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Haran K, Kranyak A, Johnson CE, Smith P, Farberg AS, Bhutani T, Liao W. Commercial Diagnostics and Emerging Precision Medicine Technologies in Psoriasis and Atopic Dermatitis. PSORIASIS (AUCKLAND, N.Z.) 2024; 14:87-92. [PMID: 39132449 PMCID: PMC11314430 DOI: 10.2147/ptt.s478377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/15/2024] [Accepted: 07/27/2024] [Indexed: 08/13/2024]
Abstract
While psoriasis and atopic dermatitis (AD) are two common dermatological conditions, their diagnosis and therapeutic decision-making pathways are often complex. As a result, there has been increased focus on the development of precision medicine approaches for psoriasis and AD. Two companies at the forefront of dermatology precision medicine research are Mindera Health and Castle Biosciences. Here, we review the technologies developed by these two companies using a dermal diagnostic patch and superficial skin scrapings, respectively, their research published to date, and their future research goals. Research from both companies shows promise in predicting the response of inflammatory skin disease to biologics using minimally invasive techniques. However, challenges to adoption include insurance coverage and patient trust in the technologies. While there are several differences between Mindera Health and Castle Biosciences, they have a shared goal of utilizing minimally invasive technologies to sample skin and predict response to biologic treatments using a panel of optimized biomarkers.
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Affiliation(s)
- Kathryn Haran
- Department of Dermatology, University of California San Francisco, San Francisco, CA, USA
| | - Allison Kranyak
- Department of Dermatology, University of California San Francisco, San Francisco, CA, USA
| | - Chandler E Johnson
- Institute for Human Genetics, University of California San Francisco, San Francisco, CA, USA
| | - Payton Smith
- Institute for Human Genetics, University of California San Francisco, San Francisco, CA, USA
| | - Aaron S Farberg
- Baylor Scott & White Health System, Dallas, TX, USA
- Bare Dermatology, Dallas, TX, USA
| | - Tina Bhutani
- Department of Dermatology, University of California San Francisco, San Francisco, CA, USA
| | - Wilson Liao
- Department of Dermatology, University of California San Francisco, San Francisco, CA, USA
- Institute for Human Genetics, University of California San Francisco, San Francisco, CA, USA
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Shan DM, Greenzaid JD, Greene E, Feldman SR. Analyzing the Benefits and Costs of the Safe Step Act on Patients, Physicians, and Insurers. JOURNAL OF PSORIASIS AND PSORIATIC ARTHRITIS 2024; 9:115-120. [PMID: 39301213 PMCID: PMC11361492 DOI: 10.1177/24755303241253203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/22/2024]
Abstract
Pharmaceutical expenditures in the United States, particularly in dermatology, have grown rapidly, driven by expensive topical and biologic treatments. Insurers are employing cost-containing strategies such as step therapy, which mandates the use of lower-cost treatments before more expensive medications. The bipartisan Safe Step Act aims to enhance step therapy policies by introducing a transparent process for requesting exceptions and reasonable timelines for the process. However, there is limited analysis on how the Safe Step Act would affect the healthcare environment. We examine the policies of the Safe Step Act and existing literature on prior authorizations and discuss how the bill could affect patients, physicians, and insurers. While the act could expedite access to necessary medications and prevent irreversible harm to patients from delaying efficacious treatment, it falls short in relieving the administrative burdens on dermatology clinics. Although there is no ideal solution for managing healthcare costs, measures like step therapy encourage cost-effective treatments and optimizing care for the population. Curtailing step therapy with the exemptions process of the Safe Step Act might streamline patient access to treatments but could impede cost-containment strategies, weaken the bargaining power of insurers, and result in higher insurance premiums.
