis and LP showed only JAK1 and JAK3 upregulation, while AA and CLE were characterized by a single dermal JAK signal (pJAK3 and pJAK1, respectively). This indicates that the latter diseases may benefit from more targeted JAK inhibitors. Our in vitro keratinocyte psoriasis model displayed reversal of the psoriatic JAK profile following tofacitinib treatment. This direct interaction with keratinocytes may decrease the need for deep skin penetration of topical JAK inhibitors in order to exert its effects on dermal immune cells. In conclusion, these results point to the important contribution of the JAK/STAT pathway in several ISDs. Considering the epidermal JAK3 expression levels, great interest should go to the investigation of topical JAK3 inhibitors as therapeutic option of ISDs.
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Affiliation(s)
- Ana Karina Alves de Medeiros
- Department of Dermatology, Ghent University Hospital, Ghent, Belgium
- Department of Dermatology, Ghent University, Ghent, Belgium
- * E-mail:
| | - Reinhart Speeckaert
- Department of Dermatology, Ghent University Hospital, Ghent, Belgium
- Department of Dermatology, Ghent University, Ghent, Belgium
| | - Eline Desmet
- Department of Dermatology, Ghent University, Ghent, Belgium
| | | | - Sofie De Schepper
- Department of Dermatology, Ghent University Hospital, Ghent, Belgium
| | - Jo Lambert
- Department of Dermatology, Ghent University Hospital, Ghent, Belgium
- Department of Dermatology, Ghent University, Ghent, Belgium
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269
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Papp KA, Bissonnette R, Gooderham M, Feldman SR, Iversen L, Soung J, Draelos Z, Mamolo C, Purohit V, Wang C, Ports WC. Treatment of plaque psoriasis with an ointment formulation of the Janus kinase inhibitor, tofacitinib: a Phase 2b randomized clinical trial. BMC DERMATOLOGY 2016; 16:15. [PMID: 27716172 PMCID: PMC5048458 DOI: 10.1186/s12895-016-0051-4] [Citation(s) in RCA: 62] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/03/2016] [Accepted: 09/09/2016] [Indexed: 12/30/2022]
Abstract
Background Most psoriasis patients have mild to moderate disease, commonly treated topically. Current topical agents have limited efficacy and undesirable side effects associated with long-term use. Tofacitinib is a small molecule Janus kinase inhibitor investigated for the topical treatment of psoriasis. Methods This was a 12-week, randomized, double-blind, parallel-group, vehicle-controlled Phase 2b study of tofacitinib ointment (2 % and 1 %) applied once (QD) or twice (BID) daily in adults with mild to moderate plaque psoriasis. Primary endpoint: proportion of patients with Calculated Physician’s Global Assessment (PGA-C) clear or almost clear and ≥2 grade improvement from baseline at Weeks 8 and 12. Secondary endpoints: proportion of patients with PGA-C clear or almost clear; proportion achieving Psoriasis Area and Severity Index 75 (PASI75) response; percent change from baseline in PASI and body surface area; change from baseline in Itch Severity Item (ISI). Adverse events (AEs) were monitored and clinical laboratory parameters measured. Results Overall, 435 patients were randomized and 430 patients received treatment. The proportion of patients with PGA-C clear or almost clear and ≥2 grade improvement from baseline at Week 8 was 18.6 % for 2 % tofacitinib QD (80 % confidence interval [CI] for difference from vehicle: 3.8, 18.2 %) and 22.5 % for 2 % tofacitinib BID (80 % CI: 3.1, 18.5 %); this was significantly higher vs vehicle for both dosage regimens. No significant difference vs vehicle was seen at Week 12. Significantly more patients achieved PGA-C clear or almost clear with 2 % tofacitinib QD and BID and 1 % tofacitinib QD (not BID) at Week 8, and with 2 % tofacitinib BID at Week 12. Pruritus was significantly reduced vs vehicle with 2 % and 1 % tofacitinib BID (starting Day 2), and 2 % tofacitinib QD (starting Day 3). Overall, 44.2 % of patients experienced AEs, 8.1 % experienced application site AEs, and 2.3 % experienced serious AEs. The highest incidence of AEs (including application site AEs) was in the vehicle QD group. Conclusions In adults with mild to moderate plaque psoriasis, 2 % tofacitinib ointment QD and BID showed greater efficacy than vehicle at Week 8, but not Week 12, with an acceptable safety and local tolerability profile. Trial registration NCT01831466 registered March 28, 2013. Electronic supplementary material The online version of this article (doi:10.1186/s12895-016-0051-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Kim A Papp
- K Papp Clinical Research and Probity Medical Research Inc, Waterloo, ON, Canada
| | | | - Melinda Gooderham
- SKiN Centre for Dermatology and Probity Medical Research Inc, Peterborough, and Queens University, Kingston, ON, Canada
| | | | | | | | - Zoe Draelos
- Dermatology Consulting Services, High Point, NC, USA
| | - Carla Mamolo
- Pfizer Worldwide Biopharmaceuticals, Global Innovative Pharma Business, Groton, CT, USA
| | - Vivek Purohit
- Pfizer Worldwide Biopharmaceuticals, Global Innovative Pharma Business, Groton, CT, USA
| | - Cunshan Wang
- Pfizer Worldwide Biopharmaceuticals, Global Innovative Pharma Business, Groton, CT, USA
| | - William C Ports
- Pfizer Worldwide Biopharmaceuticals, Global Innovative Pharma Business, Groton, CT, USA.
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270
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Marra F, Lo E, Kalashnikov V, Richardson K. Risk of Herpes Zoster in Individuals on Biologics, Disease-Modifying Antirheumatic Drugs, and/or Corticosteroids for Autoimmune Diseases: A Systematic Review and Meta-Analysis. Open Forum Infect Dis 2016; 3:ofw205. [PMID: 27942537 PMCID: PMC5144657 DOI: 10.1093/ofid/ofw205] [Citation(s) in RCA: 62] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2015] [Accepted: 09/21/2016] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Studies examining the risk of herpes zoster (HZ) associated with immunosuppressants, such as biologics, nonbiological disease-modifying antirheumatic drugs (nbDMARDs), or corticosteroids, have generated conflicting results. METHODS We conducted a systematic literature search from January 1946 to February 2016. Search terms related to HZ, rheumatoid arthritis, psoriasis, psoriatic arthritis, systemic lupus erythematous, or inflammatory bowel disease, biologics, nbDMARDS, and corticosteroids were used. We included randomized controlled trials (RCTs) and observational studies reporting associations between immunosuppressants and HZ outcomes in adults. For RCTs, we used the Mantel-Haenszel fixed-effects model to estimate pooled odds ratios (ORs) and 95% confidence intervals (CIs) for HZ risk. For observational studies, adjusted ORs were pooled separately using random-effects inverse variance models. RESULTS Data were pooled from 40 eligible RCTs (20136 patients) and 19 observational studies (810939 patients). Biologics were associated with a greater risk of HZ than control (RCTs: OR = 1.71, 95% CI = 1.11-2.64; observational studies: OR = 1.58, 95% CI = 1.39-1.81). In RCTs, the OR of non-tumor necrosis factor (TNF) blockers was 2.19 (95% CI 1.20-4.02), but that of TNF blockers was not significantly different from control. Increased risks of HZ with nbDMARDs (OR = 1.21; 95% CI = 1.15-1.28) and corticosteroids (OR = 1.73; 95% CI = 1.57-1.89) were observed in observational studies, but few RCTs examined these comparisons. CONCLUSIONS Immunocompromised patients receiving biologics were associated with an increased risk of HZ. The risk is also increased with corticosteroids and nbDMARDs. These findings raise the issue of prophylaxis with zoster vaccine in patients initiating immunosuppressive therapy for autoimmune diseases.
