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Miyazaki C, Masuda J, Rodriguez-Rey MD, Stelmaszuk MN, Freilich J, Tsai PIC, Saeki H. Real-world biologic treatment patterns and healthcare resource utilization in psoriasis patients using an insurance claims database in Japan. J DERMATOL TREAT 2024; 35:2299598. [PMID: 38317525 DOI: 10.1080/09546634.2023.2299598] [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: 10/04/2023] [Accepted: 12/11/2023] [Indexed: 02/07/2024]
Abstract
BACKGROUND With advent of newer treatments for psoriasis, real-world use of biologics in Japan is evolving. METHODS This retrospective study utilized data from patients with ≥1 psoriasis-related biologic claims record between January 2016 and December 2020 in Japan to evaluate treatment patterns, healthcare resource utilization (HCRU), and associated costs. Data were analyzed using descriptive statistics. RESULTS Of 1,614 eligible patients, 72.5% were male, 29.2% had comorbid hypertension and 26.6% had comorbid cardiovascular disease. Interleukin (IL)-17 and tumor necrosis factor alpha (TNFα) inhibitors were commonly prescribed across lines of treatment, while IL-23 inhibitors were most considered for switches (92% of switches were from IL-12/23/IL-17/TNFα inhibitors). The overall mean adherence rate for all classes was 80.1%, but adherence varied across biologics. Infliximab and IL-23 inhibitor users exhibited optimal medical possession ratios, reflecting the best adherence rates. Overall HCRU (visits/patient-year) was 9.05 for outpatient visits, 0.09 for inpatient hospitalization, and 0.5 for psoriasis-related phototherapy. HCRU associated with hospitalization was slightly higher for bio-experienced patients and so was the overall costs per patient-year relative to bio-naïve patients. CONCLUSION Variable adherence rates observed suggest the need for improvement in treatment management with different biologics. Bio-experienced patients burdened by disease progression and treatment switches may result in increased HCRU.
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Affiliation(s)
- Celine Miyazaki
- Value, Evidence and Access Department, Janssen Pharmaceutical K.K., Tokyo, Japan
| | - Junya Masuda
- Medical Affairs Division, Immunology and Infectious Disease Department, Janssen Pharmaceutical K.K., Tokyo, Japan
| | | | | | - Jonatan Freilich
- Parexel International, Stockholm, Sweden
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Phiona I-Ching Tsai
- Value, Evidence and Access Department, Janssen Pharmaceutical K.K., Tokyo, Japan
| | - Hidehisa Saeki
- Department of Dermatology, Nippon Medical School, Tokyo, Japan
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Dilokthornsakul P, Sawangjit R, Noppakun N, Rajatanavin N, Pattamadilok B, Chularojanamontri L, Permsuwan U. Sequential interleukin-17 inhibitors for moderate-to-severe plaque psoriasis who have an IL-17 inhibitors failure in a resource limited country: An economic evaluation. PLoS One 2024; 19:e0307050. [PMID: 39121033 PMCID: PMC11315331 DOI: 10.1371/journal.pone.0307050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Accepted: 06/26/2024] [Indexed: 08/11/2024] Open
Abstract
BACKGROUND Biologics has been known to be effective for patients with psoriasis. However, optimal treatment pathways and their cost-effectiveness are limited in a resource-limited country. This study assessed the cost-effectiveness of different sequential biologics for moderate-to-severe plaque psoriasis. METHOD A hybrid model from a societal perspective was used. Model inputs were derived from network meta-analysis, clinical trials, and published literature. Three different sequential biologic treatments were assessed; Sequence 1; 1st Interleukin-17 (IL-17) inhibitor (secukinumab) followed by 2nd IL-17 inhibitors (ixekizumab or brodalumab), then 3rd IL-23 inhibitor (guselkumab), Sequence 2; ixekizumab followed by secukinumab or brodalumab, then guselkumab, and Sequence 3; brodalumab followed by ixekizumab or secukinumab, then guselkumab. Methotrexate or ciclosporin was used as standard of care (SoC). RESULTS All three different sequential biologic therapies could gain total quality-adjusted life year (QALY), but they had higher cost than SoC. Sequence 1 had the lowest incremental cost-effectiveness ratio (ICER) compared to SoC at 621,373 THB/QALY (19,449 $/QALY). ICER for Sequence 2 was 957,258 THB/QALY (29,962 $/QALY), while that for Sequence 3 was 1,332,262 THB/QALY (41,700 $/QALY). Fully incremental analysis indicated that Sequence 3 was dominated by Sequence 1 and Sequence 2. ICER for Sequence 2 was 7,206,104 THB/QALY (225,551 $/QALY) when compared to Sequence 1. CONCLUSION At the current willingness-to-pay of 160,000 THB/QALY, no sequential IL-17 inhibitor was cost-effective compared to SoC. Secukinumab followed by ixekizumab or brodalumab then guselkumab (Sequence 1) may be the most appropriate option compared with other treatments.
