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Foley P, Mahar PD, Smith SD, Gupta M, Manuelpillai N, Orchard D, Wong LC, Su JC, James A, Fischer G, Marshman G, Rawlin M, Turner M, King E, Kennedy R, Baker C. Australian consensus: Treatment goals for moderate to severe psoriasis in the era of targeted therapies - Considerations for paediatric patients. Australas J Dermatol 2024. [PMID: 38741474 DOI: 10.1111/ajd.14303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2024] [Revised: 04/14/2024] [Accepted: 04/28/2024] [Indexed: 05/16/2024]
Abstract
BACKGROUND Treatment goals have been established in Australia to facilitate the management of adults with moderate to severe psoriasis. The Australasian College of Dermatologists sought to determine if and how these adult treatment goals could be modified to accommodate the needs of paediatric and adolescent patients. METHODS A modified Delphi approach was used. Comprehensive literature review and guideline evaluation resulted in the development of statements and other questions to establish current clinical practices. Two rounds of anonymous voting were undertaken, with a collaborative meeting held in between to discuss areas of discordance. Overall, consensus was defined as achievement of ≥75% agreement in the range 7-9 on a 9-point scale (1 strongly disagree; 9 strongly agree). RESULTS Consensus was achieved on 23/29 statements in round 1 and 17/18 statements in round 2. There was a high level of concordance with treatment criteria in the adult setting. The limitations of applying assessment tools developed for use in adult patients to the paediatric setting were highlighted. Treatment targets in the paediatric setting should include objective metrics for disease severity and psychological impact on the patients and their family, and be based on validated, age-appropriate tools. CONCLUSION While the assessment, classification and management of moderate to severe psoriasis in paediatric patients aligns with metrics established for adults, it is vital that nuances in the transition from childhood to adolescence be taken into account. Future research should focus on psoriasis severity assessment scales specific to the paediatric setting.
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Affiliation(s)
- Peter Foley
- Skin Health Institute, Carlton, Victoria, Australia
- Department of Dermatology, St Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia
- The University of Melbourne, Melbourne, Victoria, Australia
| | - Patrick D Mahar
- Skin Health Institute, Carlton, Victoria, Australia
- The University of Melbourne, Melbourne, Victoria, Australia
- Department of Dermatology, The Royal Children's Hospital, Parkville, Victoria, Australia
| | - Saxon D Smith
- Sydney Adventist Hospital Clinical School, ANU College of Health and Medicine, The Australian National University, Canberra, Australian Capital Territory, Australia
- The Dermatology and Skin Cancer Centre, St Leonards, New South Wales, Australia
| | - Monisha Gupta
- Department of Dermatology, Liverpool Hospital, Liverpool, New South Wales, Australia
- The Skin Hospital, Westmead, New South Wales, Australia
- The University of New South Wales, Sydney, New South Wales, Australia
- Western Sydney University, Sydney, New South Wales, Australia
| | - Nicholas Manuelpillai
- Department of Dermatology, St Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia
| | - David Orchard
- Department of Dermatology, The Royal Children's Hospital, Parkville, Victoria, Australia
- Barkers Road Dermatology, Kew, Victoria, Australia
| | - Li-Chuen Wong
- Royal Prince Alfred Hospital Medical Centre, Newtown, New South Wales, Australia
- Department of Dermatology, Children's Hospital, Westmead, New South Wales, Australia
- The University of Sydney, Camperdown, New South Wales, Australia
| | - John C Su
- The University of Melbourne, Melbourne, Victoria, Australia
- Department of Dermatology, The Royal Children's Hospital, Parkville, Victoria, Australia
- Eastern Health, Melbourne, Victoria, Australia
- Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Amelia James
- Department of Dermatology, The Alfred Hospital, Melbourne, Victoria, Australia
| | - Gayle Fischer
- The University of Sydney, Camperdown, New South Wales, Australia
- Department of Dermatology, Royal North Shore Hospital, St Leonards, New South Wales, Australia
| | - Gillian Marshman
- Dermatology Clinic, Flinders Medical Centre, Adelaide, South Australia, Australia
- Willan House Dermatology, Brighton, South Australia, Australia
- College of Medicine and Public Health, Flinders University, Bedford Park, South Australia, Australia
| | - Morton Rawlin
- Macedon Medical Centre, Templestowe Lower, Victoria, Australia
| | | | - Emma King
- Department of Dermatology, The Royal Children's Hospital, Parkville, Victoria, Australia
| | - Robyn Kennedy
- Department of Dermatology, The Royal Children's Hospital, Parkville, Victoria, Australia
| | - Christopher Baker
- Skin Health Institute, Carlton, Victoria, Australia
- Department of Dermatology, St Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia
- The University of Melbourne, Melbourne, Victoria, Australia
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van Riel CAM, Michielsens CAJ, van Muijen ME, van der Schoot LS, van den Reek JMPA, de Jong EMGJ. Dose reduction of biologics in patients with plaque psoriasis: a review. Front Pharmacol 2024; 15:1369805. [PMID: 38606178 PMCID: PMC11007084 DOI: 10.3389/fphar.2024.1369805] [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: 01/13/2024] [Accepted: 03/04/2024] [Indexed: 04/13/2024] Open
Abstract
Dose reduction (DR) of first-generation biologics for plaque psoriasis (TNF-alpha inhibitors (i) and interleukin (IL)-12/23i) has been described in a previous scoping review. The literature on the DR of the newest generation of biologics (IL-17/23i) was scarce. The current review provides a literature update on the previous scoping review on the DR of all biologics, including the newest generation, with a focus on the uptake and implementation of DR in practice. The current literature search on DR revealed 14 new articles in addition to those in the previous review. Four of the newly found articles tested DR strategies, mostly focusing on first-generation biologics; only guselkumab (IL-23i) was included in one study. The other 10 studies showed data on regaining response after failure of DR, safety, cost-effectiveness, and uptake and implementation, as well as information about IL-17/23i. The eligibility criteria to start DR included both absolute and relative Psoriasis Area and Severity Index (PASI) scores (PASI ≤3/≤5/PASI 75-100) and/or Dermatology Life Quality Index (DLQI) ≤3/≤5, or BSA ≤1/≤2, or Physician Global Assessment (PGA) ≤1/0-2 during a period ranging from 12 weeks to ≥1 year. Most studies used PASI ≤5 and/or DLQI ≤5 or PGA ≤1 for ≥6 months. DR strategies were mostly performed by stepwise interval prolongation in two steps (to 67% of the standard dose, followed by 50%). Some studies of IL-17/23i reduced the dose to ±25%. The tested DR strategies on stepwise or fixed DR on TNF-αi and IL-12/23i (three studies), as well as one "on-demand" dosing study on IL-23i guselkumab, were successful. In the case of relapse of DR on TNF-αi and IL-12/23i, clinical effectiveness was regained by retreatment with the standard dose. All studies showed substantial cost savings with the biologic DR of TNF-αi and IL-12/23i. The identified barriers against the implementation of DR were mainly a lack of guidelines and scientific evidence on effectiveness and safety, and a lack of time and (technical) support. The identified facilitators were mainly clear guidelines, feasible protocols, adequate education of patients and physicians, and cost reduction. In conclusion, DR seems promising, but a research gap still exists in randomized, prospective studies testing DR strategies, especially of IL-17/23i, hampering the completion of guidelines on DR. Taking into account the identified barriers and facilitators most likely results in a more successful implementation of biologic DR in practice.
