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Bucur S, Serban ED, Ileanu BV, Costache RS, Nicolescu AC, Constantin T, Costache DO, Constantin MM. Effectiveness and Drug Survival of Ixekizumab and Secukinumab in Patients with Moderate to Severe Plaque Psoriasis: Real-World Data from Bucharest, Romania. PSORIASIS (AUCKLAND, N.Z.) 2024; 14:79-86. [PMID: 38946911 PMCID: PMC11214564 DOI: 10.2147/ptt.s456393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/23/2023] [Accepted: 06/15/2024] [Indexed: 07/02/2024]
Abstract
Purpose Multiple biological therapies have been developed for the treatment of inflammatory diseases, including moderate to severe plaque psoriasis. Choosing the optimal treatment for psoriasis can depend on several factors and is strongly influenced by a drug's efficacy and safety profile. Continuous treatment with biological therapies is recommended to achieve effective disease management in patients with psoriasis. However, in real-world, patients often discontinue biologic therapy within the first year of treatment. Therefore, in this study, we aimed to investigate the effectiveness and drug survival of two anti-interleukin 17 agents (ixekizumab and secukinumab) in a group of adult patients with moderate to severe psoriasis from Bucharest, Romania. Patients and Methods We designed an observational, non-interventional, retrospective study of 255 adult patients with moderate to severe psoriasis receiving ixekizumab and secukinumab. We performed descriptive statistics and inferential methods, such as z-test, median test and Kaplan Meier curve comparison, to characterize the groups with two biological treatments. Results Patients treated with ixekizumab had a longer drug survival compared to those treated with secukinumab with lower risks of non-persistence, discontinuation and switching therapy. Patients age-groups and psoriasis durations found to be significant factors in drug survival. Conclusion This study contributes to the understanding of the drug survival profile and the factors that may influence it in ixekizumab and secukinumab treatment in a real-world setting.
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Affiliation(s)
- Stefana Bucur
- 2nd Department of Dermatology, “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania
- 2nd Department of Dermatology, Colentina Clinical Hospital, Bucharest, Romania
| | - Elena-Daniela Serban
- 2nd Department of Dermatology, “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania
| | | | - Raluca Simona Costache
- Department of Internal Medicine and Gastroenterology, “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania
- Department of Gastroenterology, Central Military Emergency University Hospital “Dr. Carol Davila”, Bucharest, Romania
| | - Alin Codrut Nicolescu
- Department of Dermatology, “Agrippa Ionescu” Emergency Clinical Hospital, Bucharest, 011773, Romania
| | - Traian Constantin
- Department of Urology, “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania
- Department of Urology, “Prof. Dr. Theodor Burghele” Hospital, Bucharest, 050659, Romania
| | - Daniel Octavian Costache
- 2nd Department of Dermatology, “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania
- Department of Dermatology, Central Military Emergency University Hospital “Dr. Carol Davila”, Bucharest, Romania
| | - Maria-Magdalena Constantin
- 2nd Department of Dermatology, “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania
- 2nd Department of Dermatology, Colentina Clinical Hospital, Bucharest, Romania
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Pünnel LC, Lunter DJ. Development of a film-forming oleogel with increased substantivity for the treatment of psoriasis. Int J Pharm 2024; 659:124278. [PMID: 38806095 DOI: 10.1016/j.ijpharm.2024.124278] [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: 03/28/2024] [Revised: 05/21/2024] [Accepted: 05/24/2024] [Indexed: 05/30/2024]
Abstract
The aim of this work was the development of a film-forming formulation (FFF) for the topical treatment of psoriasis that shows an increased substantivity compared to conventional semi-solid dosage forms. The developed formulation is an oleogel. It is based on a combination of castor oil and medium chain triglycerides, and the oil-soluble film former MP-30 (Croda GmbH, Nettetal, Germany), a polyamide that upon mixing with a polar oil entraps the oil und thus substantially increases the viscosity of the formulation up to a semisolid state. Betamethasone dipropionate (BDP) and calcipotriole (CA) were used as active pharmaceutical ingredients (APIs). Oleogels of different compositions were evaluated regarding substantivity, rheological properties, ex-vivo penetration into the skin and ex-vivo permeation through the skin. Marketed products were used as controls. It was found that the amount of betamethasone dipropionate penetrating and permeating into and through the skin from the film-forming formulation is at an intermediate value compared to the marketed products. The substantivity of the developed formulation is described by an amount of 57.7 % formulation that remains on the skin surface and is thus significantly higher compared to the marketed products. In the film forming formulation, the proportion of API penetrating the skin remains the same when the skin repetitively brought in contact with a piece of textile during the penetration experiment. In contrast with the in-market formulations tested, this proportion was reduced by up to 97 %. As a result, the developed formulations can lead to an increased patient compliance.
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Affiliation(s)
- Larissa Carine Pünnel
- Department of Pharmaceutical Technology, Eberhard Karls University, Auf der Morgenstelle 8, 72076 Tübingen, Germany
| | - Dominique Jasmin Lunter
- Department of Pharmaceutical Technology, Eberhard Karls University, Auf der Morgenstelle 8, 72076 Tübingen, Germany.
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Maier CS, Eckert D, Laroux FS, Hew KM, Suleiman AA, Liu W, Mohamed MEF. Cedirogant Population Pharmacokinetics and Pharmacodynamic Analyses of Interleukin-17A Inhibition in Two Phase 1 Studies in Healthy Participants and Participants with Moderate to Severe Psoriasis. Clin Pharmacol Drug Dev 2024; 13:474-484. [PMID: 38231873 DOI: 10.1002/cpdd.1377] [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: 09/19/2023] [Accepted: 12/19/2023] [Indexed: 01/19/2024]
Abstract
Cedirogant (ABBV-157) is an orally bioavailable inverse agonist of retinoic acid-related orphan receptor gamma thymus. Data from 2 Phase 1 studies were used to characterize cedirogant pharmacokinetics and evaluate target engagement. Cedirogant plasma concentrations and ex vivo interleukin 17A (IL-17A) concentrations from healthy participants and participants with moderate to severe psoriasis (PsO) were analyzed in a population pharmacokinetic and pharmacodynamic modeling framework to characterize cedirogant pharmacokinetics following single and multiple doses and assess ex vivo IL-17A inhibition in relation to cedirogant exposure. Cedirogant population pharmacokinetics were best described by a 2-compartment pharmacokinetic model with delayed absorption and an enzyme turnover compartment to describe cytochrome P450 3A autoinduction. The pharmacokinetics of cedirogant were comparable between healthy participants and participants with PsO. Cedirogant steady-state average and maximum plasma concentrations were predicted to be 7.56 and 11.8 mg/L, respectively, for participants with PsO for the 375 mg once-daily regimen on Day 14. The apparent clearance and apparent volume of distribution for cedirogant were estimated to be 24.5 L/day and 28.2 L, respectively. A direct maximum inhibition model adequately characterized the exposure-response relationship of cedirogant and ex vivo IL-17A inhibition, indicating no temporal delay between exposure and response with a saturable inhibition of IL-17A. Model-estimated half-maximal inhibitory concentration and maximum inhibition values for cedirogant inhibition of ex vivo IL-17A were 0.56 mg/L and 0.76, respectively. The established relationship between cedirogant exposure and biomarker effect supported dose selection for the Phase 2 dose-ranging study in patients with PsO.
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Affiliation(s)
| | | | | | - Kinjal M Hew
- Precision Medicine Immunology, AbbVie Inc., South San Francisco, CA, USA
| | | | - Wei Liu
- Clinical Pharmacology, AbbVie Inc., North Chicago, IL, USA
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Mohammadi F, Harofteh FZ, Sahebnasagh A, Ghaneei N, Ardakani MEZ, Saghafi F. Efficacy and safety of topical rosuvastatin & melatonin vs. placebo in patients with mild to moderate plaque psoriasis: A preliminary randomized double-blinded clinical trial. Skin Res Technol 2024; 30:e13689. [PMID: 38563131 PMCID: PMC10985546 DOI: 10.1111/srt.13689] [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: 04/24/2023] [Accepted: 01/16/2024] [Indexed: 04/04/2024]
Abstract
BACKGROUND Considering the pathogenesis of psoriasis and also the anti-oxidant, immunomodulatory, and anti-inflammatory properties of rosuvastatin and melatonin, the current clinical trial aimed to evaluate the efficacy of topical rosuvastatin and melatonin in patients with mild to moderate psoriasis. METHODS The current randomized placebo-controlled clinical trial was conducted using a 3-arm parallel group included 77 adult patients (≥18 years old) with mild to moderate plaque psoriasis. Patients were randomized into a 1:1:1 ratio to one of three groups to receive one of the three interventions: melatonin cream, 5.0% (w/w), rosuvastatin cream, 5.0% (w/w), or placebo cream with a similar transparent appearance twice a day for 12 weeks. The primary outcome was severity of the disease using Psoriasis Area Severity Index (PASI). The secondary outcomes included the Dermatological Sum Score (DSS) to assess the erythema, scaling, and plaque elevation and the Dermatology Life Quality Index (DLQI). Photographs of the lesions were also taken at the baseline and at different periodic intervals thereafter. RESULTS Among 77 randomized patients, 52 (mean (SD) age, 40.67 (10.85) years; 22 (42.30%) men) completed the study. A significant reduction of 45% (mean (SD) of 2.67 (0.98) to 1.74 (1.12)) and 70% (mean (SD) of 2.67 (0.98) to 1.31 (1.13)) in PASI score, and 46% (mean (SD) of 2.91(1.85) to 1.57 (1.11)) and 77% (mean (SD) of 2.91 (1.85) to 0.87 (0.67)) in DSS score on days 30 and 60 with rosuvastatin cream, 5% w/w (P < 0.001) compared with baseline was observed, respectively. Also a significant decrease of 35% (mean (SD) of 2.67 (0.98) to 1.74 (1.12)) and 51% (mean (SD) of 2.67 (0.98) to 1.31 (1.13)) in PASI score, and 40% (mean (SD) of 5.00 (1.58) to 3.00 (1.76))and 61% (mean (SD) of 5.00 (1.58) to 1.92 (1.71)) in DSS score on days 30 and 60 with melatonin cream, 5% w/w (P < 0.001) compared with baseline were observed, respectively. In each of the melatonin or rosuvastatin groups, DLQI improved significantly on days 30 (P < 0.0001) and 60 (P < 0.001) while the changes in the control group were not significant. CONCLUSION The results of this clinical trial demonstrated that topical melatonin and rosuvastatin diminished the severity of mild to moderate plaque psoriasis with a satisfactory safety profile. Future clinical trials should assess both the long-term efficacy and safety of melatonin and rosuvastatin creams in larger study populations.
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Affiliation(s)
- Farhad Mohammadi
- Department of PharmaceuticsSchool of PharmacyShahid Sadoughi University of Medical Sciences and Health ServicesYazdIran
| | - Fatemeh Zare Harofteh
- Pharmaceutical Sciences Research CenterSchool of PharmacyStudent Research CommitteeShahid Sadoughi University of Medical Sciences and Health ServicesYazdIran
| | - Adeleh Sahebnasagh
- Department of Internal MedicineClinical Research CenterFaculty of MedicineNorth Khorasan University of Medical SciencesBojnurdIran
| | - Narges Ghaneei
- Department of DermatologySchool of MedicineShahid Sadoughi University of Medical Sciences and Health ServicesYazdIran
| | | | - Fatemeh Saghafi
- Department of Clinical PharmacySchool of PharmacyShahid Sadoughi University of Medical Sciences and Health ServicesYazdIran
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Gao Y, Gong B, Chen Z, Song J, Xu N, Weng Z. Damage-Associated Molecular Patterns, a Class of Potential Psoriasis Drug Targets. Int J Mol Sci 2024; 25:771. [PMID: 38255845 PMCID: PMC10815563 DOI: 10.3390/ijms25020771] [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: 12/07/2023] [Revised: 12/29/2023] [Accepted: 01/04/2024] [Indexed: 01/24/2024] Open
Abstract
Psoriasis is a chronic skin disorder that involves both innate and adaptive immune responses in its pathogenesis. Local tissue damage is a hallmark feature of psoriasis and other autoimmune diseases. In psoriasis, damage-associated molecular patterns (DAMPs) released by damaged local tissue act as danger signals and trigger inflammatory responses by recruiting and activating immune cells. They also stimulate the release of pro-inflammatory cytokines and chemokines, which exacerbate the inflammatory response and contribute to disease progression. Recent studies have highlighted the role of DAMPs as key regulators of immune responses involved in the initiation and maintenance of psoriatic inflammation. This review summarizes the current understanding of the immune mechanism of psoriasis, focusing on several important DAMPs and their mechanisms of action. We also discussed the potential of DAMPs as diagnostic and therapeutic targets for psoriasis, offering new insights into the development of more effective treatments for this challenging skin disease.
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Affiliation(s)
| | | | | | | | - Na Xu
- Shenzhen Key Laboratory of Systems Medicine for Inflammatory Diseases, School of Medicine, Shenzhen Campus of Sun Yat-sen University, Shenzhen 518107, China; (Y.G.); (B.G.); (Z.C.); (J.S.)
| | - Zhuangfeng Weng
- Shenzhen Key Laboratory of Systems Medicine for Inflammatory Diseases, School of Medicine, Shenzhen Campus of Sun Yat-sen University, Shenzhen 518107, China; (Y.G.); (B.G.); (Z.C.); (J.S.)