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Affiliation(s)
| | - Elaine Lo
- Hong Kong University, China,; National University Hospital, Singapore
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271
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Bissonnette R, Papp K, Poulin Y, Gooderham M, Raman M, Mallbris L, Wang C, Purohit V, Mamolo C, Papacharalambous J, Ports W. Topical tofacitinib for atopic dermatitis: a phase
II
a randomized trial. Br J Dermatol 2016; 175:902-911. [DOI: 10.1111/bjd.14871] [Citation(s) in RCA: 279] [Impact Index Per Article: 34.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/12/2016] [Indexed: 12/11/2022]
Affiliation(s)
| | - K.A. Papp
- K Papp Clinical Research and Probity Medical Research Inc. Waterloo ON Canada
| | - Y. Poulin
- Centre de Recherche Dermatologique du Quebec Metropolitain Quebec QC Canada
| | - M. Gooderham
- SKiN Centre for Dermatology and Probity Medical Research Inc. Peterborough ON Canada
| | - M. Raman
- The Centre for Dermatology and Probity Medical Research Inc. Richmond Hill ON Canada
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272
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Mackay-Wiggan J, Jabbari A, Nguyen N, Cerise JE, Clark C, Ulerio G, Furniss M, Vaughan R, Christiano AM, Clynes R. Oral ruxolitinib induces hair regrowth in patients with moderate-to-severe alopecia areata. JCI Insight 2016; 1:e89790. [PMID: 27699253 DOI: 10.1172/jci.insight.89790] [Citation(s) in RCA: 184] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND. Alopecia areata (AA) is a common autoimmune disease with a lifetime risk of 1.7%; there are no FDA-approved treatments for AA. We previously identified a dominant IFN-γ transcriptional signature in cytotoxic T lymphocytes (CTLs) in human and mouse AA skin and showed that treatment with JAK inhibitors induced durable hair regrowth in mice by targeting this pathway. Here, we investigated the use of the oral JAK1/2 inhibitor ruxolitinib in the treatment of patients with moderate-to-severe AA. METHODS. We initiated an open-label clinical trial of 12 patients with moderate-to-severe AA, using oral ruxolitinib, 20 mg twice per day, for 3-6 months of treatment followed by 3 months follow-up off drug. The primary endpoint was the proportion of subjects with 50% or greater hair regrowth from baseline to end of treatment. RESULTS. Nine of twelve patients (75%) demonstrated a remarkable response to treatment, with average hair regrowth of 92% at the end of treatment. Safety parameters remained largely within normal limits, and no serious adverse effects were reported. Gene expression profiling revealed treatment-related downregulation of inflammatory markers, including signatures for CTLs and IFN response genes and upregulation of hair-specific markers. CONCLUSION. In this pilot study, 9 of 12 patients (75%) treated with ruxolitinib showed significant scalp hair regrowth and improvement of AA. Larger randomized controlled trials are needed to further assess the safety and efficacy of ruxolitinib in the treatment of AA. TRIAL REGISTRATION. Clinicaltrials.gov NCT01950780. FUNDING. Locks of Love Foundation, the Alopecia Areata Initiative, NIH/National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS), and the Irving Institute for Clinical and Translational Research/Columbia University Medical Center Clinical and Translational Science Award (CUMC CTSA).
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Affiliation(s)
| | | | | | | | | | | | | | | | - Angela M Christiano
- Department of Dermatology.,Department of Genetics and Development, Columbia University, New York, New York, USA
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273
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Kennedy Crispin M, Ko JM, Craiglow BG, Li S, Shankar G, Urban JR, Chen JC, Cerise JE, Jabbari A, Winge MC, Marinkovich MP, Christiano AM, Oro AE, King BA. Safety and efficacy of the JAK inhibitor tofacitinib citrate in patients with alopecia areata. JCI Insight 2016; 1:e89776. [PMID: 27699252 DOI: 10.1172/jci.insight.89776] [Citation(s) in RCA: 199] [Impact Index Per Article: 24.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Alopecia areata (AA) is an autoimmune disease characterized by hair loss mediated by CD8+ T cells. There are no reliably effective therapies for AA. Based on recent developments in the understanding of the pathomechanism of AA, JAK inhibitors appear to be a therapeutic option; however, their efficacy for the treatment of AA has not been systematically examined. METHODS This was a 2-center, open-label, single-arm trial using the pan-JAK inhibitor, tofacitinib citrate, for AA with >50% scalp hair loss, alopecia totalis (AT), and alopecia universalis (AU). Tofacitinib (5 mg) was given twice daily for 3 months. Endpoints included regrowth of scalp hair, as assessed by the severity of alopecia tool (SALT), duration of hair growth after completion of therapy, and disease transcriptome. RESULTS Of 66 subjects treated, 32% experienced 50% or greater improvement in SALT score. AA and ophiasis subtypes were more responsive than AT and AU subtypes. Shorter duration of disease and histological peribulbar inflammation on pretreatment scalp biopsies were associated with improvement in SALT score. Drug cessation resulted in disease relapse in 8.5 weeks. Adverse events were limited to grade I and II infections. An AA responsiveness to JAK/STAT inhibitors score was developed to segregate responders and nonresponders, and the previously developed AA disease activity index score tracked response to treatment. CONCLUSIONS At the dose and duration studied, tofacitinib is a safe and effective treatment for severe AA, though it does not result in a durable response. Transcriptome changes reveal unexpected molecular complexity within the disease. TRIAL REGISTRATION ClinicalTrials.gov NCT02197455 and NCT02312882. FUNDING This work was supported by the US Department of Veterans Affairs Office of Research and Development, National Institute of Arthritis and Musculoskeletal and Skin Diseases National Institutes of Health grant R01 AR47223 and U01 AR67173, the National Psoriasis Foundation, the Swedish Society of Medicine, the Fernström Foundation, the Locks of Love Foundation, the National Alopecia Areata Foundation, and the Ranjini and Ajay Poddar Resource Fund for Dermatologic Diseases Research.
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Affiliation(s)
- Milène Kennedy Crispin
- Program in Epithelial Biology and Department of Dermatology, Stanford University School of Medicine, Stanford, California, USA
| | - Justin M Ko
- Program in Epithelial Biology and Department of Dermatology, Stanford University School of Medicine, Stanford, California, USA
| | | | - Shufeng Li
- Program in Epithelial Biology and Department of Dermatology, Stanford University School of Medicine, Stanford, California, USA
| | - Gautam Shankar
- Program in Epithelial Biology and Department of Dermatology, Stanford University School of Medicine, Stanford, California, USA
| | - Jennifer R Urban
- Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut, USA
| | - James C Chen
- Department of Dermatology.,Department of Systems Biology, and
| | | | | | - Mårten Cg Winge
- Program in Epithelial Biology and Department of Dermatology, Stanford University School of Medicine, Stanford, California, USA
| | - M Peter Marinkovich
- Program in Epithelial Biology and Department of Dermatology, Stanford University School of Medicine, Stanford, California, USA
| | - Angela M Christiano
- Department of Dermatology.,Department of Genetics and Development, Columbia University, New York, New York, USA
| | - Anthony E Oro
- Program in Epithelial Biology and Department of Dermatology, Stanford University School of Medicine, Stanford, California, USA
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274
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Zhong J, Wen MJ, Kwong KS, Cheung SH. Testing of non-inferiority and superiority for three-arm clinical studies with multiple experimental treatments. Stat Methods Med Res 2016; 27:1751-1765. [PMID: 27647816 DOI: 10.1177/0962280216668913] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
The purpose of a non-inferiority trial is to assert the efficacy of an experimental treatment compared with a reference treatment by showing that the experimental treatment retains a substantial proportion of the efficacy of the reference treatment. Statistical methods have been developed to test multiple experimental treatments in three-arm non-inferiority trials. In this paper, we report the development of procedures that simultaneously test the non-inferiority and the superiority of experimental treatments after the assay sensitivity has been established. The advantage of the proposed test procedures is the additional ability to identify superior treatments while retaining an non-inferiority testing power comparable to that of existing testing procedures. Single-step and stepwise procedures are derived and then compared with each other to determine their relative testing power and testing error in a simulation study. Finally, the suggested procedures are illustrated with two clinical examples.