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Affiliation(s)
- C. A. M. van Riel
- Radboud University Medical Centre, Nijmegen, Netherlands
- Department of Dermatology, Radboud University Medical Centre, Nijmegen, Gelderland, Netherlands
| | - C. A. J. Michielsens
- Radboud University Medical Centre, Nijmegen, Netherlands
- Department of Dermatology, Radboud University Medical Centre, Nijmegen, Gelderland, Netherlands
| | - M. E. van Muijen
- Maastricht University Medical Centre, Maastricht, Limburg, Netherlands
- Department of Dermatology, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, Netherlands, Netherlands
| | - L. S. van der Schoot
- Radboud University Medical Centre, Nijmegen, Netherlands
- Department of Dermatology, Radboud University Medical Centre, Nijmegen, Gelderland, Netherlands
| | - J. M. P. A. van den Reek
- Radboud University Medical Centre, Nijmegen, Netherlands
- Department of Dermatology, Radboud University Medical Centre, Nijmegen, Gelderland, Netherlands
| | - E. M. G. J. de Jong
- Radboud University Medical Centre, Nijmegen, Netherlands
- Department of Dermatology, Radboud University Medical Centre, Nijmegen, Gelderland, Netherlands
- Radboud University, Nijmegen, Gelderland, Netherlands
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Vyas J, Johns JR, Ali FM, Singh RK, Ingram JR, Salek S, Finlay AY. A systematic review of 454 randomized controlled trials using the Dermatology Life Quality Index: experience in 69 diseases and 43 countries. Br J Dermatol 2024; 190:315-339. [PMID: 36971254 DOI: 10.1093/bjd/ljad079] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Revised: 01/31/2023] [Accepted: 03/14/2023] [Indexed: 02/18/2024]
Abstract
BACKGROUND Over 29 years of clinical application, the Dermatology Life Quality Index (DLQI) has remained the most used patient-reported outcome (PRO) in dermatology due to its robustness, simplicity and ease of use. OBJECTIVES To generate further evidence of the DLQI's utility in randomized controlled trials (RCTs) and to cover all diseases and interventions. METHODS The methodology followed PRISMA guidelines and included seven bibliographical databases, searching articles published from 1 January 1994 until 16 November 2021. Articles were reviewed independently by two assessors, and an adjudicator resolved any opinion differences. RESULTS Of 3220 screened publications, 454 articles meeting the eligibility criteria for inclusion, describing research on 198 190 patients, were analysed. DLQI scores were primary endpoints in 24 (5.3%) of studies. Most studies were of psoriasis (54.1%), although 69 different diseases were studied. Most study drugs were systemic (85.1%), with biologics comprising 55.9% of all pharmacological interventions. Topical treatments comprised 17.0% of total pharmacological interventions. Nonpharmacological interventions, mainly laser therapy and ultraviolet radiation treatment, comprised 12.2% of the total number of interventions. The majority of studies (63.7%) were multicentric, with trials conducted in at least 42 different countries; 40.2% were conducted in multiple countries. The minimal clinically importance difference (MCID) was reported in the analysis of 15.0% of studies, but only 1.3% considered full score meaning banding of the DLQI. Forty-seven (10.4%) of the studies investigated statistical correlation of the DLQI with clinical severity assessment or other PRO/quality of life tools; and 61-86% of studies had within-group scores differences greater than the MCID in 'active treatment arms'. The Jadad risk-of-bias scale showed that bias was generally low, as 91.8% of the studies had Jadad scores of ≥ 3; only 0.4% of studies showed a high risk of bias from randomization. Thirteen per cent had a high risk of bias from blinding and 10.1% had a high risk of bias from unknown outcomes of all participants in the studies. In 18.5% of the studies the authors declared that they followed an intention-to-treat protocol; imputation for missing DLQI data was used in 34.4% of studies. CONCLUSIONS This systematic review provides a wealth of evidence of the use of the DLQI in clinical trials to inform researchers' and -clinicians' decisions for its further use. Recommendations are also made for improving the reporting of data from future RCTs using the DLQI.
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Affiliation(s)
| | - Jeffrey R Johns
- Division of Infection and Immunity, School of Medicine, Cardiff University, Cardiff, UK
| | - Faraz M Ali
- Division of Infection and Immunity, School of Medicine, Cardiff University, Cardiff, UK
| | - Ravinder K Singh
- Division of Infection and Immunity, School of Medicine, Cardiff University, Cardiff, UK
| | - John R Ingram
- Division of Infection and Immunity, School of Medicine, Cardiff University, Cardiff, UK
| | - Sam Salek
- School of Life and Medical Sciences, University of Hertfordshire, Hatfield, UK
| | - Andrew Y Finlay
- Division of Infection and Immunity, School of Medicine, Cardiff University, Cardiff, UK
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van der Schoot LS, Janssen JJ, Bastiaens MT, de Boer-Brand A, Christiaansen-Smit C, Enomoto DNH, Hovingh R, Tupker RA, Seyger MMB, Verhoef LM, van den Reek JMPA, de Jong EMGJ. Steps towards implementation of protocolized dose reduction of adalimumab, etanercept and ustekinumab for psoriasis in daily practice. J DERMATOL TREAT 2023; 34:2186728. [PMID: 36867069 PMCID: PMC10013325 DOI: 10.1080/09546634.2023.2186728] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/04/2023]
Abstract
BACKGROUND Dose reduction (DR) of adalimumab, etanercept and ustekinumab has proven to be (cost-)effective in psoriasis patients with low disease activity. Further implementation is needed to establish application of DR for eligible patients. OBJECTIVES To evaluate the implementation of protocolized biologic DR in daily practice. METHODS A pilot implementation study was performed in 3 hospitals during 6 months. By combining education and protocol development, involved healthcare providers (HCPs) were directed toward the adoption of protocolized DR. DR of adalimumab, etanercept, and ustekinumab was achieved by stepwise injection interval prolongation. Implementation outcomes (fidelity, feasibility) were assessed. Factors for optimizing implementation were explored in interviews with HCPs. Uptake was measured in patients by chart review. RESULTS The implementation strategy was executed as planned. Implementation fidelity was less than 100% as not all provided tools were used across study sites. HCPs indicated the feasibility of implementing protocolized DR, although time investment was needed. Identified additional factors for successful implementation included support for patients, uptake of DR into guidelines, and supportive electronic health record systems. During the 6 months intervention period, 52 patients were eligible for DR of whom 26 (50%) started DR. The proposed DR protocol was followed in 22/26 patients (85%) on DR. CONCLUSION Additional staff for support, extra time during consultations, education on DR for HCPs and patients, and effective tools such as a feasible protocol can lead to more patients on biologic DR.
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Affiliation(s)
- L S van der Schoot
- Department of Dermatology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - J J Janssen
- Department of Dermatology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - M T Bastiaens
- Department of Dermatology, Elisabeth-TweeSteden Ziekenhuis, Tilburg, The Netherlands
| | - A de Boer-Brand
- Department of Dermatology, St Antonius Ziekenhuis, Nieuwegein, The Netherlands
| | - C Christiaansen-Smit
- Department of Dermatology, Elisabeth-TweeSteden Ziekenhuis, Tilburg, The Netherlands
| | - D N H Enomoto
- Department of Dermatology, Dermatologisch Centrum Isala, Zwolle, The Netherlands
| | - R Hovingh
- Department of Dermatology, Elisabeth-TweeSteden Ziekenhuis, Tilburg, The Netherlands
| | - R A Tupker
- Department of Dermatology, St Antonius Ziekenhuis, Nieuwegein, The Netherlands
| | - M M B Seyger
- Department of Dermatology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - L M Verhoef
- Department of Rheumatology, Sint Maartenskliniek, Nijmegen, The Netherlands
| | - J M P A van den Reek
- Department of Dermatology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - E M G J de Jong
- Department of Dermatology, Radboud University Medical Center, Nijmegen, The Netherlands.,Radboud University, Nijmegen, The Netherlands
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5
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Polesie S, Alinaghi F, Egeberg A. A systematic review investigating at what proportion clinical images are shared in prospective randomized controlled trials involving patients with psoriasis and biological agents. J DERMATOL TREAT 2023; 34:2281261. [PMID: 37965743 DOI: 10.1080/09546634.2023.2281261] [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: 10/19/2023] [Accepted: 11/02/2023] [Indexed: 11/16/2023]
Abstract
For many patients including those with psoriasis, scientific manuscripts comprising clinical outcomes including psoriasis area severity index (PASI) and/or physician global assessment (PGA) may be difficult to understand. However, most patients can relate to images at baseline and follow-up, particularly for dermatological diseases. This study aimed to assess the proportion of shared clinical images in psoriasis trials. A systematic review adhering to the PRISMA guidelines was performed. The review was limited to randomized controlled trials, and among these, only investigations involving biological agents for treatment of psoriasis were included. The Embase, MEDLINE and Scopus databases were searched for eligible studies published from inception to October 26, 2021. In total, 152 studies were included. When combining these, 62,871 patients were randomized. Overall, 203 images were shared depicting 60 patients in the manuscripts yielding an overall sharing rate of 0.1%. Patient images are seldom incorporated in clinical trial manuscripts which impairs interpretation for patients. Inclusion of image material would strengthen the patients' perspective and understanding on what treatment effects that can be expected. As such, this systematic review should be an invitation to the pharmaceutical industry, other sponsors, and editorial offices to improve easy transfer of information to patients using image data.
