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Merzel Šabović EK, Kraner Šumenjak T, Janić M. Residual metabolic burden in young psoriasis patients successfully treated with biologics. Arch Dermatol Res 2024; 316:647. [PMID: 39331218 PMCID: PMC11436468 DOI: 10.1007/s00403-024-03403-4] [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: 07/25/2024] [Revised: 07/25/2024] [Accepted: 09/14/2024] [Indexed: 09/28/2024]
Abstract
Metabolic disorders are common in patients with psoriasis and contribute significantly to an increased cardiovascular risk. While biologic therapy is very successful in clearing skin lesions, its impact on metabolic parameters is uncertain. Our aim was to investigate the residual metabolic burden in psoriasis patients successfully treated with biologic therapy. We conducted a cross-sectional study of 80 young patients (54 men, 26 women, aged 30-45 years) successfully treated with either adalimumab, secukinumab or guselkumab and topical therapy or methotrexate, and 20 healthy controls. Anthropometric parameters, lipid levels and metabolic indices (HOMA-IR, TyG index and FIB-4 index) were measured. Patients did not receive any other treatments to exclude confounding effects. After analysis, we found that patients treated with three different biologics had similar metabolic status, only the FIB-4 index was higher in the adalimumab group than in the secukinumab and guselkumab treatment groups. There were no significant differences between the patients treated with biologics and the control group. The comparison with patients treated topically or with methotrexate showed that only triglyceride levels, HOMA-IR, TyG index, and FIB-4 index were elevated in patients treated with adalimumab compared to patients treated with topical therapy. Finally, metabolic status was also similar in patients treated with methotrexate or topical therapy. In conclusion, this study suggests that psoriasis patients successfully treated with biologics have similar metabolic parameters to the control group and patients treated with topical therapy or methotrexate. This indicates that there is no significant residual metabolic burden in young patients successfully treated with biologics. These results are clinically relevant and should be considered in the treatment of psoriasis patients.The study is registered at http://clinicaltrials.gov (identifier: NCT05957120). Date of registration: 24th of July 2023.
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Affiliation(s)
- Eva Klara Merzel Šabović
- Department of Dermatovenerology, University Medical Centre Ljubljana, Gradiškova ulica 10, Ljubljana, Slovenia.
- Faculty of Medicine, University of Ljubljana, Vrazov trg 2, Ljubljana, Slovenia.
| | - Tadeja Kraner Šumenjak
- Faculty of Agriculture and Life Sciences, University of Maribor, Pivola 10, Hoče, Slovenia
| | - Miodrag Janić
- Faculty of Medicine, University of Ljubljana, Vrazov trg 2, Ljubljana, Slovenia
- Clinical Department of Endocrinology, Diabetes and Metabolic Diseases, University Medical Centre Ljubljana, Zaloška 7, Ljubljana, Slovenia
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Akdogan N, Balan K, Armagan BY, Gulseren D, Dogan S. Psoriatic arthritis, biologic therapy experience, body mass index, and onset age of psoriasis were independent factors of secukinumab discontinuation in patients with psoriasis. Expert Rev Clin Pharmacol 2024; 17:755-762. [PMID: 38994659 DOI: 10.1080/17512433.2024.2378762] [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: 02/14/2024] [Accepted: 07/08/2024] [Indexed: 07/13/2024]
Abstract
INTRODUCTION Despite the availability of several treatments for psoriasis (PsO), factors influencing the persistence of secukinumab (SEC) therapy remain inadequately understood. This study aimed to identify predictors of SEC persistence in PsO. METHODS A retrospective analysis was conducted on 109 PsO patients who received SEC treatment at least 1 year. Patients were categorized based on continued or discontinued SEC therapy. RESULTS Among the 109 patients, 64 continued SEC treatment while 45 discontinued. Univariate analysis demonstrated that PsA presence and previous biologic therapy use increased the risk of SEC discontinuation 3.56- and 2.33-fold (p = 0.001, %95 CI: 1.66-7.65 and p = 0.032, %95 CI: 1.08-5.04, respectively). Additionally, the risk of SEC discontinuation is 57% higher in patients with a body mass index (BMI) above 26.5 compared to those with a BMI below 26.5 (p = 0.016, %95 CI: 0.22-0.85). Additionally, patients with PsO onset age below 26.5 years were found to have a 2.93-times higher risk of discontinuing SEC compared to those with PsO onset age above 26.5 years (p = 0.004, %95 CI: 1.40-6.13). CONCLUSION PsA presence, previous biologic therapy experience, BMI, and PsO onset age were identified as independent predictors of SEC discontinuation. These findings underscore the importance of personalized treatment strategies for PsO patients receiving SEC therapy.
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Affiliation(s)
- Neslihan Akdogan
- School of Medicine, Department of Dermatology and Venereology, Hacettepe University, Ankara, Turkey
| | - Kerem Balan
- School of Medicine, Department of Dermatology and Venereology, Hacettepe University, Ankara, Turkey
| | - Basak Yalici Armagan
- School of Medicine, Department of Dermatology and Venereology, Hacettepe University, Ankara, Turkey
| | - Duygu Gulseren
- School of Medicine, Department of Dermatology and Venereology, Hacettepe University, Ankara, Turkey
| | - Sibel Dogan
- School of Medicine, Department of Dermatology and Venereology, Hacettepe University, Ankara, Turkey
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Secchiero P, Rimondi E, Marcuzzi A, Longo G, Papi C, Manfredini M, Fields M, Caruso L, Di Caprio R, Balato A. Metabolic Syndrome and Psoriasis: Pivotal Roles of Chronic Inflammation and Gut Microbiota. Int J Mol Sci 2024; 25:8098. [PMID: 39125666 PMCID: PMC11311610 DOI: 10.3390/ijms25158098] [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: 05/20/2024] [Revised: 07/19/2024] [Accepted: 07/22/2024] [Indexed: 08/12/2024] Open
Abstract
In recent years, the incidence of metabolic syndrome (MS) has increased due to lifestyle-related factors in developed countries. MS represents a group of conditions that increase the risk of diabetes, cardiovascular diseases, and other severe health problems. Low-grade chronic inflammation is now considered one of the key aspects of MS and could be defined as a new cardiovascular risk factor. Indeed, an increase in visceral adipose tissue, typical of obesity, contributes to the development of an inflammatory state, which, in turn, induces the production of several proinflammatory cytokines responsible for insulin resistance. Psoriasis is a chronic relapsing inflammatory skin disease and is characterized by the increased release of pro-inflammatory cytokines, which can contribute to different pathological conditions within the spectrum of MS. A link between metabolic disorders and Psoriasis has emerged from evidence indicating that weight loss obtained through healthy diets and exercise was able to improve the clinical course and therapeutic response of Psoriasis in patients with obesity or overweight patients and even prevent its occurrence. A key factor in this balance is the gut microbiota; it is an extremely dynamic system, and this makes its manipulation through diet possible via probiotic, prebiotic, and symbiotic compounds. Given this, the gut microbiota represents an additional therapeutic target that can improve metabolism in different clinical conditions.
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Affiliation(s)
- Paola Secchiero
- Department of Translational Medicine and LTTA Centre, University of Ferrara, 44121 Ferrara, Italy; (P.S.); (E.R.)
| | - Erika Rimondi
- Department of Translational Medicine and LTTA Centre, University of Ferrara, 44121 Ferrara, Italy; (P.S.); (E.R.)
| | - Annalisa Marcuzzi
- Department of Translational Medicine, University of Ferrara, 44121 Ferrara, Italy; (G.L.); (C.P.); (M.M.); (M.F.)
| | - Giovanna Longo
- Department of Translational Medicine, University of Ferrara, 44121 Ferrara, Italy; (G.L.); (C.P.); (M.M.); (M.F.)
| | - Chiara Papi
- Department of Translational Medicine, University of Ferrara, 44121 Ferrara, Italy; (G.L.); (C.P.); (M.M.); (M.F.)
| | - Marta Manfredini
- Department of Translational Medicine, University of Ferrara, 44121 Ferrara, Italy; (G.L.); (C.P.); (M.M.); (M.F.)
| | - Matteo Fields
- Department of Translational Medicine, University of Ferrara, 44121 Ferrara, Italy; (G.L.); (C.P.); (M.M.); (M.F.)
| | - Lorenzo Caruso
- Department of Environmental and Prevention Sciences, University of Ferrara, 44121 Ferrara, Italy;
| | - Roberta Di Caprio
- Dermatology Unit, Department of Mental and Physical Health and Preventive Medicine, University of Campania Luigi Vanvitelli, 80131 Naples, Italy; (R.D.C.); (A.B.)
| | - Anna Balato
- Dermatology Unit, Department of Mental and Physical Health and Preventive Medicine, University of Campania Luigi Vanvitelli, 80131 Naples, Italy; (R.D.C.); (A.B.)
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Acer E, Erdoğan HK, Ağaoğlu E, Baştürk H, Bilgin M, Saraçoğlu ZN. Efficacy and safety of secukinumab in psoriasis: five-year real life experience. An Bras Dermatol 2024:S0365-0596(24)00140-5. [PMID: 39030105 DOI: 10.1016/j.abd.2023.12.004] [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: 11/02/2023] [Revised: 12/17/2023] [Accepted: 12/20/2023] [Indexed: 07/21/2024] Open
Abstract
BACKGROUND The efficacy and safety of secukinumab in psoriasis patients has been demonstrated in randomized controlled clinical trials. OBJECTIVES The authors aimed to evaluate the efficacy and safety of secukinumab in plaque psoriasis patients followed in our clinic. METHODS Data from 101 plaque psoriasis patients who received at least 16 weeks of secukinumab treatment between June 2018 and June 2023 were retrospectively analyzed. RESULTS Fifty-three (53%) of the patients were bionaive. PASI-75, -90, -100 response rates were 72%, 50%, 30% respectively at week 16 in all patients. PASI-75 and -90 responses were higher in naive patients at weeks 16 and 28 (p < 0.001, p < 0.001, p < 0.01, p = 0.01, respectively). The percentage of patients with PASI ≤ 1, ≤ 3, ≤ 5 were 50%, 77%, and 92%, respectively at week 16. They were higher in the naive group than in nonnaive group at weeks 16 and 28 (p = 0.02, p < 0.01, p = 0.05, p = 0.07, p < 0.01, p = 0.03, respectively). At week 52, PASI-75, -90, -100 responses were significantly lower in smoking patients (p = 0.04, p = 0.03, p < 0.01, respectively). The mean duration of secukinumab treatment was 19.80 ± 12.76 months. Secukinumab was discontinued 14 (26.4%) naive patients and 28 (58.3%) nonnaive patients at one occasion during treatment (p < 0.001). The most common adverse event in patients was mucocutaneous candida infection (8%). No hepatitis B or C reactivation and no active or reactivation tuberculosis were observed in any of the patients during the follow-up period. LIMITATIONS OF THE STUDY This is a single-center retrospective study with relatively few patients including only the Turkish population. CONCLUSION Secukinumab seems to be effective in plaque psoriasis, particularly in bionaive and non-smokers. Moreover, it is safe in patients with inactive hepatitis or tuberculosis.