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Affiliation(s)
- Junjiang Zhong
- 1 School of Applied Mathematics, Xiamen University of Technology, Xiamen, China.,2 Department of Statistics, National Cheng Kung University, Tainan, Taiwan
| | - Miin-Jye Wen
- 2 Department of Statistics, National Cheng Kung University, Tainan, Taiwan
| | - Koon Shing Kwong
- 3 School of Economics, Singapore Management University, Singapore, Singapore
| | - Siu Hung Cheung
- 2 Department of Statistics, National Cheng Kung University, Tainan, Taiwan.,4 Department of Statistics, The Chinese University of Hong Kong, Shatin, Hong Kong, China
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275
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Griffiths CEM, Vender R, Sofen H, Kircik L, Tan H, Rottinghaus ST, Bachinsky M, Mallbris L, Mamolo C. Effect of tofacitinib withdrawal and re-treatment on patient-reported outcomes: results from a Phase 3 study in patients with moderate to severe chronic plaque psoriasis. J Eur Acad Dermatol Venereol 2016; 31:323-332. [PMID: 27600367 PMCID: PMC5297866 DOI: 10.1111/jdv.13808] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2016] [Accepted: 04/14/2016] [Indexed: 12/25/2022]
Abstract
BACKGROUND Tofacitinib is an oral Janus kinase inhibitor being investigated for psoriasis. A Phase 3 withdrawal/re-treatment study (NCT01186744; OPT Retreatment) showed tofacitinib re-treatment was effective in patients with chronic plaque psoriasis. OBJECTIVES To describe the effects of tofacitinib withdrawal/re-treatment on health-related quality of life (HRQoL) and disease symptoms measured by patient-reported outcomes (PROs). METHODS The study was divided into initial treatment, treatment withdrawal, and re-treatment periods. Initial treatment: patients were randomized to receive tofacitinib 5 (n = 331) or 10 mg (n = 335) BID for 24 weeks. Treatment withdrawal: patients who achieved both ≥ 75% reduction in Psoriasis Area and Severity Index (PASI) score from baseline and Physician's Global Assessment of 'clear'/'almost clear' at Week (W)24 received placebo (withdrawal) or the previous dose (continuous treatment). Re-treatment: at relapse (> 50% loss of W24 PASI response) or at W40, patients received their initial tofacitinib dose. PROs included: Dermatology Life Quality Index (DLQI), Itch Severity Item (ISI), Short Form-36 (SF-36) and Patient's Global Assessment (PtGA). RESULTS After initial treatment with tofacitinib 5 and 10 mg BID, substantial and significant improvements were reported for mean DLQI (baseline: 12.6 and 12.6; W24: 5.1 and 2.6) and ISI (baseline: 6.7 and 6.9; W24: 2.9 and 1.6). Patients continuously treated with tofacitinib 5 and 10 mg BID maintained those improvements through Week 56 (DLQI: 3.0 and 2.1; ISI: 2.3 and 1.4). By W40, patients withdrawn from tofacitinib 5 and 10 mg BID showed worsening in DLQI (5.0 and 6.2) and ISI (3.7 and 4.0) scores; improvements were regained upon re-treatment (W56, DLQI: 3.4 and 2.4; ISI: 2.2 and 1.6). Similar results were reported for PtGA and SF-36. CONCLUSION Continuous tofacitinib treatment provided sustained improvement in HRQoL and disease symptoms. Patients randomized to treatment withdrawal lost initial improvements. Upon re-treatment, improvements were recaptured to levels comparable to those seen with continuous treatment.
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Affiliation(s)
- C E M Griffiths
- The Dermatology Centre, Salford Royal Hospital, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - R Vender
- Dermatrials Research Inc, Hamilton, ON, Canada
| | - H Sofen
- UCLA School of Medicine, Los Angeles, CA, USA
| | - L Kircik
- Icahn School of Medicine at Mount Sinai, New York, NY, USA.,Indiana School of Medicine, Indianapolis, IN, USA.,DermResearch PLLC, Louisville, KY, USA
| | - H Tan
- Pfizer Inc, Global Innovative Pharmaceuticals, Groton, CT, USA
| | - S T Rottinghaus
- Pfizer Inc, Global Innovative Pharmaceuticals, Groton, CT, USA
| | - M Bachinsky
- Pfizer Inc, Global Innovative Pharmaceuticals, Groton, CT, USA
| | | | - C Mamolo
- Pfizer Inc, Global Innovative Pharmaceuticals, Groton, CT, USA
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Wu JJ, Strober BE, Hansen PR, Ahlehoff O, Egeberg A, Qureshi AA, Robertson D, Valdez H, Tan H, Wolk R. Effects of tofacitinib on cardiovascular risk factors and cardiovascular outcomes based on phase III and long-term extension data in patients with plaque psoriasis. J Am Acad Dermatol 2016; 75:897-905. [PMID: 27498960 DOI: 10.1016/j.jaad.2016.06.012] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2016] [Revised: 05/27/2016] [Accepted: 06/06/2016] [Indexed: 12/30/2022]
Abstract
BACKGROUND Psoriasis is a systemic inflammatory condition that is associated with a higher risk of cardiovascular (CV) disease. Tofacitinib is being investigated as a treatment for psoriasis. OBJECTIVE We sought to evaluate the effects of tofacitinib on CV risk factors and major adverse CV events (MACEs) in patients with plaque psoriasis. METHODS Changes in select CV risk factors and the incidence rate (IR) of MACEs were evaluated in patients who were treated with tofacitinib. RESULTS Tofacitinib treatment was associated with small, dose-dependent increases in total cholesterol, low-density lipoprotein (LDL), and high-density lipoprotein (HDL) cholesterol, while the total/HDL cholesterol ratio was unchanged. There were no changes in blood pressure and glycated hemoglobin levels; C-reactive protein levels decreased. The IRs of a MACE were low and similar for both tofacitinib doses. Among 3623 subjects treated with tofacitinib, the total patient-years of exposure was 5204, with a median follow-up of 527 days, and the IR of MACEs was 0.37 (95% confidence interval, 0.22-0.57) patients with events per 100 patient-years. LIMITATIONS There was relatively short follow-up time for patients who had MACEs. CONCLUSIONS While treatment with tofacitinib is associated with a small increase in cholesterol levels, the total/HDL cholesterol ratio does not change, there are no unfavorable changes in several CV risk factors, and the incidence of MACEs is low.
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Affiliation(s)
- Jashin J Wu
- Department of Dermatology, Kaiser Permanente Los Angeles Medical Center, Los Angeles, California.
| | - Bruce E Strober
- University of Connecticut Health Center, Farmington, Connecticut; Probity Medical Research, Waterloo, Ontario, Canada
| | - Peter R Hansen
- Department of Cardiology, Herlev and Gentofte Hospital, Hellerup, Denmark
| | - Ole Ahlehoff
- Department of Cardiology, Copenhagen University Hospital Rigshospitalet, The Heart Centre, Copenhagen, Denmark
| | - Alexander Egeberg
- Department of Cardiology, Herlev and Gentofte Hospital, Hellerup, Denmark; Department of Dermato-Allergology, Herlev and Gentofte Hospital, Hellerup, Denmark
| | - Abrar A Qureshi
- Department of Dermatology, Warren Alpert Medical School, Brown University, Providence, Rhode Island; Department of Epidemiology, School of Public Health, Brown University, Providence, Rhode Island
| | | | | | - Huaming Tan
- Pfizer location in Groton, Groton, Connecticut
| | - Robert Wolk
- Pfizer location in Groton, Groton, Connecticut
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278
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Joerger M, Finn SP, Cuffe S, Byrne AT, Gray SG. The IL-17-Th1/Th17 pathway: an attractive target for lung cancer therapy? Expert Opin Ther Targets 2016; 20:1339-1356. [PMID: 27353429 DOI: 10.1080/14728222.2016.1206891] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
INTRODUCTION There is strong pharmaceutical development of agents targeting the IL-17-TH17 pathway for the treatment of psoriasis (Ps) and psoriatic arthritis (PsA). Lung cancer accounts for 28% of all cancer-related deaths worldwide, and roughly 80% of patients with newly-diagnosed non-small cell lung cancer (NSCLC) present with metastatic disease, with a poor prognosis of around 12 months. Therefore, there is a high unmet medical need for the development of new and potent systemic treatments in this deadly disease. The emergence of immunotherapies such as anti-PD-1 or anti-PDL1 as candidate therapies in non-small cell lung cancer (NSCLC) indicates that targeting critical immuno-modulatory cytokines including those within the IL-17-Th1/Th17 axis may have proven benefit in the treatment of lung cancer. Areas covered: In this review we describe the current evidence for aberrant IL-17-Th1/Th17 settings in cancer, particularly with regard to targeting this axis in NSCLC. We further discuss the current agents under pharmaceutical development which could potentially target this axis, and discuss the current limitations and areas of concern regarding the use of these in lung cancer. Expert opinion: Current evidence suggests that moving forward agents targeting the IL-17-Th1/Th17 pathway may have novel new oncoimmunology indications in the treatment paradigm for NSCLC.
