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Tsai YC, Hsu FL, Tsai TF. Targeted immunotherapy for moderate-to-severe palmoplantar pustulosis: A network meta-analysis of randomized controlled trials. J Am Acad Dermatol 2024:S0190-9622(24)01029-6. [PMID: 38972483 DOI: 10.1016/j.jaad.2024.06.071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Revised: 05/29/2024] [Accepted: 06/10/2024] [Indexed: 07/09/2024]
Affiliation(s)
- Ya-Chu Tsai
- Department of Dermatology, Far Eastern Memorial Hospital, New Taipei, Taiwan; Minghsin University of Science and Technology, Hsinchu, Taiwan
| | - Francis Lt Hsu
- Department of Medical Education, National Taiwan University Hospital, Taipei, Taiwan
| | - Tsen-Fang Tsai
- Department of Dermatology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan.
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Bubna AK, Viplav V. Guselkumab - In Psoriasis and Beyond. Dermatol Pract Concept 2024; 14:dpc.1403a181. [PMID: 39122539 PMCID: PMC11314551 DOI: 10.5826/dpc.1403a181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/15/2024] [Indexed: 08/12/2024] Open
Abstract
INTRODUCTION Guselkumab is an interleukin 23p19 inhibitor, and the first in this group, to be approved by the US Food and Drug Administration for the management of moderate to severe psoriasis. Apart from its utility in psoriasis, there are a number of other dermatologic conditions where guselkumab has demonstrated value. OBJECTIVES The aim of this narrative review is to describe the utility of guselkumab in psoriasis as well as its implication in off-label dermatologic disorders. METHODS Pubmed, Google Scholar, Scopus and ResearchGate were searched for scholarly articles related to guselkumab and its utility in dermatology using the search terms "Guselkumab" AND "Psoriasis" AND "other dermatological disorders". RESULTS Guselkumab is a valuable biologic agent for the management of psoriasis and psoriatic arthropathy. It has also been used successfully for other dermatologic disorders like hidradenitis suppurativa, lichen planus, pityriasis rubra pilaris and pyoderma gangrenosum. Recently, its utility in Stewart-Treves angiosarcoma (STA) has been exemplified. CONCLUSION Guselkumab usage is not limited to psoriasis. Its benefit extends to many more dermatologic conditions. Its utility in STA could open an avenue for its application in the field of oncology. Furthermore, it has an acceptable safety profile.
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Affiliation(s)
- Aditya Kumar Bubna
- Department of Dermatology, Katihar Medical College, Karim Bagh, Katihar, Bihar, India
| | - Vinayak Viplav
- Department of Dermatology, Katihar Medical College, Karim Bagh, Katihar, Bihar, India
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Leong HF, Wang WH, Peng F. Biologics as a novel treatment option for palmoplantar pustulosis: a comprehensive review. Postepy Dermatol Alergol 2024; 41:262-269. [PMID: 39027700 PMCID: PMC11253319 DOI: 10.5114/ada.2024.141128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2024] [Accepted: 05/13/2024] [Indexed: 07/20/2024] Open
Abstract
Introduction Palmoplantar pustulosis (PPP) is a complex inflammatory skin disease. Currently, no standardized treatments exist, and traditional systemic therapies often display limited effectiveness and substantial adverse effects. Biologics, however, have shown potential for enhanced clinical outcomes in psoriasis patients, thereby prompting this investigation into their applicability in PPP treatment. Aim This study constitutes the first comprehensive review to assess the effectiveness and underlying mechanisms of biologics for PPP. Material and methods We conducted a PubMed search to identify studies on biologics for PPP from 1992 onward. The review focused on assessing the efficacy of biologics targeting cytokines like IL-1, IL-8, IL-17, IL-12/23, IL-36, and TNF-α. Results Biologics for PPP are generally less effective than for psoriasis. Secukinumab and guselkumab, IL-17 and IL-23 inhibitors respectively, have shown better results compared to other biologics in trials. However, the effectiveness of other biologics remains uncertain due to limited data. Conclusions More research is needed to find effective treatments for PPP, and selecting the right biologic for each patient is challenging.
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Affiliation(s)
- Hio Fong Leong
- Department of Dermatology, Peking University Third Hospital, Beijing, China
| | - Wen-Hui Wang
- Department of Dermatology, Peking University Third Hospital, Beijing, China
| | - Fen Peng
- Department of Dermatology, Peking University Third Hospital, Beijing, China
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Liu C, Liu X, Xin H, Li X. Associations of inflammatory cytokines with palmoplantar pustulosis: a bidirectional Mendelian randomization study. Front Med (Lausanne) 2024; 11:1387210. [PMID: 38882664 PMCID: PMC11176421 DOI: 10.3389/fmed.2024.1387210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2024] [Accepted: 05/07/2024] [Indexed: 06/18/2024] Open
Abstract
Background Variations in circulatory cytokine levels have been observed during the onset and course of palmoplantar pustulosis (PPP); however, whether these changes are due to etiological or secondary factors is unclear. To clarify the causal relationship, we conducted a summarized-level bidirectional Mendelian randomization (MR) analysis in this study. Methods A FinnGen biobank genome-wide association study (GWAS) of 212,766 individuals (524 PPP patients and 212,242 controls) provided summary data for PPP, whereas genetic instrumental variables (IVs) linked to circulation cytokine levels were gathered from a GWAS of 14,824 European individuals. The inverse-variance weighted (IVW), weighted median (WME), simple mode, and MR-Egger methods were used to ascertain the changes in PPP pathogenic cytokine taxa. Sensitivity analysis, which included horizontal pleiotropy analysis, was then conducted. The reliability of the results was assessed using the leave-one-out approach and the MR Steiger test, which evaluated the strength of a causal relationship. To evaluate the reverse causality between PPP and circulating cytokine levels, a reverse MR analysis was carried out. Results Our study demonstrated positive associations between C-X-C motif chemokine 6 (CXCL6) and PPP (odds ratio, OR 1.257, 95%CI: 1.001-1.570, p = 0.043). C-C motif chemokine 19 (CCL19) and interleukin-6 (IL-6) were suggested to be protectively associated with the development of PPP (OR: 0.698,95% CI: 0.516-0.944, p = 0.020; OR: 0.656, 95%CI:0.437-0.985, p = 0.042). The results were steady after sensitivity and heterogeneity analyses. Conclusion At the genetic prediction level, we identified causally connected inflammation-related variables that contributed to the onset and development of PPP. The therapeutic options for some refractory PPP have expanded due to tailored cytokine therapy, generating fresh concepts for PPP diagnostics and mechanism investigation.
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Affiliation(s)
- Chengling Liu
- Center of Burns and Plastic Surgery and Dermatology, The 924th Hospital of Joint Logistics Support Force of the PLA, Guilin, China
| | - Xingchen Liu
- Department of Pathology, Changhai Hospital, Naval Medical University, Shanghai, China
| | - Haiming Xin
- Center of Burns and Plastic Surgery and Dermatology, The 924th Hospital of Joint Logistics Support Force of the PLA, Guilin, China
| | - Xin Li
- Center of Burns and Plastic Surgery and Dermatology, The 924th Hospital of Joint Logistics Support Force of the PLA, Guilin, China
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Baldo A, Di Domizio J, Yatim A, Vandenberghe-Dürr S, Jenelten R, Fries A, Grizzetti L, Kuonen F, Paul C, Modlin RL, Conrad C, Gilliet M. Human neutrophils drive skin autoinflammation by releasing interleukin (IL)-26. J Exp Med 2024; 221:e20231464. [PMID: 38448036 PMCID: PMC10917069 DOI: 10.1084/jem.20231464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Revised: 01/04/2024] [Accepted: 02/09/2024] [Indexed: 03/08/2024] Open
Abstract
Autoinflammation is a sterile inflammatory process resulting from increased neutrophil infiltration and overexpression of IL-1 cytokines. The factors that trigger these events are, however, poorly understood. By investigating pustular forms of psoriasis, we show that human neutrophils constitutively express IL-26 and abundantly release it from granular stores upon activation. In pustular psoriasis, neutrophil-derived IL-26 drives the pathogenic autoinflammation process by inducing the expression of IL-1 cytokines and chemokines that further recruit neutrophils. This occurs via activation of IL-26R in keratinocytes and via the formation of complexes between IL-26 and microbiota DNA, which trigger TLR9 activation of neutrophils. Thus our findings identify neutrophils as an important source of IL-26 and point to IL-26 as the key link between neutrophils and a self-sustaining autoinflammation loop in pustular psoriasis.
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Affiliation(s)
- Alessia Baldo
- Department of Dermatology and Venereology, University Hospital of Lausanne, Lausanne, Switzerland
| | - Jeremy Di Domizio
- Department of Dermatology and Venereology, University Hospital of Lausanne, Lausanne, Switzerland
| | - Ahmad Yatim
- Department of Dermatology and Venereology, University Hospital of Lausanne, Lausanne, Switzerland
| | - Sophie Vandenberghe-Dürr
- Department of Dermatology and Venereology, University Hospital of Lausanne, Lausanne, Switzerland
| | - Raphael Jenelten
- Department of Dermatology and Venereology, University Hospital of Lausanne, Lausanne, Switzerland
| | - Anissa Fries
- Department of Dermatology and Venereology, University Hospital of Lausanne, Lausanne, Switzerland
| | - Lorenzo Grizzetti
- Department of Dermatology and Venereology, University Hospital of Lausanne, Lausanne, Switzerland
| | - François Kuonen
- Department of Dermatology and Venereology, University Hospital of Lausanne, Lausanne, Switzerland
| | - Carle Paul
- Department of Dermatology and Venereology, Centre Hospitalier Universitaire, Toulouse, France
| | - Robert L. Modlin
- Division of Dermatology, University of California, Los Angeles, Los Angeles, CA, USA
| | - Curdin Conrad
- Department of Dermatology and Venereology, University Hospital of Lausanne, Lausanne, Switzerland
| | - Michel Gilliet
- Department of Dermatology and Venereology, University Hospital of Lausanne, Lausanne, Switzerland
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Huang IH, Wu PC, Chiu HY, Huang YH. Small-Molecule Inhibitors and Biologics for Palmoplantar Psoriasis and Palmoplantar Pustulosis: A Systematic Review and Network Meta-Analysis. Am J Clin Dermatol 2024; 25:347-358. [PMID: 38438782 DOI: 10.1007/s40257-024-00849-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/26/2024] [Indexed: 03/06/2024]
Abstract
BACKGROUND The comparative efficacy of biologics and small-molecule inhibitors in treating palmoplantar psoriasis (PP) and palmoplantar pustulosis (PPP) remains uncertain. OBJECTIVE The aim was to perform a systematic review and network meta-analysis (NMA) to compare the efficacy of biologics and small-molecule inhibitors for the treatment of PP and PPP. METHODS MEDLINE, Embase, and Cochrane Central Register of Controlled Trials were searched for eligible studies from inception to May 13, 2023. This NMA was conducted and reported following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension Statement for Network Meta-Analyses guidelines. Frequentist random-effects models NMA was performed with the surface under the cumulative ranking curve calculated for ranking. Our primary outcome was the proportion of patients achieving a clear/minimal Palmoplantar Psoriasis/Pustulosis Physician Global Assessment score (PPPGA 0/1 or PPPPGA 0/1) response at 12-16 weeks. Secondary outcomes consisted of the percentage of overall improvement in palmoplantar score and of improvement ≥ 75%, at 12-16 weeks. RESULTS The study comprised a total of 29 randomized controlled trials (RCTs), involving 4798 psoriasis patients with palmoplantar diseases. For PP, 16 RCTs with nine different treatments, including adalimumab, apremilast, bimekizumab, etanercept, guselkumab, infliximab, ixekizumab, secukinumab, and ustekinumab were included for the analysis. In the NMA of PP, secukinumab 300 mg ranked highest (odds ratio [OR] 33.50, 95% confidence interval [CI] 4.37-256.86) in achieving PPPGA 0/1, followed by guselkumab 100 mg (OR 18.68, 95% CI 10.07-34.65). In the case of PPP, seven RCTs with six treatments, including apremilast, etanercept, guselkumab, imsidolimab, spesolimab, and ustekinumab, were included for the analysis. In the NMA of PPP, although no treatment demonstrated a significant difference compared to placebo in achieving PPPPGA 0/1, guselkumab 100 mg showed the greatest statistically significant improvement in the palmoplantar score (weighted mean difference 31.73, 95% CI 19.89-43.57) as a secondary outcome. CONCLUSION Among all available biologics and small-molecule inhibitors, secukinumab 300 mg and guselkumab 100 mg had the most favorable efficacy in treating PP and PPP, respectively.
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Affiliation(s)
- I-Hsin Huang
- Department of Dermatology, Chang Gung Memorial Hospital, Linkou, Taoyuan, Taiwan
- Research Center of Big Data and Meta-analysis, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
| | - Po-Chien Wu
- Department of Dermatology, Chang Gung Memorial Hospital, Linkou, Taoyuan, Taiwan
- Research Center of Big Data and Meta-analysis, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
| | - Hsien-Yi Chiu
- Department of Dermatology, National Taiwan University Hospital Hsin-Chu Branch, Hsinchu, Taiwan.
- Department of Dermatology, National Taiwan University Hospital, Taipei, Taiwan.
- Department of Dermatology, College of Medicine, National Taiwan University, Taipei, Taiwan.
- Department of Medical Research, National Taiwan University Hospital Hsin-Chu Branch, Hsinchu, Taiwan.
| | - Yu-Huei Huang
- Department of Dermatology, Chang Gung Memorial Hospital, Linkou, Taoyuan, Taiwan.
- College of Medicine, Chang Gung University, Taoyuan, Taiwan.
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Morimoto T, Hirata H, Sugita K, Paholpak P, Kobayashi T, Tanaka T, Kato K, Tsukamoto M, Umeki S, Toda Y, Mawatari M. A view on the skin-bone axis: unraveling similarities and potential of crosstalk. Front Med (Lausanne) 2024; 11:1360483. [PMID: 38500951 PMCID: PMC10944977 DOI: 10.3389/fmed.2024.1360483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2023] [Accepted: 02/12/2024] [Indexed: 03/20/2024] Open
Abstract
The phrase "skin as a mirror of internal medicine," which means that the skin reflects many of the diseases of the internal organs, is a well-known notion. Despite the phenotypic differences between the soft skin and hard bone, the skin and bone are highly associated. Skin and bone consist of fibroblasts and osteoblasts, respectively, which secrete collagen and are involved in synthesis, while Langerhans cells and osteoclasts control turnover. Moreover, the quality and quantity of collagen in the skin and bone may be modified by aging, inflammation, estrogen, diabetes, and glucocorticoids. Skin and bone collagen are pathologically modified by aging, drugs, and metabolic diseases, such as diabetes. The structural similarities between the skin and bone and the crosstalk controlling their mutual pathological effects have led to the advocacy of the skin-bone axis. Thus, the skin may mirror the health of the bones and conversely, the condition of the skin may be reflected in the bones. From the perspective of the skin-bone axis, the similarities between skin and bone anatomy, function, and pathology, as well as the crosstalk between the two, are discussed in this review. A thorough elucidation of the pathways governing the skin-bone axis crosstalk would enhance our understanding of disease pathophysiology, facilitating the development of new diagnostics and therapies for skin collagen-induced bone disease and of new osteoporosis diagnostics and therapies that enhance skin collagen to increase bone quality and density.
