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Silverberg JI, Boguniewicz M, Quintana FJ, Clark RA, Gross L, Hirano I, Tallman AM, Brown PM, Fredericks D, Rubenstein DS, McHale KA. Tapinarof validates the aryl hydrocarbon receptor as a therapeutic target: A clinical review. J Allergy Clin Immunol 2024; 154:1-10. [PMID: 38154665 DOI: 10.1016/j.jaci.2023.12.013] [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: 08/10/2023] [Revised: 11/09/2023] [Accepted: 12/08/2023] [Indexed: 12/30/2023]
Abstract
The aryl hydrocarbon receptor (AhR) is a ligand-dependent transcription factor that has wide-ranging roles, including regulation of inflammation and homeostasis. AhR is not a cell surface receptor; rather, it exists in a cytoplasmic complex that responds to a wide variety of structurally dissimilar endogenous, microbial, and environmental ligands. The ubiquitous expression of AhR, its ability to be activated by a wide range of ligands, and its capacity to act as a master regulator for gene expression and homeostasis make it a promising new therapeutic target. Clinical trials of tapinarof cream have now validated AhR agonism as a therapeutic approach that can deliver significant efficacy for treating inflammatory skin diseases, including psoriasis and atopic dermatitis. Tapinarof 1% cream is a first-in-class, nonsteroidal, topical, AhR agonist with a pharmacokinetic profile that results in localized exposure at sites of disease, avoiding systemic safety concerns, drug interactions, or off-target effects. Psoriasis and atopic dermatitis both involve epidermal inflammation, cellular immune responses, dysregulation of skin barrier protein expression, and oxidative stress. On the basis of the clinical effectiveness of tapinarof cream for treating inflammatory skin diseases, we review how targeting AhR may offer a significant opportunity in other conditions that share key aspects of pathogenesis, including asthma, inflammatory bowel disease, eosinophilic esophagitis, ophthalmic, and nervous system diseases.
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Affiliation(s)
| | - Mark Boguniewicz
- Division of Allergy-Immunology, Department of Pediatrics, National Jewish Health and University of Colorado School of Medicine, Denver, Colo
| | - Francisco J Quintana
- Center for Neurologic Diseases, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass
| | | | - Lara Gross
- Dallas Allergy and Asthma Center, and the Allergy and Immunology Division, Baylor University Medical Center, Dallas, Tex
| | - Ikuo Hirano
- Northwestern University Feinberg School of Medicine, Chicago, Ill
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Prieto K, Duong JQ, Feldman SR. Tapinarof cream for the topical treatment of plaque psoriasis in adults. Expert Rev Clin Immunol 2024; 20:327-337. [PMID: 38117596 DOI: 10.1080/1744666x.2023.2296607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2023] [Accepted: 12/14/2023] [Indexed: 12/22/2023]
Abstract
INTRODUCTION Plaque psoriasis, a chronic immune-mediated skin disorder, is characterized by well-demarcated erythematous plaques with silvery scales. This condition stems from complex interactions between genetic predisposition, immune dysregulation, and environmental triggers. Tapinarof downregulates the cytokine IL-17, diminishes the inflammatory infiltrate, and provides antioxidant properties while enhancing the expression of skin barrier proteins. AREAS COVERED This review begins by assessing tapinarof's mechanism in treating plaque psoriasis. Subsequently, it examines the effectiveness and safety of tapinarof 1% cream in adult patients. EXPERT OPINION Tapinarof 1% cream, which works by activating the aryl hydrocarbon receptor, is an FDA-approved treatment for adult plaque psoriasis. This therapy introduces a novel, nonsteroidal method for addressing inflammation and skin barrier issues, potentially serving as an alternative to conventional treatments. The once-daily, convenient cream formulation and favorable safety profile may enhance patient adherence, which is often poor with topical treatments. Tapinarof also maintains disease clearance for a mean of 4 months after treatment cessation.
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Affiliation(s)
- Kaley Prieto
- Department of Dermatology, Center for Dermatology Research, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Jessica Q Duong
- Department of Dermatology, Center for Dermatology Research, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Steven R Feldman
- Department of Dermatology, Center for Dermatology Research, Wake Forest University School of Medicine, Winston-Salem, NC, USA
- Department of Pathology, Wake Forest School of Medicine, Wake Forest University School of Medicine, Winston-Salem, NC, USA
- Department of Social Sciences & Health Policy, Wake Forest School of Medicine, Wake Forest University School of Medicine, Winston-Salem, NC, USA
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Carmona-Rocha E, Rusiñol L, Puig L. New and Emerging Oral/Topical Small-Molecule Treatments for Psoriasis. Pharmaceutics 2024; 16:239. [PMID: 38399292 PMCID: PMC10892104 DOI: 10.3390/pharmaceutics16020239] [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: 01/07/2024] [Revised: 01/30/2024] [Accepted: 02/04/2024] [Indexed: 02/25/2024] Open
Abstract
The introduction of biologic therapies has led to dramatic improvements in the management of moderate-to-severe psoriasis. Even though the efficacy and safety of the newer biologic agents are difficult to match, oral administration is considered an important advantage by many patients. Current research is focused on the development of oral therapies with improved efficacy and safety compared with available alternatives, as exemplified by deucravacitinib, the first oral allosteric Tyk2 inhibitor approved for the treatment of moderate to severe psoriasis in adults. Recent advances in our knowledge of psoriasis pathogenesis have also led to the development of targeted topical molecules, mostly focused on intracellular signaling pathways such as AhR, PDE-4, and Jak-STAT. Tapinarof (an AhR modulator) and roflumilast (a PDE-4 inhibitor) have exhibited favorable efficacy and safety outcomes and have been approved by the FDA for the topical treatment of plaque psoriasis. This revision focuses on the most recent oral and topical therapies available for psoriasis, especially those that are currently under evaluation and development for the treatment of psoriasis.
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Affiliation(s)
- Elena Carmona-Rocha
- Department of Dermatology, Hospital de la Santa Creu i Sant Pau, 08041 Barcelona, Spain; (E.C.-R.); (L.R.)
- Institut de Recerca Sant Pau (IR SANT PAU), 08041 Barcelona, Spain
- Sant Pau Teaching Unit, School of Medicine, Universitat Autònoma de Barcelona, 08041 Barcelona, Spain
| | - Lluís Rusiñol
- Department of Dermatology, Hospital de la Santa Creu i Sant Pau, 08041 Barcelona, Spain; (E.C.-R.); (L.R.)
- Institut de Recerca Sant Pau (IR SANT PAU), 08041 Barcelona, Spain
- Sant Pau Teaching Unit, School of Medicine, Universitat Autònoma de Barcelona, 08041 Barcelona, Spain
| | - Lluís Puig
- Department of Dermatology, Hospital de la Santa Creu i Sant Pau, 08041 Barcelona, Spain; (E.C.-R.); (L.R.)
- Institut de Recerca Sant Pau (IR SANT PAU), 08041 Barcelona, Spain
- Sant Pau Teaching Unit, School of Medicine, Universitat Autònoma de Barcelona, 08041 Barcelona, Spain
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Kircik L, Zirwas M, Kwatra SG, Lewitt GM, Glover H, Chao T, Brown PM, Rubenstein DS, Tallman AM. Rapid Improvements in Itch with Tapinarof Cream 1% Once Daily in Two Phase 3 Trials in Adults with Mild to Severe Plaque Psoriasis. Dermatol Ther (Heidelb) 2024; 14:201-211. [PMID: 38123875 PMCID: PMC10828461 DOI: 10.1007/s13555-023-01068-x] [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: 09/07/2023] [Accepted: 11/02/2023] [Indexed: 12/23/2023] Open
Abstract
INTRODUCTION Patients with psoriasis report pruritus as their most bothersome symptom. Tapinarof cream 1% once daily demonstrated significant efficacy versus vehicle and was well tolerated in adults with mild to severe plaque psoriasis in two 12-week trials: PSOARING 1 (NCT03956355) and PSOARING 2 (NCT03983980). Here, we present patient-reported pruritus outcomes from these trials. METHODS Outcomes included a Peak Pruritus Numerical Rating Scale (PP-NRS) score of 0 or 1 (itch-free state); Dermatology Life Quality Index (DLQI) itch item scores; and Psoriasis Symptom Diary (PSD) itch item scores. RESULTS Analyses included 683 tapinarof- and 342 vehicle-treated patients. At baseline, mean pruritus scores were similar across trials with only 7-11% of patients reporting an itch-free state. At week 12, the proportion of tapinarof-treated patients achieving an itch-free state was 50% in both trials compared with 32% (P = 0.0007) and 27% (P < 0.0001) in the vehicle groups. Improvements were apparent at the earliest assessments with continued improvement over the course of the trials. There were rapid and statistically significant improvements in the proportion of patients with a ≥ 4-point improvement in PP-NRS for tapinarof-treated patients versus vehicle from week 2 with 68% vs 46% (P = 0.0004) and 60% vs 31% (P = 0.0001) at week 12 achieving a response in each trial. Significantly greater reductions in itch with tapinarof versus vehicle were also demonstrated at week 12 for DLQI itch item 1 (P = 0.0026 and P < 0.0001), PSD item 1 (both P < 0.0001), and PSD item 2 (both P < 0.0001). CONCLUSION Tapinarof was highly efficacious in reducing pruritus across multiple patient-reported outcome measures, with rapid, statistically significant, and clinically meaningful improvements. The high proportion of patients achieving the treatment target of an itch-free state at week 12 (50%) is a noteworthy clinical outcome for a non-steroidal topical cream in the treatment of mild to severe plaque psoriasis. TRIAL REGISTRATION Clinical trial registration information: NCT03956355, NCT03983980.
