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Carriera L, Caporuscio S, Fantò M, D'Abramo A, Puzio G, Triolo L, Coppola A. Combination treatment with monoclonal antibodies for the management of severe asthma and immune-mediated inflammatory diseases: a comprehensive review. Monaldi Arch Chest Dis 2024. [PMID: 39373458 DOI: 10.4081/monaldi.2024.3079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2024] [Accepted: 09/09/2024] [Indexed: 10/08/2024] Open
Abstract
Biological drugs have revolutionized the management of severe asthma, and a tailored treatment approach made it possible to consider remission as an achievable treatment target. The incidence of autoimmune diseases is increasing in many parts of the world. Patients suffering from severe asthma, eligible or already treated with an asthma-approved biologic agent, may suffer from another immune-mediated inflammatory disease (IMID) that could require the simultaneous use of a second monoclonal antibody. The real-life studies available in the literature describing the concurrent administration of an asthma-approved biologic agent with another biologic for a different immune disease, obtained through a systematic search on online databases based on monoclonal antibodies, were collected and analyzed. 26 articles were included in this review according to the prespecified inclusion and exclusion criteria. All included papers were retrospective in nature. Study designs were case reports (n=18), case series (n=3), retrospective chart reviews (n=3), retrospective observational studies (n=1), and cohort studies (n=1). The study is intended to present, within the current literature, all the administered combinations of severe asthma-approved biologics with monoclonal antibodies for a different indication. Those were grouped according to the IMID for whom the second biologic agent, with a different mechanism of action, was prescribed. The combinations prescribed to the cohort of patients specifically treating uncontrolled severe asthma were deeper evaluated in the discussion section, since an analysis of these therapeutic combinations deriving from real-life experiences may be useful to optimize the management of patients with severe asthma, ultimately leading to improved patient care and outcomes. Prospective registries and future studies are required to assess the safety and efficacy of combination therapies for severe asthmatic patients who suffer from an IMID.
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Affiliation(s)
- Lorenzo Carriera
- Faculty of Medicine and Surgery, Università Cattolica del Sacro Cuore, Rome.
| | - Sara Caporuscio
- Internal Medicine Complex Operational Unit, Ospedale San Filippo Neri, Local Health Unit Roma 1, Rome.
| | - Marta Fantò
- Casa di Cura Villa Benedetta, Villa Benedetta Group SRL, Rome.
| | - Alice D'Abramo
- Pulmonology Complex Operational Unit, Ospedale San Filippo Neri, ASL Roma 1, Rome.
| | - Genesio Puzio
- Pulmonology Complex Operational Unit, Ospedale San Filippo Neri, ASL Roma 1, Rome.
| | - Luca Triolo
- Pulmonology Complex Operational Unit, Ospedale San Filippo Neri, ASL Roma 1, Rome.
| | - Angelo Coppola
- Pulmonology Complex Operational Unit, Ospedale San Filippo Neri, ASL Roma 1, Rome; Saint Camillus International University of Health Sciences, Rome.