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Chatterjee O, Sur D. Pioglitazone attenuate level of myeloperoxidases and nitic oxide in psoriatic lesion: a proof-of-concept study in a imiquimod induced psoriasis model in rat. J Basic Clin Physiol Pharmacol 2024; 35:45-52. [PMID: 38341859 DOI: 10.1515/jbcpp-2023-0254] [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: 12/09/2023] [Accepted: 01/26/2024] [Indexed: 02/13/2024]
Abstract
OBJECTIVES Psoriasis is a persistent autoimmune inflammatory condition that is primarily affecting the skin. Pioglitazone (PGZ), a peroxisome proliferator activated receptor gamma (PPARγ) agonist, has been reported to have anti-inflammatory effects. However, the role of PGZ in psoriatic disease remains unclear. In this study, we aimed to repurpose the use of the PGZ for the treatment of psoriasis. METHODS To investigate its efficacy, we employed an imiquimod (IMQ)-induced rat model. Wistar rats are randomly allocated to four different groups. Group, I served as a negative control, Group II IMQ control, Group III was treated with pioglitazone hydrogel and Group IV received standard drug betamethasone cream. PASI score was monitored on every alternative day and on day 7 animals were sacrificed and histopathology of skin was performed. Level of nitric oxide (NO) and myeloperoxidase (MPO) was also performed using established methods. RESULTS The results of the experiment revealed that treatment with PGZ significantly (p<0.05) reduced redness, scaling, and skin thickening, surpassing the effectiveness of standard drugs. Our result also indicates that PGZ significantly (p<0.05) inhibits the release of both MPO and NO from the psoriatic lesions. CONCLUSIONS PGZ effectively reduces the severity of psoriasis possibly by inhibiting the accumulation of neutrophil at the psoriatic area which indirectly regulates the release of NO in the affected area. Our study showed we can repurpose the PGZ for the management of psoriasis.
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Affiliation(s)
- Oishani Chatterjee
- Division of Pharmacology, Guru Nanak Institute of Pharmaceutical Science and Technology, Kolkata, India
| | - Debjeet Sur
- Division of Pharmacology, Guru Nanak Institute of Pharmaceutical Science and Technology, Kolkata, India
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Lu L, Zhang B, Shi M, Liu A. Identification of PANoptosis-related biomarkers and immune infiltration characteristics in psoriasis. Medicine (Baltimore) 2023; 102:e35627. [PMID: 37861483 PMCID: PMC10589561 DOI: 10.1097/md.0000000000035627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Accepted: 09/22/2023] [Indexed: 10/21/2023] Open
Abstract
BACKGROUND PANoptosis may play a vital role in psoriasis. We investigated the relationship between PANoptosis in psoriasis. METHODS Genes information was mainly obtained from GeneCards and the gene expression omnibus database. Genefunctions identification was based on gene ontology and Kyoto Encyclopedia of Genes and Genomes analyses. Gene set enrichment analysis was used to identify enriched signaling pathways in psoriasis. We constructed PPI networks using the search tool for the retrieval of interacting genes database and Cytoscape and explored mRNA-miRNA, mRNA-TF, and mRNA-drug interaction networks. Receiver operating characteristic curves were performed to screen potential biomarkers among these hub genes. Immune cell infiltration was analyzed using the Pearson algorithm, and the correlation between immune-cell abundance and PANoptosis-related differentially expressed gene (PDGs) was investigated. RESULTS We identified 10 PDGs, which were mainly involved in pyroptosis, cytokine-mediated signaling pathways, Salmonella infection and NOD-like receptor signaling pathway. The activated pathways were mostly proinflammatory and immunoregulatory pathways between immune cells. BAK1, CASP4, IL18, and IRF1 were identified as hub genes in the mRNA-miRNA network, and BAK1, IRF1, and PYCARD were hub genes in the mRNA-TF network. CASP1 was found to be the most targeted gene by drugs or molecular compounds. We found PDGs were positively associated with proinflammatory immune cell infiltration and negatively associated with anti-inflammatory or regulatory immune cells. CONCLUSION We confirmed the role of PANoptosis in psoriasis for the first time and predicted hub genes and immune characteristics, which provides new ideas for further investigation of psoriasis on pathogenic mechanisms and therapeutic strategies.
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Affiliation(s)
- Lingling Lu
- Henan University of Chinese Medicine, Zhengzhou, P.R. China
| | - Buxin Zhang
- Department of Dermatology, Henan Province Hospital of Traditional Chinese Medicine, The Second Affiliated Hospital of Henan University of Chinese Medicine, Zhengzhou, P.R. China
| | - Meiling Shi
- Jinjihu Community Health Service Center of Suzhou Industrial, Suzhou, P.R. China
| | - Aimin Liu
- Department of Dermatology, Henan Province Hospital of Traditional Chinese Medicine, The Second Affiliated Hospital of Henan University of Chinese Medicine, Zhengzhou, P.R. China
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Cruz CJG, Yang CC. Clinical application of serum biomarkers for detecting and monitoring of chronic plaque psoriasis. Front Mol Biosci 2023; 10:1196323. [PMID: 37546687 PMCID: PMC10403288 DOI: 10.3389/fmolb.2023.1196323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 06/29/2023] [Indexed: 08/08/2023] Open
Abstract
Psoriasis, a chronic, multisystemic inflammatory disease affecting millions of people globally, manifests as erythematous, thick, scaly plaques on the skin. Clinical evaluation remains to be the benchmark for diagnosis and monitoring of this debilitating disease. With current advancements in targeted molecular therapy for psoriasis such as biologics, molecular detection methods may also help guide clinical decisions and therapeutic strategies through quantification of circulating biomarkers, which could reflect the underlying pathogenic events happening at a certain point of the disease course. In this review, we will discuss how biomarkers are detected in serum samples using enzyme-linked immunosorbent assay (ELISA). This review will feature candidate biomarkers supported by clinical data for psoriasis including, but not limited to, cytokines, chemokines, adipokines, and antimicrobial peptides. A better understanding of the common method used for biomarker detection would enable physicians to interpret and correlate laboratory results with the disease pathogenesis and clinical outcomes, e.g., severity assessment and/or therapeutic response. With better health outcomes as the main goal, the utility of such information to evaluate and even predict treatment response would be a major step closer towards patient-tailored management.
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Affiliation(s)
- Criselda Jean G. Cruz
- Department of Dermatology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
- International Center for Wound Repair and Regeneration, National Cheng Kung University, Tainan, Taiwan
| | - Chao-Chun Yang
- Department of Dermatology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
- International Center for Wound Repair and Regeneration, National Cheng Kung University, Tainan, Taiwan
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Rahman SM, Abduelmula A, Jafferany M. Psychopathological symptoms in dermatology: A basic approach toward psychocutaneous disorders. Int J Dermatol 2023; 62:346-356. [PMID: 35816285 DOI: 10.1111/ijd.16344] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2022] [Revised: 05/01/2022] [Accepted: 06/17/2022] [Indexed: 11/28/2022]
Abstract
Dermatological conditions impact not only an individual's physical body but also their psychological health. Similar to how cutaneous conditions can affect one's psychological health, worsening psychological conditions can exacerbate or even induce dermatological conditions. There are four common psychiatric pathologies typically found in dermatology practices: depressive symptoms, anxiety symptoms, obsessive-compulsive disorder behaviors, and psychosis. Common cutaneous disorders associated with these psychopathological symptoms include, but are not limited to, psoriasis, acne vulgaris, atopic dermatitis, urticaria, trichotillomania, excoriation disorder, and delusions of parasitosis. The goal of this review is to examine the relationship between these four psychopathological symptoms with common psychodermatological conditions and to help providers better diagnose and implement appropriate psychological support to treat their patients.
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Affiliation(s)
- Syed Minhaj Rahman
- College of Medicine, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA
| | - Abrahim Abduelmula
- Faculty of Medicine, University of Western Ontario, London, Ontario, Canada
| | - Mohammad Jafferany
- Department of Psychiatry, Central Michigan University, Saginaw, Michigan, USA
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Parmar PK, Sharma N, Wasil Kabeer S, Rohit A, Bansal AK. Nanocrystal-based gel of apremilast ameliorates imiquimod-induced psoriasis by suppressing inflammatory responses. Int J Pharm 2022; 622:121873. [PMID: 35640806 DOI: 10.1016/j.ijpharm.2022.121873] [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: 12/14/2021] [Revised: 05/20/2022] [Accepted: 05/24/2022] [Indexed: 10/18/2022]
Abstract
Apremilast is 'difficult-to-deliver' in stratum corneum and viable layers (viable epidermis, dermis) owing to its modest lipophilicity and poor aqueous solubility, respectively. The objective of the present research was to develop apremilast nanocrystal-based gel for enhanced anti-psoriatic efficacy for the treatment of psoriasis. Nanosuspension was generated by wet media milling with a mean particle size of 200 nm. In-vivoefficacy of nanocrystal-based gels was evaluated in the imiquimod-induced psoriatic plaque model. Nanocrystal-based gel (1% and 3% w/w) improved phenotypic, histopathological features of psoriatic skin and attenuated splenic hypertrophy, psoriasis area severity scoring. Enzyme-linked immunosorbent assay was performed to evaluate levels of psoriatic biochemical markers indicating a significant decrease in the concentration of cytokines such as IL-23, IL-17A, IL-6 and TNF-α by nanocrystal-based gels (1% and 3% w/w) over disease induced group. Skin irritation study revealed that nanocrystal-based gel was significantly less irritating than the positive control. These results suggest that nanocrystal-based gel of apremilast can be an effective strategy for the management of psoriasis.
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Affiliation(s)
- Prashantkumar K Parmar
- Solid State Pharmaceutics Lab, Department of Pharmaceutics, National Institute of Pharmaceutical Education and Research (NIPER), Sector-67, S.A.S. Nagar, Mohali, Punjab 160 062, India
| | - Nisha Sharma
- Laboratory of Epigenetics and Diseases, Department of Pharmacology and Toxicology, NIPER, Sector-67, S.A.S. Nagar, Mohali, Punjab 160 062, India
| | - Shaheen Wasil Kabeer
- Laboratory of Epigenetics and Diseases, Department of Pharmacology and Toxicology, NIPER, Sector-67, S.A.S. Nagar, Mohali, Punjab 160 062, India
| | - Aastha Rohit
- Solid State Pharmaceutics Lab, Department of Pharmaceutics, National Institute of Pharmaceutical Education and Research (NIPER), Sector-67, S.A.S. Nagar, Mohali, Punjab 160 062, India
| | - Arvind K Bansal
- Solid State Pharmaceutics Lab, Department of Pharmaceutics, National Institute of Pharmaceutical Education and Research (NIPER), Sector-67, S.A.S. Nagar, Mohali, Punjab 160 062, India.
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Ixekizumab 80 mg Every 2 Weeks Treatment Beyond Week 12 for Japanese Patients with Generalized Pustular Psoriasis and Erythrodermic Psoriasis. Dermatol Ther (Heidelb) 2021; 12:481-494. [PMID: 34967916 PMCID: PMC8717693 DOI: 10.1007/s13555-021-00666-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Accepted: 12/10/2021] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION In 2018, ixekizumab (80 mg every 2 weeks [Q2W] beyond Week 12) received approval in Japan for patients with generalized pustular psoriasis (GPP) and erythrodermic psoriasis (EP). This open-label study evaluated the efficacy and safety of ixekizumab (80 mg Q2W from Week 12 to Week 20) in Japanese patients with GPP and EP. METHODS Seven patients with GPP and five patients with EP were enrolled. An initial dose of 160 mg (subcutaneous [SC] injection) was followed by 80 mg Q2W SC until Week 12. Primary endpoint assessed global improvement score (GIS) by comparing psoriatic findings, Static Physician Global Assessment, Psoriasis Area and Severity Index score, and other evaluations with those at the baseline and were graded as 1 = resolved, 2= improved, 3 = unchanged, and 4 = worsened. Patients who showed GIS = 1 (resolved) at Week 12 completed the study. Patients with GIS ≥ 2 continued to receive ixekizumab 80 mg Q2W until Week 20. RESULTS At Week 12, four of seven patients with GPP showed "resolved," two showed "improved," and one showed "worsened." Of five patients with EP, one showed "resolved" and four showed "improved." Two patients with GPP and four patients with EP continued ixekizumab treatment until Week 20. At Week 20, one of the two patients with GPP showed "resolved" and one patient showed "improved." All four patients with EP showed "improved." One non-drug related serious adverse event was reported by one patient with EP at Week 12. From Week 12 to Week 20, no adverse events (AEs) were reported in patients with GPP, but two mild AEs were reported in one of the four patients with EP. CONCLUSIONS This study indicates that ixekizumab continuous Q2W dosing is efficacious and safe for patients with GPP and EP. CLINICAL TRIAL REGISTRATION NCT03942042.
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12
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Repurposing approved therapeutics for new indication: Addressing unmet needs in psoriasis treatment. CURRENT RESEARCH IN PHARMACOLOGY AND DRUG DISCOVERY 2021; 2:100041. [PMID: 34909670 PMCID: PMC8663928 DOI: 10.1016/j.crphar.2021.100041] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Revised: 06/04/2021] [Accepted: 06/04/2021] [Indexed: 02/06/2023] Open
Abstract
Psoriasis is a chronic inflammatory autoimmune condition manifested by the hyperproliferation of keratinocytes with buildup of inflammatory red patches and scales on skin surfaces. The available treatment options for the management of psoriasis have various drawbacks, and the clinical need for effective therapeutics for this disease remain unmet; therefore, the approaches of drug repurposing or drug repositioning could potentially be used for treating indications of psoriasis. The undiscovered potential of drug repurposing or repositioning compensates for the limitations and hurdles in drug discovery and drug development processes. Drugs initially approved for other indications, including anticancer, antidiabetic, antihypertensive, and anti-arthritic activities, are being investigated for their potential in psoriasis management as a new therapeutic indication by using repurposing strategies. This article envisages the potential of various therapeutics for the management of psoriasis. Psoriasis is an autoimmune inflammatory skin disorder with complex physiology. Conventional treatments for psoriasis cause severe adverse effects; therefore an unmet need remains for safer and more effective therapies for psoriasis. Various drugs that effectively decrease the inflammation and proliferation of skin cells can be repurposed for the management of psoriasis. Repurposed drugs provide various incentives to the pharmaceutical industry.