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Affiliation(s)
- Sam Polesie
- Department of Dermatology and Venereology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Dermatology and Venereology, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Farzad Alinaghi
- National Allergy Research Centre, Department of Dermatology and Allergy, Herlev and Gentofte Hospital, University of Copenhagen, Hellerup, Denmark
| | - Alexander Egeberg
- Department of Dermatology, Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark
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6
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Raharja A, Arkir Z, Rinaldi G, Tsakok T, Dasandi T, Guard S, McGuire A, Pink AE, Woolf R, Barker JN, Smith CH, Mahil SK. Real-World Implementation and Outcomes of Adalimumab Therapeutic Drug Monitoring in Psoriasis: A National Specialized Center Experience. J Invest Dermatol 2023; 143:1708-1716.e4. [PMID: 36889663 DOI: 10.1016/j.jid.2023.01.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Revised: 01/09/2023] [Accepted: 01/18/2023] [Indexed: 03/08/2023]
Abstract
Serum adalimumab concentration is a biomarker of treatment response but therapeutic drug monitoring (TDM) is yet to be implemented in routine psoriasis care. We incorporated adalimumab TDM in a national specialized psoriasis service and evaluated it using the RE-AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance) implementation science framework. We undertook pre-implementation planning (validating local assays) and implementation interventions targeted to patients (pragmatic sampling at routine reviews), clinicians (introduction of a TDM protocol), and healthcare systems (adalimumab TDM as a key performance indicator). Over 5 months, 170 of 229 (74%) individuals treated with adalimumab received TDM. Clinical improvement after TDM-guided dose escalation occurred in 13 of 15 (87%) nonresponders with serum drug concentrations <8.3 μg/ml (median PASI reduction of 3.2 [interquartile range = 2.2-8.2] after 23.4 weeks) and in all nonresponders who had TDM-guided switch in biologic due to supratherapeutic drug concentrations (>8.3 μg/ml; n = 2) or positive antidrug antibody (n = 2) (PASI reduction of 7.8 [interquartile range = 7.5-12.9] after 20.0 weeks). Proactive TDM led to dose reduction in five individuals with clear skin and subtherapeutic or supratherapeutic drug concentrations; four (80%) sustained clear skin after 50 weeks (range = 42-52). Adalimumab TDM based on pragmatic serum sampling is clinically viable and may lead to patient benefit. Context-specific implementation interventions and systematic implementation assessment may bridge the biomarker research-to-practice gap.
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Affiliation(s)
- Antony Raharja
- St John's Institute of Dermatology, Guy's and St Thomas' NHS Foundation Trust and King's College London, London, United Kingdom
| | - Zehra Arkir
- Reference Chemistry, Synnovis, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Giulia Rinaldi
- St John's Institute of Dermatology, Guy's and St Thomas' NHS Foundation Trust and King's College London, London, United Kingdom
| | - Teresa Tsakok
- St John's Institute of Dermatology, Guy's and St Thomas' NHS Foundation Trust and King's College London, London, United Kingdom
| | - Tejus Dasandi
- St John's Institute of Dermatology, Guy's and St Thomas' NHS Foundation Trust and King's College London, London, United Kingdom
| | - Sarah Guard
- St John's Institute of Dermatology, Guy's and St Thomas' NHS Foundation Trust and King's College London, London, United Kingdom
| | - Arlene McGuire
- St John's Institute of Dermatology, Guy's and St Thomas' NHS Foundation Trust and King's College London, London, United Kingdom
| | - Andrew E Pink
- St John's Institute of Dermatology, Guy's and St Thomas' NHS Foundation Trust and King's College London, London, United Kingdom
| | - Richard Woolf
- St John's Institute of Dermatology, Guy's and St Thomas' NHS Foundation Trust and King's College London, London, United Kingdom
| | - Jonathan N Barker
- St John's Institute of Dermatology, Guy's and St Thomas' NHS Foundation Trust and King's College London, London, United Kingdom
| | - Catherine H Smith
- St John's Institute of Dermatology, Guy's and St Thomas' NHS Foundation Trust and King's College London, London, United Kingdom
| | - Satveer K Mahil
- St John's Institute of Dermatology, Guy's and St Thomas' NHS Foundation Trust and King's College London, London, United Kingdom.
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7
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Spekhorst LS, Boesjes CM, Loman L, Zuithoff NPA, Bakker DS, Kamphuis E, Kamsteeg M, Haeck IM, Oosting AJ, van Lumig PPM, van Lynden-van Nes AMT, Tupker RA, Flinterman A, Garritsen FM, Touwslager WRH, de Bruin-Weller MS, Schuttelaar MLA, de Graaf M. Successful tapering of dupilumab in patients with atopic dermatitis with low disease activity: a large pragmatic daily practice study from the BioDay registry. Br J Dermatol 2023; 189:327-335. [PMID: 37177895 DOI: 10.1093/bjd/ljad159] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 04/05/2023] [Accepted: 05/06/2023] [Indexed: 05/15/2023]
Abstract
BACKGROUND Limited data are available regarding patient-centred dosing of dupilumab for atopic dermatitis (AD) in daily practice. OBJECTIVES To evaluate our patient-centred dupilumab dosing regimen in daily practice, to assess prognostic factors for successful tapering and to estimate medication-related cost savings. METHODS This prospective multicentre study included adult patients with AD, participating in the BioDay registry, treated with dupilumab for ≥ 1.3 years. Interval prolongation was considered in the case of dupilumab standard dose for ≥ 1 year and persistent controlled AD [Eczema Area and Severity Index (EASI) ≤ 7; ≥ 6 months]. Primary endpoints were the mean EASI and Numeric Rating Scale (NRS)-pruritus after the start of tapering. Prognostic factors for successful tapering were analysed with logistic regression and a cost-savings analysis was performed. RESULTS A total of 595 patients were included, of whom 401 patients [mean EASI 2.5 (SD 2.3); NRS-pruritus of 2.4 (SD 1.9) at the start of tapering] prolonged their dupilumab interval. In 83.3% of these patients tapering was successful; most patients used dupilumab every 3 or 4 weeks (Q3W/Q4W). A significant small increase was observed for EASI (highest mean 3.5) and NRS-pruritus (highest mean 3.2) (P < 0.001); however, scores remained low. Predicting successful tapering showed nonsignificant odds ratios for all incorporated variables. The estimated cost savings was €3 977 033.98 for 401 patients between January 2019 and June 2022. CONCLUSIONS This study showed successful tapering of dupilumab in 83.3% of patients with AD who attempted tapering, while maintaining controlled disease and with the majority using Q3W/Q4W. Interval prolongation can be beneficial both for the patient and from a socio-economic perspective.
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Affiliation(s)
- Lotte S Spekhorst
- National Expertise Center for Atopic Dermatitis, Department of Dermatology and Allergology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Celeste M Boesjes
- National Expertise Center for Atopic Dermatitis, Department of Dermatology and Allergology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Laura Loman
- Department of Dermatology, University Medical Center Groningen, Groningen, the Netherlands
| | - Nicolaas P A Zuithoff
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Daphne S Bakker
- National Expertise Center for Atopic Dermatitis, Department of Dermatology and Allergology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Esmé Kamphuis
- Department of Dermatology, University Medical Center Groningen, Groningen, the Netherlands
| | - Marijke Kamsteeg
- Department of Dermatology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Inge M Haeck
- Department of Dermatology, Reinier de Graaf Hospital, Delft, the Netherlands
| | - Albert J Oosting
- Department of Dermatology, Spaarne Gasthuis, Hoofddorp, the Netherlands
| | - Paula P M van Lumig
- Department of Dermatology, University Medical Center Maastricht, Maastricht, the Netherlands
| | | | - Ron A Tupker
- Department of Dermatology, St Antonius Hospital, Nieuwegein, the Netherlands
| | | | | | | | - Marjolein S de Bruin-Weller
- National Expertise Center for Atopic Dermatitis, Department of Dermatology and Allergology, University Medical Center Utrecht, Utrecht, the Netherlands
| | | | - Marlies de Graaf
- National Expertise Center for Atopic Dermatitis, Department of Dermatology and Allergology, University Medical Center Utrecht, Utrecht, the Netherlands
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8
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van der Schoot LS, Verhoef LM, van Ee I, van Oort FPAH, Pieterse AH, Seyger MMB, de Jong EMGJ, van den Reek JMPA. Patients' perspectives towards biologic dose reduction in psoriasis: a qualitative study. Arch Dermatol Res 2023; 315:1735-1745. [PMID: 36813868 PMCID: PMC10338615 DOI: 10.1007/s00403-023-02566-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 11/22/2022] [Accepted: 02/01/2023] [Indexed: 02/24/2023]
Abstract
Dose reduction of biologics for psoriasis could contribute to more efficient use of these expensive medicines. Evidence on opinions of patients with psoriasis regarding dose reduction is sparse. The objective of this study was therefore to explore patients' perspectives towards dose reduction of biologics for psoriasis. A qualitative study was conducted, comprising semi-structured interviews with 15 patients with psoriasis with different characteristics and treatment experiences. Interviews were analyzed by inductive thematic analysis. Perceived benefits of biologic dose reduction according to patients were minimizing medication use, lowering risks of adverse effects and lowering societal healthcare costs. Patients reported to have experienced a large impact of their psoriasis, and expressed concerns about loss of disease control due to dose reduction. Fast access to flare treatment and adequate monitoring of disease activity were among reported preconditions. According to patients, they should have confidence in dose reduction effects and should be willing to change their effective treatment. Moreover, addressing information needs and involvement in decision-making were deemed important among patients. In conclusion, addressing patients' concerns, fulfilling information needs, providing the possibility of resuming standard dose, and involving patients in decision-making are important according to patients with psoriasis when considering biologic dose reduction.