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Affiliation(s)
- Leon Kircik
- Icahn School of Medicine at Mount Sinai, 5 E. 98th St., 5th Fl., New York, NY, 10029, USA.
| | - Matthew Zirwas
- DOCS Dermatology, 2359 E Main St, Bexley, OH, 43209, USA
| | - Shawn G Kwatra
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | | | | | - Tomas Chao
- Atlanta North Dermatology, Woodstock, GA, USA
| | - Philip M Brown
- Dermavant Sciences, Inc., 3300 Paramount Parkway, Suite 150, Morrisville, NC, 27560, USA
| | - David S Rubenstein
- Dermavant Sciences, Inc., 3300 Paramount Parkway, Suite 150, Morrisville, NC, 27560, USA
| | - Anna M Tallman
- Dermavant Sciences, Inc., 3300 Paramount Parkway, Suite 150, Morrisville, NC, 27560, USA
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Grossmann MC, Pixley JN, Feldman SR. A Review of Topical Tapinarof for the Treatment of Plaque Psoriasis. Ann Pharmacother 2024; 58:76-85. [PMID: 37076998 DOI: 10.1177/10600280231164775] [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] [Indexed: 04/21/2023] Open
Abstract
OBJECTIVE This article reviews the efficacy and safety of 1% tapinarof cream for plaque psoriasis. DATA SOURCES A literature search was conducted from August 2022 to February 2023. The terms tapinarof, VTAMA, benvitimod, GSK2894512, DMVT-505, and WBI-1001 were queried in PubMed. ClinicalTrials.gov was searched to identify ongoing or unpublished studies. STUDY SELECTION AND DATA EXTRACTION All clinical trials written in English and relevant to pharmacology, efficacy, and safety were included. DATA SYNTHESIS In two 12-week phase III clinical trials, disease severity assessed by a Physician's Global Assessment (PGA) score of clear or almost clear and a 2-point PGA improvement was 35.4% and 40.2% at week 12 in the 2 trials, respectively. In the 40-week, open-label extension trial, the efficacy and safety results were similar: 40.9% of patients achieved a PGA of 0 at least once during the trial, and 58.2% of patients with PGA ≥ 2 achieved PGA 0/1 at least once. RELEVANCE TO PATIENT CARE AND CLINICAL PRACTICE IN COMPARISON TO EXISTING DRUGS Tapinarof is a topical aryl hydrocarbon receptor agonist and a first-in-class, potentially promising treatment for plaque psoriasis recently approved by the U.S. Food and Drug Administration. CONCLUSION Compared with placebo, tapinarof may be an effective and safe topical treatment for mild to severe plaque psoriasis. Head-to-head trials to compare the efficacy and adverse effect profile of tapinarof to other topical treatments are still needed, as are investigation in patients with recent or current use of phototherapy or biologic or nonbiologic systemics. Cost and adherence to treatment may be barriers for treatment efficacy.
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Affiliation(s)
- Meghan C Grossmann
- Center for Dermatology Research, Department of Dermatology, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Jessica N Pixley
- 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
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Desai SR, Stein Gold L, Cameron MC, Golant A, Lewitt GM, Bruno MJ, Martin G, Brown PM, Rubenstein DS, Butners V, Tallman AM. Tapinarof Cream 1% Once Daily for the Treatment of Plaque Psoriasis: Case Photography of Clinical Outcomes from Three Phase 3 Trials. Dermatol Ther (Heidelb) 2023; 13:2443-2460. [PMID: 37697121 PMCID: PMC10539260 DOI: 10.1007/s13555-023-01008-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Accepted: 08/07/2023] [Indexed: 09/13/2023] Open
Abstract
Tapinarof cream 1% (VTAMA®; Dermavant Sciences, Inc.) is a non-steroidal, topical, aryl hydrocarbon receptor agonist approved by the US Food and Drug Administration (FDA) to treat plaque psoriasis in adults and under investigation for the treatment of psoriasis in children down to 2 years of age, and for atopic dermatitis in adults and children down to 2 years of age. The PSOARING phase 3 clinical trial program evaluated tapinarof cream 1% once daily (QD) in adults with mild to severe plaque psoriasis for up to 52 weeks (NCT03956355, NCT03983980, NCT04053387). Here we present case photography documenting outcomes in the PSOARING trials. Cases illustrate various outcomes across different body areas, including responses meeting the formal FDA-mandated regulatory endpoint of a Physician Global Assessment (PGA) score of 0 (clear) or 1 (almost clear) and a decrease of at least 2 points from baseline at week 12, meaningful clinical improvement not meeting this formal endpoint, patient-reported outcomes, and pre-specified adverse events of special interest (AESIs). Tapinarof cream 1% QD demonstrated rapid and highly statistically significant efficacy, with improvements in disease activity and quality of life. In addition, a high rate (40.9%; n = 312/763) of complete disease clearance (PGA = 0) was achieved, and improvements exceeding National Psoriasis Foundation treatment goals were demonstrated. After first achieving complete disease clearance (PGA = 0), patients treated with tapinarof experienced an approximately 4-month remittive effect off therapy. Incidence and severity of folliculitis and contact dermatitis AESIs were generally mild or moderate, localized to the site of application, and associated with low discontinuation rates. Medical images are of importance in trials of dermatologic therapies to inform clinical decision-making and enhance patient assessment. Tapinarof cream 1% QD is efficacious and well tolerated in patients with mild to severe plaque psoriasis, with clinically relevant improvements seen early in the course of treatment.Clinicaltrials.gov numbers: NCT03956355, NCT03983980, NCT04053387.
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Affiliation(s)
- Seemal R Desai
- Department of Dermatology, The University of Texas Southwestern Medical Center, 5939 Harry Hines Blvd 4th Floor, Suite 100, Dallas, TX, USA.
- Innovative Dermatology, Plano, TX, USA.
| | | | - Michael C Cameron
- Cameron Dermatology, New York, NY, USA
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | | | | | | | - George Martin
- George Martin Dermatology Associates, Kihei, HI, USA
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Sládeková L, Zgarbová E, Vrzal R, Vanda D, Soural M, Jakubcová K, Vázquez-Gómez G, Vondráček J, Dvořák Z. Switching on/off aryl hydrocarbon receptor and pregnane X receptor activities by chemically modified tryptamines. Toxicol Lett 2023; 387:63-75. [PMID: 37778463 DOI: 10.1016/j.toxlet.2023.09.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Revised: 09/01/2023] [Accepted: 09/27/2023] [Indexed: 10/03/2023]
Abstract
Microbial indoles have been demonstrated as selective or dual agonists and ligands of the pregnane X receptor (PXR) and aryl hydrocarbon receptor (AhR). However, structural determinants of microbial indoles selectivity towards both receptors remain elusive. Here, we studied the effects of existing and newly synthesized derivatives of indole microbial metabolite tryptamine on the activity of AhR and PXR receptors. We show that the elongation of indolyl-3-alkaneamine chain, indole N-methylation and conversion of indolyl-3-alkaneamines to oleamides resulted in a major increase of PXR activity and in parallel loss of AhR activity. Using reporter gene assays, RT-PCR and TR-FRET techniques, we have characterized in detail the activation of PXR by novel indolyl-3-alkanyl-oleamides, 1-methyltryptamine and 1-methyltryptamine-acetamide. As a proof of concept, we demonstrated anti-inflammatory and epithelial barrier-protective activity of lead derivatives in intestinal Caco-2 cells, employing the measurement of expression of pro-inflammatory chemokines, tight junction genes, trans-epithelial electric resistance TEER, and dextran-FITC permeability assay. In conclusion, we show that a subtle chemical modifications of simple microbial indole metabolite tryptamine, leads to substantial changes in AhR and PXR agonist activities.
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Affiliation(s)
- Lucia Sládeková
- Department of Cell Biology and Genetics, Faculty of Science, Palacký University, Šlechtitelů 27, 783 71 Olomouc, Czech Republic
| | - Eliška Zgarbová
- Department of Cell Biology and Genetics, Faculty of Science, Palacký University, Šlechtitelů 27, 783 71 Olomouc, Czech Republic
| | - Radim Vrzal
- Department of Cell Biology and Genetics, Faculty of Science, Palacký University, Šlechtitelů 27, 783 71 Olomouc, Czech Republic
| | - David Vanda
- Department of Organic Chemistry, Faculty of Science, Palacký University, 17. Listopadu 12, 771 46 Olomouc, Czech Republic
| | - Miroslav Soural
- Department of Organic Chemistry, Faculty of Science, Palacký University, 17. Listopadu 12, 771 46 Olomouc, Czech Republic
| | - Klára Jakubcová
- Department of Cytokinetics, Institute of Biophysics of the Czech Academy of Sciences, 612 65 Brno, Czech Republic
| | - Gerardo Vázquez-Gómez
- Department of Cytokinetics, Institute of Biophysics of the Czech Academy of Sciences, 612 65 Brno, Czech Republic
| | - Jan Vondráček
- Department of Cytokinetics, Institute of Biophysics of the Czech Academy of Sciences, 612 65 Brno, Czech Republic
| | - Zdeněk Dvořák
- Department of Cell Biology and Genetics, Faculty of Science, Palacký University, Šlechtitelů 27, 783 71 Olomouc, Czech Republic.