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Affiliation(s)
- Divya M Shan
- Center for Dermatology Research, Department of Dermatology, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Jonathan D Greenzaid
- Center for Dermatology Research, Department of Dermatology, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | | | - Steven R Feldman
- Center for Dermatology Research, Department of Dermatology, Wake Forest University School of Medicine, Winston-Salem, NC, USA
- Department of Pathology, Wake Forest University School of Medicine, Winston-Salem, NC, USA
- Department of Social Sciences & Health Policy, Wake Forest University School of Medicine, Winston Salem, NC, USA
- Department of Dermatology, University of Southern Denmark, Odense, Denmark
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Alabas OA, Mason KJ, Yiu ZZN, Warren RB, Dand N, Barker JN, Smith CH, Griffiths CEM. The association of age at psoriasis onset and HLA-C*06:02 with biologic survival in patients with moderate-to-severe psoriasis: a cohort study from the British Association of Dermatologists Biologics and Immunomodulators Register (BADBIR). Br J Dermatol 2024; 190:689-700. [PMID: 38051972 DOI: 10.1093/bjd/ljad481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2023] [Revised: 09/29/2023] [Accepted: 11/27/2023] [Indexed: 12/07/2023]
Abstract
BACKGROUND Few studies have used real-world data to investigate the association between biologic therapy survival and age at psoriasis onset or HLA-C*06:02 status in patients with moderate-to-severe psoriasis. The robustness of these studies is limited by small sample size, short follow-up and diverse safety and effectiveness measures. OBJECTIVES To describe biologic survival and explore whether the response to biologics is modified by age at psoriasis onset or HLA-C*06:02 status in patients with moderate-to-severe psoriasis. METHODS Data from patients in the UK and the Republic of Ireland registered in the British Association of Dermatologists Biologics and Immunomodulators Register (BADBIR) from 2007 to 2022 on a first course of adalimumab, etanercept, secukinumab or ustekinumab with at least 6 months' follow-up and a subset of BADBIR patients with available HLA-C*06:02 information registered to Biomarkers and Stratification To Optimise outcomes in Psoriasis (BSTOP) were analysed. Patients aged ≥ 50 years at treatment initiation were classified into early-onset psoriasis (EOP) (presenting in patients ≤ 40 years of age) and late-onset psoriasis (LOP) (presenting in patients > 40 years of age). BADBIR patients with available information in BSTOP were categorized as HLA-C*06:02- or HLA-C*06:02 + . Biologic survival was defined as treatment discontinuation associated with ineffectiveness or occurrence of adverse events (AEs). Adjusted survival function and hazard ratio (aHR) with 95% confidence interval (CI) were estimated using a flexible parametric model to compare discontinuing therapy between age at psoriasis onset and HLA-C*06:02 groups. Each model included exposure (biologics), effect modifier (age at onset or HLA-C*06:02 status), interaction terms and several baseline demographic, clinical and disease severity covariates. RESULTS Final analytical cohorts included 4250 patients in the age at psoriasis onset group [2929 EOP (69%) vs. 1321 LOP (31%)] and 3094 patients in the HLA-C*06:02 status group [1603 HLA-C*06:02+ (52%) vs. 1491 HLA-C*06:02- (48%)]. There was no significant difference between EOP and LOP in drug survival associated with ineffectiveness or AEs for any biologics. However, compared with patients who were HLA-C*06:02-, patients who were HLA-C*06:02 + were less likely to discontinue ustekinumab for reasons associated with ineffectiveness (aHR 0.56, 95% CI 0.42-0.75). CONCLUSIONS HLA-C*06:02, but not age at psoriasis onset, is a predictive biomarker for biologic survival in patients with psoriasis. Findings from this large cohort provide further, important information to aid clinicians using biologic therapies to manage patients with psoriasis.
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Affiliation(s)
- Oras A Alabas
- Dermatology Centre, Northern Care Alliance NHS Foundation Trust, NIHR Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, University of Manchester, UK
| | - Kayleigh J Mason
- Primary Care Centre Versus Arthritis, School of Medicine, Keele University, Keele, UK
| | - Zenas Z N Yiu
- Dermatology Centre, Northern Care Alliance NHS Foundation Trust, NIHR Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, University of Manchester, UK
| | - Richard B Warren
- Dermatology Centre, Northern Care Alliance NHS Foundation Trust, NIHR Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, University of Manchester, UK
| | - Nick Dand
- Department of Medical and Molecular Genetics, School of Basic & Medical Biosciences, King's College London, UK
| | - Jonathan N Barker
- St John's Institute of Dermatology, Guy's and St Thomas' NHS Foundation Trust and King's College London, London, UK
| | - Catherine H Smith
- St John's Institute of Dermatology, Guy's and St Thomas' NHS Foundation Trust and King's College London, London, UK