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Affiliation(s)
- Piyameth Dilokthornsakul
- Department of Pharmaceutical Care, Center for Medical and Health Technology Assessment (CM-HTA), Faculty of Pharmacy, Chiang Mai University, Chiang Mai, Thailand
- Department of Pharmacy Practice, Center of Pharmaceutical Outcomes Research, Faculty of Pharmaceutical Sciences, Naresuan University, Mueang, Phitsanulok, Thailand
| | - Ratree Sawangjit
- Clinical Trial and Evidence-Based Synthesis Research Unit (CTEBs RU), Mahasarakham University, Mahasarakham, Thailand
- Department of Clinical Pharmacy, Faculty of Pharmacy, Mahasarakham University, Mahasarakham, Thailand
| | - Nopadon Noppakun
- Division of Dermatology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Pathumwan, Bangkok, Thailand
| | - Natta Rajatanavin
- Division of Dermatology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Ratchathewi, Bangkok, Thailand
| | - Bensachee Pattamadilok
- Department of Medical Services, Institute of Dermatology, Ministry of Public Health, Ratchathewi, Bangkok, Thailand
| | - Leena Chularojanamontri
- Department of Dermatology, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok Noi, Bangkok, Thailand
| | - Unchalee Permsuwan
- Department of Pharmaceutical Care, Center for Medical and Health Technology Assessment (CM-HTA), Faculty of Pharmacy, Chiang Mai University, Chiang Mai, Thailand
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Lebwohl M, Strober B, Schrader A, Li AH, Eckmann T, Zhu B, Malatestinic WN, Birt J, Feely M, Blauvelt A. Six-Month Real-World Study to Assess the Effectiveness of Ixekizumab After Switching from IL-23 Inhibitors and Other Biologic Therapies: The CorEvitas Psoriasis Registry. Drugs Real World Outcomes 2024:10.1007/s40801-024-00439-w. [PMID: 38914857 DOI: 10.1007/s40801-024-00439-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/03/2024] [Indexed: 06/26/2024] Open
Abstract
BACKGROUND Prior work showed that patients from the CorEvitas Psoriasis Registry who had previously failed a prior biologic and then initiated ixekizumab demonstrated improvements in disease severity and patient-reported outcomes after 6 months. However, newer therapies such as interleukin-23 inhibitors (IL-23i) were not considered. Here, with more recent data including IL-23i, 6-month effectiveness of ixekizumab following a switch from any biologic was assessed as well as whether 6-month effectiveness of ixekizumab was impacted by prior biologic class. METHODS We included CorEvitas Psoriasis Registry patients who initiated ixekizumab after discontinuing another biologic therapy and had a corresponding 6-month follow-up visit following ixekizumab initiation (N = 743, 2016-2023). Immediate prior biologic class was categorized as tumor necrosis factor inhibitor (TNFi) or interleukin-12/23 inhibitors (IL-12/23i, n = 405), non-ixekizumab interleukin-17i (IL-17i, n = 237), or IL-23i (n = 101). Adjusted mean changes in body surface area (BSA), Dermatology Life Quality Index (DLQI), itch, and skin pain were calculated for prior biologic class groups using analysis of covariance (ANCOVA). Proportions achieving ≥ 75%, ≥ 90%, and ≥ 100% improvement in Psoriasis Area and Severity Index (PASI75, PASI90, and PASI100, respectively), Investigator's Global Assessment (IGA) 0/1, and DLQI 0/1 were calculated for all patients and compared among prior biologic classes via relative risks (RRs) and 95% confidence intervals (CIs) using multivariable modified Poisson regression. RESULTS Mean improvements in