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Song C, Yang C, Meng S, Li M, Wang X, Zhu Y, Kong L, Lv W, Qiao H, Sun Y. Deciphering the mechanism of Fang-Ji-Di-Huang-Decoction in ameliorating psoriasis-like skin inflammation via the inhibition of IL-23/Th17 cell axis. JOURNAL OF ETHNOPHARMACOLOGY 2021; 281:114571. [PMID: 34464701 DOI: 10.1016/j.jep.2021.114571] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/06/2021] [Revised: 08/06/2021] [Accepted: 08/25/2021] [Indexed: 06/13/2023]
Abstract
ETHNOPHARMACOLOGICAL RELEVANCE In the theory of traditional Chinese medicine (TCM), the etiology of psoriasis is assigned to damp-heat internal depression, blood poisoning, Yin deficiency and loss of nourishment. Fang-Ji-Di-Huang-Decoction (FJDH), a well-known Chinese traditional formula, is recorded in Synopsis of the Golden Chamber (in the Eastern Han Dynasty). This decoction is composed of dried roots of Rehmannia glutinosa (Gaertn.) DC., dried roots of Stephania tetrandra S. Moore, roots of Saposhnikovia divaricata (Turcz.) Schischk., dried twigs of Cinnamomum cassia (L.) J. Presl and dry roots and rhizomes of Glycyrrhiza uralensis Fisch. FJDH has the function of clearing heat, removing dampness, and nourishing blood. Therefore, in modern medical theory, FJDH can regulate the infiltration of inflammatory cells and the secretion of inflammatory cytokines in the process of psoriasis. AIM OF THE STUDY This study evaluated whether FJDH treated psoriasis and its specific mechanism for the efficacy in mice. At the same time, it clarified s what important role of the copperware played s in the curative effect of FJDH. METHODS AND MATERIALS We used imiquimod (IMQ) to induce psoriasis-like skin inflammation in mice. Mice were treated with imiquimod for one week, and FJDH was given by intragastric administration one week in advance. Record the weight change and psoriasis Area and Severity Index (PASI) score of the mouse during the whole process to assess the severity of psoriasis were recored mouse. Hematoxylin-eosin staining was used to evaluate skin tissue structure change. Immunohistochemistry was performed to observe the expressions of Ki67 and proliferating cell nuclear antigen (PCNA) in skin tissue. In order to further explore the mechanism of FJDH in the treatment of psoriasis, we used network pharmacology to predict the therapeutic target. TCMSP and Uniprot were used to collect compounds and genes of FJDH. Genecards was used for obtaining genes of psoriasis. String was used to analyze the relationship between genes. Metascape was used for gene enrichment and pathway prediction. Using molecular biological detection methods, we verified whether FJDH could regulate Interleukin 17 signaling pathway and T helper cell 17 (Th17) cell differentiation. Flow cytometry was used to detect Th17 cell differentiation in mouse spleen. Quantitative Real-time PCR was used to detect mRNA expression of IL-17 signaling pathway-related inflammatory factors in mouse skin tissues. UPLC-Triple TOF-MS/MS and Phenol-Sulphate colorimetry were used to explore the main components of FJDH, and further elaborate the mechanism of FJDH in the treatment of psoriasis. RESULTS FJDH with copper was found to improve psoriasis-related pathological symptoms in a dose-dependent manner, possibly by inhibiting IL-23/Th17 cell axis and reducing inflammatory cytokines such as IL-17A, IL-17F, IL-22 and TNF-α. Furthermore, R. glutinosa polysaccharide in FJDH was the main substance that exerted the drug effect and it work by forming a complex with copper. Experimental data proved that Rehmannia glutinosa polysaccharide and copper complex had the same pharmacological activity and therapeutic effect as FJDH. CONCLUSIONS FJDH may attenulated imiquimod-induced psoriasis-like skin inflammation in mice by inhibiting IL-23/Th17 cell axis. The material basis for the therapeutic effect may be the formation of complexes between the polysaccharides of R. glutinosa and copper in FJDH to produce the effect. These findings suggest that FJDH can be used as an effective Chinese medicine to treat psoriasis.
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Affiliation(s)
- Chenglin Song
- State Key Laboratory of Pharmaceutical Biotechnology, Chemistry and Biomedicine Innovation Center (ChemBIC), School of Life Sciences, Nanjing University, 163 Xianlin Avenue, Nanjing, 210023, China
| | - Chenxi Yang
- State Key Laboratory of Pharmaceutical Biotechnology, Chemistry and Biomedicine Innovation Center (ChemBIC), School of Life Sciences, Nanjing University, 163 Xianlin Avenue, Nanjing, 210023, China
| | - Siwei Meng
- State Key Laboratory of Pharmaceutical Biotechnology, Chemistry and Biomedicine Innovation Center (ChemBIC), School of Life Sciences, Nanjing University, 163 Xianlin Avenue, Nanjing, 210023, China
| | - Manru Li
- State Key Laboratory of Pharmaceutical Biotechnology, Chemistry and Biomedicine Innovation Center (ChemBIC), School of Life Sciences, Nanjing University, 163 Xianlin Avenue, Nanjing, 210023, China
| | - Xiao Wang
- Jiangsu Engineering Research Center for Efficient Delivery System of TCM, School of Pharmacy, Nanjing University of Chinese Medicine, 138 Xianlin Avenue, Nanjing, 210023, China
| | - Yaoxuan Zhu
- Jiangsu Engineering Research Center for Efficient Delivery System of TCM, School of Pharmacy, Nanjing University of Chinese Medicine, 138 Xianlin Avenue, Nanjing, 210023, China
| | - Lingdong Kong
- State Key Laboratory of Pharmaceutical Biotechnology, Chemistry and Biomedicine Innovation Center (ChemBIC), School of Life Sciences, Nanjing University, 163 Xianlin Avenue, Nanjing, 210023, China
| | - Wen Lv
- Department of Gynecology, Tongde Hospital of Zhejiang Province, 234 Gucui Road, Hangzhou, 310012, China.
| | - Hongzhi Qiao
- Jiangsu Engineering Research Center for Efficient Delivery System of TCM, School of Pharmacy, Nanjing University of Chinese Medicine, 138 Xianlin Avenue, Nanjing, 210023, China.
| | - Yang Sun
- State Key Laboratory of Pharmaceutical Biotechnology, Chemistry and Biomedicine Innovation Center (ChemBIC), School of Life Sciences, Nanjing University, 163 Xianlin Avenue, Nanjing, 210023, China; Jiangsu Key Laboratory of New Drug Research and Clinical Pharmacy, Xuzhou Medical University, 209 Tongshan Road, Xuzhou, 221004, Jiangsu, China.
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14
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Martínez-Morcillo FJ, Cantón-Sandoval J, Martínez-Navarro FJ, Cabas I, Martínez-Vicente I, Armistead J, Hatzold J, López-Muñoz A, Martínez-Menchón T, Corbalán-Vélez R, Lacal J, Hammerschmidt M, García-Borrón JC, García-Ayala A, Cayuela ML, Pérez-Oliva AB, García-Moreno D, Mulero V. NAMPT-derived NAD+ fuels PARP1 to promote skin inflammation through parthanatos cell death. PLoS Biol 2021; 19:e3001455. [PMID: 34748530 PMCID: PMC8601609 DOI: 10.1371/journal.pbio.3001455] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Revised: 11/18/2021] [Accepted: 10/22/2021] [Indexed: 01/26/2023] Open
Abstract
Several studies have revealed a correlation between chronic inflammation and nicotinamide adenine dinucleotide (NAD+) metabolism, but the precise mechanism involved is unknown. Here, we report that the genetic and pharmacological inhibition of nicotinamide phosphoribosyltransferase (Nampt), the rate-limiting enzyme in the salvage pathway of NAD+ biosynthesis, reduced oxidative stress, inflammation, and keratinocyte DNA damage, hyperproliferation, and cell death in zebrafish models of chronic skin inflammation, while all these effects were reversed by NAD+ supplementation. Similarly, genetic and pharmacological inhibition of poly(ADP-ribose) (PAR) polymerase 1 (Parp1), overexpression of PAR glycohydrolase, inhibition of apoptosis-inducing factor 1, inhibition of NADPH oxidases, and reactive oxygen species (ROS) scavenging all phenocopied the effects of Nampt inhibition. Pharmacological inhibition of NADPH oxidases/NAMPT/PARP/AIFM1 axis decreased the expression of pathology-associated genes in human organotypic 3D skin models of psoriasis. Consistently, an aberrant induction of NAMPT and PARP activity, together with AIFM1 nuclear translocation, was observed in lesional skin from psoriasis patients. In conclusion, hyperactivation of PARP1 in response to ROS-induced DNA damage, fueled by NAMPT-derived NAD+, mediates skin inflammation through parthanatos cell death.
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Affiliation(s)
- Francisco J. Martínez-Morcillo
- Departmento de Biología Celular e Histología, Facultad de Biología, Universidad de Murcia, Spain
- Instituto Murciano de Investigación Biosanitaria-Arrixaca, Murcia, Spain
| | - Joaquín Cantón-Sandoval
- Departmento de Biología Celular e Histología, Facultad de Biología, Universidad de Murcia, Spain
- Instituto Murciano de Investigación Biosanitaria-Arrixaca, Murcia, Spain
| | - Francisco J. Martínez-Navarro
- Departmento de Biología Celular e Histología, Facultad de Biología, Universidad de Murcia, Spain
- Instituto Murciano de Investigación Biosanitaria-Arrixaca, Murcia, Spain
| | - Isabel Cabas
- Departmento de Biología Celular e Histología, Facultad de Biología, Universidad de Murcia, Spain
- Instituto Murciano de Investigación Biosanitaria-Arrixaca, Murcia, Spain
| | - Idoya Martínez-Vicente
- Instituto Murciano de Investigación Biosanitaria-Arrixaca, Murcia, Spain
- Departamento de Bioquímica y Biología Molecular A e Inmmunología, Facultad de Medicina, Universidad de Murcia, Murcia, Spain
| | - Joy Armistead
- Institute of Zoology, Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases and Center for Molecular Medicine Cologne, University of Cologne, Cologne, Germany
| | - Julia Hatzold
- Institute of Zoology, Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases and Center for Molecular Medicine Cologne, University of Cologne, Cologne, Germany
| | - Azucena López-Muñoz
- Departmento de Biología Celular e Histología, Facultad de Biología, Universidad de Murcia, Spain
- Instituto Murciano de Investigación Biosanitaria-Arrixaca, Murcia, Spain
| | - Teresa Martínez-Menchón
- Instituto Murciano de Investigación Biosanitaria-Arrixaca, Murcia, Spain
- Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, Spain
| | - Raúl Corbalán-Vélez
- Instituto Murciano de Investigación Biosanitaria-Arrixaca, Murcia, Spain
- Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, Spain
| | - Jesús Lacal
- Departamento de Microbiología y Genética, Facultad de Biología, Universidad de Salamanca, Spain
| | - Matthias Hammerschmidt
- Institute of Zoology, Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases and Center for Molecular Medicine Cologne, University of Cologne, Cologne, Germany
| | - José C. García-Borrón
- Instituto Murciano de Investigación Biosanitaria-Arrixaca, Murcia, Spain
- Departamento de Bioquímica y Biología Molecular A e Inmmunología, Facultad de Medicina, Universidad de Murcia, Murcia, Spain
| | - Alfonsa García-Ayala
- Departmento de Biología Celular e Histología, Facultad de Biología, Universidad de Murcia, Spain
- Instituto Murciano de Investigación Biosanitaria-Arrixaca, Murcia, Spain
| | - María L. Cayuela
- Instituto Murciano de Investigación Biosanitaria-Arrixaca, Murcia, Spain
- Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, Spain
| | - Ana B. Pérez-Oliva
- Departmento de Biología Celular e Histología, Facultad de Biología, Universidad de Murcia, Spain
- Instituto Murciano de Investigación Biosanitaria-Arrixaca, Murcia, Spain
- * E-mail: (ABP-O); (DG-M); (VM)
| | - Diana García-Moreno
- Departmento de Biología Celular e Histología, Facultad de Biología, Universidad de Murcia, Spain
- Instituto Murciano de Investigación Biosanitaria-Arrixaca, Murcia, Spain
- * E-mail: (ABP-O); (DG-M); (VM)
| | - Victoriano Mulero
- Departmento de Biología Celular e Histología, Facultad de Biología, Universidad de Murcia, Spain
- Instituto Murciano de Investigación Biosanitaria-Arrixaca, Murcia, Spain
- * E-mail: (ABP-O); (DG-M); (VM)
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Sharma K, Choudhary S, Silakari O. Portraying molecular modulation and therapeutic aspects of psoriasis: Retrospection and current status. J Mol Struct 2021. [DOI: 10.1016/j.molstruc.2021.130770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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16
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Ahn H, Lee SY, Jung WJ, Pi J, Lee KH. Psoriasis treatment using minimally manipulated umbilical cord-derived mesenchymal stem cells: A case report. World J Clin Cases 2021; 9:6798-6803. [PMID: 34447827 PMCID: PMC8362539 DOI: 10.12998/wjcc.v9.i23.6798] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Revised: 05/24/2021] [Accepted: 07/06/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Psoriasis is a chronic autoimmune disease that usually manifests as a red scaly epidermis, induration, and hyperproliferation of basal keratinocytes. About 2% of the world’s population suffers from psoriasis but there are no clear therapeutics yet. Recently, mesenchymal stem cells (MSCs) have been regarded as a therapeutic alternative for autoimmune diseases, as they possess immunosuppressive effects without risks. Human umbilical cord-derived MSCs effectively regulate immune cells and are characterized by low immunogenicity, which has many advantages in treating immune diseases.
CASE SUMMARY The patient was a 47-year-old male, diagnosed with psoriasis in 1995. He had received various treatments for 25 years, but the psoriatic condition was not significantly improved. He was given three rounds of minimally manipulated umbilical cord-derived MSCs over 2 wk. The erythema gradually disappeared. Three months after the 1st round, all erythema completely disappeared, and the psoriasis did not recur.
CONCLUSION Minimally manipulated umbilical cord-derived MSC transplantation can potentially treat patients who suffer from psoriasis.
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Affiliation(s)
- Hyunjun Ahn
- bio Beauty&Health Company (bBHC)-Stem Cell Treatment and Research Institute (STRI), Seoul 04420, South Korea
- Department of Functional Genomics, University of Science and Technology KRIBB School, Deajeon 34113, South Korea
| | - Sang Yeon Lee
- bio Beauty&Health Company (bBHC)-Stem Cell Treatment and Research Institute (STRI), Seoul 04420, South Korea
| | - Won-Ju Jung
- Stem Cell Treatment, 97.7 B&H Clinic, Seoul 04420, South Korea
| | - Jia Pi
- bio Beauty&Health Company (bBHC)-Stem Cell Treatment and Research Institute (STRI), Seoul 04420, South Korea
| | - Kye-Ho Lee
- bio Beauty&Health Company (bBHC)-Stem Cell Treatment and Research Institute (STRI), Seoul 04420, South Korea
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17
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Affiliation(s)
- Levent Beker
- Department of Mechanical Engineering, Koç University, Istanbul, Turkey.
