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Berenguer-Ruiz S, Romero-Dávila M, Aparicio-Domínguez M, Olivares-Guerrero M, Daudén E, Llamas-Velasco M. Comparing the Use of Topical Therapy Along with Anti-IL-17 and Anti-IL-23 to Treat Moderate-to-Severe Psoriasis in the Routine Clinical Practice. ACTAS DERMO-SIFILIOGRAFICAS 2024; 115:647-653. [PMID: 38307164 DOI: 10.1016/j.ad.2023.12.004] [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: 03/07/2023] [Revised: 09/18/2023] [Accepted: 12/27/2023] [Indexed: 02/04/2024] Open
Abstract
BACKGROUND Combinations of topical (TT) and biological therapies (BT) are a common thing in the routine clinical practice. However, the scientific medical literature on how TT is, actually, used after the initiation of BT is scarce, particularly in combination with anti-IL17, or anti-IL23. OBJECTIVES To describe the frequency of the concomitant use of TT + BT at baseline and after a 6-month course of several drugs (anti-IL17, ustekinumab, and anti-IL23). Our secondary endpoints are to describe the type of topical therapy used, compare the frequency of use of TT among the different groups of BT, describe the survival of topical therapy in these patients, and identify the factors that can impact the use or discontinuation of topical therapy in these patients (clinical response, quality of life, type of drug, etc.). MATERIALS AND METHODS This was a retrospective, observational, and single-center study of patients with moderate-to-severe psoriasis treated with anti-IL17 (secukinumab, ixekizumab), anti-IL17R (brodalumab), ustekinumab, and guselkumab from January 2015 through December 2020. RESULTS We included a total of 138 patients. When treatment started, 82.7% were on TT (55% daily), and after 6 months, 86.6% had discontinued TT. Regarding the analysis by type of drug, at 6 months, we found that 100% of the patients with BRO had discontinued topical treatment. We did not find any significant differences in the frequency of use of TT based on the BT used during the 6-month course of treatment. The estimated mean course of TT was 4.3 months (SD, 6.7). Also, the estimated mean course of TT was significantly shorter in the group of patients who achieved PASI100 (2.8 months vs. 8.1 months). CONCLUSIONS In our cohort, we saw a significant decrease in the frequency of use of TT at 6 months after starting BT in the routine clinical practice. This reduction occurred earlier in patients who improved their objective clinical response and quality of life.
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Affiliation(s)
- S Berenguer-Ruiz
- Departamento de Dermatología, Hospital Universitario De la Princesa, Madrid, España
| | - M Romero-Dávila
- Departamento de Dermatología, Universidad Autónoma de Madrid, Madrid, España
| | - M Aparicio-Domínguez
- Departamento de Dermatología, Hospital Universitario De la Princesa, Madrid, España
| | - M Olivares-Guerrero
- Servicio de Dermatología. Hospital Universitario de La Princesa, Madrid, España
| | - E Daudén
- Departamento de Dermatología, Hospital Universitario De la Princesa, Madrid, España; Departamento de Dermatología, Universidad Autónoma de Madrid, Madrid, España
| | - M Llamas-Velasco
- Departamento de Dermatología, Hospital Universitario De la Princesa, Madrid, España; Departamento de Dermatología, Universidad Autónoma de Madrid, Madrid, España.
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Berenguer-Ruiz S, Romero-Dávila M, Aparicio-Domínguez M, Olivares-Guerrero M, Daudén E, Llamas-Velasco M. [Translated article] Comparing the Use of Topical Therapy Along with Anti-IL-17 and Anti-IL-23 to Treat Moderate-to-Severe Psoriasis in the Routine Clinical Practice. ACTAS DERMO-SIFILIOGRAFICAS 2024:S0001-7310(24)00429-0. [PMID: 38815679 DOI: 10.1016/j.ad.2024.05.008] [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: 03/07/2023] [Revised: 09/18/2023] [Accepted: 12/27/2023] [Indexed: 06/01/2024] Open
Abstract
BACKGROUND Combinations of topical (TT) and biological therapies (BT) are a common thing in the routine clinical practice. However, the scientific medical literature on how TT is, actually, used after the initiation of BT is scarce, particularly in combination with anti-IL17, or anti-IL23. OBJECTIVES To describe the frequency of the concomitant use of TT + BT at baseline and after a 6-month course of several drugs (anti-IL17, ustekinumab, and anti-IL23). Our secondary endpoints are to describe the type of topical therapy used, compare the frequency of use of TT among the different groups of BT, describe the survival of topical therapy in these patients, and identify the factors that can impact the use or discontinuation of topical therapy in these patients (clinical response, quality of life, type of drug, etc.). MATERIALS AND METHODS This was a retrospective, observational, and single-center study of patients with moderate-to-severe psoriasis treated with anti-IL17 (secukinumab, ixekizumab), anti-IL17R (brodalumab), ustekinumab, and guselkumab from January 2015 through December 2020. RESULTS We included a total of 138 patients. When treatment started, 82.7% were on TT (55% daily), and after 6 months, 86.6% had discontinued TT. Regarding the analysis by type of drug, at 6 months, we found that 100% of the patients with BRO had discontinued topical treatment. We did not find any significant differences in the frequency of use of TT based on the BT used during the 6-month course of treatment. The estimated mean course of TT was 4.3 months (SD, 6.7). Also, the estimated mean course of TT was significantly shorter in the group of patients who achieved PASI100 (2.8 months vs. 8.1 months). CONCLUSIONS In our cohort, we saw a significant decrease in the frequency of use of TT at 6 months after starting BT in the routine clinical practice. This reduction occurred earlier in patients who improved their objective clinical response and quality of life.