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Affiliation(s)
- L S van der Schoot
- Department of Dermatology, Radboud University Medical Center, Nijmegen, The Netherlands.
- Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands.
| | - L M Verhoef
- Department of Rheumatology, Sint Maartenskliniek, Nijmegen, The Netherlands
| | - I van Ee
- Psoriasispatiënten Nederland, Dutch National Psoriasis Patient Association, Nijkerk, The Netherlands
| | - F P A H van Oort
- Psoriasispatiënten Nederland, Dutch National Psoriasis Patient Association, Nijkerk, The Netherlands
| | - A H Pieterse
- Psoriasispatiënten Nederland, Dutch National Psoriasis Patient Association, Nijkerk, The Netherlands
| | - M M B Seyger
- Department of Dermatology, Radboud University Medical Center, Nijmegen, The Netherlands
- Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - E M G J de Jong
- Department of Dermatology, Radboud University Medical Center, Nijmegen, The Netherlands
- Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
- Radboud University, Nijmegen, The Netherlands
| | - J M P A van den Reek
- Department of Dermatology, Radboud University Medical Center, Nijmegen, The Netherlands
- Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
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9
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Chen ML, Nopsopon T, Akenroye A. Incidence of Anti-Drug Antibodies to Monoclonal Antibodies in Asthma: A Systematic Review and Meta-Analysis. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2023; 11:1475-1484.e20. [PMID: 36716995 PMCID: PMC10601343 DOI: 10.1016/j.jaip.2022.12.046] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 12/23/2022] [Accepted: 12/30/2022] [Indexed: 01/29/2023]
Abstract
BACKGROUND Antidrug antibodies (ADAs) may worsen the efficacy and safety of biologics. However, little is known about the incidence of ADAs associated with the 6 biologics approved for the treatment of asthma in the United States. OBJECTIVE To elucidate the incidence of ADAs and their impact on reported clinical outcomes. METHODS Systematic review and meta-analyses of randomized controlled trials, open-label extension studies, and nonrandomized studies of biologics in patients with asthma indexed in PubMed, Embase, and CENTRAL between January 1, 2000, and July 9, 2022, were carried out. The primary outcomes were treatment-emergent ADAs (incidence) and ADA prevalence. RESULTS A total of 46 studies met the eligibility criteria. ADA incidence over follow-up was 2.91% (95% CI, 1.60-4.55) and was highest in the benralizumab studies (8.35%), with a risk ratio of 4.9 (2.69-8.92) when compared with placebo, and lowest in the omalizumab studies (0.00%). Incidence was 7.61% in the dupilumab studies, 4.39% in reslizumab, 3.63% in mepolizumab, and 1.12% in the tezepelumab studies. Incidence of neutralizing antibodies was 0.00% to 10.74% and was highest for benralizumab (7.12%). Incidence of neutralizing antibodies was higher in the benralizumab every 8 weeks (8.17%) versus every 4 weeks arms (5.81%). Results were consistent in subgroup analyses by study type and length of follow-up. CONCLUSIONS Approximately 2.9% of individuals in the included studies developed ADAs over study follow-up period. The incidence was highest in the benralizumab group and lowest in the omalizumab group. The subcutaneous route and longer dosing intervals were associated with higher ADA development.
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Affiliation(s)
- Ming-Li Chen
- Harvard T.H. Chan School of Public Health, Boston, Mass; Chung Shan Medical University, Taichung, Taiwan
| | - Tanawin Nopsopon
- Division of Allergy and Clinical Immunology, Brigham and Women's Hospital, Boston, Mass; Chulalongkorn University, Bangkok, Thailand
| | - Ayobami Akenroye
- Division of Allergy and Clinical Immunology, Brigham and Women's Hospital, Boston, Mass; Channing Division of Network Medicine, Brigham and Women's Hospital, Boston, Mass; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Md.
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10
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Long V, Choi E. Comment on "Risk of rebound psoriasis flare from systemic corticosteroid use in patients with psoriasis: A retrospective cohort study". J Am Acad Dermatol 2023; 88:e173-e174. [PMID: 36739901 DOI: 10.1016/j.jaad.2023.01.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Accepted: 01/24/2023] [Indexed: 02/05/2023]
Affiliation(s)
- Valencia Long
- Division of Dermatology, Department of Medicine, National University Hospital, Singapore, Singapore
| | - Ellie Choi
- Division of Dermatology, Department of Medicine, National University Hospital, Singapore, Singapore.
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11
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Aubert H, Arlegui H, De Rycke Y, Bachelez H, Beylot-Barry M, Dupuy A, Joly P, Jullien D, Mahé E, Paul C, Richard MA, Sbidian E, Viguier M, Chosidow O, Tubach F, Bénéton N. Biologic tapering for patients with psoriasis with low disease activity: data from the French PsoBioTeq Registry. Br J Dermatol 2023; 188:150-152. [PMID: 36689510 DOI: 10.1093/bjd/ljac024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Revised: 09/10/2022] [Accepted: 09/24/2022] [Indexed: 01/22/2023]
Abstract
Dose tapering strategies with biologics in psoriasis may lower the treatment burden over time, while enabling high therapeutic response maintenance in patients benefiting from them. Our results should contribute to developing clinical guidelines to fill the current gap in knowledge on this promising therapeutic approach
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Affiliation(s)
- Helene Aubert
- Dermatology Department, Nantes University Hospital, 1, place Alexis-Ricordeau, Nantes, France
| | - Hugo Arlegui
- Assistance Publique-Hôpitaux de Paris (APHP), INSERM, Hôpital Pitié-Salpêtrière, Centre de Pharmacoépidémiologie (Cephepi), CIC-1901, Paris, France
| | - Yann De Rycke
- Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, APHP, Hôpital Pitié-Salpêtrière, Département de Santé Publique, Centre de Pharmacoépidémiologie (Cephepi), CIC-1901, Paris, France
| | - Herve Bachelez
- Dermatology Department, Saint-Louis Hospital, APHP, Paris, France
| | | | - Alain Dupuy
- Univ Rennes, CHU Rennes, Service de Dermatologie, Rennes, France
| | - Pascal Joly
- Dermatology Department, Rouen University Hospital, Rouen, France
| | | | - Emmanuel Mahé
- Dermatology Department, Victor-Dupouy Hospital, Argenteuil, France
| | - Carle Paul
- Dermatology Department, Toulouse University and CHU, Toulouse, France
| | | | - Emilie Sbidian
- Dermatology Department, Henri-Mondor University Hospital, APHP, Creteil, France
| | - Manuelle Viguier
- Dermatology Department, Reims University Hospital, Reims, France
| | - Olivier Chosidow
- Dermatology Department, Henri-Mondor University Hospital, APHP, Creteil, France
| | - Florence Tubach
- Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, APHP, Hôpital Pitié-Salpêtrière, Département de Santé Publique, Centre de Pharmacoépidémiologie (Cephepi), CIC-1901, Paris, France
| | - Nathalie Bénéton
- Dermatology Department, Le Mans Hospital, 194, av Rubillard, 72000 Le Mans, France
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12
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van der Schoot LS, Baerveldt EM, van Enst WA, Menting SP, Seyger MMB, Wanders SL, van Ee I, Pieterse AH, van den Reek JMPA, de Jong EMGJ. National consensus on biologic dose reduction in psoriasis: a modified eDelphi procedure. J DERMATOL TREAT 2022; 34:2154570. [PMID: 36472386 DOI: 10.1080/09546634.2022.2154570] [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: 10/24/2022] [Accepted: 11/29/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND Dose reduction of biologics for psoriasis is applied in daily practice, although guidelines are lacking. Striving for clear criteria is important, as it leads to a consistent application of dose reduction. OBJECTIVE To achieve consensus on criteria for biologic dose reduction in psoriasis patients with stable and low disease activity. METHODS An online Delphi procedure (eDelphi) was conducted. Dutch dermatologists were invited to participate in a maximum of 3 voting rounds. Proposed statements were selected based on literature review and included criteria for the application of dose reduction and dosing schedules. Biologic dose reduction was defined as 'application of injection interval prolongation'. Proposed statements were rated using a 9-point Likert scale; consensus was reached when ≥70% of all voters rated 'agree' (7-9) and <15% rated 'disagree' (1-3). RESULTS A total of 27 dermatologists participated and reached a consensus on 15 recommendations over 2 voting rounds. Agreed statements included criteria for dose reduction eligibility, criteria for dose reduction (dis)continuation, and dosing schedules for adalimumab, etanercept, and ustekinumab. Based on the eDelphi outcomes, an algorithm fit for implementation in current practice was developed. CONCLUSIONS Recommendations of this national consensus process can guide clinicians, and consequently their patients, toward consistent application of biologic dose reduction.