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Chen MKY, Flanagan AL, Sebaratnam DF, Gu Y. Biologics for inherited disorders of keratinisation: A systematic review. Australas J Dermatol 2024; 65:185-214. [PMID: 38126177 DOI: 10.1111/ajd.14197] [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: 10/12/2023] [Revised: 11/13/2023] [Accepted: 11/21/2023] [Indexed: 12/23/2023]
Abstract
BACKGROUND/OBJECTIVES Recent literature highlights the potential of biologics in the management of inherited disorders of keratinisation. In this study, we conducted a systematic review of existing literature on treatment outcomes of inherited keratinisation disorders treated with biologics. METHODS Eligible records were retrieved through searches of the electronic databases MEDLINE, Embase, PubMed and Scopus. Databases were searched from inception to July 2023 for eligible records. A snowballing method was employed to search the references of the retrieved records for the identification of potentially relevant articles. RESULTS One hundred and four eligible studies consisting of a total of 166 patients with an inherited disorder of keratinisation were included. Patients had a median age of 19 years (range: 0.5 to 70 years). The most common disorders were Netherton syndrome (n = 63; 38%), autosomal recessive congenital ichthyoses (n = 27; 16%), CARD14-associated papulosquamous eruptions (n = 17; 10%) and familial pityriasis rubra pilaris (PRP) (n = 15; 9%).Of the 207 times biologics were employed, the three most frequently employed biologics were secukinumab (n = 47; 23%), dupilumab (n = 44; 21%) and ustekinumab (n = 37; 18%). Complete remission was observed in 10 (5%) instances, partial remission in 129 (62%), no or limited response to biologic therapy in 68 (32%) cases, and results are still pending in one case. A total of 33 adverse events were reported. CONCLUSIONS Whilst biologics may be considered in cases of inherited keratinisation disorders recalcitrant to standard therapy, definitive conclusions are prohibited by the low-level of evidence and substantial heterogeneity in methodology across the included studies. Establishment of consensus definitions, and randomised clinical trials may help ascertain the efficacy and safety of biologic therapy in this context and establish the best agent and dosing protocol for each disorder.
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Affiliation(s)
- Michelle K Y Chen
- School of Clinical Medicine, UNSW Medicine & Health, Sydney, New South Wales, Australia
- Department of Dermatology, Liverpool Hospital, Liverpool, New South Wales, Australia
- Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
| | - Alice L Flanagan
- School of Clinical Medicine, UNSW Medicine & Health, Sydney, New South Wales, Australia
- Prince of Wales Hospital, Randwick, New South Wales, Australia
| | - Deshan F Sebaratnam
- School of Clinical Medicine, UNSW Medicine & Health, Sydney, New South Wales, Australia
- Department of Dermatology, Liverpool Hospital, Liverpool, New South Wales, Australia
| | - Yaron Gu
- School of Clinical Medicine, UNSW Medicine & Health, Sydney, New South Wales, Australia
- Department of Dermatology, Liverpool Hospital, Liverpool, New South Wales, Australia
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Lilly E, Bunick CG. Congenital Ichthyosis: A Practical Clinical Guide on Current Treatments and Future Perspectives. Clin Cosmet Investig Dermatol 2023; 16:2473-2479. [PMID: 37719935 PMCID: PMC10503504 DOI: 10.2147/ccid.s388608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Accepted: 08/29/2023] [Indexed: 09/19/2023]
Abstract
Congenital ichthyoses are a group of hereditary disorders of keratinization that are challenging to treat. Affected individuals suffer not only from thickening of the skin but also associated complications such as growth restriction, hearing and eye complications, infections, and thermodysregulation. This clinical review provides a practical roadmap to the longitudinal care of patients with ichthyosis with both general and age- and disease-specific recommendations. The allure of pathogenesis-based and targeted treatments for these monogenetic severe but orphan conditions shines bright as dermatological therapies enter a new era.