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Affiliation(s)
- Markus Joerger
- a Department of Medical Oncology & Hematology , Cantonal Hospital , St. Gallen , Switzerland
| | - Stephen P Finn
- b Department of Histopathology & Morbid Anatomy , Trinity College Dublin , Dublin , Ireland
| | - Sinead Cuffe
- c HOPE Directorate , St James's Hospital , Dublin , Ireland
| | - Annette T Byrne
- d Department of Physiology and Medical Physics & Centre for Systems Medicine , Royal College of Surgeons in Ireland , Dublin , Ireland
| | - Steven G Gray
- e Thoracic Oncology Research Group , IMM, St James's Hospital , Dublin , Ireland.,f Department of Clinical Medicine , Trinity College Dublin , Dublin , Ireland
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279
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Cline A, Hill D, Lewallen R, Feldman SR. Current status and future prospects for biologic treatments of psoriasis. Expert Rev Clin Immunol 2016; 12:1273-1287. [DOI: 10.1080/1744666x.2016.1202115] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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280
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Chiricozzi A, Saraceno R, Novelli L, Fida M, Caso F, Scarpa R, Costa L, Perricone R, Romanelli M, Chimenti S, Chimenti MS. Small molecules and antibodies for the treatment of psoriasis: a patent review (2010–2015). Expert Opin Ther Pat 2016; 26:757-66. [DOI: 10.1080/13543776.2016.1192129] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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281
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Valenzuela F, Paul C, Mallbris L, Tan H, Papacharalambous J, Valdez H, Mamolo C. Tofacitinib versus etanercept or placebo in patients with moderate to severe chronic plaque psoriasis: patient-reported outcomes from a Phase 3 study. J Eur Acad Dermatol Venereol 2016; 30:1753-1759. [PMID: 27271195 PMCID: PMC5108430 DOI: 10.1111/jdv.13702] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2015] [Accepted: 03/08/2016] [Indexed: 01/22/2023]
Abstract
BACKGROUND Tofacitinib is an oral Janus kinase inhibitor that is being investigated for psoriasis. Psoriasis impacts on physical and psychological well-being; improvements in health-related quality of life (HRQoL) with etanercept in psoriasis are well documented. OBJECTIVE To evaluate HRQoL with tofacitinib, vs. placebo or etanercept, in the Phase 3, randomized, placebo-controlled, non-inferiority, Oral-treatment Psoriasis Trial (OPT) Compare Study (NCT01241591). METHODS Adults with moderate to severe chronic plaque psoriasis were randomized 3:3:3:1 to tofacitinib 10 or 5 mg twice daily (BID), etanercept 50 mg twice weekly or placebo, for 12 weeks. Patient-reported outcomes (PROs) included Dermatology Life Quality Index (DLQI), Itch Severity Item and Patient Global Assessment of psoriasis. RESULTS At baseline, 83.4% (911/1092) of patients had a DLQI score ranging between 6 and 30, indicating a substantial burden of disease. By Week 12, 47.3%, 43.6% and 30.9% of patients in the tofacitinib 10 mg BID, etanercept and tofacitinib 5 mg BID groups, respectively, had a DLQI score of 0 or 1 (no effect of psoriasis on QoL) vs. 7.8% for placebo (all P < 0.0001). Tofacitinib significantly reduced itch vs. placebo (P < 0.05 both doses) and etanercept (P < 0.0001 both doses) within 1 day of starting treatment. Furthermore, reductions in itch were greater with tofacitinib 10 mg BID, vs. etanercept, at Weeks 2-12 (all time points P < 0.05). At Week 2, an Itch Severity Item score of 'little or no itch' was more frequent with tofacitinib 10 mg (68.6%) vs. etanercept (57.4%) and placebo (12.2%), and the PtGA response rate was significantly greater with tofacitinib 10 mg vs. placebo (P < 0.05). CONCLUSION Oral tofacitinib provided significant improvements across multiple PROs by Week 12. Improvements with tofacitinib 10 mg BID were comparable to etanercept, and improvements in itch were greater and more rapid with tofacitinib 10 mg BID.
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Affiliation(s)
- F Valenzuela
- Department of Dermatology, Faculty of Medicine, University of Chile and Probity Medical Research, Santiago, Chile.
| | - C Paul
- Toulouse University and Larrey Hospital, Toulouse, France
| | | | - H Tan
- Pfizer Inc, Groton, CT, USA
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Abstract
Several classes of new oral therapy are in use or in development for the treatment of psoriasis. Despite the high efficacy of biologics, new oral therapies remain important as patients generally prefer this mode of administration and they offer an alternative risk-benefit profile. In this review, we discuss the novel modes of action of these drugs, including modulation of cellular pathways involving diverse targets such as Janus kinase, phosphodiesterase 4, sphingosine 1-phosphate, A3 adenosine receptor and rho-associated kinase 2. We review the available evidence around licensed drugs (apremilast) and drugs that are advanced (tofacitinib) or early (ponesimod, baricitinib, peficitinib, INCB039110, CF101, KD025) in the development pipeline. The key limitations of these oral therapies are their modest efficacy profile (apremilast, ponesimod) and the limitations of their safety profile (tofacitinib, ponesimod), while the evidence for the early pipeline drugs are at phase II level only. Potential niches of current unmet needs include apremilast for patients with concomitant psoriatic arthritis, as combination treatments with biologic therapies, and/or for patients in whom multiple biologic therapies have failed due to immunogenicity and secondary inefficacy. The present knowledge gap regarding these novel drugs includes the need for longer clinical trials or observational studies to evaluate safety, and randomised phase III trials for the early pipeline drugs. We conclude that further research and data are necessary to conclusively establish the role of these agents in the current psoriasis treatment paradigm.
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283
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Volc S, Ghoreschi K. Pathophysiologische Grundlagen der Systemtherapien bei Psoriasis. J Dtsch Dermatol Ges 2016; 14:557-73. [DOI: 10.1111/ddg.13050_g] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2015] [Accepted: 04/07/2016] [Indexed: 11/30/2022]
Affiliation(s)
- Sebastian Volc
- Universitäts-Hautklinik; Universitätsklinikum Tübingen; Eberhard Karls Universität; Tübingen
| | - Kamran Ghoreschi
- Universitäts-Hautklinik; Universitätsklinikum Tübingen; Eberhard Karls Universität; Tübingen
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284
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Albrecht J, Gerdes S. A new option on the horizon for the treatment of psoriasis: it is needed, but not at any price. Br J Dermatol 2016; 174:1183-4. [PMID: 27317278 DOI: 10.1111/bjd.14712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- J Albrecht
- Division of Dermatology, Department of Medicine, J. H. Stroger Hospital of Cook County, 5th Floor Administration Building, 1900 West Polk Street, Chicago, IL, 60612, U.S.A
| | - S Gerdes
- Division of Dermatology, Department of Medicine, J. H. Stroger Hospital of Cook County, 5th Floor Administration Building, 1900 West Polk Street, Chicago, IL, 60612, U.S.A
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285
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Hoffman MB, Hill D, Feldman SR. Current challenges and emerging drug delivery strategies for the treatment of psoriasis. Expert Opin Drug Deliv 2016; 13:1461-73. [PMID: 27164301 DOI: 10.1080/17425247.2016.1188801] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
INTRODUCTION Psoriasis is a common skin disorder associated with physical, social, psychological and financial burden. Over the past two decades, advances in our understanding of pathogenesis and increased appreciation for the multifaceted burden of psoriasis has led to new treatment development and better patient outcomes. Yet, surveys demonstrate that many psoriasis patients are either undertreated or are dissatisfied with treatment. There are many barriers that need be overcome to optimize patient outcomes and satisfaction. AREAS COVERED This review covers the current challenges associated with each major psoriasis treatment strategy (topical, phototherapy, oral medications and biologics). It also reviews the challenges associated with the psychosocial aspects of the disease and how they affect treatment outcomes. Patient adherence, inconvenience, high costs, and drug toxicities are all discussed. Then, we review the emerging drug delivery strategies in topical, oral, and biologic therapy. EXPERT OPINION By outlining current treatment challenges and emerging drug delivery strategies, we hope to highlight the deficits in psoriasis treatment and strategies for how to overcome them. Regardless of disease severity, clinicians should use a patient-centered approach. In all cases, we need to balance patients' psychosocial needs, treatment costs, convenience, and effectiveness with patients' preferences in order to optimize treatment outcomes.