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Sládeková L, Mani S, Dvořák Z. Ligands and agonists of the aryl hydrocarbon receptor AhR: Facts and myths. Biochem Pharmacol 2023; 213:115626. [PMID: 37247746 DOI: 10.1016/j.bcp.2023.115626] [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: 04/21/2023] [Revised: 05/22/2023] [Accepted: 05/23/2023] [Indexed: 05/31/2023]
Abstract
The aryl hydrocarbon receptor (AhR) belongs to the essential helix-loop-helix transcription factors family. This receptor has a central role in determining host physiology and a variety of pathophysiologies ranging from inflammation and metabolism to cancer. AhR is a ligand-driven receptor with intricate pharmacology of activation depending on the type and quantity of ligand present. Therefore, a better understanding of AhR ligands per se is critical to move the field forward. In this minireview, we clarify some facts and myths about AhR ligands and how further studies could shed light on the true nature of AhR activation by these ligands. The review covers select chemical classes and explores parameters that qualify them as true receptor ligands.
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Affiliation(s)
- Lucia Sládeková
- Department of Cell Biology and Genetics, Faculty of Science, Palacký University, Šlechtitelů 27, 783 71 Olomouc, Czech Republic
| | - Sridhar Mani
- Department of Genetics and Department of Medicine, Albert Einstein College of Medicine, Bronx, NY 10461, USA
| | - Zdeněk Dvořák
- Department of Cell Biology and Genetics, Faculty of Science, Palacký University, Šlechtitelů 27, 783 71 Olomouc, Czech Republic.
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Ehsan M, Rehman AU, Athar F, Mustafa B, Javed H, Cheema HA, Ayyan M, Shahid A, Jafar U, Goldust M. Benvitimod for the treatment of psoriasis: A systematic review and meta-analysis of randomized controlled trials. Dermatol Ther 2022; 35:e15957. [PMID: 36279313 DOI: 10.1111/dth.15957] [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: 05/19/2022] [Revised: 06/27/2022] [Accepted: 10/21/2022] [Indexed: 11/26/2022]
Abstract
Benvitimod is a topical drug that has recently been approved for mild to moderate psoriasis and atopic dermatitis. The drug has just completed phase 3 trials for psoriasis, which calls for a systematic update of current evidence on the efficacy and safety of this drug. We searched MEDLINE (PubMed), EMBASE, Science Direct, International Clinical Trials Registry Platform (ICTRP), Cochrane Central Register of Controlled Trials, and Google Scholar for all available randomized controlled trials concerning the topic. We included six randomized controlled trials evaluating the efficacy of benvitimod 1.0% with a total of 1925 patients. Our meta-analysis demonstrated that more patients in the benvitimod group achieved physician global assessment score of 0 or 1 (RR 6.53, 95% CI 4.39-9.71), psoriasis area and severity index (PASI) 75 (RR 4.34, 95% CI 2.96-6.36), PASI 90 (RR 8.83, 95% CI 5.22-14.95) and body surface area reduction (MD -3.85, 95% CI -4.83, -2.88) than placebo at week 12. Patient-reported outcomes were also analyzed, yielding a significant benefit in the benvitimod group for peak pruritus numerical rating scale (PP-NRS) score (MD -1.20, 95% CI -1.98, -0.42), ≥4-point decrease in PP-NRS score (RR 1.58, 95% CI, 1.24-2.03) and dermatology life quality index score (MD -2.54, 95% CI -4.00, -1.07). There was a significantly higher incidence of adverse events in the benvitimod group compared to placebo (RR 1.98, 95% CI 1.73-2.27), while the risk was found to be non-significant for serious adverse events. Benvitimod is an effective treatment of psoriasis as compared to a placebo. However, more large-scale, high-quality trials are needed to comment on the safety of this drug.
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Affiliation(s)
- Muhammad Ehsan
- Department of Dermatology, King Edward Medical University, Lahore, Pakistan
| | - Aqeeb Ur Rehman
- Department of Dermatology, King Edward Medical University, Lahore, Pakistan
| | - Farwa Athar
- Department of Dermatology, King Edward Medical University, Lahore, Pakistan
| | - Biah Mustafa
- Department of Dermatology, King Edward Medical University, Lahore, Pakistan
| | - Haseeba Javed
- Department of Dermatology, King Edward Medical University, Lahore, Pakistan
| | | | - Muhammad Ayyan
- Department of Dermatology, King Edward Medical University, Lahore, Pakistan
| | - Abia Shahid
- Department of Dermatology, King Edward Medical University, Lahore, Pakistan
| | - Uzair Jafar
- Department of Dermatology, King Edward Medical University, Lahore, Pakistan
| | - Mohamad Goldust
- Department of Dermatology, University Medical Center of the Johannes Gutenberg University, Mainz, Germany
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Nogueira S, Rodrigues MA, Vender R, Torres T. Tapinarof for the treatment of psoriasis. Dermatol Ther 2022; 35:e15931. [PMID: 36226669 PMCID: PMC10078538 DOI: 10.1111/dth.15931] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Revised: 09/25/2022] [Accepted: 10/11/2022] [Indexed: 12/31/2022]
Abstract
Although topical drugs are the mainstay of treatment for patients with mild-to-moderate psoriasis, the developments observed in this field in the last two decades have been limited. The most commonly used drugs are still vitamin D analogues and corticosteroids, both with several limitations. The aryl hydrocarbon receptor (AhR) plays a role in the pathogenesis of psoriasis, and tapinarof, a novel, first-in-class, small molecule topical therapeutic AhR-modulating agent has been recently approved by the FDA for the topical treatment of plaque psoriasis in adults. Two large, 12-week, phase III trials, PSOARING 1 and 2, showed that 35.4%-40.2% of patients in the tapinarof 1% cream arm achieved the primary endpoint (Physician's Global Assessment [PGA] score of 0 or 1 and a decrease of ≥2-5 points at week 12) compared with 6.0%-6.3% for vehicle arm, respectively. The most common adverse effects were folliculitis, contact dermatitis, headache and pruritus. In the open label, 40-week, extension trial, PSOARING 3, the efficacy and safety results were similar, with 40.9% of patients achieving a PGA = 0 at least one time during the trial and 58.2% of patients with PGA≥2 achieved PGA = 0/1 at least once during the trial, without tachyphylaxis. There were no new safety signals, with most frequent adverse events being folliculitis, contact dermatitis, and upper respiratory tract infection. Tapinarof 1% cream has shown to be effective and to have a favorable safety profile in the treatment of psoriatic patients, representing an alternative to the current therapeutic options, increasing our armamentarium in the topical treatment of psoriasis.
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Affiliation(s)
- Sofia Nogueira
- Instituto de Ciências Biomédicas Abel Salazar, University of Porto, Porto, Portugal
| | | | - Ron Vender
- Dermatrials Research Inc, Hamilton, Canada
- McMaster University, Hamilton, Canada
| | - Tiago Torres
- Instituto de Ciências Biomédicas Abel Salazar, University of Porto, Porto, Portugal
- Department of Dermatology, Centro Hospitalar do Porto, Porto, Portugal
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Radi G, Campanti A, Diotallevi F, Martina E, Marani A, Offidani A. A Systematic Review of Atopic Dermatitis: The Intriguing Journey Starting from Physiopathology to Treatment, from Laboratory Bench to Bedside. Biomedicines 2022; 10:2700. [PMID: 36359220 PMCID: PMC9688004 DOI: 10.3390/biomedicines10112700] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 09/25/2022] [Accepted: 10/13/2022] [Indexed: 09/02/2023] Open
Abstract
Atopic dermatitis (AD) is a common chronic inflammatory and immune-mediated skin disease with a complex pathophysiology and still represents a therapeutic challenge, owing to limited responses to available treatments. However, recent advances in the understanding of AD pathophysiology have led to the discovery of several new potential therapeutic targets, and research in the field of new molecules with therapeutic perspectives is boiling, with more than 70 new promising drugs in development. The aim of this systematic review is to provide the state of the art on the current knowledge concerning the pathophysiology of the disease and on novel agents currently being investigated for AD, and to highlight which type of evolution is going to take place in therapeutic approaches of atopic dermatitis in the coming years.
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Affiliation(s)
| | | | - Federico Diotallevi
- Dermatological Clinic, Department of Clinical and Molecular Sciences, Polytechnic Marche University, 60126 Ancona, Italy
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Renert-Yuval Y, da Rosa JC, Garcet S, Pavel AB, Bares J, Chima M, Hawkes JE, Gilleaudeau P, Sullivan-Whalen M, Singer GK, Krueger JG, Guttman-Yassky E. Analysis of alopecia areata surveys suggests a threshold for improved patient-reported outcomes. Br J Dermatol 2022; 187:539-547. [PMID: 35656793 PMCID: PMC10291970 DOI: 10.1111/bjd.21696] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Revised: 05/23/2022] [Accepted: 05/31/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND Although alopecia areata (AA) greatly impacts patients' quality of life (QoL), there is no adequate validation of AA-targeted QoL surveys in clinical trials, hindering sufficient representation of patient-reported outcomes. OBJECTIVES Better understanding of patient-reported outcomes may guide treatment goals and future clinical trials. METHODS In a recent randomized controlled trial testing dupilumab in AA, patients were administered the Alopecia Areata Quality of Life Index (AA-QLI) and the Alopecia Areata Symptom Impact Scale (AASIS) surveys, specifically evaluating QoL in patients with AA. An in-depth analysis was performed to assess the utility of these questionnaires in this patient population, both at baseline and after treatment, and to determine a threshold for improved patient-reported outcomes. RESULTS While AASIS correlated with baseline Severity of Alopecia Tool (SALT) scores and with therapeutic response, AA-QLI showed no correlation with AA severity before or after treatment. Itch strongly correlated with serum IgE levels across both surveys. Using various approaches to estimate a discriminative threshold for decreased impact of AA on QoL (by AASIS) following treatment, a SALT score of 20 points or less post-treatment was associated with improved patient-reported outcomes, including both AA-related symptoms and items within the daily activities/feelings domain such as 'feeling sad' and 'feeling anxious or worry'. CONCLUSIONS AASIS is better than AA-QLI to assess patient-reported outcomes. SALT ≤ 20 following treatment should be considered as a threshold for meaningful therapeutic outcome and as a clinical endpoint in future clinical trials for AA. What is already known about this topic? Alopecia areata greatly compromises quality of life, and affected patients have increased prevalences of depression, anxiety and social phobia. Despite the significant negative impact of the disease on patients' wellbeing, validation of targeted questionnaires in alopecia areata is lacking, and a therapeutic response threshold for improved patient-reported outcomes is unknown. What does this study add? This study investigated the utility of two different alopecia areata-targeted questionnaires - Alopecia Areata Quality of Life Index and Alopecia Areata Symptom Impact Scale (AASIS) - in a clinical trial setting. AASIS was found to correlate strongly with alopecia areata severity and clinical response. What are the clinical implications of this work? Patients with ≤ 20% scalp hair loss after treatment reported improvement in multiple quality-of-life items, suggesting this as a meaningful therapeutic outcome that may guide clinicians and improve the development of future clinical trials.