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Affiliation(s)
- Evelyn Lilly
- Department of Dermatology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, 02114, USA
| | - Christopher G Bunick
- Department of Dermatology and Program in Translational Biomedicine, Yale School of Medicine, New Haven, CT, 06520, USA
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Lefferdink R, Rangel SM, Chima M, Ibler E, Pavel AB, Kim H, Wu B, Abu-Zayed H, Wu J, Jackson K, Singer G, Choate KA, Guttman-Yassky E, Paller AS. Secukinumab responses vary across the spectrum of congenital ichthyosis in adults. Arch Dermatol Res 2023; 315:305-315. [PMID: 35218370 PMCID: PMC10234080 DOI: 10.1007/s00403-022-02325-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Revised: 01/17/2022] [Accepted: 01/20/2022] [Indexed: 01/18/2023]
Abstract
IMPORTANCE Treatment of congenital ichthyoses primarily focuses on reversing skin scaling and is not pathogenesis based. Recent studies showed Th17 immune skewing, as in psoriasis, across the spectrum of ichthyosis, suggesting that targeting this pathway might broadly reduce disease severity. OBJECTIVE To determine whether secukinumab, an IL-17A inhibitor, can improve ichthyosis across several congenital ichthyosis subtypes. DESIGN Exploratory 16-week double-blind, randomized, placebo-controlled trial comparing secukinumab 300 mg every 4wks to placebo (1:1 randomization) in adults with the four major congenital ichthyosis subtypes (NCT03041038), followed by a 16-week open-label phase to evaluate response of the placebo-first group and a 20-week extension for safety. Significant differences in secukinumab- vs. placebo-treated subjects at Wk16 in the Ichthyosis Area Severity Index (IASI) score and lack of increased mucocutaneous bacterial and/or fungal infections were the co-primary efficacy and safety endpoints, respectively. SETTING Two tertiary referral centers: Northwestern University Feinberg School of Medicine, Chicago, and Mount Sinai Icahn School of Medicine, New York. PARTICIPANTS Twenty subjects ≥ 18 yo with genotype-confirmed epidermolytic ichthyosis, Netherton syndrome, lamellar ichthyosis, or congenital ichthyosiform erythroderma with at least moderate erythroderma. RESULTS IL-17A inhibition did not significantly reduce severity or increase mucocutaneous infections among the 18 who completed the 16-week double-blind phase. Five patients with 29-50% clinical improvement at Wk32 requested drug continuation. Th17-related biomarkers were not significantly reduced vs. baseline or placebo-treated levels. LIMITATIONS Small sample size; heterogeneous ichthyosis subsets. CONCLUSION IL-17 inhibition with secukinumab is safe, but not efficacious across the spectrum of adult ichthyoses. CLINICALTRIALS GOV REGISTRATION NUMBER NCT03041038; first posted on 02/02/2017.
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Affiliation(s)
- Rachel Lefferdink
- Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Stephanie M Rangel
- Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Margot Chima
- Department of Dermatology, The Laboratory of Inflammatory Skin Diseases, Icahn School of Medicine at Mount Sinai Medical Center, New York, NY, USA
| | - Erin Ibler
- Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Ana B Pavel
- Department of Dermatology, The Laboratory of Inflammatory Skin Diseases, Icahn School of Medicine at Mount Sinai Medical Center, New York, NY, USA
- Department of Biomedical Engineering, University of Mississippi, University, Oxford, MS, USA
| | - HeeJin Kim
- Department of Dermatology, The Laboratory of Inflammatory Skin Diseases, Icahn School of Medicine at Mount Sinai Medical Center, New York, NY, USA
| | - Benedict Wu
- Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Hajar Abu-Zayed
- Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Jianni Wu
- Department of Dermatology, The Laboratory of Inflammatory Skin Diseases, Icahn School of Medicine at Mount Sinai Medical Center, New York, NY, USA
| | - Kathryn Jackson
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Giselle Singer
- Department of Dermatology, The Laboratory of Inflammatory Skin Diseases, Icahn School of Medicine at Mount Sinai Medical Center, New York, NY, USA
| | - Keith A Choate
- Departments of Dermatology, Genetics, and Pathology, Yale University School of Medicine, New Haven, CT, USA
| | - Emma Guttman-Yassky
- Department of Dermatology, The Laboratory of Inflammatory Skin Diseases, Icahn School of Medicine at Mount Sinai Medical Center, New York, NY, USA.