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18
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Vucemilovic AS, Puljak L. Outcome domains and measures for pain in psoriasis used in registered trials: analysis of studies on ClinicalTrials.gov. J Comp Eff Res 2021; 10:909-915. [PMID: 34111965 DOI: 10.2217/cer-2021-0012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Aim: Psoriasis includes unpleasant symptoms such as pain. This study aimed to investigate whether clinical trials have domains related to pain in their study designs. Materials and methods: We analyzed all clinical trials about interventions for psoriasis treatment registered on ClinicalTrials.gov and the frequency of pain-related outcomes. Results: Our analysis included 1033 registered clinical trials. They had 1329 primary outcomes and 5457 secondary outcomes. The pain was used in six (0.6%) protocols as a primary outcome and 68 (6.5%) protocols as a secondary outcome. Conclusion: Pain as an outcome was used in few registered clinical trial protocols for the treatment of psoriatic conditions. Future studies should investigate why the trialists do not include pain among primary or secondary outcomes.
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Affiliation(s)
| | - Livia Puljak
- Center for Evidence-Based Medicine & Health Care, Catholic University of Croatia, Zagreb, Croatia
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19
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Kobza Black A. Obituary: Professor Malcolm Greaves, 1933–2021. Br J Dermatol 2021. [DOI: 10.1111/bjd.19864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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20
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Bagel J, Nelson E, Zapata J, Hetzel A. Adjunctive Use of Calcipotriene/Betamethasone Dipropionate Foam in a Real-World Setting Curtails the Cost of Biologics Without Reducing Efficacy in Psoriasis. Dermatol Ther (Heidelb) 2020; 10:1383-1396. [PMID: 33048333 PMCID: PMC7649184 DOI: 10.1007/s13555-020-00454-z] [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: 08/25/2020] [Indexed: 12/02/2022] Open
Abstract
Introduction Although the efficacy of monotherapy with biologics for psoriasis is well established, many patients fail to achieve complete plaque clearance from their initial biologic treatment alone. Adjunctive treatment with topical calcipotriene plus betamethasone dipropionate (Cal/BD) foam may offer substantial clinical benefit and potential cost savings. Methods We conducted a 16-week, open-label, single-arm study of adjunctive therapy with Cal/BD foam in subjects who had been treated with etanercept or adalimumab for ≥ 24 weeks but had not obtained a satisfactory treatment response. Assessments included affected body surface area (BSA), Physician’s Global Assessment (PGA) of disease severity, BSA × PGA, National Psoriasis Foundation (NPF) Treat to Target status, and likelihood of the physician to switch biologics. In parallel, a cost analysis was performed to compare the cost of switching to a different biologic versus adding Cal/BD foam to the original biologic. Results Four weeks of daily adjunctive treatment with Cal/BD foam led to notable reductions in BSA, PGA, and BSA × PGA relative to baseline. Additionally, by week 4, > 75% of subjects achieved NPF Treat to Target status, and the likelihood of the investigator to switch biologics decreased from 90.0% at baseline to 7.1%. The improved efficacy was maintained throughout the additional 12 weeks of maintenance Cal/BD foam application. The pharmacoeconomic evaluation demonstrated that adjuvant use of Cal/BD foam led to cost savings compared with switching biologic treatments. Limitations Due to the nature of the open-label study lacking a vehicle-treated control, no statistical comparison can be made. Conclusions The results of this study demonstrate that the addition of Cal/BD foam to plaque psoriasis patients who still have significant disease activity despite being on stable biologic therapy improves treatment outcomes to the point where switching to a more expensive biologic therapy is a less suitable treatment option.
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Affiliation(s)
- Jerry Bagel
- Psoriasis Treatment Center of New Jersey, East Windsor, NJ, USA.
| | - Elise Nelson
- Psoriasis Treatment Center of New Jersey, East Windsor, NJ, USA
| | - James Zapata
- Psoriasis Treatment Center of New Jersey, East Windsor, NJ, USA
| | - Alexa Hetzel
- Psoriasis Treatment Center of New Jersey, East Windsor, NJ, USA
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21
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Contini P, Murdaca G, Puppo F, Negrini S. HLA-G Expressing Immune Cells in Immune Mediated Diseases. Front Immunol 2020; 11:1613. [PMID: 32983083 PMCID: PMC7484697 DOI: 10.3389/fimmu.2020.01613] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2020] [Accepted: 06/17/2020] [Indexed: 12/12/2022] Open
Abstract
HLA-G is a HLA class Ib antigen that possesses immunomodulatory properties. HLA-G-expressing CD4+ and CD8+ T lymphocytes, NK cells, monocytes, and dendritic cells with immunoregulatory functions are present in small percentages of patients with physiologic conditions. Quantitative and qualitative derangements of HLA-G+ immune cells have been detected in several conditions in which the immune system plays an important role, such as infectious, neoplastic, and autoimmune diseases as well as in complications from transplants and pregnancy. These observations strongly support the hypothesis that HLA-G+ immune cells may be implicated in the complex mechanisms underlying the pathogenesis of these disorders.
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Affiliation(s)
- P Contini
- Department of Internal Medicine, University of Genoa, Genoa, Italy
| | - Giuseppe Murdaca
- Department of Internal Medicine, University of Genoa, Genoa, Italy
| | - Francesco Puppo
- Department of Internal Medicine, University of Genoa, Genoa, Italy
| | - Simone Negrini
- Department of Internal Medicine, University of Genoa, Genoa, Italy
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22
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Fujii K, Yamamoto Y, Mizutani Y, Saito K, Seishima M. Indoleamine 2,3-Dioxygenase 2 Deficiency Exacerbates Imiquimod-Induced Psoriasis-Like Skin Inflammation. Int J Mol Sci 2020; 21:E5515. [PMID: 32752186 PMCID: PMC7432009 DOI: 10.3390/ijms21155515] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Revised: 07/28/2020] [Accepted: 07/31/2020] [Indexed: 12/28/2022] Open
Abstract
Indoleamine 2,3-dioxygenase 1 (IDO1) is an enzyme known to suppress immune responses, and several reports have showed that it is associated with psoriasis. IDO2 is an isoform of IDO1, recently identified as a catalytic enzyme in the tryptophan-kynurenine pathway, which is expressed in dendritic cells and monocytes. The expression of IDO2 in immune cells suggests that IDO2 may contribute to immune functions. However, the role of IDO2 in the pathogenesis of psoriasis remains unclear. In this study, to elucidate the role of IDO2 in psoriasis, we assessed imiquimod (IMQ)-induced psoriasis-like dermatitis in IDO2 knockout (KO) mice. Skin inflammation, evaluated by scoring erythema, scaling, and ear thickness, was significantly worse in the IDO2 KO mice than in the wild-type (WT) mice. The mRNA expression levels of TNF-α, IL-23p19, and IL-17A, key cytokines involved in the development of psoriasis, were also increased in the IDO2 KO mice. Furthermore, immunohistochemistry revealed that the number of Ki67-positive cells in the epidermis and CD4-, CD8-, and IL-17-positive lymphocytes infiltrating the dermis were significantly increased in the IDO2 KO mice. These results suggest that IDO2 might decrease IL-17 expression, thereby resulting in the suppression of skin inflammation in IMQ-induced psoriasis-like dermatitis.
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Affiliation(s)
- Kento Fujii
- Department of Dermatology, Gifu University Graduate School of Medicine, 1-1 Yanagito, Gifu 501-1194, Japan; (Y.M.); (M.S.)
| | - Yasuko Yamamoto
- Department of Disease Control and Prevention, Fujita Health University Graduate School of Health Sciences, 1-98 Dengakugakubo, Kutsukake, Toyoake, Aichi 470-1192, Japan; (Y.Y.); (K.S.)
| | - Yoko Mizutani
- Department of Dermatology, Gifu University Graduate School of Medicine, 1-1 Yanagito, Gifu 501-1194, Japan; (Y.M.); (M.S.)
| | - Kuniaki Saito
- Department of Disease Control and Prevention, Fujita Health University Graduate School of Health Sciences, 1-98 Dengakugakubo, Kutsukake, Toyoake, Aichi 470-1192, Japan; (Y.Y.); (K.S.)
| | - Mariko Seishima
- Department of Dermatology, Gifu University Graduate School of Medicine, 1-1 Yanagito, Gifu 501-1194, Japan; (Y.M.); (M.S.)
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Abstract
INTRODUCTION Psoriasis is a common chronic skin inflammatory disease. Its presentation, apart from affected skin areas, involves other unpleasant symptoms, such as pain. Pain deteriorates the patient's quality of life, impairing their daily behaviour and functioning. Therefore, the alleviation of pain in patients with psoriasis should be one of the most desired outcomes of successful treatment. The aim of this study is to summarise available evidence about pain in patients with psoriasis using systematic scoping review methodology in order to map the relevant literature. METHODS AND ANALYSES Our scoping systematic review will provide evidence synthesis of the literature, both quantitative and qualitative, about the pain associated with psoriasis, including pain associated with psoriatic arthritis. Any types of studies will be eligible for inclusion, and we will not have any time, language or publication status restrictions. We will search MEDLINE, Embase and PsycINFO via OVID, as well as Cochrane Central Register of Clinical Trials, Cochrane Database of Systematic Reviews via Cochrane Library, CINAHL via EBSCO, OpenGrey and ProQuest Dissertations and Theses Global. All databases will be searched from the date of their inception. Retrieved bibliographic records and potentially relevant full texts will be screened by two authors independently. Two researchers will extract data independently. Any discrepancies will be resolved via discussion or consultation of the third author, if necessary. To appraise studies, we will use a Mixed Methods Appraisal Tool, AMSTAR 2, Cochrane risk of bias tool and ROBINS. Our findings will be reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews. ETHICS AND DISSEMINATION The proposed study will not be conducted with human participants. We will only use published data and therefore ethics approval is not required. Our findings will be disseminated via peer-reviewed manuscript and conference reports.
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Affiliation(s)
| | - Danijela Nujic
- Department of Public Health, Josip Juraj Strossmayer University of Osijek School of Medicine, Osijek, Osijek-Baranja, Croatia
| | - Livia Puljak
- Center for Evidence-Based Medicine and Health Care, Catholic University of Croatia, Zagreb, Croatia
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24
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The PDE4 inhibitor CHF6001 affects keratinocyte proliferation via cellular redox pathways. Arch Biochem Biophys 2020; 685:108355. [DOI: 10.1016/j.abb.2020.108355] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Revised: 03/11/2020] [Accepted: 03/31/2020] [Indexed: 11/22/2022]
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25
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Bhardwaj P, Tripathi P, Gupta R, Pandey S. Niosomes: A review on niosomal research in the last decade. J Drug Deliv Sci Technol 2020. [DOI: 10.1016/j.jddst.2020.101581] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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26
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Martínez-Navarro FJ, Martínez-Morcillo FJ, de Oliveira S, Candel S, Cabas I, García-Ayala A, Martínez-Menchón T, Corbalán-Vélez R, Mesa-Del-Castillo P, Cayuela ML, Pérez-Oliva AB, García-Moreno D, Mulero V. Hydrogen peroxide in neutrophil inflammation: Lesson from the zebrafish. DEVELOPMENTAL AND COMPARATIVE IMMUNOLOGY 2020; 105:103583. [PMID: 31862296 DOI: 10.1016/j.dci.2019.103583] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Revised: 12/16/2019] [Accepted: 12/16/2019] [Indexed: 05/15/2023]
Abstract
The zebrafish has become an excellent model for the study of inflammation and immunity. Its unique advantages for in vivo imaging and gene and drug screening have allowed the visualization of dual oxidase 1 (Duox1)-derived hydrogen peroxide (H2O2) tissue gradients and its crosstalk with neutrophil infiltration to inflamed tissue. Thus, it has been shown that H2O2 directly recruits neutrophils via the Src-family tyrosine kinase Lyn and indirectly by the activation of several signaling pathways involved in inflammation, such as nuclear factor κB (NF-κB), mitogen activated kinases and the transcription factor AP1. In addition, this model has also unmasked the unexpected ability of H2O2 to induce the expression of the gene encoding the key neutrophil chemoattractant CXC chemokine ligand 8 by facilitating the accessibility of transcription factors to its promoter through histone covalent modifications. Finally, zebrafish models of psoriasis have shown that a H2O2/NF-κB/Duox1 positive feedback inflammatory loop operates in this chronic inflammatory disorder and that pharmacological inhibition of Duox1, but not of downstream mediators, inhibits inflammation and restores epithelial homeostasis. Therefore, these results have pointed out DUOX1 and H2O2 as therapeutic targets for the treatment of skin inflammatory disorders, such as psoriasis.