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Affiliation(s)
- Tadatsugu Morimoto
- Department of Orthopaedic Surgery, Faculty of Medicine, Saga University, Saga, Japan
| | - Hirohito Hirata
- Department of Orthopaedic Surgery, Faculty of Medicine, Saga University, Saga, Japan
| | - Kazunari Sugita
- Division of Dermatology, Department of Internal Medicine, Faculty of Medicine, Saga University, Saga, Japan
| | - Permsak Paholpak
- Department of Orthopedics, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Takaomi Kobayashi
- Department of Orthopaedic Surgery, Faculty of Medicine, Saga University, Saga, Japan
| | - Tatsuya Tanaka
- Department of Neurosurgery, International University of Health and Welfare Narita Hospital, Chiba, Japan
| | - Kinshi Kato
- Department of Orthopaedic Surgery, Fukushima Medical University, Fukushima, Japan
| | - Masatsugu Tsukamoto
- Department of Orthopaedic Surgery, Faculty of Medicine, Saga University, Saga, Japan
| | - Shun Umeki
- Department of Orthopaedic Surgery, Faculty of Medicine, Saga University, Saga, Japan
| | - Yu Toda
- Department of Orthopaedic Surgery, Faculty of Medicine, Saga University, Saga, Japan
| | - Masaaki Mawatari
- Department of Orthopaedic Surgery, Faculty of Medicine, Saga University, Saga, Japan
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Bertelsen T, Egeberg A, Skov L, Rasmussen M, Bryld L, Funding A, Ajgeiy K, Thein D. Drug survival of biologic therapies for palmoplantar pustulosis: A nationwide study. J Eur Acad Dermatol Venereol 2024; 38:332-339. [PMID: 37859514 DOI: 10.1111/jdv.19584] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 09/27/2023] [Indexed: 10/21/2023]
Abstract
BACKGROUND Biological therapies have established efficacy in psoriasis vulgaris. However, palmoplantar pustulosis (PPP) has proven difficult to treat, and data on drug survival in these patients remain scarce. OBJECTIVE To investigate drug survival of biological treatments in a nationwide cohort of patients with PPP. METHODS We included all patients treated for PPP with a biologic from a prospective Danish nationwide registry between 2007 and 2019. Descriptive statistics were reported. Drug survival was calculated for all patients and specified for the most frequently used biologics. Drug survival was reported as median time to discontinuation. Kaplan-Meier plots were used to visualize drug survival. Trajectories of Dermatology Life Quality Index (DLQI) scores were plotted by interpolating between the different visits with a dermatologist for each treatment course. RESULTS We identified 85 individual patients who received biological therapy for PPP across 194 treatment courses during follow-up. Of the included treatment courses, 151 (77.8%) were discontinued. The most frequent cause of discontinuation was ineffective response to treatment (54.3%), while 18.5% of courses were discontinued due to adverse events. The median drug survival across all therapies for PPP was 9.3 (Inter quartile range (IQR), 3.9-25.6) months. Ustekinumab demonstrated the longest median time to discontinuation of 14.6 (IQR, 9.1-51.8) months. The proportion of bio-naive patients in treatment at 12 months were according to drug 47.9% for adalimumab, 64.3% for ustekinumab and 40.0% for secukinumab. For bio-experienced, it was 58.2% adalimumab, 54.5% for ustekinumab and 51.4% for secukinumab. CONCLUSIONS The treatment of PPP poses significant challenges, with limited drug survival observed across all therapies regardless of prior experience with biologics. Ustekinumab demonstrated the longest median drug survival. Notably, patients discontinuing therapy due to inefficacy exhibited higher DLQI scores, highlighting the importance of personalized treatment selection and timely consideration of therapy changes when inefficacy is established.
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Affiliation(s)
- T Bertelsen
- Department of Dermatology, Aarhus University Hospital, Aarhus, Denmark
- DERMBIO, Denmark
| | - A Egeberg
- DERMBIO, Denmark
- Department of Dermatology, Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - L Skov
- DERMBIO, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- Department of Dermatology and Allergy, Herlev and Gentofte Hospital, Hellerup, Denmark
| | - M Rasmussen
- Department of Dermatology, Aarhus University Hospital, Aarhus, Denmark
- DERMBIO, Denmark
| | - L Bryld
- DERMBIO, Denmark
- Department of Dermatology, Roskilde Hospital, Roskilde, Denmark
| | - A Funding
- DERMBIO, Denmark
- Dermatology Clinic, Hudcenter Nord, Aalborg, Denmark
| | - K Ajgeiy
- DERMBIO, Denmark
- Department of Dermatology, Odense University Hospital, Odense, Denmark
| | - D Thein
- Department of Dermatology, Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark
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Fukasawa T, Yamashita T, Enomoto A, Yoshizaki-Ogawa A, Miyagawa K, Sato S, Yoshizaki A. Optimal treatments and outcome measures of palmoplantar pustulosis: A systematic review and network meta-analysis-based comparison of treatment efficacy. J Eur Acad Dermatol Venereol 2024; 38:281-288. [PMID: 37684049 DOI: 10.1111/jdv.19499] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2023] [Accepted: 08/18/2023] [Indexed: 09/10/2023]
Abstract
Few studies have made direct comparisons between treatments for palmoplantar pustulosis (PPP); therefore, it is difficult to select the best treatment for each patient. To determine the best therapy and to compare reported measures of efficacy in clinical trials of systemic treatments for PPP in this systematic review and network meta-analysis. Six databases were used to perform database search on 10 July 2022. Randomized controlled trials (RCTs) were identified through a systematic literature search. The titles and abstracts of articles were initially screened for inclusion by two authors independently using our predetermined criteria. The full texts of selected articles were then independently assessed for inclusion in a blinded fashion. Disagreement between the authors was resolved by consensus. Data were abstracted in duplicate. Random-effects model was accepted to perform network meta-analysis. Assessed Grading of Recommendations Assessment, Development and Evaluation certainty of evidence were performed according to the PRISMA guidelines. The analysis was completed in July 2022. The primary outcome was the change of PPP Area and Severity Index (PPPASI) from baseline and the secondary outcome was the achievement of PPPASI-50 response. Seven RCTs with 567 patients were included. Guselkumab 100 mg was the one with the highest probability of reaching the proposed outcomes (mean difference [MD], -8.00; 95% confidence interval [CI], 4.88-11.11), while the achievement of PPPASI-50 response did not show a significant difference (odds ratio [OR], 3.79; 95% CI, 0.51-28.37). Guselkumab 200 mg was next to 100 mg of reaching the proposed outcomes (MD, -4.71; 95% CI, 2.12-7.30), while the achievement of PPPASI-50 response did not show a significant difference (OR, 2.34; 95% CI, 0.48-11.43). Network meta-analysis showed guselkumab 100 mg was the treatment with the highest probability of reaching both PPPASI and PPPASI-50 outcomes. Absolute PPPASI may be more appropriate as an outcome than PPPASI-50.
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Affiliation(s)
- Takemichi Fukasawa
- Department of Dermatology, Psoriasis Center, The University of Tokyo Graduate School of Medicine, Tokyo, Japan
- Department of Clinical Cannabinoid Research, The University of Tokyo Graduate School of Medicine, Tokyo, Japan
| | - Takashi Yamashita
- Department of Dermatology, Psoriasis Center, The University of Tokyo Graduate School of Medicine, Tokyo, Japan
| | - Atsushi Enomoto
- Laboratory of Molecular Radiology, Center for Disease Biology and Integrative Medicine, The University of Tokyo Graduate School of Medicine, Tokyo, Japan
| | - Asako Yoshizaki-Ogawa
- Department of Dermatology, Psoriasis Center, The University of Tokyo Graduate School of Medicine, Tokyo, Japan
| | - Kiyoshi Miyagawa
- Laboratory of Molecular Radiology, Center for Disease Biology and Integrative Medicine, The University of Tokyo Graduate School of Medicine, Tokyo, Japan
| | - Shinichi Sato
- Department of Dermatology, Psoriasis Center, The University of Tokyo Graduate School of Medicine, Tokyo, Japan
| | - Ayumi Yoshizaki
- Department of Dermatology, Psoriasis Center, The University of Tokyo Graduate School of Medicine, Tokyo, Japan
- Department of Clinical Cannabinoid Research, The University of Tokyo Graduate School of Medicine, Tokyo, Japan
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Fukasawa T, Yamashita T, Enomoto A, Toyama S, Yoshizaki-Ogawa A, Tateishi S, Kanda H, Miyagawa K, Sato S, Yoshizaki A. Utility of nailfold capillary assessment for predicting pustulotic arthro-osteitis in palmoplantar pustulosis based on a prospective cohort study. J Am Acad Dermatol 2023; 89:984-991. [PMID: 37517674 DOI: 10.1016/j.jaad.2023.07.1014] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Revised: 06/24/2023] [Accepted: 07/10/2023] [Indexed: 08/01/2023]
Abstract
BACKGROUND Pustulotic arthro-osteitis (PAO) is 1 of the most serious comorbidities associated with palmoplantar pustulosis (PPP). Risk factors of PAO development are not well-known. OBJECTIVE To evaluate the clinical significance of nailfold capillary (NFC) changes in patients with PPP. METHODS We conducted a prospective cohort study in a population of 102 PPP patients. Correlations of NFC abnormalities, including nailfold bleeding and enlarged capillaries, with the prevalence of PAO, the incidence of new PAO, and serum levels of cytokines were analyzed. RESULTS Detailed examination revealed that of 102 PPP patients, 52 without PAO and 50 with PAO. Both nailfold bleeding and enlarged capillaries were significantly more frequent in patients with PAO (50.0% vs 92.0%, P < .0001; 50.0% vs 94.0%, P < .0001). In addition, PPP patients without PAO were prospectively observed before they developed PAO (mean 28 months [1-52 months]). Multivariate analysis suggested that these NFC abnormalities were predictors of PAO development (hazard ratio 3.37, 95% confidence interval 1.13-10.07; 3.37, 1.13-10.07) and guselkumab prevent PAO development (0.093, 0.012-0.76). The degree of NFC abnormalities correlated with the severity of PAO and serum cytokine levels. LIMITATIONS All participants were Japanese. CONCLUSION NFC abnormalities could be predictors of PAO in PPP patients, and their degree indicators of disease severity.
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Affiliation(s)
- Takemichi Fukasawa
- Department of Dermatology, Psoriasis Center, The University of Tokyo Graduate School of Medicine, Tokyo, Japan; Department of Clinical Cannabinoid Research, The University of Tokyo Graduate School of Medicine, Tokyo, Japan
| | - Takashi Yamashita
- Department of Dermatology, Psoriasis Center, The University of Tokyo Graduate School of Medicine, Tokyo, Japan
| | - Atsushi Enomoto
- Laboratory of Molecular Radiology, Center for Disease Biology and Integrative Medicine, The University of Tokyo Graduate School of Medicine, Tokyo, Japan
| | - Satoshi Toyama
- Department of Dermatology, Psoriasis Center, The University of Tokyo Graduate School of Medicine, Tokyo, Japan
| | - Asako Yoshizaki-Ogawa
- Department of Dermatology, Psoriasis Center, The University of Tokyo Graduate School of Medicine, Tokyo, Japan
| | - Shoko Tateishi
- Immune-Mediated Diseases Therapy Center, The University of Tokyo Graduate School of Medicine, Tokyo, Japan
| | - Hiroko Kanda
- Immune-Mediated Diseases Therapy Center, The University of Tokyo Graduate School of Medicine, Tokyo, Japan
| | - Kiyoshi Miyagawa
- Laboratory of Molecular Radiology, Center for Disease Biology and Integrative Medicine, The University of Tokyo Graduate School of Medicine, Tokyo, Japan
| | - Shinichi Sato
- Department of Dermatology, Psoriasis Center, The University of Tokyo Graduate School of Medicine, Tokyo, Japan
| | - Ayumi Yoshizaki
- Department of Dermatology, Psoriasis Center, The University of Tokyo Graduate School of Medicine, Tokyo, Japan; Department of Clinical Cannabinoid Research, The University of Tokyo Graduate School of Medicine, Tokyo, Japan; Immune-Mediated Diseases Therapy Center, The University of Tokyo Graduate School of Medicine, Tokyo, Japan.
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Bartholomew E, Chung BY, Davis M, Yeroushalmi S, Chung M, Hakimi M, Bhutani T, Liao W. Rapid Remission of Sunburn-Induced Guttate Psoriasis with Guselkumab. Dermatol Ther (Heidelb) 2023; 13:2473-2478. [PMID: 37676470 PMCID: PMC10539232 DOI: 10.1007/s13555-023-01013-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Accepted: 08/11/2023] [Indexed: 09/08/2023] Open
Abstract
Guselkumab is an anti-interleukin-23 monoclonal antibody that is approved for plaque psoriasis and psoriatic arthritis. We present a case of a 28-year-old female patient with acute onset of guttate psoriasis after a blistering sunburn. She had no personal or family history of psoriasis or chronic inflammatory skin disease. The guttate psoriasis was refractory to topical treatment. After the first dose of guselkumab (100 mg subcutaneous injection), the patient experienced near-clearance of her guttate psoriasis, with continued improvement and drug-free remission 8 months after cessation of treatment. Dermatologists could consider guselkumab as a treatment option for patients with guttate psoriasis. Future studies should examine the potential for guselkumab to induce drug-free remissions in guttate psoriasis.
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Affiliation(s)
- Erin Bartholomew
- Department of Dermatology, The University of California, San Francisco (UCSF), 2340 Sutter Street, Box 0808, San Francisco, CA, 94115, USA
| | - Bo-Young Chung
- Department of Dermatology, The University of California, San Francisco (UCSF), 2340 Sutter Street, Box 0808, San Francisco, CA, 94115, USA
- Department of Dermatology, Kangnam Sacred Heart Hospital, Hallym University, Seoul, Republic of Korea
| | - Mitchell Davis
- Department of Dermatology, The University of California, San Francisco (UCSF), 2340 Sutter Street, Box 0808, San Francisco, CA, 94115, USA
| | - Samuel Yeroushalmi
- Department of Dermatology, The University of California, San Francisco (UCSF), 2340 Sutter Street, Box 0808, San Francisco, CA, 94115, USA
| | - Mimi Chung
- Department of Dermatology, The University of California, San Francisco (UCSF), 2340 Sutter Street, Box 0808, San Francisco, CA, 94115, USA
| | - Marwa Hakimi
- Department of Dermatology, The University of California, San Francisco (UCSF), 2340 Sutter Street, Box 0808, San Francisco, CA, 94115, USA
| | - Tina Bhutani
- Department of Dermatology, The University of California, San Francisco (UCSF), 2340 Sutter Street, Box 0808, San Francisco, CA, 94115, USA
| | - Wilson Liao
- Department of Dermatology, The University of California, San Francisco (UCSF), 2340 Sutter Street, Box 0808, San Francisco, CA, 94115, USA.
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12
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Burden AD, Bissonnette R, Navarini AA, Murakami M, Morita A, Haeufel T, Ye B, Baehner F, Terui T. Spesolimab Efficacy and Safety in Patients with Moderate-to-Severe Palmoplantar Pustulosis: A Multicentre, Double-Blind, Randomised, Placebo-Controlled, Phase IIb, Dose-Finding Study. Dermatol Ther (Heidelb) 2023; 13:2279-2297. [PMID: 37731086 PMCID: PMC10539230 DOI: 10.1007/s13555-023-01002-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Accepted: 08/02/2023] [Indexed: 09/22/2023] Open
Abstract
INTRODUCTION We evaluated the anti-interleukin-36 receptor antibody spesolimab in patients with moderate-to-severe palmoplantar pustulosis (PPP). METHODS This phase IIb trial comprised a loading dose period to week (W) 4, then maintenance dosing to W52. Patients were randomised 2:1:1:1:2 to subcutaneous spesolimab 3000 mg to W4 then 600 mg every 4 weeks (q4w), spesolimab 3000 mg to W4 then 300 mg q4w, spesolimab 1500 mg to W4 then 600 mg q4w, spesolimab 1500 mg to W4, 300 mg q4w to W16 then 300 mg every 8 weeks (q8w), or placebo switching to spesolimab 600 mg q4w at W16. The primary efficacy endpoint was percentage change from baseline in Palmoplantar Pustular Area and Severity Index (PPP ASI) at W16. Secondary endpoints included a Palmoplantar Pustular Physician's Global Assessment (PPP PGA) score of 0/1. Safety (including adverse events [AEs], local tolerability) was assessed. RESULTS 152 patients were treated. The primary endpoint was not met; mean differences for spesolimab versus placebo ranged from - 14.6% (95% confidence interval [CI]: - 31.5%, 2.2%) to - 5.3% (95% CI: - 19.1%, 8.6%); none reached significance. At W16, 23 (21.1%) and two (4.7%) patients in the combined spesolimab and placebo groups, respectively, achieved PPP PGA 0/1 (mean difference 16.4%; 95% CI: 3.8%, 25.7%), increasing to 59 (54.1%; combined spesolimab) and 12 (27.9%; placebo switch to spesolimab) patients at W52. Non-Asian patients had significant improvements in the primary endpoint (mean difference - 17.7%; nominal P = 0.0394) and PPP PGA 0/1 at W16 with spesolimab versus placebo. Rates of AEs and AE-related discontinuations were similar for spesolimab and placebo. Local tolerability events and injection-site reactions were more frequent with spesolimab than placebo. CONCLUSION The primary objective to demonstrate a non-flat dose-response relationship and proof-of-concept was not achieved; improvements with spesolimab occurred in secondary endpoints and in non-Asian patients, indicating potential modest benefits. Spesolimab was generally well tolerated (ClinicalTrials.gov NCT04015518).
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Affiliation(s)
- A David Burden
- School of Infection and Immunity, University of Glasgow, Glasgow, UK.
| | | | | | - Masamoto Murakami
- Department of Dermatology, Ehime University Graduate School of Medicine, Ehime, Japan
| | - Akimichi Morita
- Department of Geriatric and Environmental Dermatology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Thomas Haeufel
- Boehringer Ingelheim International GmbH, Ingelheim, Germany
| | - Binqi Ye
- Boehringer Ingelheim (China) Investment Corporation Limited, Shanghai, People's Republic of China
| | - Frank Baehner
- Boehringer Ingelheim International GmbH, Ingelheim, Germany
| | - Tadashi Terui
- Division of Cutaneous Science, Department of Dermatology, Nihon University School of Medicine, Tokyo, Japan
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Heidemeyer K, May Lee M, Cazzaniga S, Yawalkar N, Naldi L. Palmoplantar Pustulosis: A Systematic Review of Risk Factors and Therapies. PSORIASIS (AUCKLAND, N.Z.) 2023; 13:33-58. [PMID: 37772169 PMCID: PMC10522454 DOI: 10.2147/ptt.s400402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Accepted: 09/16/2023] [Indexed: 09/30/2023]
Abstract
Palmoplantar pustulosis (PPP) is a chronic, relapsing, inflammatory disease that can occur alone or in association with arthritis. There is still controversy about whether it should be separated from psoriasis or classified as pustular psoriasis. Furthermore, drug-induced paradoxical PPP is a special variant of PPP that differs from classic PPP in several ways. Treatment of PPP is still challenging, and there are a number of treatment-resistant cases. This review summarizes the risk factors for the development of PPP and the currently available treatment modalities. Female sex, smokers or ex-smokers, obesity, thyroid dysfunction, and treatment with a tumor necrosis factor (TNF)-α inhibitor have been identified as risk factors for the disease's development, severity, and course. Topical treatments and phototherapy are effective for some patients and are used as a first-line or adjuvant treatment modality. Conventional treatments including retinoids and fumaric acid show good effects and can increase the efficacy of treatment with psoralen + ultraviolet light therapy (PUVA). Ciclosporin is fast acting, but relapse mostly occurs immediately after cessation. TNF-α inhibitors are efficient, and an even better response can be achieved with IL-17 and IL-23 blockers as well as apremilast. The effect of Janus kinase inhibitors seems to be promising according to case reports, but further investigations with larger cohorts are needed.