BSA, DLQI, itch, and skin pain, were 7.6, 3.6, 23.3, and 16.7, respectively, for ixekizumab patients who switched from TNFi or IL-12/23i (all p < 0.05); 6.8, 3.3, 19.6, and 14.1, respectively, for those who switched from non-ixekizumab IL-17i (all p < 0.05); and 7.8, 3.4, 22.2, and 12.8, respectively, for those who switched from IL-23i (all p < 0.05). Overall, 54%, 41%, and 31% of ixekizumab initiators achieved PASI75, PASI90, and PASI100, respectively, 50% maintained or achieved IGA 0/1, and 48% maintained or achieved DLQI 0/1. The prior TNFi or IL-12/23i group was 31% more likely to achieve PASI100 (RR = 1.31, 95% CI 1.01, 1.69) and 32% more likely to maintain or achieve IGA 0/1 (RR = 1.32, 95% CI 1.11, 1.57), but not significantly more likely to achieve PASI90. The prior IL-23i group was 45% more likely to achieve PASI90 (RR = 1.45, 95% CI 1.10, 1.91), 55% more likely to achieve PASI100 (RR = 1.55, 95% CI 1.12, 2.13), and 39% more likely to maintain or achieve IGA 0/1 (RR = 1.39, 95% CI 1.12, 1.73) compared to the prior non-ixekizumab IL-17i group. Achievement of PASI75 and DLQI 0/1 was consistent across the prior TNFi or IL-12/23i, IL-23i, and non-ixekizumab IL-17i groups. CONCLUSIONS These updated findings with IL-23i data reaffirm that patients with psoriasis who switch to ixekizumab after discontinuing another biologic demonstrate improvement in disease severity and patient-reported outcomes at 6 months in real-world settings. Compared to patients who switched from another IL-17i, patients who switched class from a TNFi or IL-12/23i were more likely to achieve PASI100 and IGA 0/1, and patients who switched class from an IL-23i were more likely to achieve PASI90 in addition to PASI100 and IGA 0/1.
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Affiliation(s)
- Mark Lebwohl
- Icahn School of Medicine at Mount Sinai, New York, NY, USA.
| | - Bruce Strober
- Yale University School of Medicine, New Haven, CT, USA
| | | | | | | | - Baojin Zhu
- Eli Lilly and Company, Indianapolis, IN, USA
| | | | - Julie Birt
- Eli Lilly and Company, Indianapolis, IN, USA
| | - Meghan Feely
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Eli Lilly and Company, Indianapolis, IN, USA
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Tada Y, Soliman AM, Ishii K, Sakuma R, Puig L, Davis M, Nunag D, Pinter A, Imafuku S. Real-World Discontinuation and Switching Patterns for Interleukin-Inhibitor Treatments in Patients with Moderate-to-Severe Psoriasis in Japan. Dermatol Ther (Heidelb) 2024; 14:99-114. [PMID: 38019410 PMCID: PMC10828160 DOI: 10.1007/s13555-023-01064-1] [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: 08/18/2023] [Accepted: 10/25/2023] [Indexed: 11/30/2023] Open
Abstract
INTRODUCTION Patients with moderate-to-severe psoriasis (PsO) treated with interleukin (IL)-inhibitors may require treatment modification to achieve disease control. This study evaluated discontinuation and switching of IL-inhibitors for PsO patients in Japan. METHODS Japan Medical Data Center claims (1/2005-5/2022) were used to identify patients with PsO diagnosis preceding a first IL-inhibitor claim (index date) with ≥ 6 months of eligibility prior. Treatment switch (claim for another biologic) and discontinuation (gap in care ≥ 150% of the days' supply of the preceding prescription) were assessed up to 24 months following initiation. Censored Kaplan-Meier time-to-event analyses calculated rates, and Cox proportional hazards models estimated hazard ratios (HRs) adjusting for baseline characteristics. RESULTS