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Affiliation(s)
- Francisco J Martínez-Navarro
- Departmento de Biología Celular e Histología, Facultad de Biología, Universidad de Murcia, Spain; Instituto Murciano de Investigación Biosanitaria (IMIB)-Arrixaca, Murcia, Spain
| | - Francisco J Martínez-Morcillo
- Departmento de Biología Celular e Histología, Facultad de Biología, Universidad de Murcia, Spain; Instituto Murciano de Investigación Biosanitaria (IMIB)-Arrixaca, Murcia, Spain
| | - Sofia de Oliveira
- Departmento de Biología Celular e Histología, Facultad de Biología, Universidad de Murcia, Spain; Instituto Murciano de Investigación Biosanitaria (IMIB)-Arrixaca, Murcia, Spain
| | - Sergio Candel
- Departmento de Biología Celular e Histología, Facultad de Biología, Universidad de Murcia, Spain; Instituto Murciano de Investigación Biosanitaria (IMIB)-Arrixaca, Murcia, Spain
| | - Isabel Cabas
- Departmento de Biología Celular e Histología, Facultad de Biología, Universidad de Murcia, Spain; Instituto Murciano de Investigación Biosanitaria (IMIB)-Arrixaca, Murcia, Spain
| | - Alfonsa García-Ayala
- Departmento de Biología Celular e Histología, Facultad de Biología, Universidad de Murcia, Spain; Instituto Murciano de Investigación Biosanitaria (IMIB)-Arrixaca, Murcia, Spain
| | - Teresa Martínez-Menchón
- Instituto Murciano de Investigación Biosanitaria (IMIB)-Arrixaca, Murcia, Spain; Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, Spain
| | - Raúl Corbalán-Vélez
- Instituto Murciano de Investigación Biosanitaria (IMIB)-Arrixaca, Murcia, Spain; Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, Spain
| | - Pablo Mesa-Del-Castillo
- Instituto Murciano de Investigación Biosanitaria (IMIB)-Arrixaca, Murcia, Spain; Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, Spain
| | - María L Cayuela
- Instituto Murciano de Investigación Biosanitaria (IMIB)-Arrixaca, Murcia, Spain; Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, Spain
| | - Ana B Pérez-Oliva
- Departmento de Biología Celular e Histología, Facultad de Biología, Universidad de Murcia, Spain; Instituto Murciano de Investigación Biosanitaria (IMIB)-Arrixaca, Murcia, Spain.
| | - Diana García-Moreno
- Departmento de Biología Celular e Histología, Facultad de Biología, Universidad de Murcia, Spain; Instituto Murciano de Investigación Biosanitaria (IMIB)-Arrixaca, Murcia, Spain.
| | - Victoriano Mulero
- Departmento de Biología Celular e Histología, Facultad de Biología, Universidad de Murcia, Spain; Instituto Murciano de Investigación Biosanitaria (IMIB)-Arrixaca, Murcia, Spain.
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Leonardi C, Reich K, Foley P, Torii H, Gerdes S, Guenther L, Gooderham M, Ferris LK, Griffiths CEM, ElMaraghy H, Crane H, Patel H, Burge R, Gallo G, Shrom D, Leung A, Lin CY, Papp K. Efficacy and Safety of Ixekizumab Through 5 Years in Moderate-to-Severe Psoriasis: Long-Term Results from the UNCOVER-1 and UNCOVER-2 Phase-3 Randomized Controlled Trials. Dermatol Ther (Heidelb) 2020; 10:431-447. [PMID: 32200512 PMCID: PMC7211779 DOI: 10.1007/s13555-020-00367-x] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Indexed: 01/09/2023] Open
Abstract
Introduction Ixekizumab, a high-affinity monoclonal antibody that selectively targets interleukin-17A, is approved for treatment of moderate-to-severe plaque psoriasis. Our objective was to evaluate the long-term efficacy and safety of ixekizumab in moderate-to-severe plaque psoriasis through 5 years. Methods Data were integrated from the UNCOVER-1 and UNCOVER-2, randomized, double-blinded, phase-3 trials. Patients who continuously received the labeled ixekizumab dose, were static Physician’s Global Assessment (sPGA) (0,1) responders at Week 12 and completed 60 weeks of treatment could enter the long-term extension (LTE) period. Patients could escalate to every-2-week dosing per investigator opinion. Efficacy and health outcomes included proportion of patients achieving Psoriasis Area and Severity Index (PASI) 75/90/100, sPGA (0,1) and (0), absolute PASI ≤ 5/ ≤ 3/ ≤ 2/ ≤ 1 and Dermatology Life Quality Index (DLQI) (0,1). Results exclude patients who escalated to every-2-week dosing. A modified non-responder imputation method was used to account for missing data. Supplemental analyses include patients who escalated to every-2-week dosing and observed and multiple imputation results. Exposure-adjusted safety outcomes are also reported. Results Of 206 patients who entered the LTE periods, 172 completed treatment. At Week 60, PASI 75/90/100 responses were 94.7%, 85.0% and 62.1%, respectively, and at year 5 were 90.3%, 71.3% and 46.3%, respectively. Similarly, meaningful responses were achieved for the other efficacy and health measures. Among patients with PASI 100 through 5 years, 92% achieved DLQI (0,1), indicating no impact of skin disease on quality of life. During the LTE period, exposure-adjusted incidence rates were 31.4 per 100 patient-years for treatment-emergent adverse events and 6.8 per 100 patient-years for serious adverse events. No deaths were reported. No new or unexpected safety findings were noted. Conclusions The results demonstrate 80 mg ixekizumab maintains long-term efficacy and a safety profile consistent with previous data in patients with moderate-to-severe plaque psoriasis through 5 years of treatment. Trial Registration ClinicalTrials.gov identifier, UNCOVER-1: NCT01474512, UNCOVER-2: NCT01597245. Electronic Supplementary Material The online version of this article (10.1007/s13555-020-00367-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
| | - Kristian Reich
- Center for Translational Research in Inflammatory Skin Diseases, Institute for Health Services Research in Dermatology and Nursing, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,Skinflammation® Center, Hamburg, Germany
| | - Peter Foley
- St. Vincent's Hospital Melbourne and Probity Medical Research, Skin Health Institute, The University of Melbourne, Melbourne, VIC, Australia
| | - Hideshi Torii
- Division of Dermatology, Tokyo Yamate Medical Center, Tokyo, Japan
| | - Sascha Gerdes
- Psoriasis-Center at the Department of Dermatology, University Medical Center Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Lyn Guenther
- Guenther Dermatology Research Centre, London, ON, Canada
| | - Melinda Gooderham
- SkiN Centre for Dermatology and Probity Medical Research, Peterborough, ON, Canada
| | - Laura K Ferris
- University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | | | - Hany ElMaraghy
- Eli Lilly and Company, Lilly Corporate Center, Indianapolis, IN, USA
| | - Heidi Crane
- Eli Lilly and Company, Lilly Corporate Center, Indianapolis, IN, USA
| | - Himanshu Patel
- Eli Lilly and Company, Lilly Corporate Center, Indianapolis, IN, USA
| | - Russel Burge
- Eli Lilly and Company, Lilly Corporate Center, Indianapolis, IN, USA
| | - Gaia Gallo
- Eli Lilly and Company, Lilly Corporate Center, Indianapolis, IN, USA
| | - David Shrom
- Eli Lilly and Company, Lilly Corporate Center, Indianapolis, IN, USA.
| | | | - Chen-Yen Lin
- Eli Lilly and Company, Lilly Corporate Center, Indianapolis, IN, USA
| | - Kim Papp
- K. Papp Clinical Research and Probity Medical Research Inc., Waterloo, ON, Canada
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28
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Eichenfield LF, Marcoux D, Kurvits M, Liljedahl M. Safety and efficacy of topical, fixed-dose combination calcipotriene (0.005%) and betamethasone (0.064% as dipropionate) gel in adolescent patients with scalp and body psoriasis: a phase II trial. J Eur Acad Dermatol Venereol 2019; 34:1098-1104. [PMID: 31721327 PMCID: PMC7318187 DOI: 10.1111/jdv.16077] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Accepted: 10/24/2019] [Indexed: 11/29/2022]
Abstract
Background Psoriasis is a disease that commonly manifests in adolescence. Up to half of adults with psoriasis develop it before the age of 20. Topical formulations containing corticosteroids and/or vitamin D3 analogs are recommended for treatment. Objective This phase II study aimed to evaluate the safety, including any potential effect on the hypothalamic–pituitary–adrenal axis and calcium metabolism, and efficacy of fixed‐dose combination calcipotriene (0.005%) and betamethasone (0.064% as dipropionate) (Cal/BD) gel in adolescents with psoriasis. Methods Patients aged 12 to <17 years, with at least mild psoriasis on the body and scalp, received topical Cal/BD gel once daily for ≤8 weeks. Safety response criteria included adverse drug reactions [ADRs; any adverse event (AE) possibly or probably related to treatment as determined by the investigator; a primary response criterion] and AEs (a secondary response criterion). Only treatment‐emergent AEs (events that occurred after the first application of Cal/BD gel or events which started before this and increased in intensity after the first application of Cal/BD gel) are presented here. Efficacy response criteria included controlled disease, by physician's global assessment of disease severity (PGA), following Cal/BD gel treatment. Results A total of 107 patients (median age 14 years; range 12–16) were enrolled and treated. Eight ADRs were observed in 7 (7%) patients and 38 (36%) patients experienced ≥1 AE. The most common AEs were headache [6 (6%) patients], nasopharyngitis [6 (6%) patients] and blood parathyroid hormone increased [4 (4%) patients]. One severe AE was reported (attempted suicide) but was considered unrelated to treatment. At the end of treatment, 58% of patients had controlled disease on the body and 69% on the scalp according to PGA. Conclusion In this uncontrolled phase II study, Cal/BD gel was well tolerated and effective for treating scalp and body psoriasis in adolescents.
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Affiliation(s)
- L F Eichenfield
- University of California, San Diego and Rady Children's Hospital, San Diego, CA, USA
| | - D Marcoux
- Sainte-Justine University Hospital Center, Montreal, QC, Canada
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Li B, He S, Liu R, Huang L, Liu G, Wang R, Yang Z, Liu X, Leng Y, Liu D, Ye C, Li Y, Chen Y, Yin H, Fang W. Total glucosides of paeony attenuates animal psoriasis induced inflammatory response through inhibiting STAT1 and STAT3 phosphorylation. JOURNAL OF ETHNOPHARMACOLOGY 2019; 243:112121. [PMID: 31356966 DOI: 10.1016/j.jep.2019.112121] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Revised: 07/19/2019] [Accepted: 07/25/2019] [Indexed: 06/10/2023]
Abstract
ETHNOPHARMACOLOGICAL RELEVANCE Psoriasis is an immune system meditated disease, especially T cells. It disturbed many people around the world and hard to therapy. Paeonia lactiflora Pall has been used as a medicine in china for thousands of years. Recent studies found that the main component of Paeonia lactiflora Pall can alleviates the immune response in many diseases. In this study, we researched the effects and possible mechanisms of total glucosides of paeony (TGP) on animal psoriasis. AIM OF THE STUDY To study the therapeutic effects and mechanisms of TGP in 5% propranolol cream-induced psoriasis in guinea pigs and Imiquimod (IMQ) cream-induced psoriasis in mice. MATERIALS AND METHODS The effect of TGP was evaluated using a psoriasis-like model of guinea pigs and mice. Ear thickness was accessed, and pathology injury was observed by H&E staining. The levels of serum IL-1β, IL-6, IL-12, IL-17, IL-23, TNF-α, and IFN-γ, skin IL-17A, IL-22 and orphan nuclear receptor (RORγt) mRNA expression, proliferating cell nuclear antigen (PCNA), total or phosphorylated signal transducers and activators of transcription (STAT1, STAT3) were determined by enzyme linked immunosorbent assays (ELISAs), real time PCR, immunohistochemical staining, and western blotting, respectively. RESULTS Compared with model group, TGP treatment decreased the ear thickness, improved pathology of psoriasis, alleviated IMQ-induced keratinocyte proliferation, reduced the inflammatory cytokine, and downregulated IL-17A, IL-22, and RORγt mRNA in mice. Further study indicated that TGP inhibited STAT1 and STAT3 phosphorylation in lesion skins of psoriasis-like mice. CONCLUSIONS TGP alleviates the symptoms of psoriasis-like guinea pigs and mice, and the possible mechanism may relate to inhibit T helper 17 (TH17) cell differentiation and keratinocytes proliferation by inhibiting STAT1 and STAT3 phosphorylation.
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Affiliation(s)
- Binbin Li
- State Key Laboratory of Natural Medicines, School of Basic Medical Sciences and Clinical Pharmacy, China Pharmaceutical University, Nanjing, 210009, PR China
| | - Shucheng He
- State Key Laboratory of Natural Medicines, School of Basic Medical Sciences and Clinical Pharmacy, China Pharmaceutical University, Nanjing, 210009, PR China
| | - Rui Liu
- State Key Laboratory of Natural Medicines, School of Basic Medical Sciences and Clinical Pharmacy, China Pharmaceutical University, Nanjing, 210009, PR China
| | - Liangliang Huang
- State Key Laboratory of Natural Medicines, School of Basic Medical Sciences and Clinical Pharmacy, China Pharmaceutical University, Nanjing, 210009, PR China
| | - Ge Liu
- State Key Laboratory of Natural Medicines, School of Basic Medical Sciences and Clinical Pharmacy, China Pharmaceutical University, Nanjing, 210009, PR China
| | - Ruixuan Wang
- State Key Laboratory of Natural Medicines, School of Basic Medical Sciences and Clinical Pharmacy, China Pharmaceutical University, Nanjing, 210009, PR China
| | - Zhuoyue Yang
- State Key Laboratory of Natural Medicines, School of Basic Medical Sciences and Clinical Pharmacy, China Pharmaceutical University, Nanjing, 210009, PR China
| | - Xinyi Liu
- State Key Laboratory of Natural Medicines, School of Basic Medical Sciences and Clinical Pharmacy, China Pharmaceutical University, Nanjing, 210009, PR China
| | - Ye Leng
- State Key Laboratory of Natural Medicines, School of Basic Medical Sciences and Clinical Pharmacy, China Pharmaceutical University, Nanjing, 210009, PR China
| | - Dan Liu
- State Key Laboratory of Natural Medicines, School of Basic Medical Sciences and Clinical Pharmacy, China Pharmaceutical University, Nanjing, 210009, PR China
| | - Chengyu Ye
- State Key Laboratory of Natural Medicines, School of Basic Medical Sciences and Clinical Pharmacy, China Pharmaceutical University, Nanjing, 210009, PR China
| | - Yunman Li
- State Key Laboratory of Natural Medicines, School of Basic Medical Sciences and Clinical Pharmacy, China Pharmaceutical University, Nanjing, 210009, PR China.
| | - Yongjian Chen
- Ningbo Liwah Pharmaceutical Co, Ningbo, 315174, PR China
| | - Hong Yin
- Ningbo Liwah Pharmaceutical Co, Ningbo, 315174, PR China
| | - Weirong Fang
- State Key Laboratory of Natural Medicines, School of Basic Medical Sciences and Clinical Pharmacy, China Pharmaceutical University, Nanjing, 210009, PR China.