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Affiliation(s)
- Kristine Heidemeyer
- Department of Dermatology, Inselspital University Hospital of Bern, Bern, Switzerland
- Centro Studi GISED, Bergamo, Italy
| | - Marco May Lee
- Section of Dermatology, Department of Clinical and Experimental Medicine, University of Parma, Parma, Italy
| | - Simone Cazzaniga
- Department of Dermatology, Inselspital University Hospital of Bern, Bern, Switzerland
- Centro Studi GISED, Bergamo, Italy
| | - Nikhil Yawalkar
- Department of Dermatology, Inselspital University Hospital of Bern, Bern, Switzerland
| | - Luigi Naldi
- Centro Studi GISED, Bergamo, Italy
- Dermatology Department, S. Bortolo Hospital, Vicenza, Italy
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14
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Zhang M, Hua L, Hong S, Sun X, Zhou Y, Luo Y, Liu L, Wang J, Wang C, Lin N, Li X. Efficacy and safety of biological agents to treat patients with palmoplantar pustulosis: A systematic scoping review. Int Immunopharmacol 2023; 122:110553. [PMID: 37480749 DOI: 10.1016/j.intimp.2023.110553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Revised: 06/02/2023] [Accepted: 06/20/2023] [Indexed: 07/24/2023]
Abstract
BACKGROUND Palmoplantar pustulosis (PPP), a chronic, recurrent pustular dermatosis associated with erythema, scales, and sterile pustules on the palms and soles, is commonly encountered in dermatology clinics. Whether PPP is a variant of psoriasis or a distinct condition is still debated. Although biological agents have been successfully used to treat moderate-to-severe psoriasis, existing literature on PPP is limited to case reports or small case series. The lack of well-documented clinical studies makes it difficult to select the ideal treatment for this condition. This review aims to discuss the efficacy and safety of biological agents in PPP treatment based on randomized controlled trials with the hope of inspiring dermatologist clinicians to propose new therapeutic approaches. OBJECTIVES This review aims to obtain high-level evidence to assess the efficacy and safety of biological agents in the treatment of patients with PPP. METHODS We searched the PubMed, Embase, and Cochrane databases up to May 18, 2023, for high-quality randomized controlled trials that reported at least one adverse event after PPP treatment with biological agents in patients > 18 years of age. RevMan 5.3 software was used for the meta-analysis. RESULTS Nine trials involving 799 participants were included in the analysis. We used ppPASI 75 as the primary efficacy measure. Anti-IL-23 and anti-IL-17A agents afforded 4.14-fold and 1.95-fold better outcomes than placebo treatment at weeks 16 and 12, respectively (P-value = 0.009, RR = 4.14, 95% confidence interval [CI; 1.43-11.98]; P-value = 0.02, RR = 1.95, 95% CI [1.11-3.42]). Moreover, anti-IL-23 agents at a dose of 100 mg were more effective than at 200 mg, indicating that 100 mg may be the best dose for anti-IL-23 agents. Next, we investigated the safety of biological agents for PPP treatment. The incidence of total adverse events (AEs) was 1.25 times higher for biological agents than for controls, indicating a good safety profile (RR = 1.25, P-value < 0.00001, 95% CI [1.13, 1.37]). Additionally, we divided the common AEs into 16 categories and found that anti-IL-23 agents were more likely to induce infections. In conclusion, we evaluated safety and efficacy in a comprehensive comparison and found that anti-IL-23 agents conferred good clinical efficacy with a low incidence of AEs and could be recommended with caution. LIMITATIONS Only a few relevant, high-quality, randomized controlled trials were included in the study. CONCLUSION This study showed that biological agents can be used to treat patients with PPP with good efficacy; however, AEs cannot be ignored. Multi-center, high-quality clinical studies with large sample sizes are needed to further evaluate the effects and safety of biological agents in PPP treatment.
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Affiliation(s)
- Miao Zhang
- Department of Dermatology, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai 200437, China; Institute of Dermatology, Shanghai Academy of Traditional Chinese Medicine, Shanghai 201203, China
| | - Liang Hua
- Department of Dermatology, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai 200437, China; Institute of Dermatology, Shanghai Academy of Traditional Chinese Medicine, Shanghai 201203, China
| | - Seokgyeong Hong
- Institute of Dermatology, Shanghai Academy of Traditional Chinese Medicine, Shanghai 201203, China
| | - Xiaoying Sun
- Institute of Dermatology, Shanghai Academy of Traditional Chinese Medicine, Shanghai 201203, China
| | - Yaqiong Zhou
- Institute of Dermatology, Shanghai Academy of Traditional Chinese Medicine, Shanghai 201203, China
| | - Ying Luo
- Institute of Dermatology, Shanghai Academy of Traditional Chinese Medicine, Shanghai 201203, China
| | - Liu Liu
- Department of Dermatology, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai 200437, China; Institute of Dermatology, Shanghai Academy of Traditional Chinese Medicine, Shanghai 201203, China
| | - Jiao Wang
- Department of Dermatology, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai 200437, China; Institute of Dermatology, Shanghai Academy of Traditional Chinese Medicine, Shanghai 201203, China
| | - Chunxiao Wang
- Department of Dermatology, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai 200437, China; Institute of Dermatology, Shanghai Academy of Traditional Chinese Medicine, Shanghai 201203, China
| | - Naixuan Lin
- Department of Dermatology, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai 200437, China; Institute of Dermatology, Shanghai Academy of Traditional Chinese Medicine, Shanghai 201203, China
| | - Xin Li
- Department of Dermatology, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai 200437, China; Institute of Dermatology, Shanghai Academy of Traditional Chinese Medicine, Shanghai 201203, China.
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15
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Terui T, Okubo Y, Kobayashi S, Sano S, Morita A, Imafuku S, Tada Y, Abe M, Yaguchi M, Uehara N, Handa T, Tanaka M, Zhang W, Paris M, Murakami M. Efficacy and Safety of Apremilast for the Treatment of Japanese Patients with Palmoplantar Pustulosis: Results from a Phase 2, Randomized, Placebo-Controlled Study. Am J Clin Dermatol 2023; 24:837-847. [PMID: 37233897 PMCID: PMC10213585 DOI: 10.1007/s40257-023-00788-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/19/2023] [Indexed: 05/27/2023]
Abstract
BACKGROUND Palmoplantar pustulosis (PPP) is a pruritic, painful, recurrent, and chronic dermatitis with limited therapeutic options. OBJECTIVE To evaluate the efficacy and safety of apremilast for the treatment of Japanese patients with PPP and inadequate response to topical treatment. METHODS This phase 2, randomized, double-blind, placebo-controlled study enrolled patients with Palmoplantar Pustulosis Area and Severity Index (PPPASI) total score ≥ 12 and moderate or severe pustules/vesicles on the palm or sole (PPPASI pustule/vesicle severity score ≥ 2) at screening and baseline with an inadequate response to topical treatment. Patients were randomized (1:1) to apremilast 30 mg twice daily or placebo for 16 weeks, followed by a 16-week extension phase during which all patients received apremilast. The primary endpoint was achievement of PPPASI-50 response (≥ 50% improvement from baseline in PPPASI). Key secondary endpoints included change from baseline in PPPASI total score, Palmoplantar Pustulosis Severity Index (PPSI), and patient's visual analog scale (VAS) for PPP symptoms (pruritus and discomfort/pain). RESULTS A total of 90 patients were randomized (apremilast: 46; placebo: 44). A significantly greater proportion of patients achieved PPPASI-50 at week 16 with apremilast versus placebo (P = 0.0003). Patients receiving apremilast showed greater improvement in PPPASI at week 16 versus placebo (nominal P = 0.0013), as well as PPSI and patient-reported pruritus and discomfort/pain (nominal P ≤ 0.001 for all). Improvements were sustained through week 32 with apremilast treatment. The most common treatment-emergent adverse events included diarrhea, abdominal discomfort, headache, and nausea. CONCLUSIONS Apremilast treatment demonstrated greater improvements in disease severity and patient-reported symptoms versus placebo at week 16 in Japanese patients with PPP with sustained improvements through week 32. No new safety signals were observed. CLINICALTRIALS GOV: NCT04057937.
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Affiliation(s)
- Tadashi Terui
- Nihon University School of Medicine, 30-1 Oyaguchikamicho, Itabashi, Tokyo, 173-8610, Japan.
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16
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Tsiogkas SG, Grammatikopoulou MG, Kontouli KM, Minopoulou I, Goulis DD, Zafiriou E, Bogdanos DP, Patsatsi A. Efficacy of biologic agents for palmoplantar psoriasis: a systematic review and network meta-analysis. Expert Rev Clin Immunol 2023; 19:1485-1498. [PMID: 37842734 DOI: 10.1080/1744666x.2023.2272049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Accepted: 10/10/2023] [Indexed: 10/17/2023]
Abstract
BACKGROUND Palmoplantar psoriasis (PP) represents a localized type of disease. While controversy over its' classification exists, a hyperkeratotic type, a pustular type and palmoplantar pustulosis (PPP) have been recognized. PP management is regularly supported by biologic agents. Our study aimed to review and synthesize available data regarding the efficacy of approved biologics for PP and PPP. RESEARCH DESIGN AND METHODS A literature search was conducted in PubMed, CENTRAL, Scopus, and ClinicalTrilas.gov. Utilizing random-effects inverse-variance frequentist network meta-analyses (NMAs), we ranked interventions. The proportion of participants with cleared skin was the primary outcome. Fifty and 75% improvement in palmoplantar psoriasis area severity index (PPASI) were also explored (PPASI50, PPASI75). RESULTS In total, 15 randomized controlled trials (RCTs) exploring the efficacy of on-label adalimumab, bimekizumab, etanercept, guselkumab, infliximab, ixekizumab, secukinumab, and ustekinumab were included. Data for PP were synthesized. Every biologic agent examined, except from infliximab, outperformed placebo. On-label secukinumab exhibited the highest probability of inducing complete resolution. Ixekizumab and infliximab ranked best on inducing PPASI50 and PPASI75. Our review supports that guselkumab is effective for PPP. CONCLUSIONS Secukinumab, ixekizumab and infliximab are effective for PP. Research is warranted to produce evidence about the efficacy of biologics in PP and PPP.
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Affiliation(s)
- Sotirios G Tsiogkas
- Department of Rheumatology and Clinical Immunology, Faculty of Medicine, University of Thessaly, Larissa, Greece
| | - Maria G Grammatikopoulou
- Department of Rheumatology and Clinical Immunology, Faculty of Medicine, University of Thessaly, Larissa, Greece
| | - Katerina-Maria Kontouli
- Laboratory of Hygiene and Epidemiology, Medical School, University of Thessaly, Larissa, Greece
- Department of Primary Education, School of Education University of Ioannina, Ioannina, Greece
| | - Ioanna Minopoulou
- Medical School, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Dimitrios D Goulis
- Unit of Reproductive Endocrinology, 1st Department of Obstetrics and Gynecology, Medical School, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Efterpi Zafiriou
- Department of Dermatology, University of Thessaly, Larissa, Greece
| | - Dimitrios P Bogdanos
- Department of Rheumatology and Clinical Immunology, Faculty of Medicine, University of Thessaly, Larissa, Greece
| | - Aikaterini Patsatsi
- 2ndDepartment of Dermatology and Venereology, Aristotle University of Thessaloniki, Thessaloniki, Greece
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Ahmed SS, De A, Das S, Manchanda Y. Biologics and Biosimilars in Psoriasis. Indian J Dermatol 2023; 68:282-295. [PMID: 37529455 PMCID: PMC10389141 DOI: 10.4103/ijd.ijd_421_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/03/2023] Open
Abstract
Psoriasis is a chronic, debilitating, relapsing, inflammatory dermatosis, which affects approximately 2-3% of the population. The burgeoning research on pathogenesis of psoriasis has opened up new directions in management of this common condition. The introduction of biologics has given additional elements to the arsenal of psoriatic disease treatments. TNF-α inhibitors, IL-12/23 inhibitors, IL-17 inhibitors, CD-6 inhibitor proved highly efficient and have a good safety profile in numerous clinical trials. Biosimilar drugs are structurally almost similar to their reference biologic and are also made from living organism. Long-term follow-up and post-marketing surveillance are required to understand, long-term efficacy, adverse events of these powerful potent molecules.
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Affiliation(s)
- Sk Shahriar Ahmed
- From the Department of Dermatology, Calcutta National Medical College, Kolkata, West Bengal, India
| | - Abhishek De
- From the Department of Dermatology, Calcutta National Medical College, Kolkata, West Bengal, India
| | - Sudip Das
- From the Department of Dermatology, Calcutta National Medical College, Kolkata, West Bengal, India
| | - Yashpal Manchanda
- Department of Dermatology, Farwaniya Hospital, Kuwait University, Kuwait
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18
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Xu JM, Wang HM, Jin HZ. An update on therapeutic options for palmoplantar pustulosis: a narrative review and expert recommendations. Expert Rev Clin Immunol 2023; 19:499-516. [PMID: 36970858 DOI: 10.1080/1744666x.2023.2185775] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/29/2023]
Abstract
INTRODUCTION Palmoplantar pustulosis (PPP) is a chronic inflammatory skin disease belonging to the localized form of pustular psoriasis. It is characterized by sterile pustule formation in palms and soles and a recurrent disease course. Although we have many treatments for PPP, there is no authoritative guidance. AREAS COVERED A thorough search of PubMed was conducted to identify studies in PPP from 1973 onwards, with additional references to specific articles. Any treatment methods were outcomes of interest, including topical treatment, systemic treatment, biologics, other targeted treatments, phototherapy, and tonsillectomy. EXPERT OPINION Topical corticosteroids are suggested as first-line therapy. Oral acitretin has become the most applied systemic retinoid recommended in PPP without joint involvement. For patients with arthritis, immunosuppressants like cyclosporin A and methotrexate are more recommended. UVA1, NB-UVB, and 308-nm excimer laser are effective phototherapy options. The combinations of topical or systemic agents and phototherapy may enhance the efficacy, particularly in recalcitrant cases. Secukinumab, ustekinumab, and apremilast are the most investigated targeted therapies. However, heterogeneous reported outcomes in clinical trials provided low-to-moderate quality evidence of their efficacy. Future studies are required to address these evidence gaps. We suggest managing PPP based on the acute phase, maintenance phase, and comorbidities.
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19
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Ikumi N, Fujita H. Clinically and radiologically successful treatment of spondylitis by guselkumab in a patient with pustulotic arthro‐osteitis. JOURNAL OF CUTANEOUS IMMUNOLOGY AND ALLERGY 2023. [DOI: 10.1002/cia2.12299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023] Open
Affiliation(s)
- Natsumi Ikumi
- Division of Cutaneous Science, Department of Dermatology Nihon University School of Medicine Tokyo Japan
| | - Hideki Fujita
- Division of Cutaneous Science, Department of Dermatology Nihon University School of Medicine Tokyo Japan
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Terui H, Moroi R, Masamune A, Aiba S, Yamasaki K. Possible Efficacy of Vedolizumab, an Anti-α4β7 Integrin Antibody, in Palmoplantar Pustulosis. Case Rep Dermatol 2023; 15:22-25. [PMID: 36726801 PMCID: PMC9885181 DOI: 10.1159/000529080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2022] [Accepted: 01/04/2023] [Indexed: 01/28/2023] Open
Abstract
Palmoplantar pustulosis (PPP) is a chronic skin inflammatory disease in which blisters and pustules repeatedly develop on palms and soles. PPP is often refractory to topical therapy, oral therapy, phototherapy, and biologics that are usually applied for PPP. We report a patient with PPP improved by vedolizumab (anti-α4β7 integrin antibody) treatment for ulcerative colitis, suggesting the possibility of a new molecular target for PPP therapy.