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Affiliation(s)
- S Berenguer-Ruiz
- Departamento de Dermatología, Hospital Universitario De la Princesa, Madrid, Spain
| | - M Romero-Dávila
- Departamento de Dermatología, Universidad Autónoma de Madrid, Madrid, Spain
| | - M Aparicio-Domínguez
- Departamento de Dermatología, Hospital Universitario De la Princesa, Madrid, Spain
| | - M Olivares-Guerrero
- Servicio de Dermatología. Hospital Universitario de La Princesa, Madrid, Spain
| | - E Daudén
- Departamento de Dermatología, Hospital Universitario De la Princesa, Madrid, Spain; Departamento de Dermatología, Universidad Autónoma de Madrid, Madrid, Spain
| | - M Llamas-Velasco
- Departamento de Dermatología, Hospital Universitario De la Princesa, Madrid, Spain; Departamento de Dermatología, Universidad Autónoma de Madrid, Madrid, Spain.
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Hou YL, Lin SH. Real-world efficacy of adjunctive calcipotriene/betamethasone dipropionate foam for recalcitrant psoriatic lesions on the scalp or lower legs with biologic therapy. J Dermatol 2023; 50:1272-1278. [PMID: 37350066 DOI: 10.1111/1346-8138.16867] [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: 04/13/2023] [Revised: 05/23/2023] [Accepted: 06/06/2023] [Indexed: 06/24/2023]
Abstract
Many patients with moderate-to-severe psoriasis may not achieve complete skin clearance with recalcitrant lesions despite being on biologics. We aimed to evaluate the real-world effectiveness and safety of combining topical calcipotriene/betamethasone dipropionate (Cal/BD) foam with biologic therapy for the treatment of recalcitrant psoriatic lesions over the scalp or lower legs. We retrospectively reviewed the medical charts of psoriasis patients receiving adjunctive topical Cal/BD foam with biologics for at least 16 weeks on recalcitrant psoriatic lesions of the scalp or lower legs between 2020 and 2021 at a tertiary referral medical center in southern Taiwan. Among the 18 recruited patients, the severity outcomes of body surface area (BSA), Physician's Global Assessment (PGA), and BSA × PGA of the recalcitrant areas decreased by approximately 31%, 48%, and 50%, respectively, after 4 weeks of once-daily adjunctive Cal/BD foam use. Thereafter, the effect remained nearly constant after dose reduction to twice weekly until week 16. The Dermatology Life Quality Index and the nine-item Treatment Satisfaction Questionnaire for Medication questionnaire revealed improved life quality and a high level of satisfaction, with only a few mild adverse effects reported. In conclusion, adjunctive topical Cal/BD foam might be an effective and safe option for patients with recalcitrant lesions on the scalp and lower legs despite biologics use.