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Engin B, Tanakol A, Bulut H, Songür A, Vehid HE, Gökalp E, Kutlubay Z, Özkoca D, Tüzün Y, Serdaroğlu S. Changes in serum TNF‐like weak inducer of apoptosis (TWEAK) levels and Psoriasis Area Severity Index (PASI) scores in plaque psoriasis patients treated with conventional versus anti‐TNF treatments. Int J Dermatol 2019; 59:207-215. [DOI: 10.1111/ijd.14646] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2018] [Revised: 07/30/2019] [Accepted: 08/15/2019] [Indexed: 12/11/2022]
Affiliation(s)
- Burhan Engin
- Department of Dermatology Cerrahpaşa Medical Faculty İstanbul University‐Cerrahpaşa Istanbul Turkey
| | - Ali Tanakol
- Department of Dermatology Cerrahpaşa Medical Faculty İstanbul University‐Cerrahpaşa Istanbul Turkey
| | - Huri Bulut
- Department of Biochemistry Medical Faculty Bezm‐i Alem University Istanbul Turkey
| | | | - Hayriye E. Vehid
- Department of Biostatistics Cerrahpaşa Medical Faculty İstanbul University‐Cerrahpaşa Istanbul Turkey
| | - Eral Gökalp
- Department of Biostatistics Cerrahpaşa Medical Faculty İstanbul University‐Cerrahpaşa Istanbul Turkey
| | - Zekayi Kutlubay
- Department of Dermatology Cerrahpaşa Medical Faculty İstanbul University‐Cerrahpaşa Istanbul Turkey
| | - Defne Özkoca
- Department of Dermatology Cerrahpaşa Medical Faculty İstanbul University‐Cerrahpaşa Istanbul Turkey
| | - Yalçın Tüzün
- Department of Dermatology Medical Park Bahçelievler Hospital Altınbaş University Istanbul Turkey
| | - Server Serdaroğlu
- Department of Dermatology Cerrahpaşa Medical Faculty İstanbul University‐Cerrahpaşa Istanbul Turkey
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Mansouri P, Mirafzal S, Najafizadeh P, Safaei-Naraghi Z, Salehi-Surmaghi MH, Hashemian F. The impact of topical Saint John's Wort ( Hypericum perforatum) treatment on tissue tumor necrosis factor-alpha levels in plaque-type psoriasis: A pilot study. J Postgrad Med 2019; 63:215-220. [PMID: 28272075 PMCID: PMC5664864 DOI: 10.4103/0022-3859.201423] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Context: Psoriasis is an inflammatory disorder, formed by inappropriate interaction of T lymphocytes with keratinocytes, and consequent eruption of immune responses. High concentrations of tumor necrosis factor-alpha (TNFα) are found in the skin lesions and plasma of patients with psoriasis. Hypericum perforatum, a phytomedicine that has both anti-inflammatory and antiproliferative properties, has been recently reported to be clinically helpful for improvement of psoriatic lesions. Aims: The aim of the present study was to investigate the effects of topical H. perforatum on TNFα levels in psoriatic lesions for possible identification of the mechanism by which Hypericum reduces inflammation and modulates the disease in patients with plaque-type psoriasis. Settings and Design: A double-blind, placebo-controlled, pilot study with intraindividual comparison was conducted on twenty patients with mild to moderate plaque-type psoriasis. Subjects and Methods: TNFα levels in tissue samples were measured with immunohistochemistry method. Moreover, Psoriasis Area Severity Index (PASI) scores and histological and clinical changes were investigated after topical application of Hypericum extract. Statistical Analysis Used: The Wilcoxon signed-rank test was used to evaluate the possible differences between the drug and placebo group. Results: TNFα concentrations in dermis (p= 0.025), endothelial cells (p=0.033), and dendrite cells (p=0.014) were significantly reduced in lesions treated with drug and the reduction observed in epidermis was superior to placebo (p=0.046). Results of PASI scores showed that erythema, scaling, and thickness were significantly lower where the ointment had been applied compared to application of placebo (p=0.014, p=0.004, p=0.003, respectively). Moreover, significant improvement in clinical and histological features of treated lesions in comparison with untreated lesions was observed (p < 0.05). Conclusions: H. perforatum ointment can help decrease PASI scores and TNFα levels in psoriatic tissue. Its efficacy is probably related to its effect on lowering cytokines including TNFα.
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Affiliation(s)
- P Mansouri
- Skin and Stem Cell Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - S Mirafzal
- Department of Clinical Pharmacy, Faculty of Pharmacy, Islamic Azad University, Pharmaceutical Sciences Branch, Tehran, Iran
| | - P Najafizadeh
- Department of Pharmacology, Faculty of Pharmacy, Islamic Azad University, Pharmaceutical Sciences Branch, Tehran, Iran
| | - Z Safaei-Naraghi
- Department of Dermatopathology, Razi Skin Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - M H Salehi-Surmaghi
- Department of Pharmacognosy, Faculty of Pharmacy, Islamic Azad University, Pharmaceutical Sciences Branch, Tehran, Iran
| | - F Hashemian
- Department of Clinical Pharmacy, Faculty of Pharmacy, Islamic Azad University, Pharmaceutical Sciences Branch, Tehran, Iran
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Sathe P, Saka R, Kommineni N, Raza K, Khan W. Dithranol-loaded nanostructured lipid carrier-based gel ameliorate psoriasis in imiquimod-induced mice psoriatic plaque model. Drug Dev Ind Pharm 2019; 45:826-838. [PMID: 30764674 DOI: 10.1080/03639045.2019.1576722] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVE The aim of this study was to formulate nanostructured lipid carriers (NLCs) of dithranol-loaded in gel for ease of application and to evaluate its anti-psoriatic efficacy vis-a-vis conventional ointment formulation. SIGNIFICANCE This study will provide an insight about the use of nanocarriers, esp. NLCs loaded with dithranol for the effective treatment of psoriasis. METHODS Dithranol-loaded NLCs were prepared by hot melt homogenization method and characterized for particle size and percentage entrapment efficiency. The optimized NLCs were loaded into gel and evaluated for drug release, spreadability, rheological behavior, and staining. Anti-psoriatic efficacy of the NLC gel was evaluated in imiquimod (IMQ) induced psoriatic plaque model in comparison with prepared conventional ointment formulation (1.15% w/w dithranol). RESULTS NLCs were prepared with particle size below 300 nm, polydispersity index (PDI) below 0.3 and percentage entrapment efficiency of ∼100%. The prepared NLC gel was then compared with the ointment for drug release, staining property, and efficacy. Topical application of dithranol-loaded NLC gel on IMQ-induced psoriatic plaque model reduced the symptoms of psoriasis assessed by both Psoriasis area severity index (PASI) scoring and enzyme-linked immunosorbent assay. There was a significant reduction in disease severity and cytokines like Interleukins-17, 22, 23 and Tumor necrosis factor-α by the developed system in comparison to the negative control. CONCLUSIONS To conclude dithranol-loaded NLCs in gel base was efficacious in management of psoriasis at the same drug concentration and also offer less cloth staining to that of the ointment product.
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Affiliation(s)
- Priyadarshini Sathe
- a Department of Pharmaceutics , National Institute of Pharmaceutical Education & Research (NIPER) , Hyderabad , India
| | - Raju Saka
- a Department of Pharmaceutics , National Institute of Pharmaceutical Education & Research (NIPER) , Hyderabad , India
| | - Nagavendra Kommineni
- a Department of Pharmaceutics , National Institute of Pharmaceutical Education & Research (NIPER) , Hyderabad , India
| | - Kaisar Raza
- b Department of Pharmacy, School of Chemical Sciences and Pharmacy , Central University of Rajasthan , Ajmer , India
| | - Wahid Khan
- a Department of Pharmaceutics , National Institute of Pharmaceutical Education & Research (NIPER) , Hyderabad , India
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Curcumin-loaded lipid-hybridized cellulose nanofiber film ameliorates imiquimod-induced psoriasis-like dermatitis in mice. Biomaterials 2018; 182:245-258. [DOI: 10.1016/j.biomaterials.2018.08.030] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2018] [Revised: 07/31/2018] [Accepted: 08/11/2018] [Indexed: 01/02/2023]
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Larian A, Emer JJ, Gordon K, Blum R, Okun M, Gu Y, Lebwohl M. Efficacy and Safety of a Second Adalimumab Treatment Cycle in Psoriasis Patients who Relapsed after Adalimumab Discontinuation or Dosage Reduction: A Double-Blind, Randomized, Placebo-Controlled Trial. ACTA ACUST UNITED AC 2018. [DOI: 10.1177/247553031117a00201] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objective To evaluate re-treatment with weekly adalimumab in patients with moderate to severe psoriasis who had been successfully treated with weekly adalimumab but relapsed following randomization to either dosage reduction or discontinuation. Methods Patients who had achieved a Psoriasis Area and Severity Index (PASI) response of 50 or greater after 12 weeks on adalimumab 40 mg weekly in a previous study (M02-538), but then fell below a PASI 50 response within 12 weeks following reduction of dosage frequency to adalimumab 40 mg every other week or treatment discontinuation, could enter study M03-596 and receive open-label re-treatment with 12 weeks of weekly adalimumab. Results Thirty-two patients relapsed on or before week 24 of M02-538 and entered study M03-596. Overall, 81.3% (26 of 32) again achieved a PASI 50 response after 12 weeks of re-treatment. Of the 19 M03-596 patients who had a PASI 75 response at week 12 of M02-538, 12 (63.1%) again achieved a PASI 75 response at week 12 of M03-596. Conclusion Most patients who had initially responded to weekly adalimumab and who relapsed after randomization to a lower dosage or discontinuation regained response upon re-treatment with weekly adalimumab.
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Affiliation(s)
- Amir Larian
- Mount Sinai School of Medicine, Department of Dermatology, New York, New York
| | - Jason J. Emer
- Mount Sinai School of Medicine, Department of Dermatology, New York, New York
| | - Kenneth Gordon
- North Shore University HealthSystem, Evanston, Illinois, New York
| | - Robin Blum
- Mount Sinai School of Medicine, Department of Dermatology, New York, New York
| | - Martin Okun
- Abbott Laboratories, Abbott Park, Illinois New York
| | - Yihua Gu
- Abbott Laboratories, Abbott Park, Illinois New York
| | - Mark Lebwohl
- Mount Sinai School of Medicine, Department of Dermatology, New York, New York
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Reich K, Menter A, Plotnick M, Guzzo C, Li S, Gottlieb AB. Consistency of Infliximab Response across Subgroups of Patients with Psoriasis: Integrated Results from Randomized Clinical Trials. ACTA ACUST UNITED AC 2018. [DOI: 10.1177/247553030713a00104] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background To assess the consistency of infliximab (Remicade) response among different subgroups of patients with moderate to severe psoriasis, the impact of gender, obesity, age, baseline psoriasis severity, concomitant psoriatic arthritis (PsA), or prior therapies on response to infliximab was studied in an integrated efficacy analysis. Methods Data from three randomized, placebo-controlled clinical trials (SPIRIT, EXPRESS and EXPRESS II) that evaluated the use of infliximab in patients with moderate to severe psoriasis were included in this integrated analysis. Patients received placebo, infliximab 3 mg/kg, or infliximab 5 mg/kg at 0, 2 and 6 wks. The common primary end point at week 10 was the proportion of patients achieving ≥75% improvement in the Psoriasis Area and Severity Index (PASI 75) from baseline. Safety data through week 16 were pooled for analysis. Results Of the 1,462 patients included in this analysis, 70.6% and 79.3% in the infliximab 3 and 5 mg/kg groups, respectively, achieved at least a PASI 75 response at week 10, compared with 2.7% in the placebo group (both p<0.001). The proportions of patients achieving PASI 75 at week 10 were consistent in subgroups defined by baseline demographic characteristics (gender, age, body mass index) and also defined by baseline disease characteristics (PASI severity, body surface area, presence of psoriatic arthritis). Consistent results were also observed regardless of psoriasis therapeutic history. Infliximab treatment was generally well-tolerated by the majority of study participants. Conclusion A consistently high level of clinical response to infliximab was demonstrated across subgroups defined by a variety of baseline demographic and disease characteristics in patients with psoriasis. Infliximab was similarly effective regardless of previous use of phototherapy or major conventional systemic therapies.
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Affiliation(s)
- Kristian Reich
- Department of Dermatology, Georg-August University, Göttingen, Germany
| | - Alan Menter
- Division of Dermatology, Baylor University Medical Center, Dallas, Texas, USA
| | | | | | - Shu Li
- Centocor, Inc., Malvern, Pa., USA
| | - Alice B. Gottlieb
- Department of Dermatology, Tufts-New England Medical Center, Boston, Mass., USA
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Carvajal-Vidal P, Mallandrich M, García ML, Calpena AC. Effect of Different Skin Penetration Promoters in Halobetasol Propionate Permeation and Retention in Human Skin. Int J Mol Sci 2017; 18:E2475. [PMID: 29160818 PMCID: PMC5713441 DOI: 10.3390/ijms18112475] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2017] [Revised: 11/14/2017] [Accepted: 11/17/2017] [Indexed: 01/28/2023] Open
Abstract
Halobetasol propionate (HB) is a potent synthetic corticosteroid used against inflammatory skin diseases, such as dermatitis, eczema, and psoriasis, among others. The aim of this study is to define how the presence of different skin penetration enhancers (nonane, menthone, limonene, azone, carene, decanol, linoleic acid and cetiol) affects the penetration and retention in skin of HB. To determine drug penetration through skin, 5% of each promoter was used in an ex vivo system with human skin on Franz cells. The results showed that the highest permeation occurs in the presence of menthone, followed by nonane. Permeation parameters were determined. The in vivo test was assessed, and the formulation containing HB-menthone presented better anti-inflammatory efficacy. These results are useful to generate a specific treatment according to each patient's needs, and the inflammatory characteristics of the disease.
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Affiliation(s)
- Paulina Carvajal-Vidal
- Department of Pharmacy, Pharmaceutical Technology and Physical Chemistry, Faculty of Pharmacy and Food Sciences, University of Barcelona, 08028 Barcelona, Spain.
- Institute of Nanoscience and Nanotechnology (IN2UB), University of Barcelona, 08028 Barcelona, Spain.
| | - Mireia Mallandrich
- Department of Pharmacy, Pharmaceutical Technology and Physical Chemistry, Faculty of Pharmacy and Food Sciences, University of Barcelona, 08028 Barcelona, Spain.
| | - María Luisa García
- Department of Pharmacy, Pharmaceutical Technology and Physical Chemistry, Faculty of Pharmacy and Food Sciences, University of Barcelona, 08028 Barcelona, Spain.