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Affiliation(s)
- Hitoshi Terui
- Department of Dermatology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Rintaro Moroi
- Division of Gastroenterology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Atsushi Masamune
- Division of Gastroenterology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Setsuya Aiba
- Department of Dermatology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Kenshi Yamasaki
- Department of Dermatology, Tohoku University Graduate School of Medicine, Sendai, Japan
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Ruggiero A, Megna M, Fabbrocini G, Ocampo-Garza SS. Anti-IL23 biologic therapies in the treatment of psoriasis: real-world experience versus clinical trials data. Immunol Res 2023; 71:328-355. [PMID: 36598647 PMCID: PMC9811885 DOI: 10.1007/s12026-022-09356-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Accepted: 12/27/2022] [Indexed: 01/05/2023]
Abstract
Nowadays, the biological equipment available for the treatment of moderate-to-severe psoriasis is plenty. Anti-interleukin-23 represents the latest class of biologic approved for the management of moderate-to-severe psoriasis. Their efficacy and safety have been assessed through two major sources: clinical trials (CTs) and real-world experiences data (RWE). Notably, the two sources differ from one another, but together, they complement information and current knowledge on both efficacy and safety of biological therapy. We carry out a review on CTs and RWE reports on the latest group of biological approved for moderate-to-severe psoriasis: anti-IL23 (guselkumab, risankizumab, and tildrakizumab).
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Affiliation(s)
- Angelo Ruggiero
- grid.4691.a0000 0001 0790 385XSection of Dermatology - Department of Clinical Medicine and Surgery, University of Naples Federico II, Via Pansini 5, 80131 Naples, Italy
| | - Matteo Megna
- grid.4691.a0000 0001 0790 385XSection of Dermatology - Department of Clinical Medicine and Surgery, University of Naples Federico II, Via Pansini 5, 80131 Naples, Italy
| | - Gabriella Fabbrocini
- grid.4691.a0000 0001 0790 385XSection of Dermatology - Department of Clinical Medicine and Surgery, University of Naples Federico II, Via Pansini 5, 80131 Naples, Italy
| | - Sonia Sofia Ocampo-Garza
- grid.4691.a0000 0001 0790 385XSection of Dermatology - Department of Clinical Medicine and Surgery, University of Naples Federico II, Via Pansini 5, 80131 Naples, Italy ,grid.411455.00000 0001 2203 0321Dermatology Department, Universidad Autónoma de Nuevo León, University Hospital “Dr, José Eleuterio González”, Monterrey, NL Mexico
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Comparison of the Inflammatory Circuits in Psoriasis Vulgaris, Non‒Pustular Palmoplantar Psoriasis, and Palmoplantar Pustular Psoriasis. J Invest Dermatol 2023; 143:87-97.e14. [PMID: 35934055 DOI: 10.1016/j.jid.2022.05.1094] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 05/26/2022] [Accepted: 05/27/2022] [Indexed: 11/20/2022]
Abstract
Palmoplantar pustular psoriasis (PPPP) and non‒pustular palmoplantar psoriasis (NPPP) are localized, debilitating forms of psoriasis. The inflammatory circuits involved in PPPP and NPPP are not well-understood. To compare the cellular and immunological features that differentiate PPPP and NPPP, skin biopsies were collected from a total of 30 participants with PPPP, NPPP, and psoriasis vulgaris (PV) and from 10 healthy participants. A subset consented to a second biopsy after 3 additional weeks off medication. Histologic staining of lesional and nonlesional skin showed higher neutrophil counts in PPPP than in NPPP and PV and higher CD8+ T-cell counts in NPPP. RNA sequencing and transcriptional analysis of skin biopsies showed enhanced IFN-γ pathway activation in NPPP lesions but stronger signatures of IL-17 pathway and neutrophil-related genes (e.g., IL36A) in PPPP lesional skin. Serum analysis on the Olink platform detected higher concentrations of T helper type 1, IFN-γ‒inducible chemokines in NPPP, and higher neutrophil-associated cytokines in PPPP. Taken together, this evidence suggests more pronounced T helper 1‒mediated inflammation in NPPP than in PV and PPPP and stronger neutrophil-associated activity in PPPP than in NPPP and PV. These data support targeting inflammatory pathways associated with neutrophilic inflammation (e.g., IL-36 signaling) for therapeutic development in PPPP.
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Sachen KL, Arnold Greving CN, Towne JE. Role of IL-36 cytokines in psoriasis and other inflammatory skin conditions. Cytokine 2022; 156:155897. [DOI: 10.1016/j.cyto.2022.155897] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Revised: 03/29/2022] [Accepted: 04/22/2022] [Indexed: 12/15/2022]
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Fukasawa T, Yoshizaki-Ogawa A, Enomoto A, Miyagawa K, Sato S, Yoshizaki A. Involvement of Molecular Mechanisms between T/B Cells and IL-23: From Palmoplantar Pustulosis to Autoimmune Diseases. Int J Mol Sci 2022; 23:8261. [PMID: 35897837 PMCID: PMC9332852 DOI: 10.3390/ijms23158261] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Revised: 07/22/2022] [Accepted: 07/25/2022] [Indexed: 11/17/2022] Open
Abstract
Palmoplantar pustulosis (PPP) is a disease that causes recurrent blisters and aseptic pustules on the palms and soles. It has been suggested that both innate and acquired immunity are involved. In particular, based on the tonsils and basic experiments, it has been assumed that T and B cells are involved in its pathogenesis. In addition, the results of clinical trials have suggested that IL-23 is closely related to the pathogenesis. This review describes PPP and the genetic background, the factors involved in the onset and exacerbation of disease and its relation to the molecular mechanism. In addition, we describe the usefulness of biological therapy and its implications in relation to the importance in pathology, the pathogenesis of PPP, the importance of the role of the IL-23-Th17 axis and IL-36 in PPP. Furthermore, we describe an animal experimental model of PPP, the efficacy and mechanism of action of guselkumab, an anti-IL-23 antibody, the latest research, and finally the possibility for it to be effective for other autoimmune diseases.
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Affiliation(s)
- Takemichi Fukasawa
- Department of Dermatology, The University of Tokyo Graduate School of Medicine, Tokyo 113-8655, Japan; (T.F.); (A.Y.-O.); (S.S.)
| | - Asako Yoshizaki-Ogawa
- Department of Dermatology, The University of Tokyo Graduate School of Medicine, Tokyo 113-8655, Japan; (T.F.); (A.Y.-O.); (S.S.)
| | - Atsushi Enomoto
- Laboratory of Molecular Radiology, Center for Disease Biology and Integrative Medicine, The University of Tokyo Graduate School of Medicine, Tokyo 113-8655, Japan; (A.E.); (K.M.)
| | - Kiyoshi Miyagawa
- Laboratory of Molecular Radiology, Center for Disease Biology and Integrative Medicine, The University of Tokyo Graduate School of Medicine, Tokyo 113-8655, Japan; (A.E.); (K.M.)
| | - Shinichi Sato
- Department of Dermatology, The University of Tokyo Graduate School of Medicine, Tokyo 113-8655, Japan; (T.F.); (A.Y.-O.); (S.S.)
| | - Ayumi Yoshizaki
- Department of Dermatology, The University of Tokyo Graduate School of Medicine, Tokyo 113-8655, Japan; (T.F.); (A.Y.-O.); (S.S.)
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25
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Iznardo H, Puig L. Beyond plaque psoriasis - pathogenesis and treatment of other psoriasis phenotypes. Curr Opin Rheumatol 2022; 34:225-234. [PMID: 35699337 DOI: 10.1097/bor.0000000000000882] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
PURPOSE OF REVIEW Psoriasis vulgaris is the commonest presentation of psoriatic disease, but morphologic variants such as pustular psoriasis (PP) and a closely related disease, pityriasis rubra pilaris (PRP), have been known for a long time, have been associated with rheumatologic manifestations indistinguishable from psoriatic arthritis (PsA) that may go unrecognized, and often represent a therapeutic conundrum. There is recent evidence that underlying genetic and pathogenetic differences may provide the basis for newer therapeutic approaches. RECENT FINDINGS This narrative review highlights the clinical, genetic and pathogenetic characteristics of PP and PRP, their association with PsA and recent developments in their treatment, especially with biologic agents targeting IL-36 and other cytokines of pathogenic relevance. SUMMARY The clinical manifestations of PP and PRP are less well known to rheumatologists than those of psoriasis, and recent advances in our insight on their pathogenesis may eventually overcome the therapeutic difficulties faced by dermatologists and rheumatologists in the management of these diseases and their rheumatologic manifestations.
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Affiliation(s)
- Helena Iznardo
- Department of Dermatology, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma, Barcelona, Spain
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Zheng R, Ito YM, Yunoki M, Minoda K, Nobeyama S. Design and implementation of an adaptive confirmatory trial in Japanese patients with palmoplantar pustulosis. Contemp Clin Trials Commun 2022; 28:100935. [PMID: 35711679 PMCID: PMC9192787 DOI: 10.1016/j.conctc.2022.100935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Revised: 04/08/2022] [Accepted: 05/25/2022] [Indexed: 10/31/2022] Open
Abstract
Background/Aims Methods Results Conclusion
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27
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Tran L, Yao Z, Xu Z, Vermeulen A. Population Pharmacokinetics Analysis of Guselkumab in Healthy Subjects and Patients with Psoriatic Arthritis, Plaque Psoriasis, and Palmoplantar Pustulosis. Br J Clin Pharmacol 2022; 88:4481-4493. [PMID: 35470450 DOI: 10.1111/bcp.15364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Revised: 04/12/2022] [Accepted: 04/13/2022] [Indexed: 11/27/2022] Open
Abstract
AIM Guselkumab, a monoclonal antibody that binds to the p19 subunit of interleukin 23, is approved for the treatment of plaque psoriasis (PsO) and psoriatic arthritis (PsA), palmoplantar pustulosis (PPP), generalized pustular psoriasis, and erythrodermic psoriasis in various countries. The purpose of this analysis was to develop a comprehensive population pharmacokinetic (PK) model for guselkumab to determine whether PK differs across different disease populations and healthy subjects. METHODS A non-linear mixed-effects modeling approach was used to analyze 23,097 serum PK samples obtained from 2,623 healthy subjects and patients with PsO, PsA, and PPP across nine phase I-III clinical trials. RESULTS Guselkumab concentrations were adequately described by a 2-compartment linear PK model with first-order absorption and elimination. Clearance (CL), central and peripheral volume of distribution, inter-compartmental flow, absorption rate constant, and absolute bioavailability estimates were 0.255 L/day, 3.60 L, 1.78 L, 0.369 L/day, 0.313 day-1 , and 49.2%, respectively, for a subject weighing 70 kg. Terminal half-life was estimated to be approximately 14.6 days. Body weight was the primary factor affecting CL and central volume of distribution. CL of guselkumab was similar among patients with PsA, PsO, and PPP, but CL in disease populations was 11%-17% lower than that in healthy subjects after other covariate effects such as body weight were accounted for. CONCLUSION The population pharmacokinetic analysis indicated that, after other covariate effects were taken into account, patients with PsO, PsA, and PPP had similar PK characteristics, with CL in these disease populations being slightly lower than healthy individuals.
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Affiliation(s)
- Lana Tran
- Clinical Pharmacology and Pharmacometrics, Janssen Research & Development, LLC, Spring House, PA, USA.,Current Address: Clinical Pharmacology, Global Product Development, Pfizer Inc, San Diego, CA, USA
| | - Zhenling Yao
- Clinical Pharmacology and Pharmacometrics, Janssen Research & Development, LLC, Spring House, PA, USA.,Current Address: Transcenta, Princeton, NJ, USA
| | - Zhenhua Xu
- Clinical Pharmacology and Pharmacometrics, Janssen Research & Development, LLC, Spring House, PA, USA
| | - An Vermeulen
- Clinical Pharmacology and Pharmacometrics, Janssen Research & Development, a division of Janssen Pharmaceutica NV, Beerse, Belgium
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28
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Kim TH, Kim JS, Kwon JE, Park B, Lee ES. Principal Component Analysis to Differentiate Patients with Palmoplantar Pustulosis from Those with Palmoplantar Pustular Psoriasis. Ann Dermatol 2022; 34:7-13. [PMID: 35221589 PMCID: PMC8831310 DOI: 10.5021/ad.2022.34.1.7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Revised: 06/30/2021] [Accepted: 07/01/2021] [Indexed: 11/12/2022] Open
Abstract
Background Palmoplantar pustulosis (PPP) is initiated from the acrosyringium. However, it is unclear whether PPP should be considered a distinct entity or should be classified into the spectrum of pustular psoriasis, also known as palmoplantar pustular psoriasis (PPPP). Objective We evaluated the differences in immunohistochemical staining in patients with PPP to determine whether they can be classified into two groups based on psoriatic properties or acrosyringeal properties. Methods Nineteen punch biopsy specimens diagnosed with PPP were collected. Antibodies were chosen for identifying the acrosyringeal properties of α-3-nicotine acetylcholine receptors (α-3-nAChR), psoriatic properties of interleukin (IL)-23 and IL-36R, inflammatory cell properties of human cathelicidin antimicrobial peptide 18/LL-37, IL-8, lipocalin-2 (LCN2), and CD3. The degree of staining of the epidermis was evaluated using the ordinal scale (0~3). The principal component analysis was used to derive principal components (PCs) of common variation between the stains, and the two groups were divided using PCs and cluster analysis. Results Three main PCs explained 64% of the total variance in PPP. PC1 (pustular psoriasis properties) showed a higher correlation with IL-36R. PC2 (acrosyringeal/inflammatory properties) showed a higher correlation with α-3-nAChR, IL-8, LCN2, and CD3. PC3 (psoriasis properties) showed a higher correlation with IL-23. PC1 showed a statistically significant difference (p=0.0284) between the two groups. We identified three PCs associated with the pathomechanisms of PPP. Conclusion Although PC1 showed a statistically significant difference between the two groups, we did not identify differential protein expression related to the pathogenesis between PPP and PPPP.
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Affiliation(s)
- Tae Hyung Kim
- Department of Dermatology, Ajou University School of Medicine, Suwon, Korea
| | - Ji Su Kim
- Office of Biostatistics, Medical Research Collaborating Center, Ajou Research Institute for Innovative Medicine, Ajou University Medical Center, Suwon, Korea
| | - Ji Eun Kwon
- Department of Pathology, Ajou University School of Medicine, Suwon, Korea
| | - Bumhee Park
- Office of Biostatistics, Medical Research Collaborating Center, Ajou Research Institute for Innovative Medicine, Ajou University Medical Center, Suwon, Korea
- Department of Biomedical Informatics, Ajou University School of Medicine, Suwon, Korea
| | - Eun-So Lee
- Department of Dermatology, Ajou University School of Medicine, Suwon, Korea
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29
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Ueno M, Miyagawa I, Miyazaki Y, Hanami K, Fukuyo S, Kubo S, Nakayamada S, Tanaka Y. Efficacy and safety of guselkumab and adalimumab for pustulotic arthro-osteitis and their impact on peripheral blood immunophenotypes. Arthritis Res Ther 2022; 24:240. [PMID: 36303202 PMCID: PMC9609190 DOI: 10.1186/s13075-022-02934-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2022] [Accepted: 10/20/2022] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVES We compared the treatment effectiveness between guselkumab and adalimumab in patients with pustulotic arthro-osteitis (PAO). In addition, we performed peripheral blood immunophenotyping to elucidate the immunological background and analyzed the impact of therapeutic drugs to verify the validity of immunological phenotypes as therapeutic targets. METHODS Patients were treated with guselkumab 100 mg (guselkumab group; n = 12) and adalimumab 40 mg (adalimumab group; n = 13). Arthritis disease activity, skin lesion activity, and patient-reported outcomes (PROs) were evaluated and compared between the two groups. The retention rate and adverse events were evaluated. Comprehensive phenotyping of peripheral immune cells was performed in both groups, and phenotypes were compared before and after treatment. RESULTS At 6 months, both groups showed significant improvement in arthritis disease activity and PROs. In the guselkumab group, skin symptoms significantly improved. The 6-month continuation rates were 91.7% (11/12) and 69.2% (9/13) in the guselkumab and adalimumab groups, respectively. Adverse events occurred in 2/12 and 5/13 patients in the guselkumab (16.7%) and adalimumab (38.5%) groups, respectively. Peripheral blood immunophenotyping showed that the proportion of activated T helper (Th) 1 cells was significantly lower in patients with PAO than in healthy controls and that the proportion of activated Th17 cells was significantly higher in patients with PAO, which significantly decreased after treatment with guselkumab. CONCLUSION Although guselkumab and adalimumab have comparable efficacy for PAO, their impact on immunophenotypes varies.