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Affiliation(s)
- Melissa B Hoffman
- a Center for Dermatology Research, Department of Dermatology , Wake Forest School of Medicine , Winston-Salem , NC , USA
| | - Dane Hill
- a Center for Dermatology Research, Department of Dermatology , Wake Forest School of Medicine , Winston-Salem , NC , USA
| | - Steven R Feldman
- a Center for Dermatology Research, Department of Dermatology , Wake Forest School of Medicine , Winston-Salem , NC , USA.,b Department of Pathology , Wake Forest School of Medicine , Winston-Salem , NC , USA.,c Department of Public Health Sciences , Wake Forest School of Medicine , Winston-Salem , NC , USA
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286
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Gooderham M, Gavino-Velasco J, Clifford C, MacPherson A, Krasnoshtein F, Papp K. A Review of Psoriasis, Therapies, and Suicide. J Cutan Med Surg 2016; 20:293-303. [DOI: 10.1177/1203475416648323] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Many chronic medical disorders are associated with psychiatric morbidity. Yet the psychological burden of these disorders often goes unnoticed. In dermatology, psoriasis has a higher association with psychiatric illness, including depression and suicide risk, compared with many other conditions. Studies suggest that effective treatment of psoriasis results in the improvement of psychiatric morbidity, particularly depression and anxiety. New biologic treatments for psoriasis may offer help beyond clearing of the skin in these patients and may lead to a reduction of psychiatric morbidity. Although concerns have been raised regarding the potential link between interleukin-17R blockade in the treatment of psoriasis and suicide, current literature provides no evidence to support this association.
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Affiliation(s)
- Melinda Gooderham
- Skin Centre for Dermatology, Peterborough, ON, Canada
- Probity Medical Research, Waterloo, ON, Canada
| | | | - Cole Clifford
- Skin Centre for Dermatology, Peterborough, ON, Canada
| | | | | | - Kim Papp
- K. Papp Clinical Research, Waterloo, ON, Canada
- Probity Medical Research, Waterloo, ON, Canada
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287
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Papp KA, Krueger JG, Feldman SR, Langley RG, Thaci D, Torii H, Tyring S, Wolk R, Gardner A, Mebus C, Tan H, Luo Y, Gupta P, Mallbris L, Tatulych S. Tofacitinib, an oral Janus kinase inhibitor, for the treatment of chronic plaque psoriasis: Long-term efficacy and safety results from 2 randomized phase-III studies and 1 open-label long-term extension study. J Am Acad Dermatol 2016; 74:841-50. [DOI: 10.1016/j.jaad.2016.01.013] [Citation(s) in RCA: 90] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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288
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Oon S, Wilson NJ, Wicks I. Targeted therapeutics in SLE: emerging strategies to modulate the interferon pathway. Clin Transl Immunology 2016; 5:e79. [PMID: 27350879 PMCID: PMC4910120 DOI: 10.1038/cti.2016.26] [Citation(s) in RCA: 64] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2016] [Revised: 04/12/2016] [Accepted: 04/12/2016] [Indexed: 12/20/2022] Open
Abstract
Systemic lupus erythematosus (SLE) is a prototypic autoimmune disease characterized by impaired immune tolerance, resulting in the generation of pathogenic autoantibodies and immune complexes. Although autoreactive B lymphocytes have been the first targets for biologic therapies in SLE, the importance of the innate immune system, and in particular, pathways involved in interferon (IFN) signaling, has emerged. There are now data supporting a central role for a plasmacytoid dendritic cell-derived type I IFN pathway in SLE, with a number of biologic therapeutics and small-molecule inhibitors undergoing clinical trials. Monoclonal antibodies targeting IFN-α have completed phase II clinical trials, and an antibody against the type I IFN receptor is entering a phase III trial. However, other IFNs, such as IFN gamma, and the more recently discovered type III IFNs, are also emerging as targets in SLE; and blockade of upstream components of the IFN signaling pathway may enable inhibition of more than one IFN subtype. In this review, we discuss the current understanding of IFNs in SLE, focusing on emerging therapies.
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Affiliation(s)
- Shereen Oon
- Division of Inflammation, The Walter and Eliza Hall Institute of Medical Research, Parkville, Victoria, Australia
- Rheumatology Department, The Royal Melbourne Hospital, Parkville, Victoria, Australia
- Department of Medical Biology, The University of Melbourne, Parkville, Victoria, Australia
| | | | - Ian Wicks
- Division of Inflammation, The Walter and Eliza Hall Institute of Medical Research, Parkville, Victoria, Australia
- Rheumatology Department, The Royal Melbourne Hospital, Parkville, Victoria, Australia
- Department of Medical Biology, The University of Melbourne, Parkville, Victoria, Australia
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289
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Yiu ZZN, Exton LS, Jabbar-Lopez Z, Mohd Mustapa MF, Samarasekera EJ, Burden AD, Murphy R, Owen CM, Parslew R, Venning V, Ashcroft DM, Griffiths CEM, Smith CH, Warren RB. Risk of Serious Infections in Patients with Psoriasis on Biologic Therapies: A Systematic Review and Meta-Analysis. J Invest Dermatol 2016; 136:1584-1591. [PMID: 27085754 PMCID: PMC4946794 DOI: 10.1016/j.jid.2016.03.035] [Citation(s) in RCA: 53] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2016] [Revised: 03/15/2016] [Accepted: 03/28/2016] [Indexed: 12/13/2022]
Abstract
A comprehensive evaluation of the risk of serious infections in biologic therapies for psoriasis is lacking. We performed a systematic review and meta-analysis of randomized controlled trials (RCTs) and prospective cohort studies reporting serious infections in people taking any licensed biologic therapy for psoriasis compared with those taking placebo, nonbiologic therapy, or other biologic therapies. The quality of the studies was assessed using Grading of Recommendations Assessment, Development and Evaluation criteria. No significant heterogeneity was detected in data from 32 RCTs (n = 13,359 participants) and one cohort study (n = 4,993 participants). In adults, low- to very-low-quality RCT data showed no significant difference between any biologic therapy and placebo at weeks 12–16 (overall pooled Peto odds ratio = 0.71, 95% confidence interval = 0.36–1.41) and weeks 20–30 (odds ratio = 2.27, 95% confidence interval = 0.45–11.49). No significant differences were found in any of the other comparisons in underpowered RCT data. Prospective cohort study data of low quality suggests that only adalimumab (adjusted hazard ratio [adjHR] = 2.52, 95% confidence interval = 1.47–4.32) was associated with a significantly higher risk of serious infection compared with retinoid and/or phototherapy in adults. No association between biologic therapies and serious infections in patients with psoriasis who were eligible for RCTs was detected. Further observational studies are needed to inform the uncertainty around this risk in the real world.
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Affiliation(s)
- Zenas Z N Yiu
- Dermatology Centre, Salford Royal NHS Foundation Trust, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK; Centre for Pharmacoepidemiology and Drug Safety, Manchester Pharmacy School, The University of Manchester, Manchester, UK
| | | | - Zarif Jabbar-Lopez
- Department of Dermatology, Royal Victoria Infirmary, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle, UK
| | | | | | - A David Burden
- Department of Dermatology, Western Infirmary, Glasgow, UK
| | - Ruth Murphy
- Sheffield University Teaching Hospitals and Sheffield Children's Hospitals, Sheffield, UK
| | - Caroline M Owen
- Department of Dermatology, East Lancashire Hospitals NHS Trust, Royal Blackburn Hospital, Blackburn, Lancashire, UK
| | - Richard Parslew
- Department of Dermatology, Royal Liverpool and Broadgreen University Hospitals Trust, Liverpool, UK
| | - Vanessa Venning
- Department of Dermatology, Oxford University Hospitals Foundation Trust, Oxford, UK
| | - Darren M Ashcroft
- Centre for Pharmacoepidemiology and Drug Safety, Manchester Pharmacy School, The University of Manchester, Manchester, UK
| | - Christopher E M Griffiths
- Dermatology Centre, Salford Royal NHS Foundation Trust, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - Catherine H Smith
- St John's Institute of Dermatology, Guy's and St. Thomas' NHS Foundation Trust, London, UK.
| | - Richard B Warren
- Dermatology Centre, Salford Royal NHS Foundation Trust, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK.