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Affiliation(s)
- Yael Renert-Yuval
- Laboratory for Investigative Dermatology, The Rockefeller University, New York, NY, USA
- Department of Dermatology, and Laboratory of Inflammatory Skin Diseases, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Joel Correa da Rosa
- Laboratory for Investigative Dermatology, The Rockefeller University, New York, NY, USA
| | - Sandra Garcet
- Department of Dermatology, and Laboratory of Inflammatory Skin Diseases, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Ana B. Pavel
- Department of Biomedical Engineering, University of Mississippi, Oxford, MS, USA
| | - Jennifer Bares
- Department of Dermatology, and Laboratory of Inflammatory Skin Diseases, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Margot Chima
- Department of Dermatology, and Laboratory of Inflammatory Skin Diseases, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Jason E. Hawkes
- Department of Dermatology, UC Davis Medical Center, University of California Davis Health System, Sacramento, CA, USA
| | - Patricia Gilleaudeau
- Laboratory for Investigative Dermatology, The Rockefeller University, New York, NY, USA
| | - Mary Sullivan-Whalen
- Laboratory for Investigative Dermatology, The Rockefeller University, New York, NY, USA
| | - Giselle K. Singer
- Department of Dermatology, and Laboratory of Inflammatory Skin Diseases, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - James G. Krueger
- Laboratory for Investigative Dermatology, The Rockefeller University, New York, NY, USA
| | - Emma Guttman-Yassky
- Department of Dermatology, and Laboratory of Inflammatory Skin Diseases, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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Treat psoriasis with traditional and novel topical therapies. DRUGS & THERAPY PERSPECTIVES 2022. [DOI: 10.1007/s40267-022-00936-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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14
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Abstract
Tapinarof cream 1% (VTAMA®) is an aryl hydrocarbon receptor (AhR) agonist that is being developed by Dermavant Sciences Inc. (a subsidiary of Roivant Sciences Inc.) as a once-daily topical treatment for plaque psoriasis and atopic dermatitis. AhR is a ligand-dependent transcription factor that has a role in immune-mediated skin responses. In May 2022, tapinarof cream 1% was approved in the USA for the topical treatment of plaque psoriasis in adults. Tapinarof cream 1% is also being investigated for the treatment of atopic dermatitis. This article summarizes the milestones in the development of tapinarof cream 1% leading to this first approval for the topical treatment of plaque psoriasis.
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A Poly (Caprolactone)-Cellulose Nanocomposite Hydrogel for Transdermal Delivery of Hydrocortisone in Treating Psoriasis Vulgaris. Polymers (Basel) 2022; 14:polym14132633. [PMID: 35808678 PMCID: PMC9269097 DOI: 10.3390/polym14132633] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Revised: 06/09/2022] [Accepted: 06/22/2022] [Indexed: 02/04/2023] Open
Abstract
Psoriasis vulgaris (PV) is a common chronic disease, affecting much of the population. Hydrocortisone (HCT) is currently utilized as a PV treatment; however, it is associated with undesirable side effects. The aim of this research was to create a thermo-responsive nano-hydrogel delivery system. HCT-loaded sorbitan monostearate (SMS)-polycaprolactone (PCL) nanoparticles, encapsulated with thermo-responsive hydrogel carboxymethyl cellulose (CMC), were synthesized by applying the interfacial polymer-deposition method following solvent displacement. The nanoparticles’ properties were evaluated employing Differential Scanning Colorimetry, Thermogravimetric Analysis, Fourier Transform Infrared Spectroscopy, Scanning Electron Microscopy, Zeta sizer, Ultraviolet/Visual spectroscopy, and cytotoxicity testing. The nanoparticle sizes were 110.5 nm, with polydispersity index of 0.15 and zeta potential of −58.7 mV. A drug-entrapment efficacy of 76% was attained by the HCT-loaded SMS-PCL nanoparticles and in vitro drug-release profiles showed continuous drug release over a period of 24 hrs. Keratinocyte skin cells were treated with HCT-loaded SMS-PCL nanoparticles encapsulated with CMC; the results indicated that the synthesized drug-delivery system was less toxic to the keratinocyte cells compared to HCT. The combined trials and results from the formulation of HCT-loaded SMS-PCL nanoparticles encapsulated with CMC showed evidence that this hydrogel can be utilized as a potentially invaluable formulation for transdermal drug delivery of HCT, with improved efficacy and patient conformity.
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Tsuji G, Hashimoto-Hachiya A, Matsuda-Taniguchi T, Takai-Yumine A, Takemura M, Yan X, Furue M, Nakahara T. Natural Compounds Tapinarof and Galactomyces Ferment Filtrate Downregulate IL-33 Expression via the AHR/IL-37 Axis in Human Keratinocytes. Front Immunol 2022; 13:745997. [PMID: 35663970 PMCID: PMC9161696 DOI: 10.3389/fimmu.2022.745997] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Accepted: 04/22/2022] [Indexed: 12/12/2022] Open
Abstract
Interleukin (IL)-37 suppresses systemic and local inflammation. It is expressed in the epidermis, the external layer of the skin, and is decreased in inflammatory skin diseases including atopic dermatitis (AD) and psoriasis. Therefore, an agent applied topically on the skin that can increase IL-37 could be promising for treating AD and psoriasis; however, the mechanism regulating IL-37 remains largely unknown. Given that IL-37 expression is induced in differentiated keratinocytes, a major component of the epidermis, and that activation of aryl hydrocarbon receptor (AHR), a ligand-activated transcription factor, promotes keratinocyte differentiation, we hypothesized that AHR might be involved in the IL-37 expression in human keratinocytes. We analyzed normal epidermal human keratinocytes (NHEKs) treated with tapinarof and Galactomyces ferment filtrate (GFF), which are potent AHR modulators. We found that tapinarof and GFF upregulated IL-37 in NHEKs, which was canceled by the knockdown of AHR using siRNA transfection, indicating that AHR mediates IL-37 expression in NHEKs. Furthermore, we found that the knockdown of IL-37 resulted in the upregulation of IL-33, an alarmin cytokine with crucial roles in the pathogenesis of AD and psoriasis. These findings suggest that IL-37 negatively regulates IL-33 expression in NHEKs. Finally, we examined whether tapinarof and GFF treatment modulates IL-33 expression in NHEKs. Such treatment inhibited IL-33 expression, which was partially reversed by the knockdown of either AHR or IL-37. Taken together, our findings provide the first evidence that tapinarof and GFF could have potential to prevent IL-33-overexpressing disorders such as AD and psoriasis via the AHR/IL-37 axis.
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Affiliation(s)
- Gaku Tsuji
- Research and Clinical Center for Yusho and Dioxin, Kyushu University, Fukuoka, Japan.,Department of Dermatology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Akiko Hashimoto-Hachiya
- Research and Clinical Center for Yusho and Dioxin, Kyushu University, Fukuoka, Japan.,Department of Dermatology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Tomoyo Matsuda-Taniguchi
- Department of Dermatology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Ayako Takai-Yumine
- Department of Dermatology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Masaki Takemura
- Department of Dermatology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Xianghong Yan
- Science Communications, Procter & Gamble (P&G) Innovation Godo Kaisha, Kobe, Japan
| | - Masutaka Furue
- Department of Dermatology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Takeshi Nakahara
- Research and Clinical Center for Yusho and Dioxin, Kyushu University, Fukuoka, Japan.,Department of Dermatology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
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Abstract
Psoriasis is a chronic immune-mediated skin disease with a significant impact on patients' quality of life. Mild-to-moderate forms of the disease usually require long-term topical treatment, but prolonged use of corticosteroids and vitamin D analogues is limited by adverse effects. With further understanding of psoriasis pathogenesis, new molecules are emerging aiming to fulfil these clinical needs. Tapinarof, an aryl hydrocarbon receptor modulator, has completed a phase III study and demonstrated good efficacy results, even in long treatment courses, with a favourable safety profile. It additionally appears to have a promising remitting effect as patients presented with an average relapsing time of over 3 months. Roflumilast, a phosphodiesterase type 4 inhibitor, also underwent a phase III study with significant lesion improvement and notable pruritus management, and with no reported side effects. Roflumilast was evaluated as an option for intertriginous areas with good outcomes in a small sample, but larger trials are required. The Janus kinase-signal transducer and activator of transcription pathway has been targeted in recent clinical investigations with promising options, currently with brepocitinib pending phase IIb results. Ongoing preclinical studies involving interleukin-2 inhibition, RNA modulators and amygdalin analogues may lead to forthcoming clinical trials. New topical drugs are successfully emerging and future research comparing them to classical options will dictate their clinical role in the treatment of psoriasis.