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Affiliation(s)
- Masanobu Ueno
- grid.271052.30000 0004 0374 5913The First Department of Internal Medicine, School of Medicine, University of Occupational and Environmental Health, 1-1 Iseigaoka, Kitakyushu, 807-8555 Japan
| | - Ippei Miyagawa
- grid.271052.30000 0004 0374 5913The First Department of Internal Medicine, School of Medicine, University of Occupational and Environmental Health, 1-1 Iseigaoka, Kitakyushu, 807-8555 Japan ,grid.5330.50000 0001 2107 3311Department of Internal Medicine 3, Rheumatology and Immunology, Friedrich-Alexander-University Erlangen-Nürnberg (FAU) and Universitätsklinikum Erlangen, Erlangen, Germany ,grid.411668.c0000 0000 9935 6525Deutsches Zentrum für Immuntherapie (DZI), FriedrichAlexander-University Erlangen-Nürnberg (FAU) and Universitätsklinikum Erlangen, Erlangen, Germany
| | - Yusuke Miyazaki
- grid.271052.30000 0004 0374 5913The First Department of Internal Medicine, School of Medicine, University of Occupational and Environmental Health, 1-1 Iseigaoka, Kitakyushu, 807-8555 Japan
| | - Kentaro Hanami
- grid.271052.30000 0004 0374 5913The First Department of Internal Medicine, School of Medicine, University of Occupational and Environmental Health, 1-1 Iseigaoka, Kitakyushu, 807-8555 Japan
| | - Shunsuke Fukuyo
- grid.271052.30000 0004 0374 5913The First Department of Internal Medicine, School of Medicine, University of Occupational and Environmental Health, 1-1 Iseigaoka, Kitakyushu, 807-8555 Japan
| | - Satoshi Kubo
- grid.271052.30000 0004 0374 5913The First Department of Internal Medicine, School of Medicine, University of Occupational and Environmental Health, 1-1 Iseigaoka, Kitakyushu, 807-8555 Japan
| | - Shingo Nakayamada
- grid.271052.30000 0004 0374 5913The First Department of Internal Medicine, School of Medicine, University of Occupational and Environmental Health, 1-1 Iseigaoka, Kitakyushu, 807-8555 Japan
| | - Yoshiya Tanaka
- The First Department of Internal Medicine, School of Medicine, University of Occupational and Environmental Health, Japan, 1-1 Iseigaoka, Kitakyushu, 807-8555, Japan.
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Li C, Geng S, Wei S, Guo S. Dr. Li et al reply. J Rheumatol 2021; 49:657. [PMID: 34911804 DOI: 10.3899/jrheum.211185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
We appreciate Wang et al1 for their interest in our article2 and for highlighting the pathogenic role of cytokine dysregulation in SAPHO (synovitis, acne, pustulosis, hyperostosis, and osteitis) syndrome. The authors also address the possible mechanism of secukinumab in the treatment of SAPHO syndrome: blocking the expression of Th17 cell-related cytokines.
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Affiliation(s)
- Chen Li
- Department of Rheumatology, Fangshan Hospital, Beijing University of Chinese Medicine; Department of Traditional Chinese Medicine, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences; School of Life Sciences, Beijing University of Chinese Medicine, Beijing, China. C. Li and S. Geng contributed equally to this work. This study was supported by the National Natural Science Foundation of China (81822030), Beijing Natural Science Foundation (7172175), the CAMS Initiative for Innovation Fund for Medical Sciences (CIFMS; 2017-I2M-3-001, 2017- I2M-3-003), the Central Level Public Interest Program for Scientific Research Institute (2018RC31003), the Capital Medical Research and Development Fund (2016-4-40112), and the National Key Research and Development Program of China (2016YFC0901500). The authors declare no conflicts of interest relevant to this article. Address correspondence to Dr. C. Li, Department of Rheumatology, Fangshan Hospital, Beijing University of Chinese Medicine, No.4, Chengguan Health Care Road, Fangshan District, Beijing, China; Department of Traditional Chinese Medicine, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, No. 1 Shuaifuyuan, 100730 Beijing, China.
| | - Shaohui Geng
- Department of Rheumatology, Fangshan Hospital, Beijing University of Chinese Medicine; Department of Traditional Chinese Medicine, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences; School of Life Sciences, Beijing University of Chinese Medicine, Beijing, China. C. Li and S. Geng contributed equally to this work. This study was supported by the National Natural Science Foundation of China (81822030), Beijing Natural Science Foundation (7172175), the CAMS Initiative for Innovation Fund for Medical Sciences (CIFMS; 2017-I2M-3-001, 2017- I2M-3-003), the Central Level Public Interest Program for Scientific Research Institute (2018RC31003), the Capital Medical Research and Development Fund (2016-4-40112), and the National Key Research and Development Program of China (2016YFC0901500). The authors declare no conflicts of interest relevant to this article. Address correspondence to Dr. C. Li, Department of Rheumatology, Fangshan Hospital, Beijing University of Chinese Medicine, No.4, Chengguan Health Care Road, Fangshan District, Beijing, China; Department of Traditional Chinese Medicine, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, No. 1 Shuaifuyuan, 100730 Beijing, China.
| | - Shufeng Wei
- Department of Rheumatology, Fangshan Hospital, Beijing University of Chinese Medicine; Department of Traditional Chinese Medicine, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences; School of Life Sciences, Beijing University of Chinese Medicine, Beijing, China. C. Li and S. Geng contributed equally to this work. This study was supported by the National Natural Science Foundation of China (81822030), Beijing Natural Science Foundation (7172175), the CAMS Initiative for Innovation Fund for Medical Sciences (CIFMS; 2017-I2M-3-001, 2017- I2M-3-003), the Central Level Public Interest Program for Scientific Research Institute (2018RC31003), the Capital Medical Research and Development Fund (2016-4-40112), and the National Key Research and Development Program of China (2016YFC0901500). The authors declare no conflicts of interest relevant to this article. Address correspondence to Dr. C. Li, Department of Rheumatology, Fangshan Hospital, Beijing University of Chinese Medicine, No.4, Chengguan Health Care Road, Fangshan District, Beijing, China; Department of Traditional Chinese Medicine, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, No. 1 Shuaifuyuan, 100730 Beijing, China.
| | - Shuwen Guo
- Department of Rheumatology, Fangshan Hospital, Beijing University of Chinese Medicine; Department of Traditional Chinese Medicine, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences; School of Life Sciences, Beijing University of Chinese Medicine, Beijing, China. C. Li and S. Geng contributed equally to this work. This study was supported by the National Natural Science Foundation of China (81822030), Beijing Natural Science Foundation (7172175), the CAMS Initiative for Innovation Fund for Medical Sciences (CIFMS; 2017-I2M-3-001, 2017- I2M-3-003), the Central Level Public Interest Program for Scientific Research Institute (2018RC31003), the Capital Medical Research and Development Fund (2016-4-40112), and the National Key Research and Development Program of China (2016YFC0901500). The authors declare no conflicts of interest relevant to this article. Address correspondence to Dr. C. Li, Department of Rheumatology, Fangshan Hospital, Beijing University of Chinese Medicine, No.4, Chengguan Health Care Road, Fangshan District, Beijing, China; Department of Traditional Chinese Medicine, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, No. 1 Shuaifuyuan, 100730 Beijing, China.
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Noe MH, Wan MT, Mostaghimi A, Gelfand JM, Agnihothri R, Armstrong AW, Bhutani T, Bridges A, Brownstone N, Butt M, Duffin KPC, Carr C, Creadore A, DeNiro KL, Desai S, Dominguez AR, Duffy EK, Fairley JA, Femia A, Gudjonsson JE, Kaffenberger JA, Katz KL, Kirby JS, Le ST, Martinez E, Maverakis E, Myers B, Naik HB, Nelson CA, Ortega-Loayza AG, Plovanich ME, Rangel LK, Ravi V, Reddy VD, Saleh JZ, Sandhu JK, Shakshouk H, Shields BE, Sharif-Sidi Z, Smith J, Steahr A, Toussi A, Wanat KA, Wang B, Wei BM, Weinhammer A, Worswick SD, Yang A. Evaluation of a Case Series of Patients With Palmoplantar Pustulosis in the United States. JAMA Dermatol 2021; 158:68-72. [PMID: 34878495 DOI: 10.1001/jamadermatol.2021.4635] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Importance Palmoplantar pustulosis (PPP) is a is a chronic, orphan disease with limited epidemiological data. Objective To describe the clinical characteristics, treatments, longitudinal disease course, and health care utilization in adults with PPP across the US. Design, Setting, and Participants This retrospective, longitudinal case series from 20 academic dermatology practices in the US included a consecutive sample of 197 adults who met the European Rare and Severe Psoriasis Expert Network consensus definition for PPP between January 1, 2007, and December 31, 2018. Data analysis was performed June 2020 to December 2020. Main Outcomes and Measures The primary outcome was to describe the patient characteristics, associated medical comorbidities, treatment patterns, complications, and PPP-specific health care utilization. Results Of 197 patients, 145 (73.6%) were female, and the mean (SD) age at presentation was 53.0 (12.6) years, with a mean (SD) follow-up time of 22.1 (28.0) months. On initial presentation, 95 (48.2%) patients reported skin pain, and 39 (19.8%) reported difficulty using hands and/or feet. Seventy patients (35.5%) were treated with systemic treatments, and use of more than 20 different systemic therapies was reported. In patients with at least 6 months of follow-up (n = 128), a median (IQR) of 3.7 (4-10) dermatology visits per year were reported; 24 (18.8%) patients had 5 or more visits during the study period. Conclusions and Relevance In this case series, PPP was associated with persistent symptoms, continued health care utilization, and a lack of consensus regarding effective treatments, emphasizing the unmet medical need in this population. Additional research is necessary to understand treatment response in these patients.
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Affiliation(s)
- Megan H Noe
- Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Marilyn T Wan
- Department of Internal Medicine, Memorial Hospital West, Pembroke Pines, Florida
| | - Arash Mostaghimi
- Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Joel M Gelfand
- Department of Dermatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia.,Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia
| | | | - Ritesh Agnihothri
- Department of Dermatology, University of Rochester, School of Medicine & Dentistry, Rochester, New York
| | - April W Armstrong
- Department of Dermatology, Keck Hospital of USC, University of Southern California Keck School of Medicine, Los Angeles, California
| | - Tina Bhutani
- Department of Dermatology, UCSF Medical Center, University of California San Francisco School of Medicine
| | - Alina Bridges
- Department of Dermatology, Mayo Clinic Graduate School of Education, Rochester, Minnesota.,Richfield Laboratory of Dermatopathology, Dermpath Diagnostics, Cincinnati, Ohio
| | - Nicholas Brownstone
- Department of Dermatology, Psoriasis and Skin Treatment Center, University of California San Francisco
| | - Melissa Butt
- Department of Dermatology, Penn State Hershey Medical Center, Hershey, Pennsylvania
| | | | | | - Andrew Creadore
- Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.,Boston University School of Medicine, Boston, Massachusetts
| | - Katherine L DeNiro
- Division of Dermatology, Department of Medicine, University of Washington, Seattle
| | - Sheena Desai
- Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.,Tufts University School of Medicine, Boston, Massachusetts
| | - Arturo R Dominguez
- Departments of Dermatology and Internal Medicine, University of Texas Southwestern Medical Center, Dallas
| | - Emily K Duffy
- Division of Dermatology, Department of Medicine, University of Washington, Seattle
| | - Janet A Fairley
- Department of Dermatology, University of Iowa Carver College of Medicine, Iowa City
| | - Alisa Femia
- Ronald O. Perelman Department of Dermatology, NYU Langone Hospitals, New York University Grossman School of Medicine, New York, New York
| | | | | | - Kimberly L Katz
- Department of Dermatology, Medical College of Wisconsin, Milwaukee
| | - Joslyn S Kirby
- Department of Dermatology, Penn State Hershey Medical Center, Hershey, Pennsylvania
| | - Stephanie T Le
- Department of Dermatology, University of California, Davis School of Medicine, Sacramento
| | | | - Emanual Maverakis
- Department of Dermatology, University of California, Davis School of Medicine, Sacramento
| | - Bridget Myers
- University of California San Francisco School of Medicine
| | - Haley B Naik
- Department of Dermatology, UCSF Medical Center, University of California San Francisco School of Medicine
| | - Caroline A Nelson
- Department of Dermatology, Yale School of Medicine, New Haven, Connecticut
| | - Alex G Ortega-Loayza
- Department of Dermatology, Oregon Health and Science University School of Medicine, Portland
| | - Molly E Plovanich
- Department of Dermatology, University of Rochester, School of Medicine & Dentistry, Rochester, New York
| | - Lauren K Rangel
- Ronald O. Perelman Department of Dermatology, NYU Langone Hospitals, New York University Grossman School of Medicine, New York, New York
| | - Vignesh Ravi
- Department of Dermatology, Keck Hospital of USC, University of Southern California Keck School of Medicine, Los Angeles, California
| | | | - Jamal Z Saleh
- Department of Dermatology, Medical College of Wisconsin, Milwaukee
| | - Jeena K Sandhu
- Department of Dermatology, Keck Hospital of USC, University of Southern California Keck School of Medicine, Los Angeles, California.,Division of Dermatology, John H. Stroger Jr Hospital of Cook County, Chicago, Illinois
| | - Hadir Shakshouk
- Department of Dermatology, Mayo Clinic, Rochester, Minnesota
| | - Bridget E Shields
- Department of Dermatology, School of Medicine and Public Health, University of Wisconsin, Madison
| | | | - Jacob Smith
- Oregon Health and Science University School of Medicine, Portland
| | - Amanda Steahr
- Department of Dermatology, University of Iowa Carver College of Medicine, Iowa City
| | - Atrin Toussi
- Department of Dermatology, University of California, Davis School of Medicine, Sacramento
| | - Karolyn A Wanat
- Department of Dermatology, Medical College of Wisconsin, Milwaukee
| | - Bo Wang
- Department of Dermatology, University of Michigan, Ann Arbor
| | - Brian M Wei
- Yale School of Medicine, New Haven, Connecticut
| | - Annika Weinhammer
- Department of Dermatology, School of Medicine and Public Health, University of Wisconsin, Madison
| | - Scott D Worswick
- Department of Dermatology, Keck Hospital of USC, University of Southern California Keck School of Medicine, Los Angeles, California
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Genovese G, Moltrasio C, Cassano N, Maronese CA, Vena GA, Marzano AV. Pustular Psoriasis: From Pathophysiology to Treatment. Biomedicines 2021; 9:biomedicines9121746. [PMID: 34944562 PMCID: PMC8698272 DOI: 10.3390/biomedicines9121746] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Revised: 11/18/2021] [Accepted: 11/19/2021] [Indexed: 12/21/2022] Open
Abstract
Pustular psoriasis (PP) is a clinicopathological entity encompassing different variants, i.e., acute generalized PP (GPP), PP of pregnancy (impetigo herpetiformis), annular (and circinate) PP, infantile/juvenile PP, palmoplantar PP/palmoplantar pustulosis, and acrodermatitis continua of Hallopeau (ACH), which have in common an eruption of superficial sterile pustules on an erythematous base. Unlike psoriasis vulgaris, in which a key role is played by the adaptive immune system and interleukin (IL)-17/IL-23 axis, PP seems to be characterized by an intense inflammatory response resulting from innate immunity hyperactivation, with prominent involvement of the IL-36 axis. Some nosological aspects of PP are still controversial and debated. Moreover, owing to the rarity and heterogeneity of PP forms, data on prognosis and therapeutic management are limited. Recent progresses in the identification of genetic mutations and immunological mechanisms have promoted a better understanding of PP pathogenesis and might have important consequences on diagnostic refinement and treatment. In this narrative review, current findings in the pathogenesis, classification, clinical features, and therapeutic management of PP are briefly discussed.
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Affiliation(s)
- Giovanni Genovese
- Dermatology Unit, Fondazione IRCCS Ca’ Granda, Ospedale Maggiore Policlinico, 20122 Milan, Italy; (G.G.); (C.M.); (C.A.M.)
- Department of Pathophysiology and Transplantation, Università Degli Studi di Milano, 20122 Milan, Italy
| | - Chiara Moltrasio
- Dermatology Unit, Fondazione IRCCS Ca’ Granda, Ospedale Maggiore Policlinico, 20122 Milan, Italy; (G.G.); (C.M.); (C.A.M.)
- Department of Medical Surgical and Health Sciences, University of Trieste, 34137 Trieste, Italy
| | - Nicoletta Cassano
- Dermatology and Venereology Private Practice, 76121 Barletta, Italy; (N.C.); (G.A.V.)
| | - Carlo Alberto Maronese
- Dermatology Unit, Fondazione IRCCS Ca’ Granda, Ospedale Maggiore Policlinico, 20122 Milan, Italy; (G.G.); (C.M.); (C.A.M.)
- Department of Pathophysiology and Transplantation, Università Degli Studi di Milano, 20122 Milan, Italy
| | - Gino Antonio Vena
- Dermatology and Venereology Private Practice, 76121 Barletta, Italy; (N.C.); (G.A.V.)
| | - Angelo Valerio Marzano
- Dermatology Unit, Fondazione IRCCS Ca’ Granda, Ospedale Maggiore Policlinico, 20122 Milan, Italy; (G.G.); (C.M.); (C.A.M.)