- Institute of Nanoscience and Nanotechnology (IN2UB), University of Barcelona, 08028 Barcelona, Spain.
| | - Ana Cristina Calpena
- Department of Pharmacy, Pharmaceutical Technology and Physical Chemistry, Faculty of Pharmacy and Food Sciences, University of Barcelona, 08028 Barcelona, Spain.
- Institute of Nanoscience and Nanotechnology (IN2UB), University of Barcelona, 08028 Barcelona, Spain.
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Armstrong AW, Edson-Heredia E, Zhu B, Nikaï E, Goldblum O, Hollister K, Russell J, Siegel M, Lebwohl M. Burden of Psoriasis as Reported in a Cross-Sectional Study: Association of Psoriasis Severity with Health-Related Quality of Life, Depression, and Work Productivity. ACTA ACUST UNITED AC 2017. [DOI: 10.1177/247553031700200408] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Background A significant gap exists in how psoriasis severity is related to validated patient-reported outcomes (PROs), which are critical in characterizing disease burden. Objective Determine the association between psoriasis severity and PROs, including health-related quality of life (HRQoL), depression, and work productivity, from patients’ perspectives. Methods An online survey using validated PRO instruments was administered in 2013. PROs included the Dermatology Life Quality Index, Quick Inventory of Depressive Symptoms-Self-Report (16 items) (QIDS-SR16), and Work Productivity and Activity Impairment Questionnaire-Psoriasis. Results The survey was completed by 1109 patients, 42% of whom had psoriatic arthritis. Respondents reported worse HRQoL and work productivity impairment with greater psoriasis severity ( p < 0.05). Similarly, there was a greater proportion of participants with moderate-or-greater depressive symptoms (QIDS-SR16 total score) among patients with increasing psoriasis severity ( p < 0.05). Conclusion Greater levels of impairment in HRQoL, work productivity, and depressive symptoms were associated with increased psoriasis severity.
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Affiliation(s)
| | | | - Baojin Zhu
- Eli Lilly and Company, Indianapolis, Indiana
| | | | | | | | - James Russell
- Eli Lilly and Company, Indianapolis, Indiana
- Oregon Health Sciences University, Department of Psychiatry, Portland, Oregon
| | | | - Mark Lebwohl
- Icahn School of Medicine at Mount Sinai, New York, New York
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Pashirzad M, Shafiee M, Rahmani F, Behnam-Rassouli R, Hoseinkhani F, Ryzhikov M, Moradi Binabaj M, Parizadeh MR, Avan A, Hassanian SM. Role of Wnt5a in the Pathogenesis of Inflammatory Diseases. J Cell Physiol 2017; 232:1611-1616. [DOI: 10.1002/jcp.25687] [Citation(s) in RCA: 58] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2016] [Accepted: 11/09/2016] [Indexed: 12/14/2022]
Affiliation(s)
- Mehran Pashirzad
- Department of Medical Biochemistry; School of Medicine; Mashhad University of Medical Sciences; Mashhad Iran
| | - Mojtaba Shafiee
- Department of Nutrition; School of Medicine; Mashhad University of Medical Sciences; Mashhad Iran
| | - Farzad Rahmani
- Department of Medical Biochemistry; School of Medicine; Mashhad University of Medical Sciences; Mashhad Iran
| | | | - Fatemeh Hoseinkhani
- Department of Medical Biochemistry; School of Medicine; Iran University of Medical Sciences; Tehran Iran
| | - Mikhail Ryzhikov
- Department of Biochemistry and Molecular Biology; St. Louis University School of Medicine; Saint Louis Missouri
| | - Maryam Moradi Binabaj
- Department of Medical Biochemistry; School of Medicine; Mashhad University of Medical Sciences; Mashhad Iran
| | - Mohammad Reza Parizadeh
- Department of Medical Biochemistry; School of Medicine; Mashhad University of Medical Sciences; Mashhad Iran
| | - Amir Avan
- Molecular Medicine Group; Department of Modern Sciences and Technologies; School of Medicine; Mashhad University of Medical Sciences; Mashhad Iran
- Departments of Medical Oncology and Neurology; VU University Medical Center; Amsterdam The Netherlands
| | - Seyed Mahdi Hassanian
- Department of Medical Biochemistry; School of Medicine; Mashhad University of Medical Sciences; Mashhad Iran
- Department of Biochemistry and Molecular Biology; St. Louis University School of Medicine; Saint Louis Missouri
- Microanatomy Research Center; Mashhad University of Medical Sciences; Mashhad Iran
- Metabolic Syndrome Research Center; School of Medicine; Mashhad University of Medical Sciences; Mashhad Iran
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Choi CW, Kim BR, Ohn J, Youn SW. The Advantage of Cyclosporine A and Methotrexate Rotational Therapy in Long-Term Systemic Treatment for Chronic Plaque Psoriasis in a Real World Practice. Ann Dermatol 2017; 29:55-60. [PMID: 28223747 PMCID: PMC5318527 DOI: 10.5021/ad.2017.29.1.55] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2016] [Revised: 06/06/2016] [Accepted: 06/10/2016] [Indexed: 11/09/2022] Open
Abstract
Background Psoriasis is a chronic inflammatory disease. In the treatment of psoriasis, cyclosporine is commonly prescribed systemic agents. However, long-term use of cyclosporine is not recommended because of side effects such as nephrotoxicity or hypertension. Objective To ascertain the improved safety of rotational therapy using cyclosporine and methotrexate, we investigated the frequency of abnormal results in laboratory test after long term rotational therapy using cyclosporine and methotrexate. Methods From January 2009 to June 2014, patients who were treated with cyclosporine or methotrexate were enrolled. The clinical data and usage of medications were reviewed. Laboratory tests were conducted before starting the treatment and regularly follow-up. The occurrences of any laboratory abnormalities during the treatments were investigated. Results A total of 21 psoriatic patients were enrolled. The mean of medication period and cumulative dose of cyclosporine and methotrexate were 497.81±512.06 days and 115.68±184.34 g in cyclosporine and 264.19±264.71 days and 448.71±448.63 mg in methotrexate. Laboratory abnormalities were found in total two patients after rotational therapy: two patients (9.5%) in aspartate aminotransferase/alanine aminotransferase and one patient (4.8%) in uric acid. No laboratory abnormalities were found in renal function test. Conclusion We found that the rotational approaches using cyclosporine and methotrexate reduced the possibility of the development of nephrotoxicity. In addition to other advantage such as quick switching from one agent to another, the rotational therapy using cyclosporine and methotrexate can minimize the adverse events during the systemic treatment of chronic plaque psoriasis.
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Affiliation(s)
- Chong Won Choi
- Department of Dermatology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Bo Ri Kim
- Department of Dermatology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Jungyoon Ohn
- Department of Dermatology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Sang Woong Youn
- Department of Dermatology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
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Abstract
Psoriasis generally does not affect survival but has significant detrimental effect on quality of life (QOL), which may be comparable to that of ischemic heart disease, diabetes, depression, and cancer. The foremost important thing in the management of psoriasis is counseling of the patient. The clinician needs to be empathetic and spend adequate time with the patient and educating the patient about psoriasis. Clinicians should make it clear to the patient that the primary goal of treatment is control of the disease rather than cure. Eating a balanced and low glycemic diet could be an important adjuvant factor in the prevention and treatment of moderate nonpustular psoriasis. Obese people are more likely to have severe psoriasis and psoriatic arthritis than people with an average body mass index. Dietary supplementation with oily fish, rich in n-3 fatty acids, in psoriasis had shown mixed results in trials. Promising results have been documented for parenteral application of n-3 fatty acid, but not with oral supplementation. Increased smoking or alcohol abuse increases the risk of developing psoriasis and may influence disease severity, and hence must be avoided. Soaking in warm water with bath oil can be done in extensive psoriasis for hydration and emollient effect, and bland soaps or soap substitutes should be used; antiseptics should be avoided as they may irritate the skin. Relatively small, localized patches of psoriasis may improve with occlusion, i.e., waterproof adhesive dressings. The use of emollients is an internationally accepted standard adjunctive to the treatment of psoriasis. Dermatology Life Quality Index is a psychometrically sound and responsive measure of psoriasis-specific outcomes and most comprehensively captures the impact of clinical signs and symptoms on patient's well-being.
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Affiliation(s)
- Rashmi Sarkar
- Department of Dermatology, Maulana Azad Medical College, New Delhi, India
| | - Shikha Chugh
- Department of Dermatology, Maulana Azad Medical College, New Delhi, India
| | - Shivani Bansal
- Department of Dermatology, Maulana Azad Medical College, New Delhi, India
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Sauder DN, Mamelak AJ. Understanding the New Clinical Landscape for Psoriasis: A Comparative Review of Biologics. J Cutan Med Surg 2016; 8:205-12. [PMID: 16091996 DOI: 10.1177/120347540400800401] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background: Encouraging results from clinical trials suggest that biologic therapies are effective treatments for psoriasis. Objective: The aim of our study was to evaluate the scientific evidence for the efficacy and safety of biologic drugs for psoriasis. Methods: The studies reviewed include data on the biologies alefacept, efalizumab, etanercept, and infliximab. This article reviews all data published in the dermatology literature listed in the MEDLINE database, as well as data presented as abstracts and posters at dermatology society meetings, including the annual meetings of the American Academy of Dermatology. Results: The majority of the studies used an improvement from baseline of 75% or more in the psoriasis area and severity index (PASI 75) as the primary measure of efficacy. Conclusions: Overall, biologics represent an important addition to the psoriatic therapies and have a great impact on the disease course and life quality of those afflicted with psoriasis.
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Affiliation(s)
- Daniel N Sauder
- Department of Dermatology, The Johns Hopkins University School of Medicine, Baltimore, Maryland 21205-0900, USA.
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Oh PI, Gupta AK, Einarson TR, Maerov P, Shear NH. Calcipotriol in the Treatment of Psoriasis of Limited Severity: Pharmacoeconomic Evaluation. J Cutan Med Surg 2016. [DOI: 10.1177/120347549700200103] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background: Calcipotriol (calcipotriene) is a vitamin-D3 analogue that has recently become available in North America for the treatment of psoriasis. Objective: To perform a pharmacoeconomic analysis to determine the cost-effectiveness from a government payer perspective of calcipotriol compared with medium- to high-potency steroids in the management of plaque-type psoriasis of limited severity. Methods: A stepwise analysis was performed. Relevant clinical algorithms were developed after a thorough literature review and input from a clinical panel. A meta-analysis of 31 clinical trials was performed to determine efficacy rates. Costs and resource estimates were obtained from formularies, physician responses, and the literature. Utility values (ratings of health states) were obtained through interviews with 30 patients. Three different decision analytic models reflecting different clinical scenarios in psoriasis management were developed. Total expected costs of therapy including drugs, physician visits, and treatment of failures, and the total Quality Adjusted Life Years (QALYs) for each strategy were calculated. Extensive sensitivity analyses were carried out to explore uncertainty in the parameter estimates entered into the models. Results: In the comparison of drug acquisition cost and efficacy, the incremental cost per cure was $414 using a 6-week course of calcipotriol compared with betamethasone valerate. The cost-utility analyses demonstrated that when calcipotriol was used as a second-line therapy to betamethasone valerate, it was as cost-effective as, if not more cost-effective than, clobetasol propionate used for 4 to 6 weeks. Also, when calcipotriol was used as a primary therapy in patients who had failed prior therapies, it was an attractive alternate compared to betamethasone dipropionate and fluocinonide. Conclusion: Calcipotriol is a relatively new addition to the topical therapies available to treat psoriasis. In general, tolerability and efficacy are similar to those of topical corticosteroids. In the treatment of psoriatic patients with limited plaque disease, calcipotriol, as a second-line treatment to betamethasone valerate, is a cost-effective alternative to medium- to high-potency corticosteroids.
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Affiliation(s)
- Paul I. Oh
- Divisions of Clinical Pharmacology, Sunnybrook Health Science Centre, The University of Toronto, Toronto, Ontario
| | - Aditya K. Gupta
- Divisions of Clinical Pharmacology, Sunnybrook Health Science Centre, The University of Toronto, Toronto, Ontario
- Dermatology, Department of Medicine, Sunnybrook Health Science Centre, The University of Toronto, Toronto, Ontario
| | - Thomas R. Einarson
- Faculty of Pharmacy and Department of Health Administration, The University of Toronto, Toronto, Ontario
| | - Phillip Maerov
- Divisions of Clinical Pharmacology, Sunnybrook Health Science Centre, The University of Toronto, Toronto, Ontario
| | - Neil H. Shear
- Divisions of Clinical Pharmacology, Sunnybrook Health Science Centre, The University of Toronto, Toronto, Ontario
- Dermatology, Department of Medicine, Sunnybrook Health Science Centre, The University of Toronto, Toronto, Ontario
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Yang P, Zheng M, Zhang L, Du L, Zhou Q, Cai T, Qi J, Liang L, Kijlstra A. Uveitis in Chinese Patients with Psoriasis. Ocul Immunol Inflamm 2016; 25:855-865. [PMID: 27419842 DOI: 10.1080/09273948.2016.1185528] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
PURPOSE To investigate the clinical features of 51 uveitis patients with psoriasis in China. METHODS The psoriasis type, demographics, ocular findings, auxiliary examination findings, complications, and therapeutic effects were analyzed. RESULTS A total of 37 male and 14 female uveitis patients with psoriasis were classified into four groups: psoriasis vulgaris (29 cases); psoriatic arthritis (15 cases); psoriatic erythroderma (6 cases); and pustular psoriasis (1 case). The onset age of psoriasis was younger than for uveitis (p < 0.001). Anterior uveitis, panuveitis, and posterior uveitis was observed in 58.8%, 35.3%, and 5.9% of the patients, respectively. Hypopyon was more frequently noted in the group with psoriatic arthritis (p = 0.007). Optic disc staining was more frequently noted in the group with psoriatic erythroderma (p = 0.029). Significant visual improvement was observed in 17 patients. CONCLUSIONS Uveitis can be associated with various types of psoriasis in China, but was most frequently observed in patients with psoriasis vulgaris and psoriatic arthritis.