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Affiliation(s)
- Ersoy Acer
- Dermatology and Venereology Department, Eskisehir Osmangazi University, Eskisehir, Turkey.
| | - Hilal Kaya Erdoğan
- Dermatology and Venereology Department, Eskisehir Osmangazi University, Eskisehir, Turkey
| | - Esra Ağaoğlu
- Dermatology and Venereology Department, Eskisehir Osmangazi University, Eskisehir, Turkey
| | - Hatice Baştürk
- Dermatology and Venereology Department, Eskisehir Osmangazi University, Eskisehir, Turkey
| | - Muzaffer Bilgin
- Biostatistics Department, Eskisehir Osmangazi University, Eskisehir, Turkey
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Taliercio M, Lebwohl M. Psoriasis Comorbidities and Their Treatment Impact. Dermatol Clin 2024; 42:405-416. [PMID: 38796272 DOI: 10.1016/j.det.2024.02.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2024]
Abstract
Psoriasis, a systemic inflammatory disease classically presenting with cutaneous lesions, has significant involvement in other organ systems. This article explores the prevalence, clinical manifestations, screening mechanisms, and laboratory testing by which to evaluate these comorbidities. Treatment approach for these comorbidities must combine patient preference with established treatment algorithms while recognizing innovative therapeutics currently under development.
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Affiliation(s)
- Mark Taliercio
- Department of Dermatology Clinical Trials, Icahn School of Medicine at Mount Sinai, 5 East 98th Street, 5th Floor, New York, NY 10029, USA.
| | - Mark Lebwohl
- Department of Clinical Therapeutics, Icahn School of Medicine at Mount Sinai, 5, East 98th Street, 5th Floor, New York, NY 10029, USA
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Mateu-Arrom L, Puig L. Choosing the right biologic treatment for moderate-to-severe plaque psoriasis: the impact of comorbidities. Expert Rev Clin Pharmacol 2024; 17:363-379. [PMID: 38603464 DOI: 10.1080/17512433.2024.2340552] [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: 11/29/2023] [Accepted: 03/01/2024] [Indexed: 04/13/2024]
Abstract
INTRODUCTION Psoriasis is a chronic inflammatory skin disease often associated with several comorbidities, such as psoriatic arthritis, inflammatory bowel disease, obesity, diabetes mellitus or cardiovascular diseases, infections, or cancer, among others. With the progressive aging of the population, a growing number of patients with psoriasis can be expected to present multiple comorbidities. Currently, there is a wide range of biological treatments available for moderate to severe psoriasis, including tumor necrosis alpha (TNF) inhibitors, IL12/23 inhibitor, IL17 inhibitors, and IL23 inhibitors. AREAS COVERED This review aims to describe the specific characteristics of these drugs in relation to psoriasis comorbidities, in order to facilitate decision-making in clinical practice. EXPERT OPINION Some of the biological treatments can influence comorbidities, in some cases even improving them. Therefore, comorbidities are a key factor when deciding on one biological treatment over another. The development of new drugs is expanding the therapeutic arsenal for psoriasis. A high level of expertise in the field with a detailed knowledge of the characteristics of every drug is imperative to provide personalized medicine.
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Affiliation(s)
- Laura Mateu-Arrom
- Department of Dermatology, Hospital de la Santa Creu i Sant Pau, Institut d'Investigació Biomèdica Sant Pau (IIB SANT PAU), Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Lluis Puig
- Department of Dermatology, Hospital de la Santa Creu i Sant Pau, Institut d'Investigació Biomèdica Sant Pau (IIB SANT PAU), Universitat Autònoma de Barcelona, Barcelona, Spain
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Hong EJ, Yoon HJ, Kwon MJ, Kim JY, Kim JE, Park YL, Lee S, Bae Y, Lee SH. Factors Associated With Achieving Complete Skin Clearance Compared to Almost Complete Skin Clearance in Patients With Moderate to Severe Psoriasis Treated With Biologics: A Retrospective Chart Review. Ann Dermatol 2024; 36:91-98. [PMID: 38576247 PMCID: PMC10995612 DOI: 10.5021/ad.23.074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2023] [Revised: 11/24/2023] [Accepted: 12/13/2023] [Indexed: 04/06/2024] Open
Abstract
BACKGROUND Biologics have demonstrated high efficacy in achieving 'almost complete' skin clearance in patients with moderate to severe psoriasis. Nonetheless, achieving 'complete' skin clearance remains a treatment goal for some highly biologics-resistant patients, as residual lesions impact their quality of life. OBJECTIVE The risk factors for failure to achieve a Psoriasis Area and Severity Index (PASI) 100 response in patients with good response to biologics remain unknown. METHODS This retrospective study evaluated the risk factors by comparing patients who achieved complete skin clearance (PASI100) with those who achieved almost complete skin clearance (PASI90). A database of 131 psoriasis patients treated with biologics, who achieved a PASI90 or PASI100 response, was reviewed from a tertiary referral hospital in South Korea. The patients were classified into PASI90 and PASI100 groups according to their PASI response. RESULTS The PASI100 group had a lower prevalence of smoking history (adjusted odds ratio [OR], 0.34; 95% confidence interval [CI], 0.14-0.85; p=0.021) and psoriasis on the anterior lower legs at baseline (adjusted OR, 0.18; 95% CI, 0.03-0.99; p=0.049) than patients in the PASI90 group. CONCLUSION This study suggested that smoking history and psoriatic skin lesions on the anterior lower legs are considered as the risk factors for the failure to achieve a PASI100 response in psoriasis patients treated with biologics.
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Affiliation(s)
- Eun Ji Hong
- Department of Dermatology, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, Korea
| | - Hee Jung Yoon
- Department of Dermatology, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, Korea
| | - Min Jung Kwon
- Department of Dermatology, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, Korea
| | - Jae Yun Kim
- Department of Dermatology, Soonchunhyang University Cheonan Hospital, Soonchunhyang University College of Medicine, Cheonan, Korea
| | - Jung Eun Kim
- Department of Dermatology, Soonchunhyang University Cheonan Hospital, Soonchunhyang University College of Medicine, Cheonan, Korea
| | - Young Lip Park
- Department of Dermatology, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, Korea
| | - SangHoon Lee
- Department of Dermatology, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, Korea
| | - Youin Bae
- Department of Dermatology, Soonchunhyang University Seoul Hospital, Soonchunhyang University College of Medicine, Seoul, Korea.
| | - Sul Hee Lee
- Department of Dermatology, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, Korea.
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Schwarz CW, Skov L, Egeberg A, Passey A, Lee J, Gorecki P, Loft N. Characteristics of Patients With Psoriasis Treated With Various Biologics - A Danish Cohort Study. JOURNAL OF PSORIASIS AND PSORIATIC ARTHRITIS 2024; 9:51-60. [PMID: 39301091 PMCID: PMC11361497 DOI: 10.1177/24755303241234292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/22/2024]
Abstract
Background Psoriasis is associated with several comorbidities and patients with psoriasis are more often obese than individuals without psoriasis. The excess disease burden is important to consider in choice of and response to treatment at the individual level. Objective To investigate whether patient characteristics differ across biologics for patients initiating biologic therapy and for patients still on biologic therapy after 1 year. Also, to quantify and compare the use of topical therapy among patients still on biologic therapy after 1 year. Methods This nationwide cohort study compared characteristics of patients prescribed adalimumab, etanercept, infliximab, secukinumab or ustekinumab for treatment of psoriasis by using data from the Danish registries. Results In the ustekinumab group, patients were younger and fewer had psoriatic arthritis. Patients treated with secukinumab and ustekinumab were less frequently co-treated with conventional systemics and topical therapy. All other patient characteristics such as sex, smoking and comorbidities other than psoriatic arthritis were similar across the biologic cohorts. Conclusion These results highlight the need to better understand which factors to consider when prescribing biologics to patients with psoriasis.
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Affiliation(s)
- Christopher Willy Schwarz
- Department of Dermatology and Allergy, Copenhagen University Hospital - Herlev and Gentofte, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- Copenhagen Research Group for Inflammatory Skin, Copenhagen University Hospital - Herlev and Gentofte, Copenhagen, Denmark
| | - Lone Skov
- Department of Dermatology and Allergy, Copenhagen University Hospital - Herlev and Gentofte, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- Copenhagen Research Group for Inflammatory Skin, Copenhagen University Hospital - Herlev and Gentofte, Copenhagen, Denmark
| | - Alexander Egeberg
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- Department of Dermatology, Copenhagen University Hospital - Bispebjerg, Copenhagen, Denmark
| | | | | | | | - Nikolai Loft
- Department of Dermatology and Allergy, Copenhagen University Hospital - Herlev and Gentofte, Copenhagen, Denmark
- Copenhagen Research Group for Inflammatory Skin, Copenhagen University Hospital - Herlev and Gentofte, Copenhagen, Denmark
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Thangaraj SS, Gunlund TSG, Stubbe J, Palarasah Y, Svenningsen P, Nielsen LH, Ovesen PG, Jensen BL. Effect of short-term changes in salt intake on plasma cytokines in women with healthy and hypertensive pregnancies. Pregnancy Hypertens 2024; 35:82-87. [PMID: 38301351 DOI: 10.1016/j.preghy.2024.01.135] [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: 08/29/2023] [Revised: 12/05/2023] [Accepted: 01/16/2024] [Indexed: 02/03/2024]
Abstract
BACKGROUND Salt (NaCl) promotes T-lymphocyte conversion to pro-inflammatory Th-17 cells in vitro. Interleukin (IL)-17A aggravates hypertension in preeclampsia (PE) models. OBJECTIVES It was hypothesized that 1) women with PE exhibit increased plasma IL-17A and related cytokines and 2) high dietary salt intake elevates circulating IL-17A in patients with PE compared to women with healthy pregnancy (HP) and non-pregnant (NonP) women. MAIN OUTCOME MEASURES Plasma concentration of cytokines IL-17A, IFN-γ, IL-10, TNF, IL-6, and IL-1β in samples from NonP women (n = 13), HP (n = 15), and women with PE (n = 7). STUDY DESIGN Biobanked samples from a randomized, double-blind, cross-over placebo-controlled dietary intervention study. Participants received a low sodium diet (50-60 mmol NaCl/24 h) for 10 days and were randomly assigned to ingest placebo tablets (low salt intake) or salt tablets (172 mmol NaCl/24 h, high salt intake) for 5 + 5 days. Plasma samples were drawn at baseline and after each diet. RESULTS While a high salt diet suppressed renin, angiotensin II, and aldosterone levels, it did not affect blood pressure or plasma cytokine concentrations in any group compared to low salt intake. Plasma TNF was significantly higher in PE than in HP and NonP at baseline and after a low salt diet. Plasma IL-6 was significantly higher in PE compared to HP at baseline and NonP at low salt. CONCLUSION Interleukin-17A and related T-cell and macrophage-cytokines are not sensitive to salt-intake in PE. Preeclampsia is associated with elevated levels of TNF and IL-6 macrophage-derived cytokines. Salt-sensitive changes in systemic IL-17A are less likely to explain hypertension in PE.