- Department of Pathophysiology and Transplantation, Università Degli Studi di Milano, 20122 Milan, Italy
- Correspondence:
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Bissonnette R, Maari C, Tsianakas A, Reid D, McCutchan S, Baumgartner S, Mackay J, Bhakta N. A Randomized, Double-Blind, Placebo-Controlled, Phase 2a Study to Evaluate the Efficacy and Safety of RIST4721 in Subjects with Palmoplantar Pustulosis. Dermatol Ther (Heidelb) 2021; 11:2179-2193. [PMID: 34716902 PMCID: PMC8611156 DOI: 10.1007/s13555-021-00632-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Accepted: 10/06/2021] [Indexed: 12/31/2022] Open
Abstract
Introduction Palmoplantar pustulosis (PPP) is a chronic inflammatory skin condition with neutrophilic infiltration of the epidermis. RIST4721 antagonizes CXC chemokine receptor type 2, which is important in neutrophil recruitment and migration. In this study, the efficacy and safety of RIST4721 versus placebo were assessed in adult subjects with moderate to severe PPP. Methods This phase 2a, multicenter, randomized, double-blind, placebo-controlled study investigated RIST4721 versus placebo in subjects with moderate to severe PPP. Key eligibility criteria included: Palmoplantar Pustulosis Area and Severity Index (PPPASI) ≥ 8 and Palmoplantar Pustulosis Physician Global Assessment ≥ 3. Subjects were randomized 1:1 to RIST4721 300 mg or placebo once daily for 28 days. The primary efficacy endpoints were relative change from baseline in fresh and total pustule count at day 28. Results Fifteen subjects received RIST4721 and 19 subjects received placebo. Treatment with RIST4721 was found to be generally well tolerated. At day 28, the mean ± standard deviation (SD) relative change from baseline in fresh pustule count was 0.86 ± 0.692 and 0.53 ± 0.561 (P = 0.240) and in total pustule count was 0.99 ± 0.667 and 0.96 ± 0.672 (P = 0.804) for RIST4721 and placebo groups, respectively. Subgroup analysis of subjects with progressing disease demonstrated that subjects with a PPPASI-50 at day 28 was significantly higher for subjects treated with RIST4721 (71%) than placebo (15%) (P = 0.022). Conclusion Preliminary data suggest RIST4721 is well tolerated and may be a potential therapy for patients with PPP. Trial Registration RIST4721-201 was registered in June 2019 at clinicaltrials.gov: NCT03988335. Supplementary Information The online version contains supplementary material available at 10.1007/s13555-021-00632-7.
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Affiliation(s)
| | | | | | - DeAnne Reid
- Aristea Therapeutics, Inc., San Diego, CA, USA
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Voutsa V, Battaglia D, Bracken LJ, Brovelli A, Costescu J, Díaz Muñoz M, Fath BD, Funk A, Guirro M, Hein T, Kerschner C, Kimmich C, Lima V, Messé A, Parsons AJ, Perez J, Pöppl R, Prell C, Recinos S, Shi Y, Tiwari S, Turnbull L, Wainwright J, Waxenecker H, Hütt MT. Two classes of functional connectivity in dynamical processes in networks. J R Soc Interface 2021; 18:20210486. [PMID: 34665977 PMCID: PMC8526174 DOI: 10.1098/rsif.2021.0486] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2021] [Accepted: 09/13/2021] [Indexed: 12/12/2022] Open
Abstract
The relationship between network structure and dynamics is one of the most extensively investigated problems in the theory of complex systems of recent years. Understanding this relationship is of relevance to a range of disciplines-from neuroscience to geomorphology. A major strategy of investigating this relationship is the quantitative comparison of a representation of network architecture (structural connectivity, SC) with a (network) representation of the dynamics (functional connectivity, FC). Here, we show that one can distinguish two classes of functional connectivity-one based on simultaneous activity (co-activity) of nodes, the other based on sequential activity of nodes. We delineate these two classes in different categories of dynamical processes-excitations, regular and chaotic oscillators-and provide examples for SC/FC correlations of both classes in each of these models. We expand the theoretical view of the SC/FC relationships, with conceptual instances of the SC and the two classes of FC for various application scenarios in geomorphology, ecology, systems biology, neuroscience and socio-ecological systems. Seeing the organisation of dynamical processes in a network either as governed by co-activity or by sequential activity allows us to bring some order in the myriad of observations relating structure and function of complex networks.
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Affiliation(s)
- Venetia Voutsa
- Department of Life Sciences and Chemistry, Jacobs University Bremen, 28759 Bremen, Germany
| | - Demian Battaglia
- Aix-Marseille Université, Inserm, Institut de Neurosciences des Systèmes (UMR 1106), Marseille, France
- University of Strasbourg Institute for Advanced Studies (USIAS), Strasbourg 67083, France
| | | | - Andrea Brovelli
- Aix-Marseille Université, CNRS, Institut de Neurosciences de la Timone (UMR 7289), Marseille, France
| | - Julia Costescu
- Department of Geography, Durham University, Durham DH1 3LE, UK
| | - Mario Díaz Muñoz
- Department of Sustainability, Governance and Methods, Modul University Vienna, 1190 Vienna, Austria
| | - Brian D. Fath
- Department of Biological Sciences, Towson University, Towson, Maryland 21252, USA
- Advancing Systems Analysis Program, International Institute for Applied Systems Analysis, Laxenburg 2361, Austria
- Department of Environmental Studies, Masaryk University, 60200 Brno, Czech Republic
| | - Andrea Funk
- Institute of Hydrobiology and Aquatic Ecosystem Management (IHG), University of Natural Resources and Life Sciences Vienna (BOKU), 1180 Vienna, Austria
- WasserCluster Lunz - Biologische Station GmbH, Dr. Carl Kupelwieser Promenade 5, 3293 Lunz am See, Austria
| | - Mel Guirro
- Department of Geography, Durham University, Durham DH1 3LE, UK
| | - Thomas Hein
- Institute of Hydrobiology and Aquatic Ecosystem Management (IHG), University of Natural Resources and Life Sciences Vienna (BOKU), 1180 Vienna, Austria
- WasserCluster Lunz - Biologische Station GmbH, Dr. Carl Kupelwieser Promenade 5, 3293 Lunz am See, Austria
| | - Christian Kerschner
- Department of Sustainability, Governance and Methods, Modul University Vienna, 1190 Vienna, Austria
- Department of Environmental Studies, Masaryk University, 60200 Brno, Czech Republic
| | - Christian Kimmich
- Department of Environmental Studies, Masaryk University, 60200 Brno, Czech Republic
- Regional Science and Environmental Research, Institute for Advanced Studies, 1080 Vienna, Austria
| | - Vinicius Lima
- Aix-Marseille Université, Inserm, Institut de Neurosciences des Systèmes (UMR 1106), Marseille, France
- Aix-Marseille Université, CNRS, Institut de Neurosciences de la Timone (UMR 7289), Marseille, France
| | - Arnaud Messé
- Department of Computational Neuroscience, University Medical Center Eppendorf, Hamburg University, Germany
| | | | - John Perez
- Department of Geography, Durham University, Durham DH1 3LE, UK
| | - Ronald Pöppl
- Department of Geography and Regional Research, University of Vienna, Universitätsstr. 7, 1010 Vienna, Austria
| | - Christina Prell
- Department of Cultural Geography, University of Groningen, 9747 AD, Groningen, The Netherlands
| | - Sonia Recinos
- Institute of Hydrobiology and Aquatic Ecosystem Management (IHG), University of Natural Resources and Life Sciences Vienna (BOKU), 1180 Vienna, Austria
| | - Yanhua Shi
- Department of Environmental Studies, Masaryk University, 60200 Brno, Czech Republic
| | - Shubham Tiwari
- Department of Geography, Durham University, Durham DH1 3LE, UK
| | - Laura Turnbull
- Department of Geography, Durham University, Durham DH1 3LE, UK
| | - John Wainwright
- Department of Geography, Durham University, Durham DH1 3LE, UK
| | - Harald Waxenecker
- Department of Environmental Studies, Masaryk University, 60200 Brno, Czech Republic
| | - Marc-Thorsten Hütt
- Department of Life Sciences and Chemistry, Jacobs University Bremen, 28759 Bremen, Germany
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Hadeler E, Mosca M, Hong J, Brownstone N, Liao W, Bhutani T, Shinkai K. Inpatient Management of Psoriasis: A Current Perspective and Update for Clinicians. CURRENT DERMATOLOGY REPORTS 2021. [DOI: 10.1007/s13671-021-00342-5] [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]
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Okubo Y, Morishima H, Zheng R, Terui T. Sustained efficacy and safety of guselkumab in patients with palmoplantar pustulosis through 1.5 years in a randomized phase 3 study. J Dermatol 2021; 48:1838-1853. [PMID: 34453358 PMCID: PMC9290648 DOI: 10.1111/1346-8138.16132] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Accepted: 08/16/2021] [Indexed: 12/12/2022]
Abstract
The safety and efficacy of guselkumab for palmoplantar pustulosis (PPP) have been established through week (W)52; however, no sufficient information is available beyond 1 year. This study was conducted to assess the efficacy and safety of guselkumab through W84, and to explore factors associated with the sustainability of its efficacy in Japanese PPP patients. Patients received guselkumab 100 or 200 mg at W0, W4, W12, and every 8 weeks (q8w) until W60, or placebo at W0, W4, and W12. At W16, patients receiving placebo were re‐randomized to receive guselkumab 100/200 mg at W16, W20, and q8w until W60. Efficacy end‐points included PPP Area and Severity Index (PPPASI), PPP Severity Index (PPSI), Physician’s Global Assessment scores, and patient reported outcomes (PRO) (Dermatology Life Quality Index, EuroQoL‐5 Dimensions, and 36‐item Short Form Health Survey). Post‐hoc comparison of patient characteristics was performed between PPPASI‐75/90 responders and non‐responders at W60, and sustained responders and non‐responders at W84. Safety was evaluated through W84. A total of 45, 43, 21, and 24 patients from the guselkumab 100 mg, guselkumab 200 mg, placebo→guselkumab 100 mg, and placebo→guselkumab 200 mg groups, respectively, completed the study through W84. Overall, the mean improvement in the guselkumab groups from baseline in the PPPASI and PPSI total scores at W84 was ~79% and ~66%, respectively. All PRO improved through W84. The proportion of responders through W60 was higher in patients who had not received prior phototherapy and non‐biologic systemic therapy for PPP. Non‐smokers and patients with no prior non‐biologic systemic treatment tended numerically towards sustained efficacy through W84. The majority of treatment‐emergent adverse events (TEAE) were mild to moderate (~88%) with low incidence of serious TEAE (7.6%). Overall, guselkumab showed sustained efficacy and safety with improvement in the health‐related quality of life through W84 in Japanese PPP patients.
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Affiliation(s)
- Yukari Okubo
- Department of Dermatology, Tokyo Medical University, Tokyo, Japan
| | | | | | - Tadashi Terui
- Department of Dermatology, Nihon University School of Medicine, Tokyo, Japan
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Ghazawi FM, Mahmood F, Kircik L, Poulin Y, Bourcier M, Vender R, Wiseman MC, Lynde C, Litvinov IV. A Review of the Efficacy and Safety for Biologic Agents Targeting IL-23 in Treating Psoriasis With the Focus on Tildrakizumab. Front Med (Lausanne) 2021; 8:702776. [PMID: 34447766 PMCID: PMC8383205 DOI: 10.3389/fmed.2021.702776] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Accepted: 07/13/2021] [Indexed: 12/21/2022] Open
Abstract
Psoriasis is a chronic and debilitating inflammatory immune-mediated skin disorder. Several cytokines including interleukin (IL)-23 were demonstrated to play a central role in the pathogenesis of this disease. Treatment options for psoriasis range from topical to systemic modalities, depending on the extent, anatomical locations involved and functional impairment level. Targeting cytokines or their cognate receptors that are involved in disease pathogenesis such as IL-12/23 (i.e., targeting the IL-12p40 subunit shared by these cytokines), IL-17A, IL-17F, IL-17RA, and TNF-α using biologic agents emerged in recent years as a highly effective therapeutic option for patients with moderate-to-severe disease. This review provides an overview of the important role of IL-23 signaling in the pathogenesis of psoriasis. We describe in detail the available IL-23 inhibitors for chronic plaque psoriasis. The efficacy, pharmacokinetic properties, and the safety profile of one of the most recent IL-23 biologic agents (tildrakizumab) are evaluated and reviewed in depth.
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Affiliation(s)
- Feras M Ghazawi
- Division of Dermatology, University of Ottawa, Ottawa, ON, Canada
| | - Farhan Mahmood
- Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Leon Kircik
- Department of Dermatology, Mount Sinai Hospital, New York City, NY, United States
| | - Yves Poulin
- Division of Dermatology, Laval University, Quebec City, QC, Canada
| | - Marc Bourcier
- Faculty of Medicine, University of Sherbrooke, Sherbrooke, QC, Canada
| | - Ronald Vender
- Division of Dermatology, McMaster University, Hamilton, ON, Canada
| | - Marni C Wiseman
- Section of Dermatology, Department of Medicine, University of Manitoba, Winnipeg, MB, Canada
| | - Charles Lynde
- Division of Dermatology, University of Toronto, Toronto, ON, Canada
| | - Ivan V Litvinov
- Division of Dermatology, McGill University, Montréal, QC, Canada
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Cro S, Cornelius V, Pink A, Wilson R, Pushpa‐Rajah A, Patel P, Abdul‐Wahab A, August S, Azad J, Becher G, Chapman A, Dunnill G, Ferguson A, Fogo A, Ghaffar S, Ingram J, Kavakleiva S, Ladoyanni E, Leman J, Macbeth A, Makrygeorgou A, Parslew R, Ryan A, Sharma A, Shipman A, Sinclair C, Wachsmuth R, Woolf R, Wright A, McAteer H, Barker J, Burden A, Griffiths C, Reynolds N, Warren R, Lachmann H, Capon F, Smith C. Anakinra for palmoplantar pustulosis: results from a randomized, double-blind, multicentre, two-staged, adaptive placebo-controlled trial (APRICOT). Br J Dermatol 2021; 186:245-256. [PMID: 34411292 PMCID: PMC9255857 DOI: 10.1111/bjd.20653] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/14/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Palmoplantar pustulosis (PPP) is a rare, debilitating, chronic inflammatory skin disease that affects the hands and feet. Clinical, immunological and genetic findings suggest a pathogenic role for interleukin (IL)-1. OBJECTIVES To determine whether anakinra (an IL-1 receptor antagonist) delivers therapeutic benefit in PPP. METHODS This was a randomized (1 : 1), double-blind, two-staged, adaptive, UK multicentre, placebo-controlled trial [ISCRTN13127147 (registered 1 August 2016); EudraCT number: 2015-003600-23 (registered 1 April 2016)]. Participants had a diagnosis of PPP (> 6 months) requiring systemic therapy. Treatment was 8 weeks of anakinra or placebo via daily, self-administered subcutaneous injections. Primary outcome was the Palmoplantar Pustulosis Psoriasis Area and Severity Index (PPPASI) at 8 weeks. RESULTS A total of 374 patients were screened; 64 were enrolled (31 in the anakinra arm and 33 in the placebo arm) with a mean (SD) baseline PPPASI of 17·8 (10·5) and a PPP investigator's global assessment of severe (50%) or moderate (50%). The baseline adjusted mean difference in PPPASI favoured anakinra but did not demonstrate superiority in the intention-to-treat analysis [-1·65, 95% confidence interval (CI) -4·77 to 1·47; P = 0·30]. Similarly, secondary objective measures, including fresh pustule count (2·94, 95% CI -26·44 to 32·33; favouring anakinra), total pustule count (-30·08, 95% CI -83·20 to 23·05; favouring placebo) and patient-reported outcomes, did not show superiority of anakinra. When modelling the impact of adherence, the PPPASI complier average causal effect for an individual who received ≥ 90% of the total treatment (48% in the anakinra group) was -3·80 (95% CI -10·76 to 3·16; P = 0·285). No serious adverse events occurred. CONCLUSIONS No evidence for the superiority of anakinra was found. IL-1 blockade is not a useful intervention for the treatment of PPP.