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Affiliation(s)
- Yi-Li Hou
- Department of Dermatology, Kaohsiung Chang-Gung Memorial Hospital, Kaohsiung, Taiwan
| | - Shang-Hung Lin
- Department of Dermatology, Kaohsiung Chang-Gung Memorial Hospital, Kaohsiung, Taiwan
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Svendsen MT, Feldman SR, Mejldal A, Möller S, Kongstad LP, Andersen KE. Regular support provided by dermatological nurses improves outcomes in patients with psoriasis treated with topical drugs: a randomized controlled trial. Clin Exp Dermatol 2022; 47:2208-2221. [PMID: 35973788 PMCID: PMC10092433 DOI: 10.1111/ced.15370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/10/2022] [Indexed: 12/31/2022]
Abstract
BACKGROUND Patient adherence to topical antipsoriatic drugs is often poor, leading to poor efficacy. Use of long-term support delivered by dermatological nurses to patients treated with topical drugs may improve outcome. AIM To evaluate whether regular support from dermatological nurses improves outcome and treatment adherence in patients with psoriasis receiving topical medications. METHODS We conducted a randomized controlled trial (RCT) (clinicaltrials.gov registration NCT04220554), in which patients received once-daily topical medications (containing corticosteroids and/or calcipotriol) for as long as their psoriasis was visible. The patients were randomly allocated to standard care by the dermatologist either with (n = 51) or without (n = 52) support from dermatological nurses. The nurse support intervention consisted of a structured dermatological consultation at baseline and Week 1, followed by contact with a nurse each month (in the outpatient clinic or by telephone). The primary outcome was severity of psoriasis, which was measured by the Lattice System Physician's Global Assessment (LS-PGA) and assessed by intention-to-treat analyses using linear mixed regression models for longitudinal data. Secondary outcomes were quality of life (measured by the Dermatology Life Quality Index; DLQI) and good adherence (defined as use of ≥ 80% of recommended doses). RESULTS In total, 92 patients (89%) completed the 48-week trial period. The intervention group improved more than the nonintervention group from baseline to Week 24 in LS-PGA (2.21 vs. 1.28, P = 0.001) and in DLQI at Week 12 (6.50 vs. 1.55, P < 0.001). Differences between the two groups in favour of the intervention were observed throughout the study period. More participants in the intervention group had good adherence compared with the nonintervention group (36% vs. 14%, P < 0.001). CONCLUSION Regular, continued patient support from dermatological nurses increased the efficacy of psoriasis treatment, improved quality of life and enhanced long-term adherence to topical antipsoriatic drugs. However, there is still room for more improvement.
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Affiliation(s)
- Mathias Tiedemann Svendsen
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark.,Department of Dermatology and Allergy Centre, Odense University Hospital, Denmark.,Open Patient data Exploratory Network (OPEN), Odense University Hospital, Odense, Denmark
| | - Steven R Feldman
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark.,Department of Dermatology and Allergy Centre, Odense University Hospital, Denmark.,Department of Dermatology, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Anna Mejldal
- Open Patient data Exploratory Network (OPEN), Odense University Hospital, Odense, Denmark
| | - Sören Möller
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark.,Open Patient data Exploratory Network (OPEN), Odense University Hospital, Odense, Denmark
| | - Line Planck Kongstad
- Danish Centre for Health Economics (DaCHE), University of Southern Denmark, Odense, Denmark
| | - Klaus E Andersen
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
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Aschoff R, Bewley A, Dattola A, De Simone C, Lahfa M, Llamas-Velasco M, Martorell A, Pavlovic M, Sticherling M. Beyond-Mild Psoriasis: A Consensus Statement on Calcipotriol and Betamethasone Dipropionate Foam for the Topical Treatment of Adult Patients. Dermatol Ther (Heidelb) 2021; 11:1791-1804. [PMID: 34510404 PMCID: PMC8484344 DOI: 10.1007/s13555-021-00600-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Accepted: 08/19/2021] [Indexed: 11/29/2022] Open
Abstract
Introduction There are clear treatment options for mild psoriasis where topical therapies are the mainstay, and for severe psoriasis where systemic therapy (biologic or non-biologic) is necessary. However, there is less clarity in the ‘grey zone’ of patients in the moderate or so-called ‘beyond-mild’ segment. There are frequent delays to the initiation, discontinuation, switching and dose change in treatment, and many patients fail to continue treatment because of concerns about safety or lack of efficacy. Treatment with topical therapies, such as calcipotriol and betamethasone dipropionate (Cal/BD) combinations, may be suitable for these patients. Method These consensus recommendations on the use of topical therapies including Cal/BD foam for beyond-mild psoriasis originated from a modified Delphi process of European clinical experts. In the process, the experts iteratively refined a series of draft statements, which had to receive ≥ 80% approval to be incorporated into the consensus. Results The experts identified three main themes: Cal/BD foam as monotherapy, as an add-on to non-biologic systemic therapies and as an add-on to systemic biologics. The consensus emphasises disease factors and patient preference in treatment choice, summarises the evidence base for Cal/BD foam monotherapy for flare treatment as well as long-term management, and identifies the potential for improved treatment outcomes, such as reduced time to onset of action and reduced systemic dose to minimise side effects for add-on Cal/BD therapy to non-biologic systemics. The recommendations regarding add-on Cal/BD foam to biologics are similar to those for non-biologic systemic therapies, but also include suggestions for patients on biologics who are late responders. As clinical choices of Cal/BD combination vary, we have here often used ‘Cal/BD’ without reference to any particular formulation. Conclusions These recommendations aim to give practical guidance to those treating patients with beyond-mild psoriasis, to support patients’ use of topical preparations and to optimise treatment outcomes.