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Affiliation(s)
- Sai Sindhu Thangaraj
- Dept. of Cardiovascular and Renal Research, Institute for Molecular Medicine, University of Southern Denmark, Odense C, Denmark.
| | - Tina-Signe Gissel Gunlund
- Dept. of Cardiovascular and Renal Research, Institute for Molecular Medicine, University of Southern Denmark, Odense C, Denmark
| | - Jane Stubbe
- Dept. of Cardiovascular and Renal Research, Institute for Molecular Medicine, University of Southern Denmark, Odense C, Denmark
| | - Yaseelan Palarasah
- Dept. of Cancer and Inflammation Research, Institute for Molecular Medicine, University of Southern Denmark, Odense C, Denmark
| | - Per Svenningsen
- Dept. of Cardiovascular and Renal Research, Institute for Molecular Medicine, University of Southern Denmark, Odense C, Denmark
| | - Lise Hald Nielsen
- Dept. of women's disease and births, Gødstrup Regional hospital, Aarhus University Hospital Skejby, Denmark
| | - Per Glud Ovesen
- Department of Gynecology and Obstetrics, Institute of Clinical Medicine, Aarhus University Hospital Skejby, Denmark
| | - Boye L Jensen
- Dept. of Cardiovascular and Renal Research, Institute for Molecular Medicine, University of Southern Denmark, Odense C, Denmark
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Egeberg A, Conrad C, Gorecki P, Wegner S, Buyze J, Acciarri L, Thaçi D. Response Types and Factors Associated with Response Types to Biologic Therapies in Patients with Moderate-to-Severe Plaque Psoriasis from Two Randomized Clinical Trials. Dermatol Ther (Heidelb) 2024; 14:745-758. [PMID: 38485863 PMCID: PMC10965842 DOI: 10.1007/s13555-024-01123-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Accepted: 02/14/2024] [Indexed: 03/27/2024] Open
Abstract
INTRODUCTION This study aimed to understand treatment response dynamics, including factors associated with favorable response, among patients with moderate-to-severe psoriasis who received guselkumab, adalimumab, or secukinumab. METHODS These post hoc analyses used data from the phase III clinical trials ECLIPSE and VOYAGE 1, which were conducted between September 2021 and November 2022. On the basis of absolute Psoriasis Area and Severity Index (aPASI) scores, patients were divided into short-term response types (SRT1-6, based on week 20-48 response) and long-term response types (LRT1-4, based on week 52-252 response). Response types (RTs) were based on aPASI cutoffs deemed clinically relevant by the investigators; SRT1/LRT1 were the most favorable response types. Baseline characteristics were compared across RTs, and logistic regression analyses established factors associated with SRT1/LRT1. RESULTS Overall, 1045, 662, and 272 patients were included in the ECLIPSE short-term, VOYAGE 1 short-term, and VOYAGE 1 long-term analyses, respectively. Mean age, body mass index (BMI), baseline aPASI score, and body surface area were lower in SRT1 than SRT6. In VOYAGE 1, adalimumab treatment, high BMI, and current/former smoking status resulted in less favorable responses. In the VOYAGE 1 long-term analysis, patients in LRT4 had the highest baseline aPASI score, were older, and were more often obese compared with other LRT groups. Regression analyses showed that SRT1 (both treatments) in VOYAGE 1 and ECLIPSE, and LRT1 (guselkumab group) in the VOYAGE 1 long-term analysis, were associated with week 16 aPASI response. In VOYAGE 1, SRT1 was associated with psoriasis duration and smoking status. CONCLUSIONS Early treatment response and baseline characteristics, including smoking, psoriasis duration, and obesity, may be associated with longer-term response to biologics. TRIAL REGISTRATION NUMBERS ECLIPSE: NCT03090100, VOYAGE 1: NCT02207231.
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Affiliation(s)
- Alexander Egeberg
- Department of Dermatology, Bispebjerg Hospital, Nielsine Nielsens Vej 9, 2400, Copenhagen, Denmark.
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.
| | - Curdin Conrad
- Department of Dermatology, Lausanne University Hospital CHUV, Lausanne, Switzerland
| | | | | | | | | | - Diamant Thaçi
- Institute and Comprehensive Center of Inflammation Medicine, University of Lübeck, Lübeck, Germany
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Jiang Y, Huang D, Chen Q, Yu Y, Hu Y, Wang Y, Chen R, Yao L, Zhong X, Kong L, Yu Q, Lu J, Li Y, Shi Y. A novel online calculator based on clinical features and hematological parameters to predict total skin clearance in patients with moderate to severe psoriasis. J Transl Med 2024; 22:121. [PMID: 38297242 PMCID: PMC10829231 DOI: 10.1186/s12967-023-04847-4] [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: 10/26/2023] [Accepted: 12/29/2023] [Indexed: 02/02/2024] Open
Abstract
BACKGROUND Treatment responses to biologic agents vary between patients with moderate to severe psoriasis; while some patients achieve total skin clearance (TSC), a proportion of patients may only experience partial improvement. OBJECTIVE This study was designed to identify potential predictors for achieving TSC in psoriasis patients treated with IL-17 inhibitors. It also aimed to develop an easy-to-use calculator incorporating these factors by the nomogram to predict TSC response. METHODS A total of 381 patients with psoriasis receiving ixekizumab were included in the development cohort and 229 psoriasis patients who initiated secukinumab treatment were included in the validation cohort. The study endpoint was achieving TSC after 12 weeks of IL-17 inhibitors treatment, defined as the 100% improvement in Psoriasis Area and Severity Index (PASI 100). Multivariate Cox regression analyses and LASSO analysis were performed to identify clinical predictors and blood predictors respectively. RESULTS The following parameters were identified as predictive factors associated with TSC: previous biologic treatment, joint involvement, genital area affected, early response (PASI 60 at week 4), neutrophil counts and uric acid levels. The nomogram model incorporating these factors achieved good discrimination in the development cohort (AUC, 0.721; 95% CI 0.670-0.773) and validation cohort (AUC, 0.715; 95% CI 0.665-0.760). The calibration curves exhibited a satisfactory fit, indicating the accuracy of the model. Furthermore, the decision curve analysis confirmed the clinical utility of the nomogram, highlighting its favorable value for practical application. Web-based online calculator has been developed to enhance the efficiency of clinical applications. CONCLUSIONS This study developed a practical and clinically applicable nomogram model for the prediction of TSC in patients with moderate to severe psoriasis. The nomogram model demonstrated robust predictive performance and exhibited significant clinical utility. Trial registration A multi-center clinical study of systemic treatment strategies for psoriasis in Chinese population;ChiCTR2000036186; Registered 31 August 2020; https://www.chictr.org.cn/showproj.html?proj=58256 .
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Affiliation(s)
- Yuxiong Jiang
- Department of Dermatology, Shanghai Skin Disease Hospital, Tongji University School of Medicine, No. 1278 Bao de Road, Shanghai, 200443, China
- Institute of Psoriasis, Tongji University School of Medicine, Shanghai, China
| | - Dawei Huang
- Department of Dermatology, Shanghai Skin Disease Hospital, Tongji University School of Medicine, No. 1278 Bao de Road, Shanghai, 200443, China
- Institute of Psoriasis, Tongji University School of Medicine, Shanghai, China
| | - Qianyu Chen
- Department of Dermatology, Shanghai Skin Disease Hospital, Tongji University School of Medicine, No. 1278 Bao de Road, Shanghai, 200443, China
- Institute of Psoriasis, Tongji University School of Medicine, Shanghai, China
| | - Yingyuan Yu
- Department of Dermatology, Shanghai Skin Disease Hospital, Tongji University School of Medicine, No. 1278 Bao de Road, Shanghai, 200443, China
- Institute of Psoriasis, Tongji University School of Medicine, Shanghai, China
| | - Yifan Hu
- Department of Dermatology, Shanghai Skin Disease Hospital, Tongji University School of Medicine, No. 1278 Bao de Road, Shanghai, 200443, China
- Institute of Psoriasis, Tongji University School of Medicine, Shanghai, China
| | - Yu Wang
- Department of Dermatology, Shanghai Skin Disease Hospital, Tongji University School of Medicine, No. 1278 Bao de Road, Shanghai, 200443, China
- Institute of Psoriasis, Tongji University School of Medicine, Shanghai, China
| | - Rongfen Chen
- Department of Dermatology, Shanghai Skin Disease Hospital, Tongji University School of Medicine, No. 1278 Bao de Road, Shanghai, 200443, China
- Institute of Psoriasis, Tongji University School of Medicine, Shanghai, China
| | - Lingling Yao
- Department of Dermatology, Shanghai Skin Disease Hospital, Tongji University School of Medicine, No. 1278 Bao de Road, Shanghai, 200443, China
- Institute of Psoriasis, Tongji University School of Medicine, Shanghai, China
| | - Xiaoyuan Zhong
- Department of Dermatology, Shanghai Skin Disease Hospital, Tongji University School of Medicine, No. 1278 Bao de Road, Shanghai, 200443, China
- Institute of Psoriasis, Tongji University School of Medicine, Shanghai, China
| | - Luyang Kong
- Department of Dermatology, Shanghai Skin Disease Hospital, Tongji University School of Medicine, No. 1278 Bao de Road, Shanghai, 200443, China
- Institute of Psoriasis, Tongji University School of Medicine, Shanghai, China
| | - Qian Yu
- Institute of Psoriasis, Tongji University School of Medicine, Shanghai, China
- Department of Dermatology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
| | - Jiajing Lu
- Department of Dermatology, Shanghai Skin Disease Hospital, Tongji University School of Medicine, No. 1278 Bao de Road, Shanghai, 200443, China.
- Institute of Psoriasis, Tongji University School of Medicine, Shanghai, China.
| | - Ying Li
- Department of Dermatology, Shanghai Skin Disease Hospital, Tongji University School of Medicine, No. 1278 Bao de Road, Shanghai, 200443, China.