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Affiliation(s)
- S. Cro
- Imperial Clinical Trials UnitImperial College LondonLondonW12 7RHUK
| | - V.R. Cornelius
- Imperial Clinical Trials UnitImperial College LondonLondonW12 7RHUK
| | - A.E. Pink
- St John’s Institute of DermatologyGuy’s HospitalGuy’s and St Thomas’ NHS Foundation TrustLondonSE1 9RTUK
| | - R. Wilson
- St John’s Institute of DermatologyGuy’s HospitalGuy’s and St Thomas’ NHS Foundation TrustLondonSE1 9RTUK
| | - A. Pushpa‐Rajah
- St John’s Institute of DermatologyGuy’s HospitalGuy’s and St Thomas’ NHS Foundation TrustLondonSE1 9RTUK
| | - P. Patel
- St John’s Institute of DermatologyGuy’s HospitalGuy’s and St Thomas’ NHS Foundation TrustLondonSE1 9RTUK
| | - A. Abdul‐Wahab
- St George’s University Hospitals NHS Foundation TrustLondonSW17 0QTUK
| | - S. August
- Poole Hospital NHS Foundation Trust University Hospitals DorsetPooleBH15 2JBUK
| | - J. Azad
- South Tees Hospitals NHS Foundation TrustMiddlesbroughTS4 3BWUK
| | - G. Becher
- West Glasgow Ambulatory Care HospitalGlasgowG3 8SJUK
| | - A. Chapman
- Homerton University HospitalLondonE9 6SRUK
| | | | - A.D. Ferguson
- University Hospitals of Derby and Burton NHS Foundation TrustDerbyDE22 3NEUK
| | - A. Fogo
- Kingston HospitalKingston upon ThamesKT2 7QBUK
| | - S.A. Ghaffar
- Ninewells Hospital and Medical SchoolDundeeDD1 9SYUK
| | - J.R. Ingram
- Division of Infection and ImmunitySchool of MedicineCardiff UniversityUniversity Hospital of WalesCardiffCF14 4XNUK
| | | | | | | | - A.E. Macbeth
- Norfolk and Norwich University Hospitals NHS Foundation TrustNorwichNR4 7UYUK
| | | | - R. Parslew
- Liverpool University Hospitals NHS Foundation TrustLiverpoolL9 7ALUK
| | - A.J. Ryan
- King’s College HospitalLondonSE5 9RSUK
| | - A. Sharma
- Nottingham University Hospitals NHS TrustNottinghamNG7 2UHUK
| | - A.R. Shipman
- Portsmouth Hospitals Universities NHS TrustSt Mary’s Community Health CampusPortsmouthPO3 6ADUK
| | | | - R. Wachsmuth
- Royal Devon and Exeter NHS Foundation TrustExeterEX2 5DWUK
| | - R.T. Woolf
- St John’s Institute of DermatologyGuy’s HospitalGuy’s and St Thomas’ NHS Foundation TrustLondonSE1 9RTUK
| | - A. Wright
- Bradford Teaching Hospitals NHS Foundation TrustBradfordBD9 6RJUK
| | - H. McAteer
- The Psoriasis AssociationNorthamptonNN4 7BFUK
| | - J.N.W.N. Barker
- St John’s Institute of DermatologySchool of Basic and Medical BiosciencesFaculty of Life Sciences and MedicineKing’s College LondonLondonSE1 9RTUK
| | - A.D. Burden
- Institute of Infection, Immunity and InflammationUniversity of GlasgowGlasgowG12 8TAUK
| | - C.E.M. Griffiths
- Dermatology CentreSalford Royal NHS Foundation TrustUniversity of ManchesterNIHR Manchester Biomedical Research CentreManchesterM6 8HDUK
| | - N.J. Reynolds
- Institute of Translational and Clinical MedicineMedical SchoolUniversity of NewcastleDepartment of DermatologyRoyal Victoria Infirmary and NIHR Newcastle Biomedical Research CentreNewcastle Hospitals NHS Foundation TrustNewcastle upon TyneNE2 4HHUK
| | - R.B. Warren
- National Amyloidosis CentreUniversity College LondonLondonNW3 2PFUK
| | - H.J. Lachmann
- National Amyloidosis CentreUniversity College LondonLondonNW3 2PFUK
| | - F. Capon
- Department of Medical and Molecular GeneticsKing’s College LondonLondonSE1 9RTUK
| | - C.H. Smith
- St John’s Institute of DermatologyGuy’s HospitalGuy’s and St Thomas’ NHS Foundation TrustLondonSE1 9RTUK
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Iwaki Y, Shibata S, Hu C. Pharmacokinetic/Pharmacodynamic Analysis of Guselkumab for Treatment of Palmoplantar Pustulosis: Clinical Implications of Guselkumab Dose, Disease Severity and Smoking in Japanese Patients. J Clin Pharmacol 2021; 62:182-189. [PMID: 34382209 DOI: 10.1002/jcph.1953] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Accepted: 08/06/2021] [Indexed: 11/09/2022]
Abstract
Guselkumab is a human IgG1λ monoclonal antibody that has been approved for treatment of multiple immunological diseases including palmoplantar pustulosis (PPP) in Japan. The efficacy of guselkumab in reducing disease severity as compared with placebo has been demonstrated in phase 2 and 3 clinical studies. In some patients assigned to the placebo treatment, worsening of PPP Area and Severity Index (PPPASI) score was noted. Most of these patients were smokers, raising a possibility of an association of smoking with the disease progression. To understand the clinical implications of guselkumab dose, baseline disease severity and smoking on the treatment effect and describe the longitudinal relationship between guselkumab exposure and the PPPASI score, a PK/PD modeling analysis was conducted using the pooled data from one phase 2 and one phase 3 study. Data from 207 Japanese patients (77% women and 60% smokers) with a median PPPASI score of 24.6 were included in the analysis. The observed treatment efficacy (the PPPASI score reduction) appeared to be similar at the current approved dose (100) mg and the higher dose (200 mg). Greater extent of the PPPASI score reduction (in absolute points) is expected in patients with higher baseline PPPASI score (severe disease). However, the higher baseline did not translate to larger magnitude of the change from baseline (in percentage) in the PPPASI score. Incorporating a linear disease progression effect in the model significantly decreased the NONMEM objective function value (p<0.001). Smoking status appeared tobe related to disease worsening in some patients, but the covariate did not reach statistical significance in the model. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Yuki Iwaki
- Clinical Pharmacology and Pharmacometrics, Janssen Pharmaceutical K.K. Chiyoda-ku, Tokyo, Japan
| | - Sayori Shibata
- Clinical Pharmacology and Pharmacometrics, Janssen Pharmaceutical K.K. Chiyoda-ku, Tokyo, Japan
| | - Chuanpu Hu
- Clinical Pharmacology and Pharmacometrics, Janssen Research & Development, LLC, Spring House, PA, 19477, USA
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Kondo N, Sakai Y, Kakutani R, Netsu T, Kijima Y, Kudo N, Endo N, Kawashima H. Clinical characteristics and treatment status of pustulotic arthro-osteitis: A single-center study involving 51 cases. J Dermatol 2021; 48:1724-1730. [PMID: 34368990 DOI: 10.1111/1346-8138.16107] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Revised: 07/07/2021] [Accepted: 07/24/2021] [Indexed: 12/01/2022]
Abstract
Pustulotic arthro-osteitis (PAO) is a major complication of palmoplantar pustulosis (PPP). In orthopedic surgery outpatient clinics, PPP patients with osteoarticular symptoms are seen frequently, but PAO's clinical features remain not well known. To determine Japanese patients' clinical features and treatment status with PAO, we conducted a single-center retrospective epidemiologic survey. Clinical features, including gender, age, smoking habit, the onset pattern, interval between skin manifestation and osteoarticular symptoms, and the incidence of sternoclavicular joint lesions, axial and peripheral joint lesions, were examined. The association between physical status and image findings by X-ray, computed tomography, bone scintigraphy with Technetium99 , or magnetic resonance imaging was evaluated. The distribution pattern of peripheral joint lesions and the treatment status were evaluated. We identified 51 patients, 10 men and 41 women, with PAO. The average age was 48 years and 59% were smokers. The frequency of onset patterns was skin-leading type (63%), simultaneous onset (18%), and osteoarticular leading type (16%). The average interval between skin involvement and osteoarticular involvement in skin-leading type was significantly longer than that in osteoarticular leading type (7.1 years vs. 2.0 years). A sternoclavicular joint (SCJ) lesion was detected in 65% cases, and the physical findings of SCJ were significantly related to the image findings. Axial and peripheral joint lesions were detected in the same ratio (23 cases, 45%). In the peripheral joints, the finger joint was the most common (26%), followed by the shoulder joint (21%). Patients were treated with nonsteroidal anti-inflammatory drugs (76%), followed by conventional synthetic disease-modifying antirheumatic drugs (DMARDs) (29%) and biological DMARDs (9.8%). Tonsillectomy was performed in 11 cases. In conclusion, PAO more frequently involves SCJ in middle-aged women who smoke. Given that osteoarticular leading type was detected in 16% cases, seronegative oligoarthritis patients should be monitored for PPP, leading to a diagnosis of PAO.
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Affiliation(s)
- Naoki Kondo
- Division of Orthopedic Surgery, Department of Regenerative and Transplant Medicine, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Yohei Sakai
- Division of Orthopedic Surgery, Department of Regenerative and Transplant Medicine, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Rika Kakutani
- Division of Orthopedic Surgery, Department of Regenerative and Transplant Medicine, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Takahiro Netsu
- Division of Rheumatology, Nagaoka Red Cross Hospital, Nagaoka, Niigata, Japan
| | - Yasufumi Kijima
- Division of Orthopedic Surgery, Department of Regenerative and Transplant Medicine, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Naoko Kudo
- Katsumi Seikeigeka Clinic, Niigata, Japan
| | - Naoto Endo
- Division of Orthopedic Surgery, Tsubame Rosai Hospital, Tsubame, Niigata, Japan
| | - Hiroyuki Kawashima
- Division of Orthopedic Surgery, Department of Regenerative and Transplant Medicine, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
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41
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Poortinga S, Balakirski G, Kromer C, Mössner R, Schön MP, Bieber T, Wilsmann-Theis D. The challenge of palmoplantar pustulosis therapy: Are Interleukin-23 inhibitors an option? J Eur Acad Dermatol Venereol 2021; 35:e907-e911. [PMID: 34309915 DOI: 10.1111/jdv.17560] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Revised: 06/19/2021] [Accepted: 07/16/2021] [Indexed: 11/30/2022]
Affiliation(s)
- S Poortinga
- Department of Dermatology and Allergology, University Hospital of Bonn, Bonn, Germany
| | - G Balakirski
- Department of Dermatology and Allergology, University Hospital of Bonn, Bonn, Germany.,Department of Dermatology, Allergology and Dermatosurgery, HELIOS University Hospital Wuppertal, University of Witten/Herdecke, Wuppertal, Germany
| | - C Kromer
- Department of Dermatology, Venereology and Allergology, University Medical Center Göttingen, Göttingen, Germany
| | - R Mössner
- Department of Dermatology, Venereology and Allergology, University Medical Center Göttingen, Göttingen, Germany
| | - M P Schön
- Department of Dermatology, Venereology and Allergology, University Medical Center Göttingen, Göttingen, Germany.,Lower Saxony Institute of Occupational Dermatology, University Medical Center Göttingen, Göttingen, Germany
| | - T Bieber
- Department of Dermatology and Allergology, University Hospital of Bonn, Bonn, Germany
| | - D Wilsmann-Theis
- Department of Dermatology and Allergology, University Hospital of Bonn, Bonn, Germany
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42
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Kim HJ, Bang CH, Kim HO, Lee DH, Ko JY, Park EJ, Son SW, Ro YS. 2020 Korean Consensus Guidelines for Diagnosis and Treatment of Chronic Hand Eczema. Ann Dermatol 2021; 33:351-360. [PMID: 34341637 PMCID: PMC8273322 DOI: 10.5021/ad.2021.33.4.351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Revised: 12/17/2020] [Accepted: 01/11/2021] [Indexed: 11/22/2022] Open
Abstract
Background Hand eczema refers to eczema located on the hands, regardless of its etiology or morphology. Despite its high prevalence and significant impact on patients' quality of life, treatment is frequently challenging because of its heterogeneity, chronic and recurrent course, and lack of well-organized randomized controlled trials of the various treatment options. Objective These consensus guidelines aim to provide evidence-based recommendations on the diagnosis and management of hand eczema to improve patient care by helping physicians make more efficient and transparent decisions. Methods A modified Delphi method, comprising two rounds of email questionnaires with face-to-face meetings in between, was adopted for the consensus process that took place between February and September 2020. Forty experts in the field of skin allergy and contact dermatitis were invited to participate in the expert panel. Results Consensus was reached for the domains of classification, diagnostic evaluation, and treatment; and a therapeutic ladder to manage chronic hand eczema was developed. Conclusion These are the first consensus guidelines for chronic hand eczema in the Asian population, which will help standardize care and assist clinical decision-making in the diagnosis and treatment of chronic hand eczema.
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Affiliation(s)
- Hee Joo Kim
- Department of Dermatology, Gil Medical Center, Gachon University College of Medicine, Incheon, Korea
| | - Chul Hwan Bang
- Department of Dermatology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Hye One Kim
- Department of Dermatology, Hallym University College of Medicine, Seoul, Korea
| | - Dong Hoon Lee
- Department of Dermatology, Seoul National University College of Medicine, Seoul, Korea
| | - Joo Yeon Ko
- Department of Dermatology, Hanyang University College of Medicine, Seoul, Korea
| | - Eun Joo Park
- Department of Dermatology, Hallym University College of Medicine, Seoul, Korea
| | - Sang Wook Son
- Department of Dermatology, Korea University College of Medicine, Seoul, Korea
| | - Young Suk Ro
- Department of Dermatology, Hanyang University College of Medicine, Seoul, Korea
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43
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Yamamoto T. Guselkumab for the Treatment of Palmoplantar Pustulosis: A Japanese Perspective. Clin Pharmacol 2021; 13:135-143. [PMID: 34188558 PMCID: PMC8236264 DOI: 10.2147/cpaa.s266223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Accepted: 06/11/2021] [Indexed: 11/28/2022] Open
Abstract
Palmoplantar pustulosis (PPP) is a chronic inflammatory disorder characterized by sterile pustules predominantly involving the palms and soles. PPP is refractory to various therapies such as topical ointment, oral medicine, and phototherapies. Pustulotic arthro-osteitis (PAO) is a major comorbidity of PPP that severely impairs patients’ quality of life. Recently, guselkumab, a monoclonal antibody against IL-23, has been available for the treatment of PPP in Japan. The purpose of the present review is to describe the characteristics of Japanese PPP patients and biologic therapy of PPP/PAO using guselkumab. Most Japanese dermatologists consider PPP as a distinct entity and co-existence of PPP and psoriasis is rare. However, outside Japan, PPP is often considered to be palmoplantar psoriasis, and extra-palmoplantar lesions associated with PPP are regarded as psoriasis. PPP develops or exacerbates either with or without arthralgia, following focal infections, such as tonsillitis, odontogenic infection, and sinusitis. Treatment of focal infection results in dramatic effects on cutaneous lesions as well as joint pain. By contrast, we sometimes see patients whose skin/joint symptoms do not improve after treatment of focal infection, whose focus of infection cannot be identified even in a detailed examination, and/or who refuse tonsillectomy even if strongly recommended. Such cases are considered to be indications of biologics. In this review, clinical features, pathophysiology and guselkumab therapy are discussed.
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Affiliation(s)
- Toshiyuki Yamamoto
- Department of Dermatology, Fukushima Medical University, Fukushima, 960-1295, Japan
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44
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Ru Y, Ding X, Luo Y, Li H, Sun X, Zhou M, Zhou Y, Kuai L, Xing M, Liu L, Luo Y, Song J, Chen J, Li B, Li X. Adverse Events Associated With Anti-IL-23 Agents: Clinical Evidence and Possible Mechanisms. Front Immunol 2021; 12:670398. [PMID: 34177909 PMCID: PMC8226270 DOI: 10.3389/fimmu.2021.670398] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Accepted: 05/24/2021] [Indexed: 01/14/2023] Open
Abstract
Background Anti-interleukin (IL)-23 agents are widely used for autoimmune disease treatment; however, the safety and risks of specific symptoms have not been systematically assessed. Objectives The aim of this study was to summarize the characteristics and mechanisms of occurrence of five immunological and non-immunological adverse events caused by different anti-IL-23 agents. Methods The Cochrane Library, EMBASE, PubMed, and Web of Science databases were searched for eligible randomized clinical trials published from inception through May 1, 2020. Randomized clinical trials that reported at least one type of adverse event after treatment were included, regardless of sex, age, ethnicity, and diagnosis. Two investigators independently screened and extracted the characteristics of the studies, participants, drugs, and adverse event types. The Cochrane Handbook was used to assess the methodological quality of the included randomized clinical trials. Heterogeneity was assessed using the I2 statistic. Meta-regression was applied to determine the sources of heterogeneity, and subgroup analysis was used to identify the factors contributing to adverse events. Results Forty-eight studies were included in the meta-analysis, comprising 25,624 patients treated with anti-IL-23 agents. Serious immunological or non-immunological adverse events were rare. Anti-IL-12/23-p40 agents appeared to cause adverse events more easily than anti-IL-23-p19 agents. The incidence of cancer did not appear to be related to anti-IL-23 agent treatment, and long-term medication could lead to mental diseases. The prevention of complications should be carefully monitored when administered for over approximately 40 weeks to avoid further adverse reactions, and the incidence of infection was the highest among general immunological adverse events. Conclusions The application of anti-IL-23 agents induced a series of immunological and non-immunological adverse events, but these agents tend to be well-tolerated with good safety profiles.