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290
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Tofacitinib attenuates pathologic immune pathways in patients with psoriasis: A randomized phase 2 study. J Allergy Clin Immunol 2016; 137:1079-1090. [DOI: 10.1016/j.jaci.2015.12.1318] [Citation(s) in RCA: 88] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2015] [Revised: 12/09/2015] [Accepted: 12/18/2015] [Indexed: 12/16/2022]
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291
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de Masson A, Bouaziz JD, Battistella M, Bagot M, Bensussan A. Immunopathologie du psoriasis. Med Sci (Paris) 2016; 32:253-9. [DOI: 10.1051/medsci/20163203009] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
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292
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Korman AM, Hill D, Alikhan A, Feldman SR. Oral tofacitinib for the treatment of adults with moderate to severe chronic plaque psoriasis. Expert Rev Clin Pharmacol 2016; 9:525-539. [PMID: 26881913 DOI: 10.1586/17512433.2016.1154785] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
New treatments for psoriasis have been developed based on increasing knowledge of the underlying pathogenesis of the disease. The development of very safe and highly effective biologics has revolutionized the treatment of moderate-to-severe psoriasis. Biologics are not perfect, however, as they are delivered parenterally, immunogenic, and costly. Small molecule agents, with molecular weights of less than 1 kDa, are being developed and hold the advantage of being administered orally. Tofacitinib is an oral Janus kinase inhibitor that has been developed to disrupt the aberrant JAK-STAT pathway that contributes to the pathogenesis of psoriasis. Phase II and Phase III clinical trial results for tofacitinib are encouraging, demonstrating substantial efficacy and satisfactory safety in the treatment of patients with moderate-to-severe chronic plaque psoriasis. An effective oral treatment without the organ toxicities of methotrexate and cyclosporine, tofacitinib is a promising alternative to biologics in the treatment of moderate-to-severe psoriasis.
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Affiliation(s)
- Abraham M Korman
- a Center for Dermatology Research, Department of Dermatology , Wake Forest School of Medicine , Winston-Salem , NC , USA.,d Department of Dermatology , University of Cincinnati College of Medicine , Cincinnati , OH , USA
| | - Dane Hill
- a Center for Dermatology Research, Department of Dermatology , Wake Forest School of Medicine , Winston-Salem , NC , USA
| | - Ali Alikhan
- d Department of Dermatology , University of Cincinnati College of Medicine , Cincinnati , OH , USA
| | - Steven R Feldman
- a Center for Dermatology Research, Department of Dermatology , Wake Forest School of Medicine , Winston-Salem , NC , USA.,b Department of Pathology , Wake Forest School of Medicine , Winston-Salem , NC , USA.,c Department of Public Health Sciences , Wake Forest School of Medicine , Winston-Salem , NC , USA
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293
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Caso F, Del Puente A, Peluso R, Caso P, Girolimetto N, Del Puente A, Scarpa R, Costa L. Emerging drugs for psoriatic arthritis. Expert Opin Emerg Drugs 2016; 21:69-79. [PMID: 26807876 DOI: 10.1517/14728214.2016.1146679] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
INTRODUCTION The majority of Psoriatic Arthritis patients experience a good clinical response to anti-Tumor Necrosis Factor (TNF)-α therapies. However, treatment failure with anti-TNF-α can represent a relevant clinical problem. AREAS COVERED We review the efficacy and safety profile of biological therapies that have been reported from randomized, controlled trials in phase II and phase III available in Pubmed Database for agents targeting IL-12/23p40 antibody (ustekinumab) and IL-17 (secukinumab), inhibitor of phosphodiesterase 4, (apremilast), and of JAK/STAT pathways (tofacitinib) and CTLA4 co-stimulation (abatacept) in Psoriatic Arthritis. EXPERT OPINION In Psoriatic Arthritis, main emerging drugs are represented by the fully human monoclonal IL-12/23p40 antibody, ustekinumab, the agent targeting IL-17, secukinumab, and the inhibitor of phosphodiesterase 4, apremilast. Results on T cell co-stimulation inhibition by abatacept are insufficient both in psoriasis and in PsA. In vitro investigations on JAK/STAT pathways in PsA suggest that tofacitinib could represent a further valuable therapeutic option. Emerging biological treatments other than anti-TNF agents, ustekinumab, secukinumab and apremilast appear promising for Psoriatic Arthritis and recent studies have showed a good efficacy and an acceptable safety profile; however, further and long-term studies are advocated.
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Affiliation(s)
- Francesco Caso
- a Rheumatology Unit, Department of Clinical Medicine and Surgery , University Federico II , Naples , Italy.,b Rheumatology Unit, Department of Medicine DIMED , University of Padova , Padova , Italy
| | - Antonio Del Puente
- a Rheumatology Unit, Department of Clinical Medicine and Surgery , University Federico II , Naples , Italy
| | - Rosario Peluso
- a Rheumatology Unit, Department of Clinical Medicine and Surgery , University Federico II , Naples , Italy
| | - Paolo Caso
- c Geriatric Unit, Faculty of Medicine and Psychology , "Sapienza" University of Rome, S. Andrea Hospital , Rome , Italy
| | - Nicolò Girolimetto
- a Rheumatology Unit, Department of Clinical Medicine and Surgery , University Federico II , Naples , Italy
| | - Aurora Del Puente
- a Rheumatology Unit, Department of Clinical Medicine and Surgery , University Federico II , Naples , Italy
| | - Raffaele Scarpa
- a Rheumatology Unit, Department of Clinical Medicine and Surgery , University Federico II , Naples , Italy
| | - Luisa Costa
- a Rheumatology Unit, Department of Clinical Medicine and Surgery , University Federico II , Naples , Italy.,b Rheumatology Unit, Department of Medicine DIMED , University of Padova , Padova , Italy
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Asahina A, Etoh T, Igarashi A, Imafuku S, Saeki H, Shibasaki Y, Tomochika Y, Toyoizumi S, Nagaoka M, Ohtsuki M. Oral tofacitinib efficacy, safety and tolerability in Japanese patients with moderate to severe plaque psoriasis and psoriatic arthritis: A randomized, double-blind, phase 3 study. J Dermatol 2016; 43:869-80. [PMID: 26875540 PMCID: PMC5067558 DOI: 10.1111/1346-8138.13258] [Citation(s) in RCA: 66] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2015] [Accepted: 11/10/2015] [Indexed: 12/17/2022]
Abstract
Tofacitinib is an oral Janus kinase inhibitor that is being investigated for psoriasis and psoriatic arthritis. Japanese patients aged 20 years or more with moderate to severe plaque psoriasis and/or psoriatic arthritis were double‐blindly randomized 1:1 to tofacitinib 5 or 10 mg b.i.d. for 16 weeks, open‐label 10 mg b.i.d. for 4 weeks, then variable 5 or 10 mg b.i.d. to Week 52. Primary end‐points at Week 16 were the proportion of patients achieving at least a 75% reduction in Psoriasis Area and Severity Index (PASI75) and Physician's Global Assessment of “clear” or “almost clear” (PGA response) for psoriasis, and 20% or more improvement in American College of Rheumatology criteria (ACR20) for patients with psoriatic arthritis. Safety was assessed throughout. Eighty‐seven patients met eligibility criteria for moderate to severe plaque psoriasis (5 mg b.i.d., n = 43; 10 mg b.i.d., n = 44), 12 met eligibility criteria for psoriatic arthritis (5 mg b.i.d., n = 4; 10 mg b.i.d., n = 8) including five who met both criteria (10 mg b.i.d.). At Week 16, 62.8% and 72.7% of patients achieved PASI75 with tofacitinib 5 and 10 mg b.i.d., respectively; 67.4% and 68.2% achieved PGA responses; all patients with psoriatic arthritis achieved ACR20. Responses were maintained through Week 52. Adverse events occurred in 83% of patients through Week 52, including four (4.3%) serious adverse events and three (3.2%) serious infections (all herpes zoster). No malignancies, cardiovascular events or deaths occurred. Tofacitinib (both doses) demonstrated efficacy in patients with moderate to severe plaque psoriasis and/or psoriatic arthritis through 52 weeks; safety findings were generally consistent with prior studies.