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Lu ST, Kelly KA, Feldman SR. An overview of benvitimod for the treatment of psoriasis: a narrative review. Expert Opin Pharmacother 2021; 23:327-333. [DOI: 10.1080/14656566.2021.2016699] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Sarah T Lu
- Center for Dermatology Research, Department of Dermatology, Wake Forest School of Medicine, Winston-Salem, NC USA
| | - Katherine A Kelly
- Center for Dermatology Research, Department of Dermatology, Wake Forest School of Medicine, Winston-Salem, NC USA
| | - Steven R Feldman
- Center for Dermatology Research, Department of Dermatology, Wake Forest School of Medicine, Winston-Salem, NC USA
- Department of Pathology, Wake Forest School of Medicine, Winston-Salem, Nc USA
- Department of Social Sciences & Health Policy, Wake Forest School of Medicine, Winston-Salem, NC USA
- Department of Dermatology, University of Southern Denmark, Odense, Denmark
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Role of Aryl Hydrocarbon Receptor Activation in Inflammatory Chronic Skin Diseases. Cells 2021; 10:cells10123559. [PMID: 34944067 PMCID: PMC8700074 DOI: 10.3390/cells10123559] [Citation(s) in RCA: 38] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2021] [Revised: 12/10/2021] [Accepted: 12/14/2021] [Indexed: 02/06/2023] Open
Abstract
Aryl Hydrocarbon Receptor (AhR) is an evolutionary transcription factor which acts as a crucial sensor of different exogenous and endogenous molecules Recent data indicate that AhR is implicated in several physiological processes such as cell physiology, host defense, proliferation and differentiation of immune cells, and detoxification. Moreover, AhR involvement has been reported in the development and maintenance of several pathological conditions. In recent years, an increasing number of studies have accumulated highlighting the regulatory role of AhR in the physiology of the skin. However, there is evidence of both beneficial and harmful effects of AHR signaling. At present, most of the evidence concerns inflammatory skin diseases, in particular atopic dermatitis, psoriasis, acne, and hidradenitis suppurativa. This review exam-ines the role of AhR in skin homeostasis and the therapeutic implication of its pharmacological modulation in these cutaneous inflammatory diseases.
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20
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Lebwohl MG, Stein Gold L, Strober B, Papp KA, Armstrong AW, Bagel J, Kircik L, Ehst B, Hong HCH, Soung J, Fromowitz J, Guenthner S, Piscitelli SC, Rubenstein DS, Brown PM, Tallman AM, Bissonnette R. Phase 3 Trials of Tapinarof Cream for Plaque Psoriasis. N Engl J Med 2021; 385:2219-2229. [PMID: 34879448 DOI: 10.1056/nejmoa2103629] [Citation(s) in RCA: 77] [Impact Index Per Article: 25.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Tapinarof cream is a topical aryl hydrocarbon receptor-modulating agent under investigation for the treatment of psoriasis. Tapinarof modulates the expression of interleukin-17 and the skin-barrier proteins filaggrin and loricrin. METHODS We conducted two identical phase 3 randomized trials of tapinarof in patients with mild-to-severe plaque psoriasis. Adults with a baseline Physician's Global Assessment (PGA) score of 2 (mild) to 4 (severe) (on a scale from 0 to 4, with higher scores indicating more severe psoriasis) and a percent of total body-surface area affected of 3 to 20% were randomly assigned in a 2:1 ratio to use tapinarof 1% cream or vehicle cream once daily for 12 weeks. The primary end point, PGA response, was a PGA score of 0 (clear) or 1 (almost clear) and a decrease from baseline of at least 2 points at week 12. Secondary efficacy end points at week 12 were a reduction of at least 75% in the Psoriasis Area and Severity Index (PASI) score, a PGA score of 0 or 1, the mean change from baseline in the percent of body-surface area affected, and a reduction of at least 90% in the PASI score. Patient-reported outcomes were the mean changes from baseline to week 12 in the proportion of patients who had a decrease of at least 4 points in the Peak Pruritus Numeric Rating Scale (PP-NRS) score (range, 0 [no itch] to 10 [worst imaginable itch]), the PP-NRS total score, the Dermatology Life Quality Index total score, and the Psoriasis Symptom Diary score. RESULTS In trials 1 and 2, a total of 692 and 674 patients, respectively, were screened, with 510 and 515 patients being enrolled. A PGA response occurred in 35.4% of the patients in the tapinarof group and in 6.0% of those in the vehicle group in trial 1 and in 40.2% and 6.3%, respectively, in trial 2 (P<0.001 for both comparisons). Results for secondary end points and patient-reported outcomes were generally in the same direction as those for the primary end point. Adverse events with tapinarof cream included folliculitis, nasopharyngitis, contact dermatitis, headache, upper respiratory tract infection, and pruritus. CONCLUSIONS Tapinarof 1% cream once daily was superior to vehicle control in reducing the severity of plaque psoriasis over a period of 12 weeks but was associated with local adverse events and headache. Larger and longer trials are needed to evaluate the efficacy and safety of tapinarof cream as compared with existing treatments for psoriasis. (Funded by Dermavant Sciences; PSOARING 1 and 2 ClinicalTrials.gov numbers, NCT03956355 and NCT03983980, respectively.).
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Affiliation(s)
- Mark G Lebwohl
- From the Icahn School of Medicine at Mount Sinai, New York (M.G.L., L.K.); Henry Ford Health System, Detroit (L.S.G.); Yale University, New Haven, and Central Connecticut Dermatology Research, Cromwell - both in Connecticut (B.S.); Probity Medical Research, Waterloo, ON (K.A.P.), the University of British Columbia and Probity Medical Research, Surrey (H.C.H.), and Innovaderm Research, Montreal (R.B.) - all in Canada; Keck School of Medicine, University of Southern California, Los Angeles (A.W.A.), and Southern California Dermatology, Santa Ana (J.S.) - both in California; the Psoriasis Treatment Center of Central New Jersey, East Windsor (J.B.); Skin Sciences, Louisville, KY (L.K.); Oregon Medical Research Center, Portland (B.E.); Dermatology of Boca, Boca Raton, FL (J.F.); the Indiana Clinical Trials Center, Plainfield (S.G.); and Dermavant Sciences, Morrisville, NC (S.C.P., D.S.R., P.M.B., A.M.T.)
| | - Linda Stein Gold
- From the Icahn School of Medicine at Mount Sinai, New York (M.G.L., L.K.); Henry Ford Health System, Detroit (L.S.G.); Yale University, New Haven, and Central Connecticut Dermatology Research, Cromwell - both in Connecticut (B.S.); Probity Medical Research, Waterloo, ON (K.A.P.), the University of British Columbia and Probity Medical Research, Surrey (H.C.H.), and Innovaderm Research, Montreal (R.B.) - all in Canada; Keck School of Medicine, University of Southern California, Los Angeles (A.W.A.), and Southern California Dermatology, Santa Ana (J.S.) - both in California; the Psoriasis Treatment Center of Central New Jersey, East Windsor (J.B.); Skin Sciences, Louisville, KY (L.K.); Oregon Medical Research Center, Portland (B.E.); Dermatology of Boca, Boca Raton, FL (J.F.); the Indiana Clinical Trials Center, Plainfield (S.G.); and Dermavant Sciences, Morrisville, NC (S.C.P., D.S.R., P.M.B., A.M.T.)
| | - Bruce Strober
- From the Icahn School of Medicine at Mount Sinai, New York (M.G.L., L.K.); Henry Ford Health System, Detroit (L.S.G.); Yale University, New Haven, and Central Connecticut Dermatology Research, Cromwell - both in Connecticut (B.S.); Probity Medical Research, Waterloo, ON (K.A.P.), the University of British Columbia and Probity Medical Research, Surrey (H.C.H.), and Innovaderm Research, Montreal (R.B.) - all in Canada; Keck School of Medicine, University of Southern California, Los Angeles (A.W.A.), and Southern California Dermatology, Santa Ana (J.S.) - both in California; the Psoriasis Treatment Center of Central New Jersey, East Windsor (J.B.); Skin Sciences, Louisville, KY (L.K.); Oregon Medical Research Center, Portland (B.E.); Dermatology of Boca, Boca Raton, FL (J.F.); the Indiana Clinical Trials Center, Plainfield (S.G.); and Dermavant Sciences, Morrisville, NC (S.C.P., D.S.R., P.M.B., A.M.T.)
| | - Kim A Papp
- From the Icahn School of Medicine at Mount Sinai, New York (M.G.L., L.K.); Henry Ford Health System, Detroit (L.S.G.); Yale University, New Haven, and Central Connecticut Dermatology Research, Cromwell - both in Connecticut (B.S.); Probity Medical Research, Waterloo, ON (K.A.P.), the University of British Columbia and Probity Medical Research, Surrey (H.C.H.), and Innovaderm Research, Montreal (R.B.) - all in Canada; Keck School of Medicine, University of Southern California, Los Angeles (A.W.A.), and Southern California Dermatology, Santa Ana (J.S.) - both in California; the Psoriasis Treatment Center of Central New Jersey, East Windsor (J.B.); Skin Sciences, Louisville, KY (L.K.); Oregon Medical Research Center, Portland (B.E.); Dermatology of Boca, Boca Raton, FL (J.F.); the Indiana Clinical Trials Center, Plainfield (S.G.); and Dermavant Sciences, Morrisville, NC (S.C.P., D.S.R., P.M.B., A.M.T.)