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Affiliation(s)
- Yi Ru
- Department of Dermatology, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China.,Institute of Dermatology, Shanghai Academy of Traditional Chinese Medicine, Shanghai, China
| | - Xiaojie Ding
- Department of Dermatology, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China.,Institute of Dermatology, Shanghai Academy of Traditional Chinese Medicine, Shanghai, China
| | - Ying Luo
- Department of Dermatology, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China.,Institute of Dermatology, Shanghai Academy of Traditional Chinese Medicine, Shanghai, China
| | - Hongjin Li
- Institute of Dermatology, Shanghai Academy of Traditional Chinese Medicine, Shanghai, China
| | - Xiaoying Sun
- Institute of Dermatology, Shanghai Academy of Traditional Chinese Medicine, Shanghai, China
| | - Mi Zhou
- Department of Dermatology, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Yaqiong Zhou
- Institute of Dermatology, Shanghai Academy of Traditional Chinese Medicine, Shanghai, China
| | - Le Kuai
- Department of Dermatology, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China.,Institute of Dermatology, Shanghai Academy of Traditional Chinese Medicine, Shanghai, China
| | - Meng Xing
- Department of Dermatology, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China.,Institute of Dermatology, Shanghai Academy of Traditional Chinese Medicine, Shanghai, China
| | - Liu Liu
- Department of Dermatology, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China.,Institute of Dermatology, Shanghai Academy of Traditional Chinese Medicine, Shanghai, China
| | - Yue Luo
- Department of Dermatology, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China.,Institute of Dermatology, Shanghai Academy of Traditional Chinese Medicine, Shanghai, China
| | - Jiankun Song
- Department of Dermatology, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China.,Institute of Dermatology, Shanghai Academy of Traditional Chinese Medicine, Shanghai, China
| | - Jiale Chen
- Department of Dermatology, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China.,Institute of Dermatology, Shanghai Academy of Traditional Chinese Medicine, Shanghai, China
| | - Bin Li
- Department of Dermatology, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China.,Institute of Dermatology, Shanghai Academy of Traditional Chinese Medicine, Shanghai, China.,Shanghai Skin Disease Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Xin Li
- Department of Dermatology, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China.,Institute of Dermatology, Shanghai Academy of Traditional Chinese Medicine, Shanghai, China
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45
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Wilsmann-Theis D, Kromer C, Gerdes S, Linker C, Magnolo N, Sabat R, Reich K, Mössner R. A multicentre open-label study of apremilast in palmoplantar pustulosis (APLANTUS). J Eur Acad Dermatol Venereol 2021; 35:2045-2050. [PMID: 34077577 DOI: 10.1111/jdv.17441] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Accepted: 04/21/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Palmoplantar pustulosis (PPP) is a chronic skin disease with painful erythematous scaly or crusty lesions and pustules on the palms and soles. Apremilast is a phosphodiesterase 4 inhibitor that has proven effective in the therapy of psoriasis, psoriatic arthritis and in oral ulcers associated with Behcet's disease. OBJECTIVE To explore the efficacy of apremilast in PPP. METHODS APLANTUS was a phase 2 single-arm multicentre study of apremilast in 21 subjects with moderate-to-severe PPP. Primary endpoint was the per cent change of the Palmoplantar Pustulosis Psoriasis Area and Severity Index (PPPASI) at week 20 compared to baseline. RESULTS 20 weeks of oral treatment with apremilast in patients with moderate-to-severe PPP resulted in a significant decrease of the PPPASI with a median reduction of 57.1% (p < 0.001), and 61.9% of patients achieved at least a 50% improvement of the PPPASI relative to baseline. The total number of pustules per patient decreased significantly relative to baseline with 76.2% of patients achieving at least a 50% reduction in total pustules count at week 20. Improvement of PPP was also apparent in a significant decrease of the dermatologic life quality index (DLQI). The median DLQI score dropped from 8.5 at baseline to 2.0 at week 20 (p = 0.030). Apremilast was generally well tolerated, and no serious adverse events occurred. CONCLUSIONS Patients with PPP treated with apremilast showed benefit both in objective and subjective disease parameters. Apremilast should be investigated further in this difficult-to-treat skin condition. EudraCT number: 2016-005122-11.
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Affiliation(s)
- D Wilsmann-Theis
- Department of Dermatology and Allergy, University of Bonn, Bonn, Germany
| | - C Kromer
- Department of Dermatology, University Medical Center Göttingen, Göttingen, Germany
| | - S Gerdes
- Center for Inflammatory Skin Diseases, Department of Dermatology, University Medical Center Schleswig-Holstein Campus Kiel, Kiel, Germany
| | - C Linker
- TFS Clinic, TFS Trial Form Support GmbH, Hamburg, Germany
| | - N Magnolo
- Department of Dermatology, University Hospital Münster, Münster, Germany
| | - R Sabat
- Psoriasis Research and Treatment Centre, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - K Reich
- Translational Research in Inflammatory Skin Diseases, Institute for Health Services Research in Dermatology and Nursing, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - R Mössner
- Department of Dermatology, University Medical Center Göttingen, Göttingen, Germany
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46
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Obeid G, Do G, Kirby L, Hughes C, Sbidian E, Le Cleach L. Interventions for chronic palmoplantar pustulosis: abridged Cochrane systematic review and GRADE assessments. Br J Dermatol 2021; 184:1023-1032. [PMID: 32961599 DOI: 10.1111/bjd.19560] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2020] [Revised: 09/12/2020] [Accepted: 09/15/2020] [Indexed: 01/02/2023]
Abstract
BACKGROUND Palmoplantar pustulosis (PPP) is a chronic inflammatory disease in which sterile and relapsing pustules appear on the palms and soles. OBJECTIVES To assess the effects of interventions for chronic PPP to induce and maintain complete remission. METHODS We searched for randomized controlled trials (RCTs), including people with PPP or chronic palmoplantar pustular psoriasis, in the Cochrane Skin Specialised Register, CENTRAL, MEDLINE, Embase, LILACS and eight trials registers up to July 2020. Study selection, data extraction and risk-of-bias assessment were carried out independently by two review authors. Certainty of evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) method. RESULTS We included 37 RCTs (1663 participants, 76% women, mean age 50 years). Mean treatment duration was 11 weeks. Topical vitamin D derivative may be more effective than placebo in achieving clearance [risk ratio (RR) 7·83, 95% confidence interval (CI) 1·85-33·12; low-certainty evidence from two trials]. Concerning biological therapies, there was little or no difference between etanercept and placebo in achieving clearance (low-certainty evidence from one trial), ustekinumab is less effective than placebo in reducing severity (low-certainty evidence from one trial), and guselkumab (RR 2·88, 95% CI 1·24-6·69) and secukinumab (RR 1·55, 95% CI 1·02-2·35) are probably better in reducing disease severity (moderate-certainty evidence from two and one trial(s), respectively) but may cause more serious adverse events than placebo. CONCLUSIONS Evidence is lacking for or against major chronic PPP treatments. Risk of bias and imprecision limit our confidence in the results.
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Affiliation(s)
- G Obeid
- Department of Dermatology, Hôpital du Sacré Coeur, Beirut, Lebanon
| | - G Do
- Department of Dermatology, Hôpital Henri Mondor, Créteil, France
| | - L Kirby
- Department of Dermatology, Queen Elizabeth University Hospital, Glasgow, UK
| | - C Hughes
- c/o CochraneSkin Group, The University of Nottingham, Nottingham, UK
| | - E Sbidian
- Department of Dermatology, Hôpital Henri Mondor, Créteil, France
- Epidemiology in Dermatology and Evaluation of Therapeutics (EpiDermE) -EA 7379, Université Paris Est Créteil (UPEC), Créteil, France
| | - L Le Cleach
- Department of Dermatology, Hôpital Henri Mondor, Créteil, France
- Epidemiology in Dermatology and Evaluation of Therapeutics (EpiDermE) -EA 7379, Université Paris Est Créteil (UPEC), Créteil, France
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47
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Hanna ML, Singer D, Valdecantos WC. Economic burden of generalized pustular psoriasis and palmoplantar pustulosis in the United States. Curr Med Res Opin 2021; 37:735-742. [PMID: 33622113 DOI: 10.1080/03007995.2021.1894108] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
OBJECTIVE To estimate healthcare resource utilization (HCRU) and economic burden of generalized pustular psoriasis (GPP) and palmoplantar pustulosis (PPP) in a commercially insured population the United States (US). METHODS Adult patients with a GPP or PPP diagnosis were identified between April 1, 2016 and August 1, 2019 in the IQVIA PharMetrics Plus database. Patients required continuous enrollment in medical and pharmacy benefits 6 months before and ≥2 months after the index diagnosis. GPP and PPP cohorts were exactly matched 1:3 on demographics and index date to a plaque psoriasis and a control cohort of the general population. All-cause HCRU and cost measures (direct medical and pharmacy) were reported as per patient per month (PPPM). Generalized linear models estimated adjusted cost ratios between matched cohorts, controlling for comorbidities. RESULTS HCRU was high among GPP and PPP patients. Rates of inpatient visits were 4 times higher in GPP patients and 2 times higher in PPP patients compared to their matched cohorts. GPP patients experienced significantly higher total healthcare costs compared to matched cohorts (GPP vs plaque psoriasis: cost ratio 1.36, 95% confidence interval (1.22, 1.50); GPP vs control: 5.58 (3.73, 8.36)). PPP patients had significantly higher total healthcare costs compared to the general population (4.11 (3.31, 5.11)), while costs were comparable to plaque psoriasis patients (1.06 (0.97, 1.16)). CONCLUSIONS GPP and PPP patients have significant economic burden due to higher direct medical and pharmacy costs. Further investigation is needed to better understand the drivers of economic burden in patients with GPP and PPP, and how HCRU and costs are impacted by disease severity.
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Affiliation(s)
- Maya L Hanna
- Boehringer Ingelheim Pharmaceuticals, Inc, Ridgefield, CT, USA
| | - David Singer
- Boehringer Ingelheim Pharmaceuticals, Inc, Ridgefield, CT, USA
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48
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Guo J, Peng L, Zeng J, Zhang M, Xu F, Zhang X, Wei Q. Paeoniflorin suppresses allergic and inflammatory responses by promoting autophagy in rats with urticaria. Exp Ther Med 2021; 21:590. [PMID: 33884028 PMCID: PMC8056118 DOI: 10.3892/etm.2021.10022] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Accepted: 07/01/2020] [Indexed: 01/02/2023] Open
Abstract
Paeoniflorin (PF) has been reported to be effective against several skin disorders, such as allergic contact dermatitis and psoriasis; however, it remains unclear whether PF can protect against urticarial lesions. Herein, the effects of PF on rats with urticarial lesions and the possible underlying mechanism were investigated. The effects of PF administration on a rat model of ovalbumin-induced urticarial-like lesions were evaluated via pathological analysis using hematoxylin-eosin staining. Toluidine blue staining was performed to detect mast cells and ELISA was performed to determine serum histamine levels. PF-induced regulatory effects on autophagic activity and the potential underlying mechanism of this were also investigated using transmission electron microscopy, immunohistochemistry and reverse transcription-quantitative PCR. It was demonstrated that PF suppressed allergic and inflammatory responses to improve urticarial lesions, as evidenced by the attenuation of pathological abnormalities, mast cell infiltration and histamine secretion. Mechanistically, PF treatment was found to markedly limit the production and release of inflammatory cytokine interleukin (IL)-23, while the levels of IL-17 remained unchanged. PF intervention led to an increased number of autophagosomes, along with higher levels of light chain 3B (LC3B) and Beclin-1, and lower levels of P62, indicating that PF could augment autophagic activity in urticarial lesions. PF treatment increased the expression of liver kinase B1 (LKB1) and AMP-activated protein kinase-α (AMPK-α), contributing to the PF-enhanced autophagic activity. In conclusion, PF could effectively improve urticarial lesions by inhibiting inflammatory cytokine IL-23 and increasing the autophagic activity via the LKB1/AMPK-α pathway.
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Affiliation(s)
- Jing Guo
- Dermatological Department, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan 610072, P.R. China
| | - Li Peng
- Dermatological Department, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan 610072, P.R. China
| | - Jinhao Zeng
- Geriatric Department, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan 610072, P.R. China.,TCM Regulating Metabolic Diseases Key Laboratory of Sichuan Province, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan 610072, P.R. China
| | - Meiheng Zhang
- Dermatological Department, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan 610072, P.R. China
| | - Feng Xu
- Dermatological Department, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan 610072, P.R. China
| | - Xiaotong Zhang
- Dermatological Department, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan 610072, P.R. China
| | - Qin Wei
- Dermatological Department, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan 610072, P.R. China
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Mrowietz U, Burden AD, Pinter A, Reich K, Schäkel K, Baum P, Datsenko Y, Deng H, Padula SJ, Thoma C, Bissonnette R. Spesolimab, an Anti-Interleukin-36 Receptor Antibody, in Patients with Palmoplantar Pustulosis: Results of a Phase IIa, Multicenter, Double-Blind, Randomized, Placebo-Controlled Pilot Study. Dermatol Ther (Heidelb) 2021; 11:571-585. [PMID: 33661508 PMCID: PMC8019016 DOI: 10.1007/s13555-021-00504-0] [Citation(s) in RCA: 44] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Accepted: 02/11/2021] [Indexed: 12/22/2022] Open
Abstract
Introduction Palmoplantar pustulosis (PPP) is a chronic, inflammatory skin disease, with high disease burden, that is often refractory to treatment. There is a high unmet clinical need for the treatment of patients with PPP. The objectives of this study were to evaluate the safety and efficacy of spesolimab, a novel anti-interleukin-36 receptor antibody, in patients with PPP. Methods This was a phase IIa, multicenter, double-blind, randomized, placebo-controlled pilot study comparing 900 mg spesolimab (n = 19), 300 mg spesolimab (n = 19), and placebo (n = 21) administered intravenously every 4 weeks until week 12 in patients with PPP. The primary efficacy endpoint was the achievement of Palmoplantar Pustulosis Area and Severity Index 50 (PPP ASI50) at week 16, defined as achieving an ≥ 50% decrease from baseline PPP ASI. Results At week 16, 31.6% of patients in both spesolimab dose groups achieved PPP ASI50 versus 23.8% receiving placebo (risk difference 0.078; 95% confidence interval –0.190, 0.338). Thus, the primary endpoint was not met. Spesolimab was well tolerated with no clinically relevant treatment-emergent safety signals observed. Conclusions PPP severity declined over time in all treatment groups after the start of treatment, with a faster decline in the spesolimab arms than in the placebo arm, indicating a potential treatment effect for spesolimab. Limitations to the study included a small sample size and lower overall disease severity than expected at baseline. It is possible that the primary efficacy endpoint may have coincided with natural disease resolution in some patients. Further effects of the efficacy of spesolimab in PPP are being explored in a phase IIb trial. Supplementary Information The online version contains supplementary material available at 10.1007/s13555-021-00504-0.
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Affiliation(s)
- Ulrich Mrowietz
- Psoriasis-Center at the Department of Dermatology, University Medical Center, Schleswig-Holstein, Campus Kiel, Kiel, Germany.
| | - A David Burden
- Institute of Infection, Immunity and Inflammation, University of Glasgow, Glasgow, UK
| | - Andreas Pinter
- Department of Dermatology, Venereology and Allergology, University Clinic Frankfurt Am Main, Frankfurt am Main, Germany
| | - Kristian Reich
- Center of Translational Research in Inflammatory Skin Diseases, Institute for Health Services Research in Dermatology and Nursing, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Knut Schäkel
- Department of Dermatology, Universitätsklinikum Heidelberg, Heidelberg, Germany
| | - Patrick Baum
- Boehringer Ingelheim International GmbH, Biberach, Germany
| | - Yakov Datsenko
- Boehringer Ingelheim International GmbH, Biberach, Germany
| | - Hongjie Deng
- Boehringer Ingelheim (China) Investment Co. Ltd, Shanghai, China
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Yamamoto T. Similarity and difference between palmoplantar pustulosis and pustular psoriasis. J Dermatol 2021; 48:750-760. [PMID: 33650702 DOI: 10.1111/1346-8138.15826] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Accepted: 02/07/2021] [Indexed: 12/11/2022]
Abstract
Palmoplantar pustulosis is a chronic inflammatory disorder characterized by sterile pustules predominantly involving the palms and soles. Palmoplantar pustulosis has many similar aspects to psoriasis, either plaque and pustular type, namely familial occurrence between palmoplantar pustulosis and psoriasis, the appearance of the Köbner phenomenon, joint involvement, and nail involvement. Pustular psoriasis is classified into generalized and localized types, and there are a number of papers regarding palmoplantar pustulosis as an acral variant of localized pustular psoriasis. Many Japanese dermatologists consider palmoplantar pustulosis to be a distinct entity from pustular psoriasis, and the coexistence of palmoplantar pustulosis and psoriasis is rare. However, outside Japan, palmoplantar pustulosis is often considered to be palmoplantar psoriasis or palmoplantar pustular psoriasis, and extra-palmoplantar lesions are also considered to be psoriasis. The purpose of the current review is to compare the similarities and differences between palmoplantar pustulosis and generalized/localized pustular psoriasis. Japanese patients with palmoplantar pustulosis have a close relationship with focal infection, and the associated bone-joint manifestation exclusively involves the anterior chest wall. Furthermore, pediatric occurrence of palmoplantar pustulosis is extremely rare, and difference of genetic background between palmoplantar pustulosis and psoriasis has also been reported. Treatment of focal infection often results in dramatic effects on both cutaneous lesions and joint pain of palmoplantar pustulosis. Those findings suggest that palmoplantar pustulosis should be separately considered from either palmoplantar psoriasis or palmoplantar pustular psoriasis. The clinicopathological features and therapeutic approach of both diseases are discussed.
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Affiliation(s)
- Toshiyuki Yamamoto
- Department of Dermatology, Fukushima Medical University, Fukushima, Japan
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