- Institute of Psoriasis, Tongji University School of Medicine, Shanghai, China.
| | - Yuling Shi
- Department of Dermatology, Shanghai Skin Disease Hospital, Tongji University School of Medicine, No. 1278 Bao de Road, Shanghai, 200443, China.
- Institute of Psoriasis, Tongji University School of Medicine, Shanghai, China.
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Osman A, Nigro A, Taylor AC, Saal R, Ormaza Vera A, Enos C. The Effects of Cardiometabolic Comorbidities on Biologic Treatment for Psoriasis with Respect to PASI Scores: A Qualitative Systematic Review. PSORIASIS (AUCKLAND, N.Z.) 2024; 14:1-10. [PMID: 38226336 PMCID: PMC10788063 DOI: 10.2147/ptt.s441642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Accepted: 12/23/2023] [Indexed: 01/17/2024]
Abstract
Objective Cardiometabolic risk factors have been shown to decrease biologic efficacy in patients treated for inflammatory conditions. The purpose of this systematic review is to provide a qualitative evaluation of studies investigating biologic response among psoriasis patients with cardiometabolic comorbidities. Methods A comprehensive review was conducted according to the Preferred Reporting Guidelines for Systematic Reviews and Meta-Analysis guidelines to screen for studies including patients with cardiometabolic risk factors receiving biologic therapy for psoriasis. Studies not including a Psoriasis Area and Severity Index (PASI) score to evaluate treatment outcomes were not included. All studies underwent quality/bias analysis using the Methodological Index for Non-Randomized Studies (MINORS) scale. Results Obesity and Body Mass Index (BMI) were the most studied cardiometabolic risk factors. The majority of the studies reported a lower frequency of achieving PASI75 and PASI90 response with increasing BMI/obesity rates. Diabetes and hypertension showed similar findings but were not studied as frequently. Hyperlipidemia and other lipid disorders were less frequently studied. Conclusion Relationships between cardiometabolic risk factors and lower frequencies of achieving PASI75/90 exist in current literature. This qualitative systematic review reports evidence of lower PASI75 and PASI90 response rates in the presence of cardiometabolic risk factors.
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Affiliation(s)
- Alim Osman
- Department of Dermatology, Eastern Virginia Medical School, Norfolk, VA, USA
| | - Alexandra Nigro
- Department of Dermatology, Eastern Virginia Medical School, Norfolk, VA, USA
| | - Amanda Chen Taylor
- Department of Dermatology, Eastern Virginia Medical School, Norfolk, VA, USA
| | - Ryan Saal
- Department of Dermatology, Eastern Virginia Medical School, Norfolk, VA, USA
| | - Ana Ormaza Vera
- Department of Dermatology, Eastern Virginia Medical School, Norfolk, VA, USA
| | - Clinton Enos
- Department of Dermatology, Eastern Virginia Medical School, Norfolk, VA, USA
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Liu L, Wang W, Si Y, Li X. Genetic insights into the risk of metabolic syndrome and its components on psoriasis: A bidirectional Mendelian randomization. J Dermatol 2023; 50:1392-1400. [PMID: 37528547 DOI: 10.1111/1346-8138.16910] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Revised: 06/26/2023] [Accepted: 07/15/2023] [Indexed: 08/03/2023]
Abstract
The role of metabolic syndrome (MetS) on psoriasis has been explored only in observational studies. We conducted this bidirectional Mendelian randomization (MR) to clarify the causal relationship between MetS and its components and psoriasis. The genetic instruments of MetS and its five components (waist circumference [WC], hypertension, fasting blood glucose [FBG], triglycerides [TG], and high-density lipoprotein cholesterol [HDL-C]) were obtained from public genome-wide association studies (GWAS). Outcome datasets for psoriasis were collected from the FinnGen Biobank Analysis Consortium. The main method was inverse variance weighting, complemented by sensitivity approaches to rectify potential pleiotropy. MetS, WC, and hypertension increase the risk of psoriasis (MetS, odd ratios [OR] = 1.17, 95% confidence interval [CI] 1.08-1.27, p = 1.23e-04; WC, OR = 1.65, 95% CI 1.42-1.93, p = 1.06e-10; hypertension, OR = 2.02, 95% CI 1.33-3.07, p = 0.0009). In the reverse analysis, no causal association between psoriasis and MetS and its five components was identified. We provide novel genetic evidence that MetS, WC, and hypertension are risk factors for the development of psoriasis. Early management of MetS and its components may be an effective strategy to decrease the risk of psoriasis.
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Affiliation(s)
- Liming Liu
- Department of Plastic Surgery, Modern Hospital of Sichuan, Chengdu, Sichuan, China
| | - Wenxiang Wang
- Department of Plastic Surgery, Modern Hospital of Sichuan, Chengdu, Sichuan, China
| | - Yongjie Si
- Department of Plastic Surgery, Modern Hospital of Sichuan, Chengdu, Sichuan, China
| | - Xianhe Li
- Department of Plastic Surgery, Modern Hospital of Sichuan, Chengdu, Sichuan, China
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14
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Sticherling M, Nikkels AF, Hamza AM, Kwong P, Szepietowski JC, El Sayed M, Ghislain PD, Khotko AA, Patekar M, Ortmann CE, Forrer P, Papanastasiou P, Keefe D. Secukinumab in Pediatric Patients with Plaque Psoriasis: Pooled Safety Analysis from Two Phase 3 Randomized Clinical Trials. Am J Clin Dermatol 2023; 24:821-835. [PMID: 37341961 PMCID: PMC10460311 DOI: 10.1007/s40257-023-00782-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/03/2023] [Indexed: 06/22/2023]
Abstract
BACKGROUND Plaque psoriasis affects ~ 1% of the pediatric population, negatively impacting quality of life. The efficacy and safety of secukinumab in pediatric patients with moderate to severe or severe chronic plaque psoriasis have been established in two pivotal phase 3 trials (open-label, NCT03668613; double-blind, NCT02471144). OBJECTIVES The aims were to report the pooled safety of secukinumab up to 52 weeks from two studies in subgroups of pediatric patients stratified by age and bodyweight, and to present, alongside the pediatric data, the pooled safety data from four pivotal adult secukinumab trials. METHODS The safety of secukinumab was evaluated in subgroups of pediatric patients defined by age (6 to < 12 and 12 to < 18 years) and bodyweight (< 25 kg, 25 to < 50 kg, and ≥ 50 kg) in the pooled population. Patients received secukinumab low dose (LD; 75/75/150 mg), secukinumab high dose (HD; 75/150/300 mg), placebo, or etanercept (0.8 mg/kg). For safety analyses, data were pooled from the pediatric studies NCT03668613 and NCT02471144, and presented alongside the pooled data from four adult pivotal studies (NCT01365455, NCT01636687, NCT01358578, NCT01555125). RESULTS A total of 198 pediatric patients (overall exposure: 184.6 patient-years [PY]) and 1989 adult patients (1749.5 PY) receiving secukinumab up to week 52 were included in this analysis. At week 52, the incidence of adverse events (AEs) was lower in the lower age and bodyweight subgroups. The AEs reported within these subgroups were consistent with the overall AEs reported in this analysis. Overall, exposure-adjusted incidence rates for treatment-emergent AEs were lower in the secukinumab-treated pediatric pool (198.8/100 PY) compared with the etanercept (266.3/100 PY) and adult pools (256.1/100 PY). Up to 52 weeks, the incidence rates of the AEs in the secukinumab-treated patients in the 6 to < 12 years subgroup and 12 to < 18 years subgroup were 167.7/100 PY and 214.7/100 PY, respectively. Similarly, incidence rates of the AEs in the secukinumab-treated patients in the < 25 kg, 25 kg to < 50 kg, and ≥ 50 kg subgroups were 177.3/100 PY, 192.5/100 PY, and 206.8/100 PY, respectively. Nasopharyngitis was the most frequently reported AE in secukinumab-treated pediatric patients across age (< 12 years: 11.8/100 PY; ≥ 12 years: 42.4/100 PY) and bodyweight (< 25 kg: 22.8/100 PY; 25 kg to < 50 kg: 19.0/100 PY; ≥ 50 kg: 43.0/100 PY). Of the 198 secukinumab-treated pediatric patients, one reported nail Candida, one reported skin Candida, and two reported vulvovaginal Candida. Transient and mostly mild events of neutropenia were observed with secukinumab, none leading to study treatment discontinuation. No incidence of treatment-emergent anti-drug antibodies was reported in pediatric patients treated with secukinumab. CONCLUSIONS Secukinumab was well tolerated in pediatric patients with moderate to severe and severe plaque psoriasis across age and bodyweight subgroups. The overall safety profile of secukinumab in pediatric patients was consistent with that of adult patients. CLINICALTRIALS GOV IDENTIFIER NCT03668613 (Novartis Study Code CAIN457A2311, referred to as A2311), actual study start date: August 29, 2018; actual primary completion date: September 19, 2019; estimated study completion date: September 14, 2023. NCT02471144 (Novartis Study Code CAIN457A2310, referred to as A2310), study start date: September 29, 2015; primary completion date: December 13, 2018; estimated study completion date: March 31, 2023.
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Affiliation(s)
- Michael Sticherling
- Hautklinik, Friedrich-Alexander-University of Erlangen-Nürnberg (FAU) Department of Dermatology, University Hospital Erlangen, Ulmenweg 18, 91054, Erlangen, Germany.
| | - Arjen F Nikkels
- Department of Dermatology, University Hospital Centre, CHU of Sart Tilman, University of Liège, 4000, Liège, Belgium
| | - Ashraf M Hamza
- Department of Dermatology and Andrology, Alexandria University, Alexandria, Egypt
| | - Pearl Kwong
- Solutions through Advanced Research, Jacksonville, FL, USA
| | - Jacek C Szepietowski
- Department of Dermatology, Venereology and Allergology, Medical University, Wrocław, Poland
| | | | | | - Alkes A Khotko
- GBUZ Clinical Dermatology and Venereological Dispensary, Krasnodar, Russia
| | | | | | | | | | - Deborah Keefe
- Novartis Pharmaceuticals Corporation, East Hanover, NJ, USA
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15
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Bieber T. Disease modification in inflammatory skin disorders: opportunities and challenges. Nat Rev Drug Discov 2023; 22:662-680. [PMID: 37443275 DOI: 10.1038/s41573-023-00735-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/05/2023] [Indexed: 07/15/2023]
Abstract
Progress in understanding of the mechanisms underlying chronic inflammatory skin disorders, such as atopic dermatitis and psoriasis vulgaris, has led to new treatment options with the primary goal of alleviating symptoms. In addition, this knowledge has the potential to inform on new strategies aimed at inducing deep and therapy-free remission, that is, disease modification, potentially impacting on associated comorbidities. However, to reach this goal, key areas require further exploration, including the definitions of disease modification and disease activity index, further understanding of disease mechanisms and systemic spillover effects, potential windows of opportunity, biomarkers for patient stratification and successful intervention, as well as appropriate study design. This Perspective article assesses the opportunities and challenges in the discovery and development of disease-modifying therapies for chronic inflammatory skin disorders.