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Affiliation(s)
- Akihiko Asahina
- Department of Dermatology, The Jikei University School of Medicine, Tokyo, Japan
| | - Takafumi Etoh
- Department of Dermatology, Tokyo Teishin Hospital, Tokyo, Japan
| | | | - Shinichi Imafuku
- Department of Dermatology, Fukuoka University Faculty of Medicine, Fukuoka, Japan
| | - Hidehisa Saeki
- Department of Dermatology, Nippon Medical School, Tokyo, Japan
| | | | | | | | | | - Mamitaro Ohtsuki
- Department of Dermatology, Jichi Medical University, Tochigi, Japan
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295
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Danese S, Grisham M, Hodge J, Telliez JB. JAK inhibition using tofacitinib for inflammatory bowel disease treatment: a hub for multiple inflammatory cytokines. Am J Physiol Gastrointest Liver Physiol 2016; 310:G155-62. [PMID: 26608188 PMCID: PMC4971816 DOI: 10.1152/ajpgi.00311.2015] [Citation(s) in RCA: 115] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2015] [Accepted: 11/21/2015] [Indexed: 02/08/2023]
Abstract
The inflammatory diseases ulcerative colitis and Crohn's disease constitute the two main forms of inflammatory bowel disease (IBD). They are characterized by chronic, relapsing inflammation of the gastrointestinal tract, significantly impacting on patient quality of life and often requiring prolonged treatment. Existing therapies for IBD are not effective for all patients, and an unmet need exists for additional therapies to induce and maintain remission. Here we describe the mechanism of action of the Janus kinase (JAK) inhibitor, tofacitinib, for the treatment of IBD and the effect of JAK inhibition on the chronic cycle of inflammation that is characteristic of the disease. The pathogenesis of IBD involves a dysfunctional response from the innate and adaptive immune system, resulting in overexpression of multiple inflammatory cytokines, many of which signal through JAKs. Thus JAK inhibition allows multiple cytokine signaling pathways to be targeted and is expected to modulate the innate and adaptive immune response in IBD, thereby interrupting the cycle of inflammation. Tofacitinib is an oral, small molecule JAK inhibitor that is being investigated as a targeted immunomodulator for IBD. Clinical development of tofacitinib and other JAK inhibitors is ongoing, with the aspiration of providing new treatment options for IBD that have the potential to deliver prolonged efficacy and clinically meaningful patient benefits.
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Affiliation(s)
- Silvio Danese
- Division of Gastroenterology, Inflammatory Bowel Disease Center and Humanities Medical School, Milan, Italy;
| | - Matthew Grisham
- 2Department of Immunology and Molecular Microbiology, Texas Tech University Health Sciences Center, Lubbock, Texas;
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296
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Di Lernia V, Bardazzi F. Profile of tofacitinib citrate and its potential in the treatment of moderate-to-severe chronic plaque psoriasis. DRUG DESIGN DEVELOPMENT AND THERAPY 2016; 10:533-9. [PMID: 26889081 PMCID: PMC4743637 DOI: 10.2147/dddt.s82599] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
The outlook for patients with psoriasis has improved significantly over the last 10 years with the introduction of targeted therapies. Cytokines exert their effects by activating intracellular signaling and transcription pathways, among which there are Janus kinases (JAKs) and signal transducers and activators of transcription (STAT) pathways. JAKs are intracellular second messengers that are crucial for transmitting extracellular cytokine signals to the cell. JAK inhibition interrupts intracellular signaling and can suppress immune cell activation and inflammation in T-cell-mediated disorders, such as psoriasis. Consequently, JAKs are the subject of intensive research activity, since they represent possible therapeutic targets. Tofacitinib is an orally available compound belonging to a novel category of nonbiologic drugs, the "JAK inhibitors", which target JAKs. Recently, oral and topical formulations of tofacitinib have been demonstrated to be safe and effective for the treatment of plaque psoriasis in randomized clinical trials. In particular, a 10 mg bid dose of tofacitinib was shown to be noninferior to etanercept 50 mg subcutaneously twice weekly. Questions remain unresolved regarding the safety risk beyond the 5 mg bid dose. This review, assessing the available scientific literature, focuses on the profile of tofacitinib, as investigational compound in the treatment of plaque psoriasis. An overview of the efficacy and safety data from randomized clinical trials is provided. In addition, the authors highlight future potential applications of tofacitinib in other skin diseases, in particular alopecia areata and vitiligo.
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Affiliation(s)
- V Di Lernia
- Dermatology Unit, Arcispedale Santa Maria Nuova IRCCS, Reggio Emilia, Italy
| | - F Bardazzi
- Division of Dermatology, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy
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297
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Yogo T, Nagamiya H, Seto M, Sasaki S, Shih-Chung H, Ohba Y, Tokunaga N, Lee GN, Rhim CY, Yoon CH, Cho SY, Skene R, Yamamoto S, Satou Y, Kuno M, Miyazaki T, Nakagawa H, Okabe A, Marui S, Aso K, Yoshida M. Structure-Based Design and Synthesis of 3-Amino-1,5-dihydro-4H-pyrazolopyridin-4-one Derivatives as Tyrosine Kinase 2 Inhibitors. J Med Chem 2016; 59:733-49. [PMID: 26701356 DOI: 10.1021/acs.jmedchem.5b01857] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
We report herein the discovery and optimization of 3-amino-1,5-dihydro-4H-pyrazolopyridin-4-one TYK2 inhibitors. High-throughput screening against TYK2 and JAK1-3 provided aminoindazole derivative 1 as a hit compound. Scaffold hopping of the aminoindazole core led to the discovery of 3-amino-1,5-dihydro-4H-pyrazolopyridin-4-one derivative 3 as a novel chemotype of TYK2 inhibitors. Interestingly, initial SAR study suggested that this scaffold could have a vertically flipped binding mode, which prompted us to introduce a substituent at the 7-position as a moiety directed toward the solvent-exposed region. Introduction of a 1-methyl-3-pyrazolyl moiety at the 7-position resulted in a dramatic increase in TYK2 inhibitory activity, and further optimization led to the discovery of 20. Compound 20 inhibited IL-23-induced IL-22 production in a rat PD assay, as well as inhibited IL-23 signaling in human PBMC. Furthermore, 20 showed selectivity for IL-23 signaling inhibition against GM-CSF, demonstrating the unique cytokine selectivity of the novel TYK2 inhibitor.