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Affiliation(s)
- L S van der Schoot
- Department of Dermatology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - E M Baerveldt
- Department of Dermatology, IJsselland Ziekenhuis, Capelle aan den IJssel, the Netherlands
| | - W A van Enst
- Dutch Association for Dermatology and Venereology, Utrecht, the Netherlands
| | - S P Menting
- Department of Dermatology, OLVG, Amsterdam, the Netherlands
| | - M M B Seyger
- Department of Dermatology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - S L Wanders
- Dutch Association for Dermatology and Venereology, Utrecht, the Netherlands
| | - I van Ee
- Psoriasispatiënten Nederland, Dutch National Psoriasis Patient Association, Nijkerk, the Netherlands
| | - A H Pieterse
- Psoriasispatiënten Nederland, Dutch National Psoriasis Patient Association, Nijkerk, the Netherlands
| | - J M P A van den Reek
- Department of Dermatology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - E M G J de Jong
- Department of Dermatology, Radboud University Medical Center, Nijmegen, the Netherlands
- Radboud University, Nijmegen, the Netherlands
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13
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van der Schoot LS, Atalay S, Otero ME, Kievit W, van den Reek JMPA, de Jong EMGJ. Regaining adequate treatment responses in patients with psoriasis who discontinued dose reduction of adalimumab, etanercept or ustekinumab. Br J Dermatol 2022; 187:1028-1030. [PMID: 35895852 PMCID: PMC10087531 DOI: 10.1111/bjd.21797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Revised: 07/26/2022] [Accepted: 07/26/2022] [Indexed: 12/24/2022]
Affiliation(s)
- Lara S van der Schoot
- Department of Dermatology, Radboud University Medical Center, Nijmegen, the Netherlands.,Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Selma Atalay
- Department of Dermatology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Marisol E Otero
- Department of Dermatology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Wietske Kievit
- Department for Health Evidence, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Juul M P A van den Reek
- Department of Dermatology, Radboud University Medical Center, Nijmegen, the Netherlands.,Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Elke M G J de Jong
- Department of Dermatology, Radboud University Medical Center, Nijmegen, the Netherlands.,Radboud University, Nijmegen, the Netherlands
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14
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Felix PAO, Sampaio AL, Silva BL, Viana ALP. Early intervention in psoriasis: Where do we go from here? Front Med (Lausanne) 2022; 9:1027347. [PMID: 36530901 PMCID: PMC9751903 DOI: 10.3389/fmed.2022.1027347] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Accepted: 11/16/2022] [Indexed: 04/16/2024] Open
Abstract
Patients with psoriasis often have comorbidities and are at increased risk of developing several complications compared with the general population. Knowledge on the role of immune mediators and systemic inflammation in psoriasis has led to the hypothesis that early intervention with systemic therapy has the potential to modify the course of the disease and reduce the risk of long-term adverse outcomes. In this article, we address some potential issues that need to be considered before early intervention can be implemented routinely. The first is determining what constitutes "early" intervention for psoriasis. A second point is whether the intervention should be considered for patients with early disease or for selected subsets based on risk stratification. A third important consideration is defining success for early intervention. Finally, adoption of early and effective intervention should be based on high-level evidence. Ideally, randomized trials would be the best strategy to compare early vs. late systemic treatment in patients with psoriasis, probably using the frequency of long-term outcomes as primary endpoint, with cutaneous and pharmacoeconomic outcomes assessed secondarily.
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Affiliation(s)
| | - Ana Luisa Sampaio
- Dermatology Department, Hospital Universitário Pedro Ernesto, Rio de Janeiro State University, Rio de Janeiro, Brazil
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15
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Spekhorst LS, Bakker D, Drylewicz J, Rispens T, Loeff F, Boesjes CM, Thijs J, Romeijn GLE, Loman L, Schuttelaar ML, van Wijk F, de Graaf M, de Bruin-Weller MS. Patient-centered dupilumab dosing regimen leads to successful dose reduction in persistently controlled atopic dermatitis. Allergy 2022; 77:3398-3407. [PMID: 35837880 DOI: 10.1111/all.15439] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Revised: 06/14/2022] [Accepted: 06/19/2022] [Indexed: 01/28/2023]
Abstract
BACKGROUND At present, no real-world studies are available on different dupilumab dosing regimens in controlled atopic dermatitis (AD). The aim of this study was to clinically evaluate a patient-centered dupilumab dosing regimen in patients with controlled AD and to relate this to serum drug levels and serum biomarkers. METHODS Ninety adult AD patients from the prospective BioDay registry were included based on their dupilumab administration interval according to a predefined patient-centered dosing regimen. Group A (n = 30) did not fulfill the criteria for interval prolongation and continued using the standard dupilumab dosage (300 mg/2 weeks), group B (n = 30) prolonged dupilumab interval with 50% (300 mg/4 weeks), and group C (n = 30) prolonged dupilumab interval with 66%-75% (300 mg/6-8 weeks). AD severity score, patient-reported outcomes, serum dupilumab levels, and serum biomarkers were analyzed over time. RESULTS Disease severity scores did not significantly change over time during the tapering period in any of the groups. In groups B and C, the Numeric Rating Scale (NRS)-pruritus temporarily significantly increased after interval prolongation but remained low (median NRS-pruritus≤4). Median dupilumab levels remained stable in group A (standard dosage), but significantly decreased in groups B and C (24.1 mg/L (IQR = 17.1-45.6); 12.5 mg/L (IQR = 1.7-22.3)) compared with the levels during the standard dosage (88.2 mg/L [IQR = 67.1-123.0, p < .001]). Disease severity biomarker levels (CCL17/CCL18) remained low in all study groups during the whole observation period. CONCLUSIONS This study showed that dose reduction was successful in a subgroup of patients with controlled AD by using a patient-centered dosing regimen. These patients showed stable low disease activity and low severity biomarkers over time.