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Affiliation(s)
- Thomas Bieber
- Department of Dermatology and Allergy, University Hospital, Bonn, Germany.
- Christine Kühne - Center for Allergy Research and Education, Davos, Switzerland.
- Davos Biosciences, Davos, Switzerland.
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16
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Egeberg A, Merola JF, Schäkel K, Puig L, Mahar PD, Wang IY, Pavo I, Schuster C, Griffiths CEM. Efficacy of ixekizumab in patients with moderate-to-severe plaque psoriasis and prediabetes or type 2 diabetes. Front Med (Lausanne) 2023; 9:1092688. [PMID: 36777159 PMCID: PMC9912352 DOI: 10.3389/fmed.2022.1092688] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Accepted: 12/23/2022] [Indexed: 01/29/2023] Open
Abstract
Objective Patients with psoriasis have an increased prevalence of type 2 diabetes when compared to the general population. Research suggests that type 2 diabetes (T2D) as well as obesity may have an impact on patients' response to treatment. This post-hoc analysis reports the efficacy of ixekizumab in treating moderate-to-severe psoriasis in patients with prediabetes or T2D. Method and materials UNCOVER-1, UNCOVER-2, and UNCOVER-3 were three Phase 3, multicenter, randomized, double-blind, placebo-controlled trials that evaluated the efficacy and safety of ixekizumab in adult patients with moderate-to-severe psoriasis. Patients were aged ≥18 years with chronic moderate-to-severe psoriasis (defined as ≥10% body surface area affected, static Physician Global Assessment ≥3, and Psoriasis Area and Severity Index [PASI] ≥12 at screening and baseline) who were candidates for phototherapy or systemic therapy. UNCOVER-1, UNCOVER-2, and UNCOVER-3 participants received ixekizumab as per label (that is, an initial dose of two subcutaneous injections [160 mg in total] at Week 0, followed by 80 mg every 2 weeks through Week 12 and 80 mg every 4 weeks thereafter through Week 60). Results The proportions of patients with prediabetes, T2D and normoglycemia that achieved PASI75, PASI90, and PASI100 at Week 60 were similar. Results suggest that patients with T2D were slower to achieve PASI100 than patients with prediabetes or those with normoglycemia. Ixekizumab had no effect on any metabolic markers in patients receiving the treatment. Conclusions Despite the higher rate of obesity and extreme obesity in patients with prediabetes and T2D, ixekizumab was an efficacious treatment in treating patients with psoriasis.
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Affiliation(s)
- Alexander Egeberg
- Bispebjerg and Frederiksberg Hospital, Copenhagen University, Copenhagen, Denmark
| | - Joseph F. Merola
- Division of Rheumatology, Department of Dermatology and Department of Medicine, Harvard Medical School, Brigham and Women's Hospital, Boston, MA, United States
| | - Knut Schäkel
- Department of Dermatology, University Hospital Heidelberg, Heidelberg, Germany
| | - Luis Puig
- Dermatology Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Patrick D. Mahar
- Eli Lilly and Company, Indianapolis, IN, United States,Department of Dermatology, Royal Children's Hospital, Faculty of Medicine, Nursing and Health Sciences, Skin Health Institute, The University of Melbourne, Melbourne, VIC, Australia
| | | | - Imre Pavo
- Eli Lilly and Company, Indianapolis, IN, United States
| | - Christopher Schuster
- Eli Lilly and Company, Indianapolis, IN, United States,Department of Dermatology, Medical University of Vienna, Vienna, Austria
| | - Christopher E. M. Griffiths
- Dermatology Centre, Salford Royal Hospital, NIHR Manchester Biomedical Research Centre, University of Manchester, Manchester, United Kingdom,*Correspondence: Christopher E. M. Griffiths ✉
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Merola JF, Kavanaugh A, Lebwohl MG, Gniadecki R, Wu JJ. Clinical Efficacy and Safety of Psoriasis Treatments in Patients with Concomitant Metabolic Syndrome: A Narrative Review. Dermatol Ther (Heidelb) 2022; 12:2201-2216. [PMID: 36008702 PMCID: PMC9515257 DOI: 10.1007/s13555-022-00790-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Accepted: 08/02/2022] [Indexed: 11/26/2022] Open
Abstract
Metabolic syndrome (MetS) is well recognized as a frequent comorbidity of psoriasis with important implications for efficacy and safety of psoriasis treatment. The presence of concomitant MetS is associated with decreased efficacy response to biologic treatment for psoriasis in observational studies. In post hoc analyses of clinical trial data, the anti–IL-23p19 antibody tildrakizumab appears to maintain efficacy in patients compared to those without MetS; no published subgroup analyses by MetS status are yet available for other biologics. However, there is some evidence that obese patients have decreased psoriasis treatment efficacy with biologics with certain mechanisms of action relative to overweight patients. This confounds interpretation of the effect of MetS due to the association between MetS and body weight. Because of the association between MetS and cardiovascular risk, treatment of psoriasis in patients with concomitant MetS requires special consideration for cardiovascular safety and attention to potential for exacerbation of MetS and related conditions, including nonalcoholic fatty liver disease. Additional studies are needed to clarify the risks for treatment failure and cardiovascular safety concerns in patients with psoriasis and concomitant MetS.
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Affiliation(s)
- Joseph F Merola
- Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
| | | | - Mark G Lebwohl
- Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Robert Gniadecki
- Division of Dermatology, University of Alberta, Edmonton, AB, Canada
| | - Jashin J Wu
- Department of Dermatology, University of Miami Miller School of Medicine, Miami, FL, USA
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Actualización práctica de las recomendaciones del Grupo de Psoriasis de la Academia Española de Dermatología y Venereología (GPS) para el tratamiento de la psoriasis con terapia biológica. Parte 2 «Manejo de poblaciones especiales, pacientes con comorbilidad y gestión del riesgo». ACTAS DERMO-SIFILIOGRAFICAS 2022; 113:583-609. [DOI: 10.1016/j.ad.2022.01.024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Accepted: 01/26/2022] [Indexed: 12/19/2022] Open
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Carrascosa JM, Puig L, Romero IB, Salgado-Boquete L, Del Alcázar E, Lencina JJA, Moreno D, de la Cueva P. [Translated article] Practical Update of the Guidelines Published by the Psoriasis Group of the Spanish Academy of Dermatology and Venereology (GPs) on the Treatment of Psoriasis With Biologic Agents: Part 2-Management of Special Populations, Patients With Comorbid Conditions, and Risk. ACTAS DERMO-SIFILIOGRAFICAS 2022; 113:T583-T609. [PMID: 35748004 DOI: 10.1016/j.ad.2022.01.040] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Accepted: 01/26/2022] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Since its inception, the Psoriasis Group (GPs) of the Spanish Academy of Dermatology and Venereology (AEDV) has worked to continuously update recommendations for the treatment of psoriasis based on the best available evidence and incorporating proposals arising from and aimed at clinical practice. An updated GPs consensus document on the treatment of moderate to severe psoriasis was needed because of changes in the treatment paradigm and the approval in recent years of a large number of new biologic agents. METHODOLOGY The consensus document was developed using the nominal group technique complemented by a scoping review. First, a designated coordinator selected a group of GPs members for the panel based on their experience and knowledge of psoriasis. The coordinator defined the objectives and key points for the document and, with the help of a documentalist, conducted a scoping review of articles in Medline, Embase, and the Cochrane Library up to January 2021. The review included systematic reviews and meta-analyses as well as clinical trials not included in those studies and high-quality real-world studies. National and international clinical practice guidelines and consensus documents on the management of moderate to severe psoriasis were also reviewed. The coordinator then drew up a set of proposed recommendations, which were discussed and modified in a nominal group meeting. After several review processes, including external review by other GPs members, the final document was drafted. RESULTS The present guidelines include updated recommendations on assessing the severity of psoriasis and criteria for the indication of systemic treatment. They also include general principles for the treatment of patients with moderate to severe psoriasis and define treatment goals for these patients as well as criteria for the indication and selection of initial and subsequent therapies Practical issues, such as treatment failure and maintenance of response, are also addressed.
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Affiliation(s)
- J M Carrascosa
- Departamento de Dermatología, Hospital Universitari Germans Trias I Pujol, Badalona, Universitat Autònoma de Barcelona, IGTP, Barcelona, Spain.
| | - L Puig
- Departamento de Dermatología, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - I B Romero
- Departamento de Dermatología, Hospital General Universitario de Alicante-ISABIAL - Universidad Miguel Hernández de Elche, Alicante, Spain
| | - L Salgado-Boquete
- Departamento de Dermatología, Complejo Hospitalario Universitario de Pontevedra, Pontevedra, Spain
| | - E Del Alcázar
- Departamento de Dermatología, Hospital Universitari Germans Trias I Pujol, Badalona, Universitat Autònoma de Barcelona, IGTP, Barcelona, Spain
| | - J J A Lencina
- Servicio de Dermatología, Hospital Universitario Vega Baja, Alicante, Spain
| | - D Moreno
- Departamento de Dermatología, Hospital Universitario Virgen Macarena, Universidad de Sevilla, Sevilla, Spain
| | - P de la Cueva
- Servicio de Dermatología, Hospital Universitario Infanta Leonor, Universidad Complutense de Madrid, Madrid, Spain
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20
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Feldman SR, Merola JF, Pariser DM, Zhang J, Zhao Y, Mendelsohn AM, Gottlieb AB. Clinical implications and predictive values of early PASI responses to tildrakizumab in patients with moderate-to-severe plaque psoriasis. J DERMATOL TREAT 2022; 33:1670-1675. [PMID: 33678106 DOI: 10.1080/09546634.2021.1898528] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Accepted: 02/26/2021] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To evaluate whether early Psoriasis Area Severity Index (PASI) improvements can predict week 28 tildrakizumab responders and nonresponders. METHODS Psoriasis patients pooled from two tildrakizumab phase 3 trials randomized to receive tildrakizumab 100 mg at weeks 0, 4, 16, and 28 were included. Patients were grouped by week 28 PASI responses (<50, 50-74, 75-89, and 90-100). PASI improvements from baseline at weeks 4 and 16 were analyzed for each response group. RESULTS Of 575 patients included, 8.3%, 14.3%, 23.8%, and 53.6%, respectively, achieved PASI <50, 50-74, 75-89, and 90-100 at week 28. Of patients with PASI <50 at week 16, 85% did not achieve PASI ≥75 at week 28 (nonresponders). Rapid response, defined as PASI ≥50 at week 4 (after a single tildrakizumab dose), was observed in 41% of patients. Of these patients, 87% were week 28 responders (PASI ≥75); 67% were 'super responders' (PASI 90-100). Among week 28 responders and super responders, 45% and 50% achieved PASI ≥50 at week 4, respectively. CONCLUSIONS Tildrakizumab week 28 nonresponders can be identified by week 16 PASI response. PASI improvements as early as week 4 can predict patients' week 28 PASI improvement status.