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Affiliation(s)
- Roland Aschoff
- Department of Dermatology, University Hospital Carl Gustav Carus, Technical University of Dresden, Fetscherstraße 74, 01307, Dresden, Germany.
| | - Anthony Bewley
- Barts Health NHS Trust and Queen Mary University London, London, UK
| | - Annunziata Dattola
- Department of Dermatology, University of Rome "Tor Vergata", Rome, Italy
| | - Clara De Simone
- Department of Dermatology, Catholic University of the Sacred Heart Policlinico "A. Gemelli", IRCCS, Rome, Italy
| | | | - Mar Llamas-Velasco
- Department of Dermatology, Hospital Universitario de La Princesa, Madrid, Spain
| | | | - Mira Pavlovic
- Medicines Development and Training Services and Department of Dermatology, Saint-Louis Hospital, Paris, France
| | - Michael Sticherling
- Department of Dermatology, Psoriasis Center, University Medical Center, Erlangen, Germany
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A Six-Year Analysis of Biological Therapy for Severe Psoriasis in a Lithuanian Reference Centre of Dermatovenereology. ACTA ACUST UNITED AC 2020; 56:medicina56060275. [PMID: 32512854 PMCID: PMC7353857 DOI: 10.3390/medicina56060275] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 05/29/2020] [Accepted: 06/02/2020] [Indexed: 12/23/2022]
Abstract
Background and Objectives: Biological therapy is widely used for the treatment of severe psoriasis. The objective of this study was to evaluate the efficacy and safety of biological therapy for patients with severe psoriasis. Materials and Methods: A retrospective study of 79 patients with severe psoriasis, who have been treated with biological therapy between 2012 and 2018, was conducted. During this study, the following data were collected and evaluated: sex, age, body mass index (BMI), duration of illness, the results of treatment with biological therapy, concomitant therapy, Psoriasis Area and Severity Index (PASI) and adverse events. Results: In total, 74.7% (n = 59) of subjects were male. Their overall average age was 47.4 ± 11.4 (range: 18–73) years. Their baseline BMI was 27.6 ± 5.9, which increased to 29.6 ± 4.5 after 6 years of treatment. The mean duration of psoriasis was 25.7 ± 12.5 years. In total, 39.2% (n = 31) of subjects received infliximab, 36.7% (n = 29)—etanercept, 24.1% (n = 19)—ustekinumab. The treatment duration for infliximab, etanercept and ustekinumab was 201.6 ± 86.8, 156.2 ± 137.4 and 219.1 ± 95.7 weeks (p < 0.01), respectively. Overall, 65.8% (n = 52) of subjects were also on methotrexate; 30.8% (n = 16) of them discontinued it due to clinical improvement (31.3% (n = 5)), impaired liver function (31.3% (n = 5)), and intolerance (25% (n = 4)). Baseline PASI was 20.8 ± 8.8. PASI 50 was achieved by 96.2% (n = 76) of patients at week 11, PASI 75 by 86.1% (n = 68) at week 16, PASI 90 by 54.4% (n = 43) at week 35, and PASI 100 by 13.9% (n = 11) at week 33. The overall incidence rate of adverse events was 0.362 per patient year of follow-up. Conclusion: Biological therapy is an effective and safe treatment for patients with severe psoriasis.
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Apoptotic or Antiproliferative Activity of Natural Products against Keratinocytes for the Treatment of Psoriasis. Int J Mol Sci 2019; 20:ijms20102558. [PMID: 31137673 PMCID: PMC6566887 DOI: 10.3390/ijms20102558] [Citation(s) in RCA: 58] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Revised: 05/22/2019] [Accepted: 05/23/2019] [Indexed: 02/08/2023] Open
Abstract
Natural products or herbs can be used as an effective therapy for treating psoriasis, an autoimmune skin disease that involves keratinocyte overproliferation. It has been demonstrated that phytomedicine, which is used for psoriasis patients, provides some advantages, including natural sources, a lower risk of adverse effects, and the avoidance of dissatisfaction with conventional therapy. The herbal products’ structural diversity and multiple mechanisms of action have enabled the synergistic activity to mitigate psoriasis. In recent years, the concept of using natural products as antiproliferative agents in psoriasis treatment has attracted increasing attention in basic and clinical investigations. This review highlights the development of an apoptotic or antiproliferatic strategy for natural-product management in the treatment of psoriasis. We systematically introduce the concepts and molecular mechanisms of keratinocyte-proliferation inhibition by crude extracts or natural compounds that were isolated from natural resources, especially plants. Most of these studies focus on evaluation through an in vitro keratinocyte model and an in vivo psoriasis-like animal model. Topical delivery is the major route for the in vivo or clinical administration of these natural products. The potential use of antiproliferative phytomedicine on hyperproliferative keratinocytes suggests a way forward for generating advances in the field of psoriasis therapy.