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Affiliation(s)
- Takatoshi Yogo
- Pharmaceutical Research Division, Takeda Pharmaceutical Company Limited , 26-1 Muraoka-Higashi 2-chome, Fujisawa, Kanagawa 251-8555, Japan
| | - Hiroyuki Nagamiya
- Pharmaceutical Research Division, Takeda Pharmaceutical Company Limited , 26-1 Muraoka-Higashi 2-chome, Fujisawa, Kanagawa 251-8555, Japan
| | - Masaki Seto
- Pharmaceutical Research Division, Takeda Pharmaceutical Company Limited , 26-1 Muraoka-Higashi 2-chome, Fujisawa, Kanagawa 251-8555, Japan
| | - Satoshi Sasaki
- Pharmaceutical Research Division, Takeda Pharmaceutical Company Limited , 26-1 Muraoka-Higashi 2-chome, Fujisawa, Kanagawa 251-8555, Japan
| | - Huang Shih-Chung
- Millennium Pharmaceuticals, Inc., a wholly owned subsidiary of Takeda Pharmaceutical Company Limited , 40 Landsdowne Street, Cambridge, Massachusetts 02139, United States
| | - Yusuke Ohba
- Pharmaceutical Research Division, Takeda Pharmaceutical Company Limited , 26-1 Muraoka-Higashi 2-chome, Fujisawa, Kanagawa 251-8555, Japan
| | - Norihito Tokunaga
- Pharmaceutical Research Division, Takeda Pharmaceutical Company Limited , 26-1 Muraoka-Higashi 2-chome, Fujisawa, Kanagawa 251-8555, Japan
| | - Gil Nam Lee
- Chemizon , 3F Dongbang Rental Building, 333-1 Sangdaewon-Dong, Jungwon-Gu, Seongnam-Si, Kyunggi-Do 462-120, Korea
| | - Chul Yun Rhim
- Chemizon , 3F Dongbang Rental Building, 333-1 Sangdaewon-Dong, Jungwon-Gu, Seongnam-Si, Kyunggi-Do 462-120, Korea
| | - Cheol Hwan Yoon
- Chemizon , 3F Dongbang Rental Building, 333-1 Sangdaewon-Dong, Jungwon-Gu, Seongnam-Si, Kyunggi-Do 462-120, Korea
| | - Suk Young Cho
- Chemizon , 3F Dongbang Rental Building, 333-1 Sangdaewon-Dong, Jungwon-Gu, Seongnam-Si, Kyunggi-Do 462-120, Korea
| | - Robert Skene
- Takeda California , 10410 Science Center Drive, San Diego, California 92121, United States
| | - Syunsuke Yamamoto
- Pharmaceutical Research Division, Takeda Pharmaceutical Company Limited , 26-1 Muraoka-Higashi 2-chome, Fujisawa, Kanagawa 251-8555, Japan
| | - Yousuke Satou
- Pharmaceutical Research Division, Takeda Pharmaceutical Company Limited , 26-1 Muraoka-Higashi 2-chome, Fujisawa, Kanagawa 251-8555, Japan
| | - Masako Kuno
- Pharmaceutical Research Division, Takeda Pharmaceutical Company Limited , 26-1 Muraoka-Higashi 2-chome, Fujisawa, Kanagawa 251-8555, Japan
| | - Takahiro Miyazaki
- Pharmaceutical Research Division, Takeda Pharmaceutical Company Limited , 26-1 Muraoka-Higashi 2-chome, Fujisawa, Kanagawa 251-8555, Japan
| | - Hideyuki Nakagawa
- Pharmaceutical Research Division, Takeda Pharmaceutical Company Limited , 26-1 Muraoka-Higashi 2-chome, Fujisawa, Kanagawa 251-8555, Japan
| | - Atsutoshi Okabe
- Pharmaceutical Research Division, Takeda Pharmaceutical Company Limited , 26-1 Muraoka-Higashi 2-chome, Fujisawa, Kanagawa 251-8555, Japan
| | - Shogo Marui
- Pharmaceutical Research Division, Takeda Pharmaceutical Company Limited , 26-1 Muraoka-Higashi 2-chome, Fujisawa, Kanagawa 251-8555, Japan
| | - Kazuyoshi Aso
- Pharmaceutical Research Division, Takeda Pharmaceutical Company Limited , 26-1 Muraoka-Higashi 2-chome, Fujisawa, Kanagawa 251-8555, Japan
| | - Masato Yoshida
- Pharmaceutical Research Division, Takeda Pharmaceutical Company Limited , 26-1 Muraoka-Higashi 2-chome, Fujisawa, Kanagawa 251-8555, Japan
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298
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Bissonnette R, Luchi M, Fidelus-Gort R, Jackson S, Zhang H, Flores R, Newton R, Scherle P, Yeleswaram S, Chen X, Menter A. A randomized, double-blind, placebo-controlled, dose-escalation study of the safety and efficacy of INCB039110, an oral janus kinase 1 inhibitor, in patients with stable, chronic plaque psoriasis. J DERMATOL TREAT 2016; 27:332-8. [PMID: 26769332 DOI: 10.3109/09546634.2015.1115819] [Citation(s) in RCA: 60] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Chronic plaque psoriasis is partially mediated by elevation of proinflammatory cytokines, including several within the Janus kinase/signal transducer and activator of transcription (JAK/STAT) pathway. OBJECTIVE To evaluate the safety and efficacy of the oral selective JAK1 inhibitor INCB039110 in stable, chronic plaque psoriasis. METHODS This was a phase 2, randomized, double-blind, placebo-controlled, dose-escalation study of INCB039110 (100 mg once daily, 200 mg once daily, 200 mg twice daily and 600 mg once daily) for 28 days. The primary endpoint was mean percent change from baseline in the static Physician Global Assessment (sPGA) at day 28. The protocol was institutional review board approved. RESULTS Of 50 patients, 48 completed the study. At day 28, mean percent reduction from baseline in sPGA was 22.2% for INCB039110 100 mg once daily (p = 0.270 vs. placebo), 29.4% for 200 mg once daily (p = 0.118), 35.2% for 200 mg twice daily (p = 0.053), 42.4% for 600 mg once daily (p = 0.003) and 12.5% for placebo. Across groups, 11.1% to 45.5% achieved an sPGA score of 1 versus 0% for placebo. INCB039110 was generally well tolerated; the most common treatment-emergent adverse event was nasopharyngitis (18.4%). CONCLUSION INCB039110 produced significant improvements in sPGA, demonstrating proof of concept in chronic plaque psoriasis.
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Affiliation(s)
| | - Monica Luchi
- b Incyte Corporation , Wilmington , DE , USA , and
| | | | | | | | | | | | | | | | - Xuejun Chen
- b Incyte Corporation , Wilmington , DE , USA , and
| | - Alan Menter
- c Division of Dermatology , Baylor University Medical Center , Dallas , TX , USA
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299
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Schwartz DM, Bonelli M, Gadina M, O'Shea JJ. Type I/II cytokines, JAKs, and new strategies for treating autoimmune diseases. Nat Rev Rheumatol 2016; 12:25-36. [PMID: 26633291 PMCID: PMC4688091 DOI: 10.1038/nrrheum.2015.167] [Citation(s) in RCA: 428] [Impact Index Per Article: 53.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Cytokines are major drivers of autoimmunity, and biologic agents targeting cytokines have revolutionized the treatment of immune-mediated diseases. Despite the effectiveness of these drugs, they do not induce complete remission in all patients, prompting the development of alternative strategies - including targeting of intracellular signal transduction pathways downstream of cytokines. Many cytokines that bind type I and type II cytokine receptors are critical regulators of immune-mediated diseases and employ the Janus kinase (JAK) and signal transducer and activator of transcription (STAT) pathway to exert their effect. Pharmacological inhibition of JAKs blocks the actions of type I/II cytokines, and within the past 3 years therapeutic JAK inhibitors, or Jakinibs, have become available to rheumatologists. Jakinibs have proven effective for the treatment of rheumatoid arthritis and other inflammatory diseases. Adverse effects of these agents are largely related to their mode of action and include infections and hyperlipidemia. Jakinibs are currently being investigated for a number of new indications, and second-generation selective Jakinibs are being developed and tested. Targeting STATs could be a future avenue for the treatment of rheumatologic diseases, although substantial challenges remain. Nonetheless, the ability to therapeutically target intracellular signalling pathways has already created a new paradigm for the treatment of rheumatologic disease.
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Affiliation(s)
- Daniella M Schwartz
- Molecular Immunology &Inflammation Branch, and Translational Immunology Section, National Institute of Arthritis &Musculoskeletal and Skin Diseases, NIH, Building 10, 9000 Rockville Pike, Bethesda, Maryland 20892-1616, USA
| | - Michael Bonelli
- Medical University of Vienna, Department of Rheumatology, Waehringer Guertel 18-20, 1090 Vienna, Austria
| | - Massimo Gadina
- Molecular Immunology &Inflammation Branch, and Translational Immunology Section, National Institute of Arthritis &Musculoskeletal and Skin Diseases, NIH, Building 10, 9000 Rockville Pike, Bethesda, Maryland 20892-1616, USA
| | - John J O'Shea
- Molecular Immunology &Inflammation Branch, and Translational Immunology Section, National Institute of Arthritis &Musculoskeletal and Skin Diseases, NIH, Building 10, 9000 Rockville Pike, Bethesda, Maryland 20892-1616, USA
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300
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Bachelez H. Quoi de neuf en thérapeutique dermatologique ? Ann Dermatol Venereol 2015; 142 Suppl 3:S49-54. [DOI: 10.1016/s0151-9638(16)30006-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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