| | - April W Armstrong
- From the Icahn School of Medicine at Mount Sinai, New York (M.G.L., L.K.); Henry Ford Health System, Detroit (L.S.G.); Yale University, New Haven, and Central Connecticut Dermatology Research, Cromwell - both in Connecticut (B.S.); Probity Medical Research, Waterloo, ON (K.A.P.), the University of British Columbia and Probity Medical Research, Surrey (H.C.H.), and Innovaderm Research, Montreal (R.B.) - all in Canada; Keck School of Medicine, University of Southern California, Los Angeles (A.W.A.), and Southern California Dermatology, Santa Ana (J.S.) - both in California; the Psoriasis Treatment Center of Central New Jersey, East Windsor (J.B.); Skin Sciences, Louisville, KY (L.K.); Oregon Medical Research Center, Portland (B.E.); Dermatology of Boca, Boca Raton, FL (J.F.); the Indiana Clinical Trials Center, Plainfield (S.G.); and Dermavant Sciences, Morrisville, NC (S.C.P., D.S.R., P.M.B., A.M.T.)
| | - Jerry Bagel
- From the Icahn School of Medicine at Mount Sinai, New York (M.G.L., L.K.); Henry Ford Health System, Detroit (L.S.G.); Yale University, New Haven, and Central Connecticut Dermatology Research, Cromwell - both in Connecticut (B.S.); Probity Medical Research, Waterloo, ON (K.A.P.), the University of British Columbia and Probity Medical Research, Surrey (H.C.H.), and Innovaderm Research, Montreal (R.B.) - all in Canada; Keck School of Medicine, University of Southern California, Los Angeles (A.W.A.), and Southern California Dermatology, Santa Ana (J.S.) - both in California; the Psoriasis Treatment Center of Central New Jersey, East Windsor (J.B.); Skin Sciences, Louisville, KY (L.K.); Oregon Medical Research Center, Portland (B.E.); Dermatology of Boca, Boca Raton, FL (J.F.); the Indiana Clinical Trials Center, Plainfield (S.G.); and Dermavant Sciences, Morrisville, NC (S.C.P., D.S.R., P.M.B., A.M.T.)
| | - Leon Kircik
- From the Icahn School of Medicine at Mount Sinai, New York (M.G.L., L.K.); Henry Ford Health System, Detroit (L.S.G.); Yale University, New Haven, and Central Connecticut Dermatology Research, Cromwell - both in Connecticut (B.S.); Probity Medical Research, Waterloo, ON (K.A.P.), the University of British Columbia and Probity Medical Research, Surrey (H.C.H.), and Innovaderm Research, Montreal (R.B.) - all in Canada; Keck School of Medicine, University of Southern California, Los Angeles (A.W.A.), and Southern California Dermatology, Santa Ana (J.S.) - both in California; the Psoriasis Treatment Center of Central New Jersey, East Windsor (J.B.); Skin Sciences, Louisville, KY (L.K.); Oregon Medical Research Center, Portland (B.E.); Dermatology of Boca, Boca Raton, FL (J.F.); the Indiana Clinical Trials Center, Plainfield (S.G.); and Dermavant Sciences, Morrisville, NC (S.C.P., D.S.R., P.M.B., A.M.T.)
| | - Benjamin Ehst
- From the Icahn School of Medicine at Mount Sinai, New York (M.G.L., L.K.); Henry Ford Health System, Detroit (L.S.G.); Yale University, New Haven, and Central Connecticut Dermatology Research, Cromwell - both in Connecticut (B.S.); Probity Medical Research, Waterloo, ON (K.A.P.), the University of British Columbia and Probity Medical Research, Surrey (H.C.H.), and Innovaderm Research, Montreal (R.B.) - all in Canada; Keck School of Medicine, University of Southern California, Los Angeles (A.W.A.), and Southern California Dermatology, Santa Ana (J.S.) - both in California; the Psoriasis Treatment Center of Central New Jersey, East Windsor (J.B.); Skin Sciences, Louisville, KY (L.K.); Oregon Medical Research Center, Portland (B.E.); Dermatology of Boca, Boca Raton, FL (J.F.); the Indiana Clinical Trials Center, Plainfield (S.G.); and Dermavant Sciences, Morrisville, NC (S.C.P., D.S.R., P.M.B., A.M.T.)
| | - H Chih-Ho Hong
- From the Icahn School of Medicine at Mount Sinai, New York (M.G.L., L.K.); Henry Ford Health System, Detroit (L.S.G.); Yale University, New Haven, and Central Connecticut Dermatology Research, Cromwell - both in Connecticut (B.S.); Probity Medical Research, Waterloo, ON (K.A.P.), the University of British Columbia and Probity Medical Research, Surrey (H.C.H.), and Innovaderm Research, Montreal (R.B.) - all in Canada; Keck School of Medicine, University of Southern California, Los Angeles (A.W.A.), and Southern California Dermatology, Santa Ana (J.S.) - both in California; the Psoriasis Treatment Center of Central New Jersey, East Windsor (J.B.); Skin Sciences, Louisville, KY (L.K.); Oregon Medical Research Center, Portland (B.E.); Dermatology of Boca, Boca Raton, FL (J.F.); the Indiana Clinical Trials Center, Plainfield (S.G.); and Dermavant Sciences, Morrisville, NC (S.C.P., D.S.R., P.M.B., A.M.T.)
| | - Jennifer Soung
- From the Icahn School of Medicine at Mount Sinai, New York (M.G.L., L.K.); Henry Ford Health System, Detroit (L.S.G.); Yale University, New Haven, and Central Connecticut Dermatology Research, Cromwell - both in Connecticut (B.S.); Probity Medical Research, Waterloo, ON (K.A.P.), the University of British Columbia and Probity Medical Research, Surrey (H.C.H.), and Innovaderm Research, Montreal (R.B.) - all in Canada; Keck School of Medicine, University of Southern California, Los Angeles (A.W.A.), and Southern California Dermatology, Santa Ana (J.S.) - both in California; the Psoriasis Treatment Center of Central New Jersey, East Windsor (J.B.); Skin Sciences, Louisville, KY (L.K.); Oregon Medical Research Center, Portland (B.E.); Dermatology of Boca, Boca Raton, FL (J.F.); the Indiana Clinical Trials Center, Plainfield (S.G.); and Dermavant Sciences, Morrisville, NC (S.C.P., D.S.R., P.M.B., A.M.T.)
| | - Jeff Fromowitz
- From the Icahn School of Medicine at Mount Sinai, New York (M.G.L., L.K.); Henry Ford Health System, Detroit (L.S.G.); Yale University, New Haven, and Central Connecticut Dermatology Research, Cromwell - both in Connecticut (B.S.); Probity Medical Research, Waterloo, ON (K.A.P.), the University of British Columbia and Probity Medical Research, Surrey (H.C.H.), and Innovaderm Research, Montreal (R.B.) - all in Canada; Keck School of Medicine, University of Southern California, Los Angeles (A.W.A.), and Southern California Dermatology, Santa Ana (J.S.) - both in California; the Psoriasis Treatment Center of Central New Jersey, East Windsor (J.B.); Skin Sciences, Louisville, KY (L.K.); Oregon Medical Research Center, Portland (B.E.); Dermatology of Boca, Boca Raton, FL (J.F.); the Indiana Clinical Trials Center, Plainfield (S.G.); and Dermavant Sciences, Morrisville, NC (S.C.P., D.S.R., P.M.B., A.M.T.)
| | - Scott Guenthner
- From the Icahn School of Medicine at Mount Sinai, New York (M.G.L., L.K.); Henry Ford Health System, Detroit (L.S.G.); Yale University, New Haven, and Central Connecticut Dermatology Research, Cromwell - both in Connecticut (B.S.); Probity Medical Research, Waterloo, ON (K.A.P.), the University of British Columbia and Probity Medical Research, Surrey (H.C.H.), and Innovaderm Research, Montreal (R.B.) - all in Canada; Keck School of Medicine, University of Southern California, Los Angeles (A.W.A.), and Southern California Dermatology, Santa Ana (J.S.) - both in California; the Psoriasis Treatment Center of Central New Jersey, East Windsor (J.B.); Skin Sciences, Louisville, KY (L.K.); Oregon Medical Research Center, Portland (B.E.); Dermatology of Boca, Boca Raton, FL (J.F.); the Indiana Clinical Trials Center, Plainfield (S.G.); and Dermavant Sciences, Morrisville, NC (S.C.P., D.S.R., P.M.B., A.M.T.)
| | - Stephen C Piscitelli
- From the Icahn School of Medicine at Mount Sinai, New York (M.G.L., L.K.); Henry Ford Health System, Detroit (L.S.G.); Yale University, New Haven, and Central Connecticut Dermatology Research, Cromwell - both in Connecticut (B.S.); Probity Medical Research, Waterloo, ON (K.A.P.), the University of British Columbia and Probity Medical Research, Surrey (H.C.H.), and Innovaderm Research, Montreal (R.B.) - all in Canada; Keck School of Medicine, University of Southern California, Los Angeles (A.W.A.), and Southern California Dermatology, Santa Ana (J.S.) - both in California; the Psoriasis Treatment Center of Central New Jersey, East Windsor (J.B.); Skin Sciences, Louisville, KY (L.K.); Oregon Medical Research Center, Portland (B.E.); Dermatology of Boca, Boca Raton, FL (J.F.); the Indiana Clinical Trials Center, Plainfield (S.G.); and Dermavant Sciences, Morrisville, NC (S.C.P., D.S.R., P.M.B., A.M.T.)