| | - Amy S Paller
- Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
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Critical Players and Therapeutic Targets in Chronic Itch. Int J Mol Sci 2022; 23:ijms23179935. [PMID: 36077340 PMCID: PMC9456029 DOI: 10.3390/ijms23179935] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Revised: 08/28/2022] [Accepted: 08/29/2022] [Indexed: 12/04/2022] Open
Abstract
Chronic itch is one of the most prominent clinical characteristics of diverse systematic diseases. It is a devastating sensation in pathological diseases. Despite its importance, there are no FDA-labelled drugs specifically geared toward chronic itch. The associated complex pathogenesis and diverse causes escalate chronic itch to being one of the top challenges in healthcare. Humanized antibodies against IL-13, IL-4, and IL-31 proved effective in treatment of itch-associated atopic dermatitis but remain to be validated in chronic itch. There are still no satisfactory anti-itch therapeutics available toward itch-related neuropeptides including GRP, BNP, SST, CGRP, and SP. The newly identified potential itch targets including OSM, NMB, glutamate, periostin, and Serpin E1 have opened new avenues for therapeutic development. Proof-of-principle studies have been successfully performed on antagonists against these proteins and their receptors in itch treatment in animal models. Their translational interventions in humans need to be evaluated. It is of great importance to summarize and compare the newly emerging knowledge on chronic itch and its pathways to promote the development of novel anti-itch therapeutics. The goal of this review is to analyze the different physiologies and pathophysiologies of itch mediators, whilst assessing their suitability as new targets and discussing future therapeutic development.
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Kim M, Mikhaylov D, Rangel SM, Pavel AB, He H, Renert-Yuval Y, Del Duca E, Malik K, Huynh T, Ibler E, Sun M, Zhang N, Estrada Y, Krueger J, Paller AS, Guttman-Yassky E. Transcriptomic Analysis of the Major Orphan Ichthyosis Subtypes Reveals Shared Immune and Barrier Signatures. J Invest Dermatol 2022; 142:2363-2374.e18. [PMID: 35421402 PMCID: PMC10234672 DOI: 10.1016/j.jid.2022.03.022] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Revised: 03/06/2022] [Accepted: 03/07/2022] [Indexed: 12/30/2022]
Abstract
Preliminary work suggested upregulation of inflammatory pathways in patients with common forms of ichthyosis. However, a comprehensive characterization of skin from various ichthyosis subtypes is unavailable, precluding the development of targeted treatments. Thus, we sought to characterize the immune and barrier profiles of common and subtype-specific skin transcriptomes in a large group of patients with ichthyosis. We performed a global RNA-sequencing analysis in 54 patients with ichthyosis (7 with Netherton syndrome, 13 with epidermolytic ichthyosis, 16 with lamellar ichthyosis, and 18 with congenital ichthyosiform erythroderma) and 40 healthy controls. Differentially expressed genes were defined on the basis of fold changes > 2 and false discovery rate < 0.05 criteria. We found robust and significant T helper (Th) 22/Th17 skewing in all subtypes (e.g., IL-17A/C/F, S100A7/8/9/12; P < 0.001) with modest changes in Th2 pathway, primarily in Netherton syndrome, and Th1 skewing in congenital ichthyosiform erythroderma. Across all subtypes (less evident in epidermolytic ichthyosis), lipid metabolism and barrier junction markers were downregulated (e.g., FA2H, CDH10/11/12/2; P < 0.05), whereas epidermal cornification and proliferation measures were upregulated (e.g., SPRR1A/1B/2C/2G, EREG; P < 0.05). Our findings suggest that the common ichthyosis variants share aberrations in Th17/Th22 and barrier function, with minimal Th2 modulation. This may help to elucidate the pathogeneses of these subtypes and inform the development of subtype-specific treatments.
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Affiliation(s)
- Madeline Kim
- Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Daniela Mikhaylov
- Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Stephanie M Rangel
- Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Ana B Pavel
- Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, New York, USA; Department of Biomedical Engineering, The University of Mississippi, Oxford, Mississippi, USA
| | - Helen He
- Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Yael Renert-Yuval
- Laboratory of Investigative Dermatology, The Rockefeller University, New York, New York, USA
| | - Ester Del Duca
- Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, New York, USA; Department of Dermatology, Magna Graecia University of Catanzaro, Catanzaro, Italy
| | - Kunal Malik
- Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Thy Huynh
- Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Erin Ibler
- Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Mary Sun
- Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Ning Zhang
- Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Yeriel Estrada
- Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - James Krueger
- Laboratory of Investigative Dermatology, The Rockefeller University, New York, New York, USA
| | - Amy S Paller
- Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Emma Guttman-Yassky
- Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
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