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Affiliation(s)
- Lotte S Spekhorst
- Department of Dermatology and Allergology, National Expertise Center for Atopic Dermatitis, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Daphne Bakker
- Department of Dermatology and Allergology, National Expertise Center for Atopic Dermatitis, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Julia Drylewicz
- Division Laboratories, Pharmacy and Biomedical Genetics, Center for Translational Immunology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Theo Rispens
- Department of Immunopathology, Sanquin Research, and Landsteiner Laboratory, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Floris Loeff
- Sanquin Diagnostic Services, Sanquin, Amsterdam, The Netherlands
| | - Celeste M Boesjes
- Department of Dermatology and Allergology, National Expertise Center for Atopic Dermatitis, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Judith Thijs
- Department of Dermatology and Allergology, National Expertise Center for Atopic Dermatitis, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Geertruida L E Romeijn
- Department of Dermatology, University Medical Center Groningen, Groningen, The Netherlands
| | - Laura Loman
- Department of Dermatology, University Medical Center Groningen, Groningen, The Netherlands
| | | | - Femke van Wijk
- Division Laboratories, Pharmacy and Biomedical Genetics, Center for Translational Immunology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Marlies de Graaf
- Department of Dermatology and Allergology, National Expertise Center for Atopic Dermatitis, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Marjolein S de Bruin-Weller
- Department of Dermatology and Allergology, National Expertise Center for Atopic Dermatitis, University Medical Center Utrecht, Utrecht, The Netherlands
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16
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van de Kerkhof PCM. Creating room for innovation in the treatment of psoriasis. J DERMATOL TREAT 2022; 33:2885. [PMID: 36258307 DOI: 10.1080/09546634.2022.2138396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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17
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Long-Term Dose Optimization of Adalimumab via Dose Spacing in Patients with Psoriasis. Bioengineering (Basel) 2022; 9:bioengineering9080387. [PMID: 36004912 PMCID: PMC9405054 DOI: 10.3390/bioengineering9080387] [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: 07/20/2022] [Revised: 08/09/2022] [Accepted: 08/12/2022] [Indexed: 11/24/2022] Open
Abstract
Dose spacing (DS) can be useful for optimizing treatment with biologics in psoriasis patients. However, interval prolongation might increase the production of anti-drug antibodies (ADA) and, therefore, reduce the drug’s effectiveness. The long-term effects of DS with adalimumab in psoriatic patients have not been reported. The goal of our study was to evaluate the long-term follow-up of psoriatic patients after adalimumab DS regarding the clinical course and determination of circulating adalimumab, TNFα levels, and anti-adalimumab antibodies. We retrospectively included seven patients treated with adalimumab for moderate-to-severe psoriasis and benefiting from DS from 2010 to 2021. The dose interval of adalimumab was extended to three weeks for all patients and then to four weeks for three of the seven patients. Adalimumab trough levels, TNFα levels, and ADA against adalimumab were measured. For six of the seven patients, absolute PASI values remained below 3 throughout the follow-up period (median = 8.0 years; range: 1.7−11.5) after DS. All the patients were satisfied with the effectiveness of their treatment regime. Within the follow-up period, an average of 63 doses of adalimumab per patient were spared. The median adalimumab trough levels were 4.7 µg/mL (range: 1.9−12.5). TNFα levels remained under 10 pg/mL (undetectable) in all except one patient. ADA against adalimumab remained negative (<10 µg/mL) during the follow-up in all patients. Our data indicate that therapeutic drug monitoring, including the measurement of trough concentrations and ADA, together with the clinical response and patient’s preference, can be helpful for clinical decision making and treatment optimization in psoriasis.
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18
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Michielsens CA, den Broeder N, van den Hoogen FH, Mahler EA, Teerenstra S, van der Heijde D, Verhoef LM, den Broeder AA. Treat-to-target dose reduction and withdrawal strategy of TNF inhibitors in psoriatic arthritis and axial spondyloarthritis: a randomised controlled non-inferiority trial. Ann Rheum Dis 2022; 81:1392-1399. [PMID: 35701155 DOI: 10.1136/annrheumdis-2022-222260] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Accepted: 05/30/2022] [Indexed: 11/04/2022]
Abstract
OBJECTIVES Tumour necrosis factor inhibitors (TNFi) are effective in psoriatic arthritis (PsA) and axial spondyloarthritis (axSpA), but are associated with a small (0.6%) increase in serious infection risk, patient burden due to need for self-injection and high costs. Treat-to-target (T2T) tapering might ameliorate these drawbacks, but high-quality evidence on T2T tapering strategies is lacking in PsA and axSpA. METHODS We performed a pragmatic open-label, monocentre, randomised controlled non-inferiority (NI) trial on T2T tapering of TNFi. Patients with PsA and axSpA using a TNFi with ≥6 months stable low disease activity (LDA) were included. Patients were randomised 2:1 to disease activity-guided T2T with or without tapering until withdrawal and followed-up to 12 months. Primary endpoint was the difference in proportion of patients having LDA at 12 months between groups, compared with a prespecified NI margin of 20%, estimated using a Bayesian prior. RESULTS 122 patients (64 PsA and 58 axSpA) were randomised to a T2T strategy with (N=81) or without tapering (N=41). The proportion of patients in LDA at 12 months was 69% for the tapering and 73% for the no-tapering group: adjusted difference 5% (Bayesian 95% credible interval: -10% to 19%) which confirms NI considering the NI margin of 20%. The mean percentage of daily defined dose was 53% for the tapering and 91% for the no-tapering group at month 12. CONCLUSIONS A T2T TNFi strategy with tapering attempt is non-inferior to a T2T strategy without tapering with regard to the proportion of patients still in LDA at 12 months, and results in a substantial reduction of TNFi use. TRIAL REGISTRATION NUMBER NL 6771.
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Affiliation(s)
- Celia Aj Michielsens
- Rheumatology, Sint Maartenskliniek, Nijmegen, Gelderland, The Netherlands .,Department of Rheumatic Diseases, Radboudumc Radboud Institute for Health Sciences, Nijmegen, Gelderland, The Netherlands
| | - Nathan den Broeder
- Rheumatology, Sint Maartenskliniek, Nijmegen, Gelderland, The Netherlands.,Department of Rheumatic Diseases, Radboudumc Radboud Institute for Health Sciences, Nijmegen, Gelderland, The Netherlands
| | | | - Elien Am Mahler
- Rheumatology, Sint Maartenskliniek, Nijmegen, Gelderland, The Netherlands
| | - Steven Teerenstra
- Radboud Institute for Health Sciences, Department for Health Evidence, group Biostatistics, Radboudumc, Nijmegen, Gelderland, The Netherlands
| | | | - Lise M Verhoef
- Rheumatology, Sint Maartenskliniek, Nijmegen, Gelderland, The Netherlands
| | - Alfons A den Broeder
- Rheumatology, Sint Maartenskliniek, Nijmegen, Gelderland, The Netherlands.,Department of Rheumatic Diseases, Radboudumc Radboud Institute for Health Sciences, Nijmegen, Gelderland, The Netherlands
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19
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De-escalation of Anti-tumor Necrosis Factor Alpha Agents and Reduction in Adverse Effects: A Systematic Review. Biomedicines 2022; 10:biomedicines10051034. [PMID: 35625771 PMCID: PMC9139158 DOI: 10.3390/biomedicines10051034] [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: 03/26/2022] [Revised: 04/20/2022] [Accepted: 04/27/2022] [Indexed: 12/04/2022] Open
Abstract
Background: The long-term use of anti-TNF-α agents can lead to adverse effects, such as infections and immune-mediated cutaneous reactions. Whether de-escalation by dose reduction or interval lengthening reduces these adverse effects is uncertain. This systematic review aims to compare the incidence of infections and skin manifestations after anti-TNF-α dose de-escalation with standard dosing. Methods: MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials were searched from inception to 14 January 2022. Randomized controlled trials (RCTs) and observational studies comparing anti-TNF-α de-escalation strategies with standard dosing among patients with inflammatory conditions, that report on infections, skin manifestations, or both, were included. The risk of bias was assessed with the revised Cochrane risk-of bias tool (RCTs) or the Newcastle–Ottawa scale (non-RCTs). Results: Fourteen RCTs and six observational studies (or 2706 patients) were included. Eight RCTs had low risk of bias or some concerns. Four non-RCTs were of good methodological quality. The studies described patients with axial spondyloarthritis (8 studies, 780 patients), rheumatoid arthritis (7 studies, 1458 patients), psoriasis (3 studies, 332 patients), or inflammatory bowel disease (2 studies, 136 patients). De-escalation strategies included interval lengthening (12 studies, 1317 patients), dose reduction (6 studies, 1130 patients), or both (2 studies, 259 patients). Overall, the occurrence of infections and skin manifestations did not differ between standard treatment and de-escalation. The disappearance of infections or skin manifestations after de-escalation was only reported in two studies. The majority of studies focused on etanercept and adalimumab. Heterogeneity in reporting of infections and skin manifestations precluded meta-analysis. Conclusion: We found that anti-TNF-α de-escalation does not reduce infections or skin reactions. A de-escalation strategy should not be recommended for the sole purpose of reducing drug-related adverse effects. The meticulous documentation of adverse effects is recommended to further address this question. Registration: PROSPERO CRD42021252977.