| | - Christopher E M Griffiths
- Dermatology Centre, Northern Care Alliance NHS Foundation Trust, NIHR Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, University of Manchester, UK
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Li Q, Tsoi LC. Biologic survival: a novel approach for drug efficacy estimation in psoriasis. Br J Dermatol 2024; 190:612-613. [PMID: 38174815 PMCID: PMC11023616 DOI: 10.1093/bjd/ljae007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2023] [Accepted: 01/18/2024] [Indexed: 01/05/2024]
Affiliation(s)
- Qinmengge Li
- Department of Dermatology
- Department of Biostatistics
| | - Lam C Tsoi
- Department of Dermatology
- Department of Biostatistics
- Department of Computational Medicine and Bioinformatics, Mary H. Weiser Food Allergy Center, University of Michigan, Ann Arbor, MI, USA
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Graier T, Weger W, Jonak C, Sator P, Zikeli C, Prillinger K, Sassmann C, Gruber B, Saxinger W, Ratzinger G, Painsi C, Mlynek A, Häring N, Sadoghi B, Trattner H, Müllegger R, Quehenberger F, Salmhofer W, Wolf P. Real-world effectiveness of anti-interleukin-23 antibodies in chronic plaque-type psoriasis of patients from the Austrian Psoriasis Registry (PsoRA). Sci Rep 2022; 12:15078. [PMID: 36064563 PMCID: PMC9442573 DOI: 10.1038/s41598-022-18790-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Accepted: 08/19/2022] [Indexed: 11/09/2022] Open
Abstract
With the introduction of the latest class of biologic drugs targeting interleukin (IL)-23p19, three new, highly effective drugs can be used for the treatment of chronic plaque psoriasis. However, poorer skin improvement as well as higher rates of serious adverse events have been reported for patients under real-world conditions (outside clinical trials). This accounts especially for patients who have already been treated with biologic drugs. We therefore aimed to determine effectiveness and safety of IL-23p19 inhibitors in real-world patients by analysing data from the Psoriasis Registry Austria (PsoRA) in this observational, retrospective, multicentre cohort study. Data for 197 patients (52.3% biologic-non-naïve), who were treated with anti-IL-23p19 antibodies (127 guselkumab, 55 risankizumab and 15 tildrakizumab) for at least 3 months, were eligible for analysis. In general, biologic-non-naïve patients displayed a less favourable response to anti-IL-23 treatment as compared to biologic-naïve patients. However, after correction for previous biologic exposure, few differences in PASI improvement were detected among biologic-naïve and -non-naïve patients treated with different IL-23p19 inhibitors. This indicates that treatment effectiveness is not related to the class of the previously administered therapy in biologic-non-naïve patients. Therefore, IL-23p19 inhibitors represent a promising treatment alternative for patients who have not responded to previous biologics. However, as with other biologic agents (including IL-17 inhibitors), we did not observe an entirely satisfactory treatment response (i.e. PASI < 3 and/or PASI 75) to anti-IL-23 treatment in one out of four to five patients. Adverse events (mainly non-severe infections) were observed in 23 (11.7%) patients with no major differences regarding the administered IL-23 inhibitor or previous biologic exposure.
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Affiliation(s)
- T Graier
- Department of Dermatology and Venereology, Medical University of Graz, Auenbruggerplatz 8, 8036, Graz, Austria
| | - W Weger
- Department of Dermatology and Venereology, Medical University of Graz, Auenbruggerplatz 8, 8036, Graz, Austria
| | - C Jonak
- Medical University of Vienna, Vienna, Austria
| | - P Sator
- Clinic Hietzing, Vienna, Austria
| | - C Zikeli
- State Hospital Wiener Neustadt, Wiener Neustadt, Austria
| | - K Prillinger
- University Hospital of St. Poelten, Karl Landsteiner University of Health Sciences, Krems, Austria
| | - C Sassmann
- State Hospital Wiener Neustadt, Wiener Neustadt, Austria
| | - B Gruber
- Hospital of Wels-Grieskirchen, Wels, Austria
| | - W Saxinger
- Hospital of Wels-Grieskirchen, Wels, Austria
| | - G Ratzinger
- Medical University of Innsbruck, Innsbruck, Austria
| | - C Painsi
- State Hospital Klagenfurt, Klagenfurt, Austria
| | - A Mlynek
- Hospital of Elisabethinen, Linz, Austria
| | - N Häring
- Federal Academic Teaching Hospital, Feldkirch, Austria
| | - B Sadoghi
- Department of Dermatology and Venereology, Medical University of Graz, Auenbruggerplatz 8, 8036, Graz, Austria
| | - H Trattner
- Medical University of Vienna, Vienna, Austria
| | - R Müllegger
- State Hospital Wiener Neustadt, Wiener Neustadt, Austria
| | - F Quehenberger
- Institute for Medical Informatics, Statistics and Documentation, Medical University of Graz, Graz, Austria
| | - W Salmhofer
- Department of Dermatology and Venereology, Medical University of Graz, Auenbruggerplatz 8, 8036, Graz, Austria
| | - Peter Wolf
- Department of Dermatology and Venereology, Medical University of Graz, Auenbruggerplatz 8, 8036, Graz, Austria.
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