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Affiliation(s)
- Peizeng Yang
- a The First Affiliated Hospital of Chongqing Medical University, Chongqing Key Laboratory of Ophthalmology, and Chongqing Eye Institute , Chongqing , P.R. China
| | - Minming Zheng
- a The First Affiliated Hospital of Chongqing Medical University, Chongqing Key Laboratory of Ophthalmology, and Chongqing Eye Institute , Chongqing , P.R. China
| | - Lijun Zhang
- a The First Affiliated Hospital of Chongqing Medical University, Chongqing Key Laboratory of Ophthalmology, and Chongqing Eye Institute , Chongqing , P.R. China
| | - Liping Du
- a The First Affiliated Hospital of Chongqing Medical University, Chongqing Key Laboratory of Ophthalmology, and Chongqing Eye Institute , Chongqing , P.R. China
| | - Qingyun Zhou
- a The First Affiliated Hospital of Chongqing Medical University, Chongqing Key Laboratory of Ophthalmology, and Chongqing Eye Institute , Chongqing , P.R. China
| | - Tao Cai
- b Department of Dermatology , The First Affiliated Hospital of Chongqing Medical University , Chongqing , P.R. China
| | - Jian Qi
- a The First Affiliated Hospital of Chongqing Medical University, Chongqing Key Laboratory of Ophthalmology, and Chongqing Eye Institute , Chongqing , P.R. China
| | - Liang Liang
- a The First Affiliated Hospital of Chongqing Medical University, Chongqing Key Laboratory of Ophthalmology, and Chongqing Eye Institute , Chongqing , P.R. China
| | - Aize Kijlstra
- c University Eye Clinic Maastricht , Maastricht , The Netherlands
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Kimball A, Naegeli A, Edson‐Heredia E, Lin C, Gaich C, Nikaï E, Wyrwich K, Yosipovitch G. Psychometric properties of the Itch Numeric Rating Scale in patients with moderate‐to‐severe plaque psoriasis. Br J Dermatol 2016; 175:157-62. [DOI: 10.1111/bjd.14464] [Citation(s) in RCA: 56] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/02/2016] [Indexed: 12/19/2022]
Affiliation(s)
- A.B. Kimball
- Massachusetts General Hospital and Harvard Medical School Boston MA U.S.A
| | | | | | - C.‐Y. Lin
- Eli Lilly and Company Indianapolis IN U.S.A
| | - C. Gaich
- Eli Lilly and Company Indianapolis IN U.S.A
| | - E. Nikaï
- Eli Lilly and Company Indianapolis IN U.S.A
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Matterne U, Apfelbacher C. Peer-relationship-problems account for quality of life impairments in pediatric psoriasis. J Psychosom Res 2016; 84:31-36. [PMID: 27095156 DOI: 10.1016/j.jpsychores.2016.03.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2015] [Revised: 03/03/2016] [Accepted: 03/14/2016] [Indexed: 10/22/2022]
Abstract
OBJECTIVE Most research on HRQoL-impairments in psoriasis has been conducted in adult patients, small pediatric patient samples or samples not representative of the pediatric population at large. We thus aimed to comprehensively describe HRQoL in pediatric psoriasis compared to psoriasis-free children and adolescents, identify domains most commonly affected and analyze its impact on HRQoL while controlling for important other predictors of HRQoL in a representative pediatric sample. METHODS The impact of lifetime-prevalence of psoriasis on total and subscale HRQoL was analyzed by complex sample general linear models alone and adjusted for sociodemographic and clinical variables in a population-based sample (n=6518) of children and adolescents aged 11-17. RESULTS Total HRQoL and the physical domain were significantly affected by lifetime-psoriasis in univariate analysis. In multivariate analyses, lifetime-psoriasis significantly impacted on total HRQoL and the subscale 'quality of relationships with friends/peers'. Although substantial amounts of variance in HRQoL were explained by mental health, independent effects of lifetime-psoriasis remained after adjustment for this covariate. Total explained variance in total HRQoL was 20%. CONCLUSION Our findings suggest psoriasis to be a significant burden as it affects HRQoL even when controlling for mental health. Most of this effect appears to be driven by perceived impairments in the quality of relationship with friends/peers. How this exactly occurs needs to be explored in future research. Meanwhile clinicians need to be more attentive to this effect of psoriasis.
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Affiliation(s)
- Uwe Matterne
- Department of Clinical Social Medicine, Occupational and Environmental Dermatology and Health Services Research, University Hospital Heidelberg, University of Heidelberg, Germany; Medical Sociology, Institute of Epidemiology and Preventive Medicine, University of Regensburg, Germany
| | - Christian Apfelbacher
- Medical Sociology, Institute of Epidemiology and Preventive Medicine, University of Regensburg, Germany.
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Antiga E, Bonciolini V, Volpi W, Del Bianco E, Caproni M. Oral Curcumin (Meriva) Is Effective as an Adjuvant Treatment and Is Able to Reduce IL-22 Serum Levels in Patients with Psoriasis Vulgaris. BIOMED RESEARCH INTERNATIONAL 2015; 2015:283634. [PMID: 26090395 PMCID: PMC4450233 DOI: 10.1155/2015/283634] [Citation(s) in RCA: 67] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/16/2015] [Accepted: 05/05/2015] [Indexed: 12/11/2022]
Abstract
Curcumin is a complementary therapy that may be helpful for the treatment of psoriasis due to its anti-inflammatory, antiangiogenic, antioxidant, and antiproliferative effects. In the present study we performed a randomized, double-blind, placebo-controlled clinical trial to assess the effectiveness of a bioavailable oral curcumin in the treatment of psoriasis. Sixty-three patients with mild-to-moderate psoriasis vulgaris (PASI < 10) were randomly divided into two groups treated with topical steroids and Meriva, a commercially available lecithin based delivery system of curcumin, at 2 g per day (arm 1), or with topical steroids alone (arm 2), both for 12 weeks. At the beginning (T0) and at the end of the therapy (T12), clinical assessment and immunoenzymatic analysis of the serum levels of IL-17 and IL-22 were performed. At T12, both groups achieved a significant reduction of PASI values that, however, was higher in patients treated with both topical steroids and oral curcumin than in patients treated only with topical steroids. Moreover, IL-22 serum levels were significantly reduced in patients treated with oral curcumin. In conclusion, curcumin was demonstrated to be effective as an adjuvant therapy for the treatment of psoriasis vulgaris and to significantly reduce serum levels of IL-22.
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Affiliation(s)
- Emiliano Antiga
- Section of Dermatology, Department of Surgery and Translational Medicine, University of Florence, Viale Michelangiolo 41, 50125 Florence, Italy
| | - Veronica Bonciolini
- Section of Dermatology, Department of Surgery and Translational Medicine, University of Florence, Viale Michelangiolo 41, 50125 Florence, Italy
| | - Walter Volpi
- Section of Dermatology, Department of Surgery and Translational Medicine, University of Florence, Viale Michelangiolo 41, 50125 Florence, Italy
| | - Elena Del Bianco
- Section of Dermatology, Department of Surgery and Translational Medicine, University of Florence, Viale Michelangiolo 41, 50125 Florence, Italy
| | - Marzia Caproni
- Section of Dermatology, Department of Surgery and Translational Medicine, University of Florence, Viale Michelangiolo 41, 50125 Florence, Italy
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Clinical features of psoriatic uveitis in Japanese patients. Graefes Arch Clin Exp Ophthalmol 2015; 253:1175-80. [PMID: 25725620 DOI: 10.1007/s00417-015-2968-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2014] [Revised: 02/04/2015] [Accepted: 02/09/2015] [Indexed: 02/08/2023] Open
Abstract
PURPOSE To investigate the clinical features of psoriatic uveitis in Japanese patients. METHODS Clinical features of 13 consecutive patients with psoriatic uveitis treated at our facility were retrospectively examined using medical records. In this study, we collected data about psoriasis type, uveitis laterality, onset type, HLA types, visual acuity, ocular inflammation localization, anterior segment findings, funduscopy findings, complications, recurrence, and medical treatments for uveitis and skin diseases. RESULTS The cohort comprised ten males and three females (43.6 ± 7.1 years old), and types of psoriasis included psoriasis vulgaris (seven cases), psoriatic arthritis (four cases), pustular psoriasis (three cases) and psoriatic erythroderma (one case). Two cases represented complicated cases of pustular psoriasis and psoriatic arthritis. Seven cases were unilateral, and six cases were bilateral. All cases had acute non-granulomatous anterior uveitis, whereas panuveitis occurred in one case. Furthermore, macular edema and vascular leakage on fluorescein angiography occurred in four cases, and hyperemic disc occurred in two cases. Recurrence occurred in nine cases. In addition to topical corticosteroid treatment, eight cases underwent oral immunosuppressive treatment or biologics. All six cases undergoing HLA typing were HLA-A2 positive. CONCLUSIONS Cases of psoriatic uveitis in Japan appear to present with acute non-granulomatous uveitis; other symptoms may include macular edema, retinal vasculitis, or hyperemic disc.
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Hamilton M, Ntais D, Griffiths C, Davies L. Psoriasis treatment and management - a systematic review of full economic evaluations. Br J Dermatol 2015; 172:574-83. [DOI: 10.1111/bjd.13486] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/07/2014] [Indexed: 01/11/2023]
Affiliation(s)
- M.P. Hamilton
- Centre for Health Economics; University of Manchester; Jean McFarlane Building Oxford Road Manchester M13 9PL U.K
| | - D. Ntais
- Centre for Health Economics; University of Manchester; Jean McFarlane Building Oxford Road Manchester M13 9PL U.K
| | - C.E.M. Griffiths
- Centre for Dermatology Research; University of Manchester; Manchester Academic Health Science Centre; Manchester U.K
- Salford Royal NHS Foundation Trust; University of Manchester; Manchester Academic Health Science Centre; Manchester U.K
| | - L.M. Davies
- Centre for Health Economics; University of Manchester; Jean McFarlane Building Oxford Road Manchester M13 9PL U.K
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Sator P, Richter L, Saxinger W, Vasiljevic M, Stingl G. Adalimumab in the treatment of moderate-to-severe chronic plaque psoriasis in patients switching from other biologics. J Eur Acad Dermatol Venereol 2015; 29:1742-9. [PMID: 25665143 DOI: 10.1111/jdv.12981] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2014] [Accepted: 12/21/2014] [Indexed: 12/31/2022]
Abstract
BACKGROUND Ample evidence shows that switching from one biological agent to another may prove effective when response to the first one is inadequate. Nevertheless, there are little data so far showing the efficacy and safety of adalimumab in patients with plaque psoriasis who previously received another biologic agent. OBJECTIVE We evaluated the 1-year effectiveness, safety and quality-of-life outcomes patients with psoriasis who had switched to adalimumab from other biologic therapies. METHODS Forty-two patients who participated in this Austrian multicenter study were treated with adalimumab over a 1-year period, after switching from efalizumab, infliximab or etanercept. Effectiveness was assessed using standardized tools for measurement of disease severity [Psoriasis Area and Severity Index (PASI) and Nail Psoriasis Severity Index (NAPSI)] and quality of life [Dermatology Life Quality Index (DLQI)]. The study endpoints were evaluated using the all-treated population. RESULTS The mean percentage of improvement at the end of the study was 74.3% for PASI, 81.6% for DLQI and 83.6% for NAPSI, demonstrating a considerable benefit of treatment with adalimumab. The safety profile observed was consistent with previous clinical trials for adalimumab, and no new safety signals were observed. CONCLUSION Adalimumab therapy in patients with plaque psoriasis previously treated with other biologic agents demonstrates effectiveness, safety and improvement in quality of life.
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Affiliation(s)
- P Sator
- Department of Dermatology, Hospital Hietzing with Neurologic Centre Rosenhügel, Vienna, Austria
| | - L Richter
- Hospital Rudolfstiftung including site Semmelweis Clinic of Gynaecology, Vienna, Austria
| | - W Saxinger
- Department of Dermatology, Hospital Wels-Grieskirchen, Wels-Grieskirchen, Austria
| | | | - G Stingl
- Division of Immunology Allergy and Infectious Diseases (DIAID), Department of Dermatology, Medical University of Vienna, Vienna, Austria
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Eichenfield LF, Ganslandt C, Kurvits M, Schlessinger J. Safety and efficacy of calcipotriene plus betamethasone dipropionate topical suspension in the treatment of extensive scalp psoriasis in adolescents ages 12 to 17 years. Pediatr Dermatol 2015; 32:28-35. [PMID: 25412565 PMCID: PMC4491349 DOI: 10.1111/pde.12429] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
Abstract
The objective of this study was to assess the safety and efficacy of the fixed combination calcipotriene 0.005% plus betamethasone dipropionate 0.064% topical suspension in adolescents with extensive scalp psoriasis. In this phase II, open-label, 8-week study, adolescents with psoriasis (ages 12-17 years) with 20% or more of the scalp area affected (at least moderate severity according to Investigator's Global Assessment [IGA]) were assigned to once-daily treatment with calcipotriene plus betamethasone dipropionate topical suspension. The primary endpoint was safety, focusing on calcium metabolism and hypothalamic-pituitary-adrenal axis function. Secondary efficacy endpoints were the proportion of patient's achieving treatment success (clear or almost clear disease according to the IGA and clear or very mild disease according to the Patient's Global Assessment [PaGA]) and percentage change in investigator-assessed Total Sign Score (TSS). Pruritus was also assessed. Overall, 31 patients received treatment. Sixteen patients (52%) experienced a total of 20 adverse events; 19 were considered unrelated to study treatment, 14 were mild, and none were serious or lesional or perilesional on the scalp. One patient showed signs of mild adrenal suppression at week 4; the patient discontinued treatment and had normal test results at follow-up 4 weeks later. No cases of hypercalcemia were reported. By treatment end, treatment success was reported for 17 patients (55%) according to the IGA and 18 (58%) according to the PGA. Mean TSS improved from 6.9 at baseline to 2.9 at treatment end (59% improvement). By week 8, 28 patients (90%) experienced mild or no itching, versus 20 (65%) at baseline. Once-daily calcipotriene plus betamethasone dipropionate topical suspension was well tolerated and efficacious for the treatment of scalp psoriasis in adolescents.
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