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20
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Atalay S, Berends SE, Groenewoud HMM, Mathot RAA, Njoo DM, Mommers JM, Ossenkoppele PM, Koetsier MIA, Berends MA, de Vries A, van de Kerkhof PCM, den Broeder AA, de Jong EMGJ, van den Reek JMPA. Serum drug levels and anti-drug antibodies in the context of dose tapering by interval prolongation of adalimumab, etanercept and ustekinumab in psoriasis patients: results of the CONDOR trial. J DERMATOL TREAT 2022; 33:2680-2684. [PMID: 35193441 DOI: 10.1080/09546634.2022.2043546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND Biologics for psoriasis are registered in standard dosages. In patients with low disease activity, reduction of the dose by interval prolongation can prevent overtreatment, and lower risks and costs. However, fear for increased anti-drug antibody (ADA) formation due to interval prolongation of biologics is an important barrier. OBJECTIVE To investigate the course of serum drug concentrations, ADA levels, and predictors for successful dose reduction of adalimumab, ustekinumab, and etanercept for psoriasis. METHODS Patients were randomized to dose reduction (DR) or usual care (UC) and followed for one year. The course and extent of detectable ADA levels were expressed as proportions/relative risks for DR vs. UC. Association of baseline characteristics with successful tapering was investigated with log-binomial regression analysis. RESULTS In total, 118 patients were included. In adalimumab-treated patients, no significant difference in the proportion of patients with relevant ADA levels in DR vs. UC was seen. For ustekinumab, relevant ADA development was absent in both groups. Baseline trough levels were not predictive for successful DR. CONCLUSIONS Immunogenicity may not increase by interval prolongation in psoriasis patients with low disease activity. This pilot provides important and reassuring insight into the pharmacological changes after dose tapering of adalimumab, etanercept, and ustekinumab.
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Affiliation(s)
- Selma Atalay
- Department of Dermatology, Radboudumc, Nijmegen René Descartesdreef 1, Nijmegen, Netherlands
| | - Sophie E Berends
- Department of Hospital Pharmacy, Academic Medical Center, Amsterdam, Netherlands
| | - Hans M M Groenewoud
- Department for Health Evidence, Radboud Institute for Health Sciences, Radboudumc, Nijmegen, Netherlands
| | - Ron A A Mathot
- Department of Hospital Pharmacy, Academic Medical Center, Amsterdam, Netherlands
| | - David M Njoo
- Department of Dermatology, Ziekenhuis Groep Twente, Hengelo, Netherlands
| | | | | | | | - Maartje A Berends
- Department of Dermatology, Slingelandziekenhuis, Doetinchem, Netherlands
| | - Annick de Vries
- Biologics Lab, Bioanalysis, Sanquin Diagnostic Services, Amsterdam, Netherlands
| | | | | | - Elke M G J de Jong
- Department of Dermatology, Radboudumc, Nijmegen René Descartesdreef 1, Nijmegen, Netherlands.,Radboud University, Nijmegen, Netherlands
| | - Juul M P A van den Reek
- Department of Dermatology, Radboudumc, Nijmegen René Descartesdreef 1, Nijmegen, Netherlands
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21
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Aubert H, Mahé E, Fougerousse AC, Maccari F, Beneton N. Dose spacing and reduction strategies in biotherapies for stable, clear or almost clear psoriasis: A survey of practices in France. Ann Dermatol Venereol 2021; 149:68-70. [PMID: 34887084 DOI: 10.1016/j.annder.2021.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 05/12/2021] [Accepted: 07/01/2021] [Indexed: 11/26/2022]
Affiliation(s)
- H Aubert
- Department of Dermatology, Centre Hospitalier Universitaire, 1, avenue Alexis-Ricordeau, 44000 Nantes, France.
| | - E Mahé
- Department of Dermatology, Hôpital Victor Dupouy, 69, rue du Lieutenant-Colonel Prud'hon, 95100 Argenteuil, France
| | - A-C Fougerousse
- Department of Dermatology, 69, Avenue de Paris, 94160 Saint-Mandé, France
| | | | - N Beneton
- Department of Dermatology, Centre Hospitalier, 194, Avenue Rubillard, 72037 Le Mans, France
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22
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van der Schoot LS, van den Reek JMPA, Grine L, Schots L, Kievit W, Lambert JLW, de Jong EMGJ. Dose reduction of the new generation biologics (IL-17 and IL-23 inhibitors) in psoriasis: study protocol for an international, pragmatic, multicenter, randomized, controlled, non-inferiority study-the BeNeBio study. Trials 2021; 22:707. [PMID: 34656148 PMCID: PMC8520290 DOI: 10.1186/s13063-021-05681-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Accepted: 10/04/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Psoriasis is a chronic immune-mediated inflammatory skin disease for which biologics are effective treatments. Dose reduction (DR) of the first generation biologics seems a promising way for more efficient use of expensive biologics. A substantial part of patients on tumor necrosis factor (TNF)-alfa inhibitors and ustekinumab could successfully lower their dose, after following a tightly controlled DR strategy. The objective of this study is to assess whether controlled DR of interleukin (IL)-17 and IL-23 inhibitors in psoriasis patients with low disease activity is non-inferior (NI) to usual care (UC). METHODS This is an international, prospective, multicenter, pragmatic, randomized, non-inferiority trial. A total of 244 patients with stable low disease activity (Psoriasis Area and Severity Index (PASI) ≤ 5) for at least 6 months and using secukinumab, ixekizumab, brodalumab, guselkumab, risankizumab, or tildrakizumab in the standard dose, together with stable low disease activity, defined as a PASI ≤ 5 and Dermatology Life Quality Index (DLQI) ≤ 5 at the moment of inclusion, will be randomized 2:1 to DR or UC. In the DR group, dosing intervals will be prolonged stepwise to achieve 66% and 50% of the original dose. Disease activity is monitored every 3 months by PASI and DLQI. In case of disease flare (i.e., PASI and/or DLQI increase), treatment is adjusted to the previous effective dose. The primary outcome is the incidence proportion of persistent flares (PASI > 5 for ≥ 3 months), which will be compared between arms. Secondary outcomes include proportion of patients with successful DR, (course of) PASI and DLQI, serious adverse events (SAEs), health-related quality of life, costs, and pharmacokinetic profile. Outcomes of DR will be compared to UC. DISCUSSION With this study, we aim to assess whether DR of IL-17 and IL-23 inhibiting biologics can be achieved for psoriasis patients with low disease activity, without losing disease control. Reducing the dose may lead to more efficient use of biologics. TRIAL REGISTRATION ClinicalTrials.gov NCT04340076 . Registered on April 9 2020.
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Affiliation(s)
- Lara S van der Schoot
- Radboud University Medical Center, Department of Dermatology, Rene Descartesdreef 1, 6525GL, Nijmegen, The Netherlands.,Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, The Netherlands
| | - Juul M P A van den Reek
- Radboud University Medical Center, Department of Dermatology, Rene Descartesdreef 1, 6525GL, Nijmegen, The Netherlands.,Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, The Netherlands
| | - Lynda Grine
- Department of Dermatology, Ghent University Hospital, C. Heymanslaan 10, 9000, Ghent, Belgium
| | - Lisa Schots
- Department of Dermatology, Ghent University Hospital, C. Heymanslaan 10, 9000, Ghent, Belgium
| | - Wietske Kievit
- Radboud University Medical Center, Department for Health Evidence, Geert Grooteplein 21, 6525EZ, Nijmegen, The Netherlands
| | - Jo L W Lambert
- Department of Dermatology, Ghent University Hospital, C. Heymanslaan 10, 9000, Ghent, Belgium
| | - Elke M G J de Jong
- Radboud University Medical Center, Department of Dermatology, Rene Descartesdreef 1, 6525GL, Nijmegen, The Netherlands. .,Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, The Netherlands. .,Radboud University, Comeniuslaan 4, 6525HP, Nijmegen, The Netherlands.
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23
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van Muijen ME, van der Schoot LS, van den Reek JMPA, de Jong EMGJ. Attitudes and behaviour regarding dose reduction of biologics for psoriasis: a survey among dermatologists worldwide. Arch Dermatol Res 2021; 314:687-695. [PMID: 34467442 PMCID: PMC9307528 DOI: 10.1007/s00403-021-02273-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Revised: 08/11/2021] [Accepted: 08/20/2021] [Indexed: 01/23/2023]
Abstract
Dose reduction (DR) of biologics, where possible, seems promising for more efficient use of expensive biologics. For implementation of DR strategies, it is essential to get insight in factors that influence implementation. The objective of this study was to evaluate the attitudes and behaviour regarding dose reduction of biologic therapies for psoriasis among psoriasis expert dermatologists worldwide. A 27-question e-survey was sent through the International Psoriasis Council (IPC) to its 114 dermatologist councilors worldwide. The survey assessed demographics, general and DR prescription behaviour, and motivations for and barriers against application of DR. Of 57 respondents, 53 respondents who prescribed biologics were included for analysis. Thirty-seven (69.8%) applied DR (i.e., ‘DR dermatologists’), and 16 (30.2%) did not (i.e., ‘Non-DR dermatologists’). DR strategies varied among respondents. Regarding criteria for starting DR, differences were reported in required treatment duration, and interpretation and duration of stable low disease activity. In addition, the prolongation of intervals between injections varied between respondents. For most ‘DR dermatologists’ (n = 32/37, 86.5%), cost savings were one of the main reasons to apply DR. Fifteen out of 16 ‘Non-DR dermatologists’ (94%) did not apply DR due to lack of scientific evidence. In conclusion, DR of biologics for psoriasis is part of clinical practice in psoriasis experts globally. Barriers for applying DR included lack of evidence or guidelines, and uncertainty on DR effects and risks. Although growing evidence shows DR feasibility, future studies are needed to accumulate and broaden evidence, along with development of (inter)national guidelines on DR strategies.