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Affiliation(s)
| | - Joseph F Merola
- Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - David M Pariser
- Eastern Virginia Medical School, Virginia Clinical Research, Inc, Norfolk, VA, USA
| | | | - Yang Zhao
- Sun Pharmaceutical Industries Inc., Princeton, NJ, USA
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Fernandez AP, Dauden E, Gerdes S, Lebwohl MG, Menter MA, Leonardi C, Gooderham M, Gebauer K, Tada Y, Lacour JP, Bianchi L, Egeberg A, Pau-Charles I, Mendelsohn AM, Rozzo SJ, Mehta NN. Tildrakizumab efficacy and safety in patients with psoriasis and concomitant metabolic syndrome: post hoc analysis of 5-year data from reSURFACE 1 and reSURFACE 2. J Eur Acad Dermatol Venereol 2022; 36:1774-1783. [PMID: 35460287 PMCID: PMC9545614 DOI: 10.1111/jdv.18167] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Revised: 12/15/2021] [Accepted: 01/18/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND Limited data are available on long-term efficacy and safety of biologics in patients with psoriasis and metabolic syndrome (MetS), a common comorbidity. OBJECTIVES This analysis updates tildrakizumab efficacy and safety for up to 5 years in patients with and without MetS. METHODS This was a post hoc analysis of the double-blind, randomized, placebo-controlled, phase 3 reSURFACE 1 (NCT01722331) and reSURFACE 2 (NCT01729754) trials in adult patients with moderate to severe chronic plaque psoriasis. Analyses included data through Week 244 from patients who continuously received tildrakizumab 100 (TIL100) or 200 mg (TIL200) and entered the extension studies, stratified by baseline MetS status. Efficacy was assessed via Psoriasis Area and Severity Index (PASI) scores. Safety was evaluated from exposure-adjusted incidence rates (EAIRs) of treatment-emergent adverse events (TEAEs). RESULTS reSURFACE 1 and reSURFACE 2 analyses included 26 and 44 TIL100-treated patients with MetS, 98 and 167 TIL100-treated patients without MetS, 34 and 30 TIL200-treated patients with MetS, and 111 and 130 TIL200-treated patients without MetS, respectively. There were no clinically relevant differences in PASI 75/90/100 response rates at Week 244 between patients with vs without MetS. The proportion of patients with vs without MetS achieving absolute PASI score <3 at Week 244 was 53.8% vs 69.4% and 77.3% vs 80.8% in reSURFACE 1 and 2, respectively, for TIL100-treated patients and 58.8% vs 72.1% and 63.3% vs 72.3%, respectively, for TIL200-treated patients. In both studies, median reduction from baseline PASI score at all time points in patients with vs without MetS was >83% vs >89% for TIL100 and >85% vs >90% for TIL200. Pooled EAIRs of TEAEs, serious TEAEs, and TEAEs of special interest were similar in patients with and without MetS. CONCLUSIONS Tildrakizumab maintains efficacy and a favorable safety profile over 5 years in patients with psoriasis regardless of MetS status.
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Affiliation(s)
- A P Fernandez
- Departments of Dermatology and Pathology, Cleveland Clinic, Cleveland, OH, USA
| | - E Dauden
- Dermatology Department, Instituto de Investigación Sanitaria La Princesa (IIS-IP), Madrid, Spain
| | - S Gerdes
- Department of Dermatology, Psoriasis-Center, University Medical Center Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - M G Lebwohl
- Department of Dermatology, Mount Sinai Hospital, New York, NY, USA
| | - M A Menter
- Division of Dermatology, Baylor Scott & White, and Texas A&M College of Medicine, Dallas, TX, USA
| | - C Leonardi
- Central Dermatology and Saint Louis University School of Medicine, St. Louis, MO, USA
| | - M Gooderham
- Probity Medical Research, Peterborough, ON, Canada.,SKiN Centre for Dermatology, Peterborough, ON, Canada.,Queen's University, Kingston, ON, Canada
| | - K Gebauer
- Fremantle Dermatology, Fremantle, Western Australia, Australia
| | - Y Tada
- Teikyo University, Tokyo, Japan
| | - J P Lacour
- Department of Dermatology, University of Nice Sophia Antipolis, Nice, France
| | - L Bianchi
- Dermatology Unit, Tor Vergata University Hospital, Rome, Italy
| | - A Egeberg
- Department of Dermatology, Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark
| | | | | | - S J Rozzo
- Sun Pharmaceutical Industries, Inc., Princeton, NJ, USA
| | - N N Mehta
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA
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22
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Evaluation of the relationship of IL-17A and IL-17F gene polymorphisms with the response to treatment in psoriatic patients using biological drugs: a case-control study in patients in Eastern Turkey. Postepy Dermatol Alergol 2021; 38:780-787. [PMID: 34849124 PMCID: PMC8610063 DOI: 10.5114/ada.2020.95383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Accepted: 04/25/2020] [Indexed: 11/17/2022] Open
Abstract
Introduction IL-17A and IL-17F cytokines have important roles in the pathogenesis of psoriasis. Aim To examine the associations of IL-17A rs2275913 and IL-17F rs763780 variants with the development of psoriasis and whether these polymorphisms affect the responsiveness of biological agents. Material and methods In our case-controlled study, which included 83 psoriatic patients who were treated with different biological agents and 69 healthy controls, we genotyped IL-17A rs2275913 and IL-17F rs763780 variants using TaqMan probes. Results We did not observe statistically significant changes in genotype frequencies of IL-17A rs2275913 (p = 0.922) and IL-17F rs763780 (p = 0.621) variants between patient and control groups. Although we did not find any association between these polymorphisms and the development of psoriasis, statistical analyses showed that individuals with the IL-17A AA genotype had shorter disease duration (9.09 ±6.82, p = 0.020) and AA genotype frequency was higher in patients who used single conventional treatment (34.6%; p = 0.025). IL17A/rs2275913 variant in terms of disease duration, it was observed that individuals with AA genotype had a shorter disease duration (less than 10 years) (p = 0.009). For patients with PASI90 and PASI100 response, the IL-17A AA genotype was significantly higher (p = 0.015). On the other hand, we did not detect any statistically significant correlation between variants and response to biological agents. Conclusions According to our results, we may suggest that rs2275913 variant seems to be associated with disease duration, use of single conventional treatment and responsiveness of PASI90 and PASI100 however both variants have no effect on the susceptibility to psoriasis in the population of Eastern Turkey.
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23
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Hung YT, Lin YJ, Chiu HY, Huang YH. Impact of previous biologic use and body weight on the effectiveness of guselkumab in moderate-to-severe plaque psoriasis: a real-world practice. Ther Adv Chronic Dis 2021; 12:20406223211046685. [PMID: 34729147 PMCID: PMC8485267 DOI: 10.1177/20406223211046685] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2021] [Accepted: 08/26/2021] [Indexed: 11/24/2022] Open
Abstract
Background: Real-life data on patients with psoriasis treated with guselkumab are few and are needed to compare with trial-based data. We investigated the effect of clinical factors on real-world effectiveness of guselkumab. Methods: This multicentre study retrospectively included 135 patients with psoriasis treated with guselkumab from June 2018 until November 2020. Effectiveness was assessed using the degree of improvement in the Psoriasis Area and Severity Index (PASI) scores at baseline and after 4, 12, 20, 28, and 36 weeks. Predictors of effectiveness were also evaluated. Results: At week 36, 67% of the patients achieved PASI 75. Multivariate logistic regression analysis revealed that heavier patients were less likely to achieve PASI 75 at week 4 than patients with lower body weights. Fewer patients exposed to only one biologic achieved PASI 75 at weeks 4, 20, 28, and 36 [odds ratio (OR) = 0.08 (95% CI, 0.01–0.48), 0.21 (95% CI, 0.05–0.74), 0.04 (95% CI, 0.00–0.35), and 0.07 (95% CI, 0.00–0.68), respectively] than biologic-naïve patients. Patients previously treated with more than one biologic were less likely to achieve PASI 75 at weeks 12, 20, 28, and 36 [OR = 0.05 (95% CI, 0.01–0.22), 0.03 (95% CI, 0.01–0.16), 0.00 (95% CI, 0.00–0.03), and 0.00 (95% CI, 0.00–0.044), respectively] than biologic-naïve patients. Patients with previous anti-interleukin (IL)-17 exposure, rather than tumour necrosis factor-α and IL-12/23 inhibitors, had lower PASI improvements to guselkumab than biologic-naïve patients at weeks 12, 20, and 28 [OR = 0.19 (95% CI, 0.03–0.90), 0.10 (95% CI, 0.02–0.55), and 0.03 (95% CI, 0.00–0.29), respectively]. Conclusions: The effectiveness of guselkumab was compromised in a real-world setting. Delayed onset of therapeutic response was noted in heavier patients. Biologic exposure, the number of previously used biologics, and previous exposure to IL-17 inhibitors were clinical predictors of a reduced response to guselkumab. Physicians may share this information with patients to make treatment decisions.
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Affiliation(s)
- Yi-Teng Hung
- Department of Dermatology, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan City
| | - Yu-Jr Lin
- Research Services Center for Health Information, Chang Gung University, Taoyuan City
| | - Hsien-Yi Chiu
- Department of Dermatology, National Taiwan University Hsin-Chu Hospital, No. 25, Lane 442, Section 1, Jingguo Road, Hsinchu City 300
| | - Yu-Huei Huang
- Department of Dermatology, Chang Gung Memorial Hospital, Linkou Branch, No. 5, Fuxing Street, Guishan District, Taoyuan City 333. School of Medicine, College of Medicine, Chang Gung University, Taoyuan City
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24
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Schwarz CW, Loft N, Rasmussen MK, Nissen CV, Dam TN, Ajgeiy KK, Egeberg A, Skov L. Predictors of Response to Biologics in Patients with Moderate-to-severe Psoriasis: A Danish Nationwide Cohort Study. Acta Derm Venereol 2021; 101:adv00579. [PMID: 34642768 PMCID: PMC9425566 DOI: 10.2340/actadv.v101.351] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Identifying patient characteristics associated with achieving treatment response to biologics in patients with psoriasis could prevent expensive switching between biologics. The aim of this study was to identify patient characteristics that predict the efficacy of treatment for biologics that inhibit tumour necrosis factor-α, interleukin-12/-23, and -17A. The study investigated biologic-naïve patients from the DERMBIO registry treated with adalimumab, etanercept, infliximab, secukinumab, or ustekinumab. Multivariable logistic models were conducted to assess associations between patient characteristics and treatment response. A total of 2,384 patients were included (adalimumab n = 911; etanercept n = 327; infliximab n = 152; secukinumab n = 323; ustekinumab n = 671). Smoking (odds ratio 0.74; 95% confidence interval (CI) 0.56–0.97; p = 0.03) and higher bodyweight (odds ratio 0.989; 95% CI 0.984–0.994; p < 0.001) reduced the odds of achieving response defined as Psoriasis Area and Severity Index ≤2.0 after 6 months of treatment. In conclusion, higher bodyweight and smoking were associated with a reduced probability of treatment response for tumour necrosis factor-α inhibitors, ustekinumab, and secukinumab.