| | - David S Rubenstein
- From the Icahn School of Medicine at Mount Sinai, New York (M.G.L., L.K.); Henry Ford Health System, Detroit (L.S.G.); Yale University, New Haven, and Central Connecticut Dermatology Research, Cromwell - both in Connecticut (B.S.); Probity Medical Research, Waterloo, ON (K.A.P.), the University of British Columbia and Probity Medical Research, Surrey (H.C.H.), and Innovaderm Research, Montreal (R.B.) - all in Canada; Keck School of Medicine, University of Southern California, Los Angeles (A.W.A.), and Southern California Dermatology, Santa Ana (J.S.) - both in California; the Psoriasis Treatment Center of Central New Jersey, East Windsor (J.B.); Skin Sciences, Louisville, KY (L.K.); Oregon Medical Research Center, Portland (B.E.); Dermatology of Boca, Boca Raton, FL (J.F.); the Indiana Clinical Trials Center, Plainfield (S.G.); and Dermavant Sciences, Morrisville, NC (S.C.P., D.S.R., P.M.B., A.M.T.)
| | - Philip M Brown
- From the Icahn School of Medicine at Mount Sinai, New York (M.G.L., L.K.); Henry Ford Health System, Detroit (L.S.G.); Yale University, New Haven, and Central Connecticut Dermatology Research, Cromwell - both in Connecticut (B.S.); Probity Medical Research, Waterloo, ON (K.A.P.), the University of British Columbia and Probity Medical Research, Surrey (H.C.H.), and Innovaderm Research, Montreal (R.B.) - all in Canada; Keck School of Medicine, University of Southern California, Los Angeles (A.W.A.), and Southern California Dermatology, Santa Ana (J.S.) - both in California; the Psoriasis Treatment Center of Central New Jersey, East Windsor (J.B.); Skin Sciences, Louisville, KY (L.K.); Oregon Medical Research Center, Portland (B.E.); Dermatology of Boca, Boca Raton, FL (J.F.); the Indiana Clinical Trials Center, Plainfield (S.G.); and Dermavant Sciences, Morrisville, NC (S.C.P., D.S.R., P.M.B., A.M.T.)
| | - Anna M Tallman
- From the Icahn School of Medicine at Mount Sinai, New York (M.G.L., L.K.); Henry Ford Health System, Detroit (L.S.G.); Yale University, New Haven, and Central Connecticut Dermatology Research, Cromwell - both in Connecticut (B.S.); Probity Medical Research, Waterloo, ON (K.A.P.), the University of British Columbia and Probity Medical Research, Surrey (H.C.H.), and Innovaderm Research, Montreal (R.B.) - all in Canada; Keck School of Medicine, University of Southern California, Los Angeles (A.W.A.), and Southern California Dermatology, Santa Ana (J.S.) - both in California; the Psoriasis Treatment Center of Central New Jersey, East Windsor (J.B.); Skin Sciences, Louisville, KY (L.K.); Oregon Medical Research Center, Portland (B.E.); Dermatology of Boca, Boca Raton, FL (J.F.); the Indiana Clinical Trials Center, Plainfield (S.G.); and Dermavant Sciences, Morrisville, NC (S.C.P., D.S.R., P.M.B., A.M.T.)
| | - Robert Bissonnette
- From the Icahn School of Medicine at Mount Sinai, New York (M.G.L., L.K.); Henry Ford Health System, Detroit (L.S.G.); Yale University, New Haven, and Central Connecticut Dermatology Research, Cromwell - both in Connecticut (B.S.); Probity Medical Research, Waterloo, ON (K.A.P.), the University of British Columbia and Probity Medical Research, Surrey (H.C.H.), and Innovaderm Research, Montreal (R.B.) - all in Canada; Keck School of Medicine, University of Southern California, Los Angeles (A.W.A.), and Southern California Dermatology, Santa Ana (J.S.) - both in California; the Psoriasis Treatment Center of Central New Jersey, East Windsor (J.B.); Skin Sciences, Louisville, KY (L.K.); Oregon Medical Research Center, Portland (B.E.); Dermatology of Boca, Boca Raton, FL (J.F.); the Indiana Clinical Trials Center, Plainfield (S.G.); and Dermavant Sciences, Morrisville, NC (S.C.P., D.S.R., P.M.B., A.M.T.)
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21
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Application of benvitimod on psoriasis: A systematic review and meta-analysis of randomized controlled trials. A systematic review of benvitimod on psoriasis. Therapie 2021; 77:339-347. [PMID: 34689959 DOI: 10.1016/j.therap.2021.09.005] [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: 05/26/2021] [Revised: 06/04/2021] [Accepted: 09/09/2021] [Indexed: 11/21/2022]
Abstract
BACKGROUND We conducted this systematic review to clarify the efficacy and safety of benvitimod on psoriasis. METHODS We searched the databases of PubMed, China National Knowledge infrastructure, Cochrane Library, Embase, Web of science to identify randomized controlled trials (RCTs) of benvitimod on psoriasis up to April 2021. RESULTS Five RCTs of benvitimod on psoriasis were included. A total of 1237 patients were included. 0.5% or 1.0% benvitimod was applied topically once or twice a day. More patients in benvitimod group achieved PASI 90, PASI 75, PASI 50 and BSA reduction than placebo at Week 12. More patients in benvitimod group achieved PGA 0 or 1 than placebo since Week 6. There were no statistical significances in efficacies of benvitimod at different concentrations and frequencies. CONCLUSIONS Benvitimod was effective and safe for psoriasis. More RCTs with high qualities are needed to further verify the current conclusion.
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22
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Rolfes KM, Sondermann NC, Vogeley C, Dairou J, Gilardino V, Wirth R, Meller S, Homey B, Krutmann J, Lang D, Nakamura M, Haarmann-Stemmann T. Inhibition of 6-formylindolo[3,2-b]carbazole metabolism sensitizes keratinocytes to UVA-induced apoptosis: Implications for vemurafenib-induced phototoxicity. Redox Biol 2021; 46:102110. [PMID: 34418602 PMCID: PMC8379514 DOI: 10.1016/j.redox.2021.102110] [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: 07/19/2021] [Revised: 08/16/2021] [Accepted: 08/16/2021] [Indexed: 11/24/2022] Open
Abstract
Ultraviolet (UV) B irradiation of keratinocytes results in the formation of the tryptophan photoproduct 6-formylindolo[3,2-b]carbazole (FICZ) which is a high-affinity ligand for the aryl hydrocarbon receptor (AHR). The resulting activation of AHR signaling induces the expression of cytochrome P450 (CYP) 1A1 which subsequently metabolizes FICZ. Importantly, FICZ is also a nanomolar photosensitizer for UVA radiation. Here, we assess whether a manipulation of the AHR-CYP1A1 axis in human epidermal keratinocytes affects FICZ/UVA-induced phototoxic effects and whether this interaction might be mechanistically relevant for the phototoxicity of the BRAF inhibitor vemurafenib. Treatment of keratinocytes with an AHR agonist enhanced the CYP1A1-catalyzed metabolism of FICZ and thus prevented UVA photosensitization, whereas an inhibition of either AHR signaling or CYP1A1 enzyme activity resulted in an accumulation of FICZ and a sensitization to UVA-induced oxidative stress and apoptosis. Exposure of keratinocytes to vemurafenib resulted in the same outcome. Specifically, CYP phenotyping revealed that vemurafenib is primarily metabolized by CYP1A1 and to a lesser degree by CYP2J2 and CYP3A4. Hence, vemurafenib sensitized keratinocytes to UVA-induced apoptosis by interfering with the CYP1A1-mediated oxidative metabolism of FICZ. In contrast to this pro-apoptotic effect, a treatment of UVB-damaged keratinocytes with vemurafenib suppressed apoptosis, a process which might contribute to the skin carcinogenicity of the drug. Our results provide insight into the mechanisms responsible for the photosensitizing properties of vemurafenib and deliver novel information about its metabolism which might be relevant regarding potential drug-drug interactions. The data emphasize that the AHR-CYP1A1 axis contributes to the pathogenesis of cutaneous adverse drug reactions.