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Affiliation(s)
- M E van Muijen
- Department of Dermatology, Radboud University Medical Center (Radboudumc), Nijmegen, The Netherlands
- Radboud Institute for Health Sciences (RIHS), Radboud University Medical Center (Radboudumc), Nijmegen, The Netherlands
| | - L S van der Schoot
- Department of Dermatology, Radboud University Medical Center (Radboudumc), Nijmegen, The Netherlands.
- Radboud Institute for Health Sciences (RIHS), Radboud University Medical Center (Radboudumc), Nijmegen, The Netherlands.
| | - J M P A van den Reek
- Department of Dermatology, Radboud University Medical Center (Radboudumc), Nijmegen, The Netherlands
- Radboud Institute for Health Sciences (RIHS), Radboud University Medical Center (Radboudumc), Nijmegen, The Netherlands
| | - E M G J de Jong
- Department of Dermatology, Radboud University Medical Center (Radboudumc), Nijmegen, The Netherlands
- Radboud Institute for Health Sciences (RIHS), Radboud University Medical Center (Radboudumc), Nijmegen, The Netherlands
- Radboud University, Nijmegen, The Netherlands
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24
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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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25
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Michielsens CAJ, van Muijen ME, Verhoef LM, van den Reek JMPA, de Jong EMGJ. Dose Tapering of Biologics in Patients with Psoriasis: A Scoping Review. Drugs 2021; 81:349-366. [PMID: 33453052 PMCID: PMC7952351 DOI: 10.1007/s40265-020-01448-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Introduction Biologics serve as a cornerstone in psoriasis treatment, with low disease activity or sometimes even clinical remission as a realistic treatment outcome. So far, it is unclear whether biologics should be tapered when this target is achieved. Dose tapering could offer potential benefits by decreasing side effects, the burden of repetitive injections and costs of biological therapy. However, clinical guidelines on dose tapering of biologicals in psoriasis patients are lacking. This scoping review was conducted to provide an overview of the current literature on dose tapering and offer guidance for clinicians in daily clinical practice. Methods Dose tapering is defined as the administration of a lower dose per administration, or the prolongation of the regular dose interval, after initial treatment according to the standard dosing. Four electronic databases (PubMed, EMBASE, Cochrane, and Web of Science) were systematically searched for literature on tapering of biologics in adult patients with psoriasis from 1 January 2000. Results We included 19 original articles on biologic tapering in psoriasis patients: four randomized controlled trials and 15 observational studies. Tapering eligibility criteria, tapering strategies, tapering outcomes, and recapture of response after relapse were assessed. Furthermore, the available evidence on possible predictors for successful tapering, and the effect of tapering on safety, quality of life and costs is summarized. The definition of low disease activity as a measure for tapering eligibility varied widely. Beside tapering criteria, tapering strategies were also heterogeneous. Of note, quality-of-life measurements were barely integrated in the evaluation of tapering outcomes. Literature on regaining response after relapse due to tapering was limited, but restored remission has been described. The included studies did not proclaim a significant effect of tapering on the occurrence of (severe) adverse events. Even though cost savings have been reported, no proper cost-effectiveness analysis has been conducted yet. Conclusion Biologic tapering seems to be effective and safe in psoriasis patients with stable low disease activity or clinical remission. Available data on biologic dose tapering in patients with psoriasis are promising, but more research is warranted to fill the current gaps in knowledge. Supplementary Information The online version contains supplementary material available at 10.1007/s40265-020-01448-z. Biologics are effective in treating psoriasis amongst other diseases, such as rheumatoid arthritis and Crohn’s disease. However, biologics are costly, and can cause side effects, such as an increased risk of infection. In patients with rheumatoid arthritis, it is not uncommon to lower the dose of these biologics (also called “dose tapering”), once stable low disease activity, or even remission, is reached. However, in psoriasis patients, dose tapering of biologics is not common practice. In this “scoping review,” we provide an overview of the available literature on dose tapering of biologics in adult patients with plaque psoriasis in order to address the current gaps in literature. We found 19 studies that addressed dose tapering. These studies used different criteria to determine which patients were eligible for tapering, which led to various interpretations of tapering success. This made it difficult for us to draw general conclusions on which tapering criteria and strategies should be further investigated. Dose tapering seems to be effective and safe in patients with a stable low disease activity, although more (high-quality) research is needed. Future studies should focus on generating more data on long-term safety, finding predictors for successful tapering, calculating the cost-effectiveness of dose tapering, and evaluating dose tapering in the newest generation of biologics.
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Affiliation(s)
- C A J Michielsens
- Radboud University Medical Center, Radboud Institute for Health Sciences, Mailbox 9101, 6500 HB, Nijmegen, The Netherlands. .,Department of Dermatology, Radboud University Medical Center, Nijmegen, The Netherlands. .,Department of Rheumatology, Sint Maartenskliniek, Ubbergen, The Netherlands.
| | - M E van Muijen
- Radboud University Medical Center, Radboud Institute for Health Sciences, Mailbox 9101, 6500 HB, Nijmegen, The Netherlands.,Department of Dermatology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - L M Verhoef
- Department of Rheumatology, Sint Maartenskliniek, Ubbergen, The Netherlands
| | - J M P A van den Reek
- Radboud University Medical Center, Radboud Institute for Health Sciences, Mailbox 9101, 6500 HB, Nijmegen, The Netherlands.,Department of Dermatology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - E M G J de Jong
- Radboud University Medical Center, Radboud Institute for Health Sciences, Mailbox 9101, 6500 HB, Nijmegen, The Netherlands.,Department of Dermatology, Radboud University Medical Center, Nijmegen, The Netherlands.,Radboud University, Nijmegen, The Netherlands
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26
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Atalay S, van den Reek JMPA, Groenewoud JMM, van de Kerkhof PCM, Kievit W, de Jong EMGJ. Two-year follow-up of a dose reduction strategy trial of biologics adalimumab, etanercept, and ustekinumab in psoriasis patients in daily practice. J DERMATOL TREAT 2021; 33:1591-1597. [PMID: 33356686 DOI: 10.1080/09546634.2020.1869147] [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] [Indexed: 10/22/2022]
Abstract
BACKGROUND/OBJECTIVES Tightly-controlled dose reduction was possible during 1 year in psoriasis patients on adalimumab, etanercept or ustekinumab with low disease activity (CONDOR trial). Extended observation is needed to ensure long-term effectiveness and safety of the strategy. With prolonged follow-up, we investigated the clinical effects and safety of the strategy, the proportion of patients with successful dose reduction, and assessed if patients with a disease flare regained remission. METHODS Two-year follow up of a subgroup of patients previously included in a randomized pragmatic study comparing usual care (UC) with stepwise dose reduction (DR). Effectiveness (Psoriasis Area and Severity Index, PASI), Dermatology Life Quality Index (DLQI), adverse events, proportion of patients with successful DR and proportion of persistent disease flares were analyzed. RESULTS DR leads temporarily to a slightly increased PASI groupwise, but on the long-term patients regained low PASI. DLQI scores remained stable during follow-up. No serious adverse events due to DR were reported. Forty-one percent of patients remained on a low dose up to 2 years. The number of persistent flares was low in DR and UC. CONCLUSIONS The proposed dose reduction strategy is effective for a significant part of patients and remains safe up to 2 years of follow-up.
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Affiliation(s)
- S Atalay
- Department of Dermatology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - J M P A van den Reek
- Department of Dermatology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - J M M Groenewoud
- Department for Health Evidence, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - P C M van de Kerkhof
- Department of Dermatology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - W Kievit
- Department for Health Evidence, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - E M G J de Jong
- Department of Dermatology, Radboud University Medical Center, Nijmegen, The Netherlands.,Radboud University, Nijmegen, The Netherlands
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27
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Quoi de neuf en thérapeutique dermatologique ? Ann Dermatol Venereol 2020; 147:12S43-12S50. [DOI: 10.1016/s0151-9638(20)31107-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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