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Affiliation(s)
- Christopher Willy Schwarz
- Department of Dermatology and Allergy, Gentofte Hospitalsvej 15, 1. floor, DK-2900 Hellerup, Denmark.
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25
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Biologic Treatment in Combination with Lifestyle Intervention in Moderate to Severe Plaque Psoriasis and Concomitant Metabolic Syndrome: Rationale and Methodology of the METABOLyx Randomized Controlled Clinical Trial. Nutrients 2021; 13:nu13093015. [PMID: 34578893 PMCID: PMC8471656 DOI: 10.3390/nu13093015] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 08/19/2021] [Accepted: 08/27/2021] [Indexed: 01/04/2023] Open
Abstract
Inflammatory diseases including psoriasis are associated with metabolic and cardiovascular comorbidities, including obesity and metabolic syndrome. Obesity is associated with greater psoriasis disease severity and reduced response to treatment. Therefore, targeting metabolic comorbidities could improve patients’ health status and psoriasis-specific outcomes. METABOLyx is a randomized controlled trial evaluating the combination of a lifestyle intervention program with secukinumab treatment in psoriasis. Here, the rationale, methodology and baseline patient characteristics of METABOLyx are presented. A total of 768 patients with concomitant moderate to severe plaque psoriasis and metabolic syndrome were randomized to secukinumab 300 mg, or secukinumab 300 mg plus a tailored lifestyle intervention program, over 24 weeks. A substudy of immunologic and metabolic biomarkers is ongoing. The primary endpoint of METABOLyx is PASI90 response at week 24. Other endpoints include patient-reported outcomes and safety. METABOLyx represents the first large scale clinical trial of an immunomodulatory biologic in combination with a standardized lifestyle intervention.
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26
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Blauvelt A, Armstrong AW, Langley RG, Gebauer K, Thaçi D, Bagel J, Guenther LC, Paul C, Randazzo B, Flavin S, Hsu MC, You Y, Reich K. Efficacy of guselkumab versus secukinumab in subpopulations of patients with moderate-to-severe plaque psoriasis: results from the ECLIPSE study. J DERMATOL TREAT 2021; 33:2317-2324. [PMID: 34348574 DOI: 10.1080/09546634.2021.1959504] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
PURPOSE Guselkumab, an interleukin (IL)-23 inhibitor, effectively treats moderate-to-severe plaque psoriasis. MATERIALS AND METHODS ECLIPSE, was a Phase 3, multicenter, 56-week, double-blinded, active-comparator study of guselkumab vs. secukinumab (IL-17A inhibitor) in patients with moderate-to-severe psoriasis. Patients were treated with guselkumab 100 mg (n = 534) or secukinumab 300 mg (n = 514) through week 44. Efficacy (at least a 90% and 100% improvement from baseline in Psoriasis Area and Severity Index [PASI 90 and PASI 100], Investigator's Global Assessment [IGA] 0/1, and IGA 0) was analyzed across subpopulations defined by baseline: age (<45, 45 to <65, and ≥65 years old), body weight, body mass index (BMI), psoriasis disease severity (body surface area, disease duration, PASI, and IGA), psoriasis by body regions (head, trunk, upper and lower extremities), and prior psoriasis medication history at week 48. RESULTS Overall, 1048 patients were randomized. At week 48, numerically greater proportions of patients achieved PASI 90, PASI 100, IGA 0/1, and IGA 0 with guselkumab vs. secukinumab regardless of baseline age, body weight, BMI, disease severity, body region, and prior medication. The largest differences were in patients ≥65 years old and patients weighing >100 kg. CONCLUSIONS Guselkumab treatment provided greater efficacy vs. secukinumab at week 48 in most subpopulations of patients with psoriasis.
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Affiliation(s)
| | - April W Armstrong
- Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | | | - Kurt Gebauer
- Fremantle Dermatology, Fremantle, Australia.,Probity Medical Research, Waterloo, Ontario, Canada
| | - Diamant Thaçi
- The Institute and Comprehensive Center Inflammation for Medicine, University of Lübeck, Lübeck, Germany
| | - Jerry Bagel
- The Psoriasis Treatment Center of Central New Jersey, East Windsor, NJ, USA
| | | | - Carle Paul
- Toulouse University and CHU Hôpital Larrey, Toulouse, France
| | - Bruce Randazzo
- Janssen Research & Development, LLC, Spring House, PA, USA
| | - Susan Flavin
- Janssen Research & Development, LLC, Spring House, PA, USA
| | - Ming-Chun Hsu
- Janssen Research & Development, LLC, Spring House, PA, USA
| | - Yin You
- Janssen Research & Development, LLC, Spring House, PA, USA
| | - Kristian Reich
- Institute for Health Services Research in Dermatology and Nursing, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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27
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Hao Y, Zhu YJ, Zou S, Zhou P, Hu YW, Zhao QX, Gu LN, Zhang HZ, Wang Z, Li J. Metabolic Syndrome and Psoriasis: Mechanisms and Future Directions. Front Immunol 2021; 12:711060. [PMID: 34367173 PMCID: PMC8343100 DOI: 10.3389/fimmu.2021.711060] [Citation(s) in RCA: 59] [Impact Index Per Article: 19.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Accepted: 07/07/2021] [Indexed: 02/05/2023] Open
Abstract
Psoriasis is an immune-mediated systemic disease with associated comorbidities, including metabolic syndrome (MetS) which contributes substantially to premature mortality in patients with psoriasis. However, the pathological mechanisms underlying this comorbidity are unclear. Studies have shown that the pathological parameters of psoriasis mediate the development of MetS. We reviewed the potential mechanisms which mediate the association between psoriasis and MetS, including endoplasmic reticulum stress, pro-inflammatory cytokine releases, excess production of reactive oxygen species, alterations in adipocytokine levels and gut microbiota dysbiosis. Here, we highlight important research questions regarding this association and offer insights into MetS research and treatment.
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Affiliation(s)
- Yan Hao
- State Key Laboratory of Biotherapy and Cancer Center, West China Hospital, West China Medical School, Sichuan University, and Collaborative Innovation Center for Biotherapy, Chengdu, China
| | - Ya-Juan Zhu
- Department of Biotherapy and Cancer Center, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, China
| | - Song Zou
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China
| | - Pei Zhou
- State Key Laboratory of Biotherapy and Cancer Center, West China Hospital, West China Medical School, Sichuan University, and Collaborative Innovation Center for Biotherapy, Chengdu, China
| | - Ya-Wen Hu
- State Key Laboratory of Biotherapy and Cancer Center, West China Hospital, West China Medical School, Sichuan University, and Collaborative Innovation Center for Biotherapy, Chengdu, China
| | - Qi-Xiang Zhao
- State Key Laboratory of Biotherapy and Cancer Center, West China Hospital, West China Medical School, Sichuan University, and Collaborative Innovation Center for Biotherapy, Chengdu, China
| | - Lin-Na Gu
- State Key Laboratory of Biotherapy and Cancer Center, West China Hospital, West China Medical School, Sichuan University, and Collaborative Innovation Center for Biotherapy, Chengdu, China
| | - Hao-Zhou Zhang
- State Key Laboratory of Biotherapy and Cancer Center, West China Hospital, West China Medical School, Sichuan University, and Collaborative Innovation Center for Biotherapy, Chengdu, China
| | - Zhen Wang
- State Key Laboratory of Biotherapy and Cancer Center, West China Hospital, West China Medical School, Sichuan University, and Collaborative Innovation Center for Biotherapy, Chengdu, China.,Department of Liver Surgery & Liver Transplantation, State Key Laboratory of Biotherapy and Cancer Center, West China Hospital, Sichuan University and Collaborative Innovation Center of Biotherapy, Chengdu, China.,Laboratory of Liver Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Jiong Li
- State Key Laboratory of Biotherapy and Cancer Center, West China Hospital, West China Medical School, Sichuan University, and Collaborative Innovation Center for Biotherapy, Chengdu, China
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28
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Correlation Between Change in Psoriasis Area and Severity Index and Dermatology Life Quality Index in Patients with Psoriasis: Pooled Analysis from Four Phase 3 Clinical Trials of Secukinumab. Dermatol Ther (Heidelb) 2021; 11:1373-1384. [PMID: 34110605 PMCID: PMC8322374 DOI: 10.1007/s13555-021-00564-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Accepted: 05/28/2021] [Indexed: 10/27/2022] Open
Abstract
INTRODUCTION Patients with psoriasis (PsO) experience impaired health-related quality of life due to physical and psychosocial burdens. The objective of this study was to assess the correlation between change in Psoriasis Area and Severity Index (PASI) score and selected Dermatology Life Quality Index (DLQI) domain scores in patients with moderate-to-severe PsO and those with PsO and comorbid psoriatic arthritis (PsA). METHODS This post hoc analysis of four phase 3 clinical trials included patients with moderate-to-severe PsO randomized to secukinumab 150/300 mg, etanercept, or placebo. Pairwise latent growth models were applied to assess the longitudinal correlation between change in PASI scores and changes in three DLQI domain scores (daily activities, leisure activities, and symptoms/feelings). The initial (baseline to week 12) and sustained (week > 12 to week 52) treatment exposures were analysed by population type (total, PsO only, and PsO with comorbid PsA) and treatment arm (secukinumab, etanercept, or placebo). RESULTS Among the total population (N = 2401), PASI change was positively correlated with change in each assessed DLQI domain; correlations were weak to moderate over the initial treatment exposure period (β range, 0.20-0.29; all P < 0.001) and moderate to strong over the sustained exposure period (β range, 0.63-0.69; all P < 0.001). Similar trends were observed regardless of the presence of comorbid PsA. These relationships were confirmed among patients treated with secukinumab, etanercept, or placebo. CONCLUSIONS Improvements in PASI scores were directly moderately related to improvements in DLQI domain scores from initiation of treatment and extended over time, regardless of presence of comorbid PsA or treatment received. CLINICAL TRIAL REGISTRATION ERASURE (NCT01365455), FIXTURE (NCT01358578), FEATURE (NCT01555125), and JUNCTURE (NCT01636687).