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Helmer E, Nicolas JM, Long J, Roffel AF, Jones E, Chanteux H, Diaz N, Garratt H, Bosje T. A Dual-Administration Microtracer Technique to Characterize the Absorption, Distribution, Metabolism, and Excretion of [14
C]Seletalisib (UCB5857) in Healthy Subjects. J Clin Pharmacol 2017. [DOI: 10.1002/jcph.954] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Affiliation(s)
| | | | | | | | | | | | | | | | - Tjerk Bosje
- PRA Health Sciences; Groningen The Netherlands
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Helmer E, Watling M, Jones E, Tytgat D, Jones M, Allen R, Payne A, Koch A, Healy E. First-in-human studies of seletalisib, an orally bioavailable small-molecule PI3Kδ inhibitor for the treatment of immune and inflammatory diseases. Eur J Clin Pharmacol 2017; 73:581-591. [PMID: 28160012 PMCID: PMC5384962 DOI: 10.1007/s00228-017-2205-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2016] [Accepted: 01/17/2017] [Indexed: 02/06/2023]
Abstract
PURPOSE PI3Ks are potential therapeutic targets in immune-inflammatory diseases. These studies aimed to investigate the safety, tolerability and PK profile of seletalisib, a selective inhibitor of PI3Kδ in humans. METHODS These phase I, randomised, double-blind, placebo-controlled, single-centre studies (NCT02303509, NCT02207595) evaluated single and multiple oral doses of seletalisib (5-90 mg QD and 30 mg BID) in healthy adults and subjects with mild-to-moderate psoriasis (Study-1). Pharmacodynamic effects on markers of inflammation were assessed via changes in ex vivo basophil degranulation and histological assessment of psoriatic skin biopsies. RESULTS Seletalisib was well tolerated at doses ≤15 mg (Study-1) and ≤45 mg QD (Study-2) for 14 days. No safety concerns or dose-limiting toxicities were identified (Study-1). Incidence of gastrointestinal-related AEs was not dose related but higher incidences of rash AEs were associated with higher-dose seletalisib (Study-2 rash AEs: 18 in 12 seletalisib-treated subjects versus 1 in 1 placebo-treated subject). Mean seletalisib plasma concentration-time profiles increased with increasing doses after single and multiple dosing, with no major deviations from dose-proportionality. There was no unexpected accumulation or loss of exposure after multiple dosing (time-independent pharmacokinetic profile). Apparent t 1/2 values were supportive of once-daily dosing (geometric mean t1/2: Study-1, 17.7-21.1 h; Study-2, 18.1-22.4 h). No clinically significant food effect was observed (Study-1). Pharmacodynamic findings demonstrated ex vivo inhibition of basophil degranulation, improvements in histological assessment of skin biopsies and other markers of psoriatic biology and preliminary evidence of target engagement in psoriatic skin tissue. CONCLUSIONS Seletalisib safety, tolerability and pharmacokinetic/pharmacodynamic profiles support its continued clinical development in immune-inflammatory diseases.
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Affiliation(s)
- Eric Helmer
- UCB Pharma, 208 Bath Road, Slough, Berkshire, SL1 3WE, UK.
| | | | | | - Dominique Tytgat
- UCB Pharma, Braine l'Alleud, Belgium
- Clinical Pharmacokinetics/Pharmacometrics, Sanofi-Aventis, Deutschland GmbH, Frankfurt am Main, Germany
| | - Mark Jones
- UCB Pharma, 208 Bath Road, Slough, Berkshire, SL1 3WE, UK
| | - Rodger Allen
- UCB Pharma, 208 Bath Road, Slough, Berkshire, SL1 3WE, UK
| | - Andrew Payne
- UCB Pharma, 208 Bath Road, Slough, Berkshire, SL1 3WE, UK
| | | | - Eugene Healy
- Dermatopharmacology, Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
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