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Affiliation(s)
- Katharina M Rolfes
- IUF - Leibniz-Research Institute for Environmental Medicine, 40225, Düsseldorf, Germany
| | - Natalie C Sondermann
- IUF - Leibniz-Research Institute for Environmental Medicine, 40225, Düsseldorf, Germany
| | - Christian Vogeley
- IUF - Leibniz-Research Institute for Environmental Medicine, 40225, Düsseldorf, Germany
| | - Julien Dairou
- Laboratoire de Chimie et Biochimie Pharmacologiques et Toxicologiques, CNRS, UMR 8601, Université de Paris, F-75006, Paris, France
| | - Viola Gilardino
- IUF - Leibniz-Research Institute for Environmental Medicine, 40225, Düsseldorf, Germany
| | - Ragnhild Wirth
- IUF - Leibniz-Research Institute for Environmental Medicine, 40225, Düsseldorf, Germany
| | - Stephan Meller
- Department of Dermatology, Medical Faculty, Heinrich-Heine-University, 40225, Düsseldorf, Germany
| | - Bernhard Homey
- Department of Dermatology, Medical Faculty, Heinrich-Heine-University, 40225, Düsseldorf, Germany
| | - Jean Krutmann
- IUF - Leibniz-Research Institute for Environmental Medicine, 40225, Düsseldorf, Germany; Medical Faculty, Heinrich-Heine-University, 40225, Düsseldorf, Germany
| | - Dieter Lang
- Bayer AG, Drug Metabolism and Pharmacokinetics, Research Center, 42096, Wuppertal, Germany
| | - Motoki Nakamura
- IUF - Leibniz-Research Institute for Environmental Medicine, 40225, Düsseldorf, Germany; Department of Environmental and Geriatric Dermatology, Graduate School of Medical Sciences, Nagoya City University, Nagoya, 467-8601, Japan
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23
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Bieber T. Atopic dermatitis: an expanding therapeutic pipeline for a complex disease. Nat Rev Drug Discov 2021; 21:21-40. [PMID: 34417579 PMCID: PMC8377708 DOI: 10.1038/s41573-021-00266-6] [Citation(s) in RCA: 232] [Impact Index Per Article: 77.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/06/2021] [Indexed: 02/07/2023]
Abstract
Atopic dermatitis (AD) is a common chronic inflammatory skin disease with a complex pathophysiology that underlies a wide spectrum of clinical phenotypes. AD remains challenging to treat owing to the limited response to available therapies. However, recent advances in understanding of disease mechanisms have led to the discovery of novel potential therapeutic targets and drug candidates. In addition to regulatory approval for the IL-4Ra inhibitor dupilumab, the anti-IL-13 inhibitor tralokinumab and the JAK1/2 inhibitor baricitinib in Europe, there are now more than 70 new compounds in development. This Review assesses the various strategies and novel agents currently being investigated for AD and highlights the potential for a precision medicine approach to enable prevention and more effective long-term control of this complex disease. Recent advances in understanding of the complex phenotype and mechanisms underlying atopic dermatitis (AD) have revealed multiple new potential targets for pharmacological intervention. Here, Bieber reviews therapeutic strategies and assesses the expanding pipeline for the therapy of AD, highlighting the potential for a precision medicine approach to the management of this complex disorder.
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Affiliation(s)
- Thomas Bieber
- Department of Dermatology and Allergy, University Hospital, Bonn, Germany. .,Christine Kühne-Center for Allergy Research and Education, Davos, Switzerland. .,Davos Biosciences, Davos, Switzerland.
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24
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Alwan W, Di Meglio P. Guardians of the barrier: Microbiota engage AHR in keratinocytes to mantain skin homeostasis. Cell Host Microbe 2021; 29:1213-1216. [PMID: 34384523 DOI: 10.1016/j.chom.2021.07.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The skin barrier is critical in ensuring homeostasis, yet factors influencing its development, repair, and maintenance are ill-defined. In this issue of Cell Host & Microbe, Uberoi et al. demonstrate the skin microbiota's role in maintaining barrier integrity via AHR signaling in keratinocytes, which has implications for skin disease management.
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Affiliation(s)
- Wisam Alwan
- Guy's and St Thomas' NHS Foundation Trust, London, UK; St John's Institute of Dermatology, School of Basic and Medical Biosciences, King's College London, London, UK
| | - Paola Di Meglio
- St John's Institute of Dermatology, School of Basic and Medical Biosciences, King's College London, London, UK.
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25
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Abstract
Atopic dermatitis (AD) is among the most frequent inflammatory skin diseases in humans, affecting up to 20% of children and 10% of adults in higher income countries. Chronic pruritus is a disease-defining symptom of AD, representing the most burdensome symptom for patients. Severe chronic pruritus causes significant sleep disturbances and impaired quality of life, as well as increased anxiety, depression and suicidal behavior. Until recently, skin care, topical corticosteroids, and calcineurin-inhibitors were primarily used to treat mild to moderate AD, while phototherapy and immunosuppressive agents such as corticosteroids, cyclosporine, and methotrexate were used to treat patients with moderate to severe AD. The potential short- and long-term adverse events associated with these treatments or their insufficient therapeutic efficacy limited their use in controlling pruritus and eczema in AD patients over longer periods of time. As our understanding of AD pathophysiology has improved and new systemic and topical treatments have appeared on the market, targeting specific cytokines, receptors, or their intracellular signaling, a new era in atopic dermatitis and pruritus therapy has begun. This review highlights new developments in AD treatment, placing a specific focus on their anti-pruritic effects.
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Affiliation(s)
- Franz J Legat
- Department of Dermatology, Medical University of Graz, Graz, Austria
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26
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Genital and Inverse/Intertriginous Psoriasis: An Updated Review of Therapies and Recommendations for Practical Management. Dermatol Ther (Heidelb) 2021; 11:833-844. [PMID: 33914293 PMCID: PMC8163914 DOI: 10.1007/s13555-021-00536-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Indexed: 12/17/2022] Open
Abstract
Genital and inverse psoriasis can develop in more than one-third of patients who have psoriasis. Psoriatic plaques in the genital and intertriginous skin are challenging to treat because the skin is thin and often occluded, making it more sensitive to certain therapies. Traditional guidelines indicate topical therapies, such as corticosteroids, topical calcineurin inhibitors (TCI), and vitamin D analogs as first-line recommendation in treating genital and inverse psoriasis. There have been developments in the treatment of genital and inverse psoriasis using systemic therapies, including IL-17 inhibitors and PDE-4 inhibitors.
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27
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Bissonnette R, Stein Gold L, Rubenstein DS, Tallman AM, Armstrong A. Tapinarof in the treatment of psoriasis: A review of the unique mechanism of action of a novel therapeutic aryl hydrocarbon receptor-modulating agent. J Am Acad Dermatol 2020; 84:1059-1067. [PMID: 33157177 DOI: 10.1016/j.jaad.2020.10.085] [Citation(s) in RCA: 74] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 10/19/2020] [Accepted: 10/29/2020] [Indexed: 02/08/2023]
Abstract
Tapinarof, a novel, first-in-class, small-molecule topical therapeutic aryl hydrocarbon receptor (AhR)-modulating agent, is in clinical development for the treatment of psoriasis and atopic dermatitis. The efficacy of tapinarof in psoriasis is attributed to its specific binding and activation of AhR, a ligand-dependent transcription factor, leading to the downregulation of proinflammatory cytokines, including interleukin 17, and regulation of skin barrier protein expression to promote skin barrier normalization. AhR signaling regulates gene expression in immune cells and skin cells and has critical roles in the regulation of skin homeostasis. Tapinarof-mediated AhR signaling underlies the mechanistic basis for the significant efficacy and acceptable tolerability observed in early-phase clinical trials of tapinarof cream in the treatment of psoriasis.
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Affiliation(s)
| | | | | | | | - April Armstrong
- Keck School of Medicine of the University of Southern California, Los Angeles, California
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28
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Shi Y, Zeng Z, Yu J, Tang B, Tang R, Xiao R. The aryl hydrocarbon receptor: An environmental effector in the pathogenesis of fibrosis. Pharmacol Res 2020; 160:105180. [PMID: 32877693 DOI: 10.1016/j.phrs.2020.105180] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Revised: 08/23/2020] [Accepted: 08/24/2020] [Indexed: 12/16/2022]
Abstract
The aryl hydrocarbon receptor (AhR) is a highly conserved transcription factor that can be activated by small molecules provided by dietary, plant, or microbial metabolites, and environmental pollutants. AhR is expressed in many cell types and engages in crosstalk with other signaling pathways, and therefore provides a molecular pathway that integrates environmental cues and metabolic processes. Fibrosis, which is defined as an aberrant extracellular matrix formation, is a reparative process in the terminal stage of chronic diseases. Both environmental and internal factors have been shown to participate in the pathogenesis of fibrosis; however, the underlying mechanisms still remain elusive. In this review, the potential role of AhR in the process of fibrosis, as well as potential opportunities and challenges in the development of AhR targeting therapeutics, are summarized.
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Affiliation(s)
- Yaqian Shi
- Department of Dermatology, The Second Xiangya Hospital, Central South University, Changsha, Hunan 410011, China; Hunan Key Laboratory of Medical Epigenetics, The Second Xiangya Hospital, Central South University, Changsha, Hunan 410011, China
| | - Zhuotong Zeng
- Department of Dermatology, The Second Xiangya Hospital, Central South University, Changsha, Hunan 410011, China; Hunan Key Laboratory of Medical Epigenetics, The Second Xiangya Hospital, Central South University, Changsha, Hunan 410011, China
| | - Jiangfan Yu
- Department of Dermatology, The Second Xiangya Hospital, Central South University, Changsha, Hunan 410011, China; Hunan Key Laboratory of Medical Epigenetics, The Second Xiangya Hospital, Central South University, Changsha, Hunan 410011, China
| | - Bingsi Tang
- Department of Dermatology, The Second Xiangya Hospital, Central South University, Changsha, Hunan 410011, China; Hunan Key Laboratory of Medical Epigenetics, The Second Xiangya Hospital, Central South University, Changsha, Hunan 410011, China
| | - Rui Tang
- Department of Rheumatology, The Second Xiangya Hospital, Central South University, Changsha, Hunan 410011, China
| | - Rong Xiao
- Department of Dermatology, The Second Xiangya Hospital, Central South University, Changsha, Hunan 410011, China; Hunan Key Laboratory of Medical Epigenetics, The Second Xiangya Hospital, Central South University, Changsha, Hunan 410011, China.
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