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29
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Neema S, Pathania V, Pudasaini N, Subramaniyan R. Optimal biologic dosing in management of obese patients with psoriasis. Indian J Dermatol Venereol Leprol 2021; 87:424-426. [PMID: 33666055 DOI: 10.25259/ijdvl_241_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Accepted: 06/01/2020] [Indexed: 12/27/2022]
Affiliation(s)
- Shekhar Neema
- Department of Dermatology, Armed Forces Medical College, Pune, Maharashtra, India
| | - Vikas Pathania
- Department of Dermatology, Armed Forces Medical College, Pune, Maharashtra, India
| | - Niranjan Pudasaini
- Department of Dermatology, Armed Forces Medical College, Pune, Maharashtra, India
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30
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31
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Hampton P, Halliday A, Aassi M, Subramanian S, Jain M, Griffiths CEM. Twelve-week secukinumab treatment is consistently efficacious for moderate-to-severe psoriasis regardless of prior biologic and non-biologic systemic treatment: Post hoc analysis of six randomised trials. J Eur Acad Dermatol Venereol 2021; 35:928-937. [PMID: 33030755 PMCID: PMC7986672 DOI: 10.1111/jdv.16982] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Accepted: 09/22/2020] [Indexed: 01/12/2023]
Abstract
Background The efficacy of biologic therapies is greater among biologic‐naïve vs. biologic‐experienced psoriasis patients. However, little is known as to whether prior use of other systemic therapies impacts secukinumab efficacy in patients with moderate‐to‐severe psoriasis. Objective To investigate the impact of prior exposure to systemic therapies upon the efficacy and safety of secukinumab 300 mg for moderate‐to‐severe psoriasis. Methods Post hoc analysis of six randomised controlled trials (RCTs) comparing secukinumab with placebo, ustekinumab or etanercept at 12 weeks of treatment. Data comparing secukinumab with placebo and ustekinumab were meta‐analysed, while comparisons between secukinumab and etanercept were from a single RCT. Four subgroups of patients were assessed: (i) naïve to non‐biologic systemics (NBS) and biologics; (ii) exposed to NBS but naïve to biologics; (iii) naïve to NBS but exposed to biologics; and (iv) exposed to NBS and biologics. Outcomes of interest included the following: investigator’s global assessment (IGA) score, absolute psoriasis area and severity index (PASI) response, PASI 75, PASI 90 and PASI 100 responses, and dermatology life quality index (DLQI). Safety was also assessed. Results One thousand three hundred and eighty‐three patients were included in the secukinumab vs. placebo meta‐analysis: 1776 in the secukinumab vs. ustekinumab meta‐analysis and 653 in the within‐trial analyses of secukinumab vs. etanercept. For all subgroups, secukinumab was significantly more efficacious than placebo for all outcomes measured. Secukinumab generated greater responses in biologic‐naïve patients, while prior NBS had a negligible impact on treatment response. Furthermore, secukinumab was more efficacious than both ustekinumab and etanercept on many outcomes, with an even greater difference for biologic‐naïve than biologic‐exposed patients. Safety results were consistent with individual clinical trial results. Conclusions Twelve‐week treatment with secukinumab 300 mg is consistently more efficacious than placebo, etanercept and ustekinumab in patients with moderate‐to‐severe psoriasis, regardless of prior exposure to biologics or NBS. Secukinumab had a comparable safety profile to both etanercept and ustekinumab.
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Affiliation(s)
- P Hampton
- Newcastle Dermatology, Newcastle Hospitals NHS Trust, Newcastle Upon Tyne, UK
| | - A Halliday
- Novartis Pharmaceuticals UK Limited, Surrey, UK
| | - M Aassi
- Novartis Pharma AG, Basel, Switzerland
| | | | - M Jain
- Novartis Healthcare Pvt. Ltd, Hyderabad, India
| | - C E M Griffiths
- Centre for Dermatology, The University of Manchester and NIHR Manchester Biomedical Research Centre, Manchester, UK
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32
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Nast A, Smith C, Spuls P, Avila Valle G, Bata‐Csörgö Z, Boonen H, De Jong E, Garcia‐Doval I, Gisondi P, Kaur‐Knudsen D, Mahil S, Mälkönen T, Maul J, Mburu S, Mrowietz U, Reich K, Remenyik E, Rønholt K, Sator P, Schmitt‐Egenolf M, Sikora M, Strömer K, Sundnes O, Trigos D, Van Der Kraaij G, Yawalkar N, Dressler C. EuroGuiDerm Guideline on the systemic treatment of Psoriasis vulgaris – Part 2: specific clinical and comorbid situations. J Eur Acad Dermatol Venereol 2021; 35:281-317. [DOI: 10.1111/jdv.16926] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Accepted: 08/13/2020] [Indexed: 12/15/2022]
Affiliation(s)
- A. Nast
- Charité – Universitätsmedizin Berlin Corporate Member of Freie Universität Berlin Department of Dermatology, Venereology and Allergology Humboldt‐Universität zu Berlin, and Berlin Institute of Health Berlin Germany
| | - C. Smith
- St John’s Institute of Dermatology London UK
| | - P.I. Spuls
- Academic Medical Centre Amsterdam Amsterdam Netherlands
| | - G. Avila Valle
- Charité – Universitätsmedizin Berlin Corporate Member of Freie Universität Berlin Department of Dermatology, Venereology and Allergology Humboldt‐Universität zu Berlin, and Berlin Institute of Health Berlin Germany
| | | | - H. Boonen
- Office‐Based Dermatology Practice Geel Belgium
| | - E. De Jong
- Radboud University Medical Centre Nijmegen Nijmegen Netherlands
| | - I. Garcia‐Doval
- Unidad de Investigación. Fundación Piel Sana AEDV Madrid Spain
| | | | | | - S. Mahil
- Guy's and St Thomas' NHS Foundation Trust London UK
| | - T. Mälkönen
- Helsinki University Central Hospital Helsinki Finland
| | - J.T. Maul
- Department of Dermatology University Hospital of Zürich Zürich Switzerland
| | - S. Mburu
- International Federation of Psoriasis Associations (IFPA)
| | - U. Mrowietz
- Universitätsklinikum Schleswig‐Holstein Kiel Germany
| | - K. Reich
- Translational Research in Inflammatory Skin Diseases Institute for Health Services Research in Dermatology and Nursing University Medical Center Hamburg‐Eppendorf Hamburg Germany
| | | | | | - P.G. Sator
- Municipal Hospital Hietzing Vienna Austria
| | - M. Schmitt‐Egenolf
- Dermatology Department of Public Health & Clinical Medicine Umeå University Umeå Sweden
| | - M. Sikora
- Department of Dermatology Medical University of Warsaw Warsaw Poland
| | - K. Strömer
- Office‐Based Dermatology Practice Mönchengladbach Germany
| | | | - D. Trigos
- International Federation of Psoriasis Associations (IFPA)
| | | | - N. Yawalkar
- Department of Dermatology, Inselspital Bern University HospitalUniversity of Bern Bern Switzerland
| | - C. Dressler
- Charité – Universitätsmedizin Berlin Corporate Member of Freie Universität Berlin Department of Dermatology, Venereology and Allergology Humboldt‐Universität zu Berlin, and Berlin Institute of Health Berlin Germany
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33
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Hu MY, Yang Q, Zheng J. The association of psoriasis and hypertension: focusing on anti‐inflammatory therapies and immunological mechanisms. Clin Exp Dermatol 2020; 45:836-840. [DOI: 10.1111/ced.14327] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Revised: 05/09/2020] [Accepted: 05/11/2020] [Indexed: 12/18/2022]
Affiliation(s)
- M. Y. Hu
- Department of Dermatology Rui Jin HospitalShanghai Jiao Tong University School of Medicine Shanghai China
| | - Q. Yang
- Department of Dermatology Rui Jin HospitalShanghai Jiao Tong University School of Medicine Shanghai China
| | - J. Zheng
- Department of Dermatology Rui Jin HospitalShanghai Jiao Tong University School of Medicine Shanghai China
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34
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Wang HN, Huang YH. Changes in metabolic parameters in psoriatic patients treated with secukinumab. Ther Adv Chronic Dis 2020; 11:2040622320944777. [PMID: 32821362 PMCID: PMC7412909 DOI: 10.1177/2040622320944777] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Accepted: 06/26/2020] [Indexed: 12/18/2022] Open
Abstract
Background: Psoriasis is associated with cardiovascular disease and metabolic syndrome but the effects of interleukin (IL)-17A inhibitor treatment on metabolic parameters are unknown. This study aimed to determine the effects of secukinumab on metabolic parameters based on the disease activity and treatment response in patients with psoriasis. Methods: In this retrospective study, we included 99 patients with moderate to severe psoriasis, who received IL-17 inhibitor (secukinumab) treatment for 24 weeks between January 2016 and February 2020. The disease activity [Psoriasis Area and Severity Index (PASI)] and metabolic parameters at baseline and after 12 or 24 weeks of treatment were collected. Results: The PASI improved with a significant reduction of high-sensitivity C-reactive protein (hs-CRP) at weeks 12 and 24 respectively. However, body weight and body mass index were significantly increased at week 12 and 24 of treatment. Triglycerides level and atherogenic index of plasma were significantly higher in week 24 in PASI-90 non-responders. The baseline hs-CRP level and PASI-90 non-response correlated with elevated triglyceride levels. Conclusion: Our results suggest that obesity and hypertriglyceridemia still existed in patients despite the improved disease activity after secukinumab treatment. Higher baseline hs-CRP level and PASI-90 non-response were predictors for elevated triglyceride levels after treatment. Therefore, patient education, regular screening of the lipid profile, and weight control are recommended during the treatment of secukinumab.
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Affiliation(s)
- Hsuan Ning Wang
- Department of Dermatology, Chang Gung Memorial Hospital, Linkou Branch, College of Medicine, Chang Gung University, Taiwan
| | - Yu Huei Huang
- Department of Dermatology, Chang Gung Memorial Hospital, Linkou Branch, College of Medicine, Chang Gung University No.5, Fuxing St., Guishan Dist., Taoyuan City 333, Taiwan
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35
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Feldman SR, Zhang J, Martinez DJ, Lopez-Gonzalez L, Marchlewicz EH, Shrady G, Mendelsohn AM, Zhao Y. Real-world treatment patterns and healthcare costs of biologics and apremilast among patients with moderate-to-severe plaque psoriasis by metabolic condition status. J DERMATOL TREAT 2019; 32:203-211. [DOI: 10.1080/09546634.2019.1698699] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
| | | | | | | | | | | | | | - Yang Zhao
- Sun Pharmaceutical Industries, Princeton, NJ, USA
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