The study included 1481 unique patients treated with brodalumab (BRO; n = 159), guselkumab (GUS; n = 360), ixekizumab (IXE; n = 279), risankizumab (RIS; n = 327), secukinumab (SEC; n = 366), tildrakizumab (n = 40; excluded due to limited data), and ustekinumab (UST; n = 262). At 12/24 months, 25.9%/38.6% of patients overall had discontinued their index IL-inhibitor and 13.5%/21.2% had switched to another biologic. Discontinuation at 12/24 months was lowest for RIS (11.2%/17.4%), followed by UST (17.9%/32.2%), IXE (27.0%/37.0%), GUS (29.8%/43.0%), SEC (35.6%/53.8%), and BRO (37.2%/47.2%). Switching showed a similar trend: RIS (5.7%/10.7%), UST (11.2%/19.9%), SEC (14.7%/25.7%), IXE (14.8%/21.5%), GUS (16.9%/23.2%), and BRO (19.7%/26.8%). HRs of discontinuation relative to RIS were 2.07 for UST, 2.59 for IXE, 2.70 for GUS, 3.65 for BRO, and 3.69 for SEC (all P ≤ 0.001). HRs of switching relative to RIS were 2.05 for IXE, 2.45 for GUS, 2.67 for SEC, 2.73 for UST, and 2.77 for BRO (all P ≤ 0.01). CONCLUSION Treatment modification of IL-inhibitors for PsO was commonly observed and could indicate insufficient disease control and/or incremental economic burden. Discontinuation and switching rates were lowest for RIS regardless of time point and adjustment for patient characteristics.
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Affiliation(s)
- Yayoi Tada
- Teikyo University School of Medicine, Tokyo, Japan
| | - Ahmed M Soliman
- AbbVie, Inc., 1 North Waukegan Road, North Chicago, IL, 60064, USA.
| | | | | | - Luis Puig
- Department of Dermatology, IIB SANTPAU, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Carrer de Sant Quintí, 89, 08041, Barcelona, Spain
| | | | | | - Andreas Pinter
- Department of Dermatology, Venereology and Allergology, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Shinichi Imafuku
- Department of Dermatology, Fukuoka University Faculty of Medicine, Fukuoka, Japan
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Huang Y, Mao CR, Lou Y, Zhan S, Chen Z, Ding W, Ma Z. Design, Synthesis, and Biological Evaluation of an Orally Bioavailable, Potent, and Selective ROCK2 Inhibitor for Psoriasis Treatment. J Med Chem 2023; 66:15205-15229. [PMID: 37943013 DOI: 10.1021/acs.jmedchem.3c01297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2023]
Abstract
Psoriasis, a prevalent chronic skin disorder, remains a significant therapeutic obstacle. This study centers on rho-associated coiled-coil-containing kinase2 (ROCK2) as an advantageous target for treating psoriasis and identifies five potent and selective ROCK2 inhibitors (A31-35). Notably, A32-35 outperform KD025 in ROCK2/ROCK1 selectivity by up to 216-fold. Among these candidates, A31 emerged as an exceedingly promising molecule, showcasing remarkable inhibitory potency (IC50 = 3.7 ± 0.8 nM), 19-fold ROCK2/ROCK1 selectivity, and favorable pharmacokinetics. Insights from the binding mode study further underscored the pivotal role of interactions with Phe103 on the P-loop in determining the selectivity between ROCK1 and ROCK2. In an imiquimod-induced psoriasis-like mouse model, oral administration of A31 notably ameliorated symptoms by targeting the IL-23/Th17 axis. Based on these compelling findings, A31 was selected as a highly promising compound for further investigation as a potential treatment for psoriasis.
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Affiliation(s)
- Yun Huang
- Institute of Marine Biology and Pharmacology, Ocean College, Zhejiang University, Zhoushan 316021, China
| | - Chu-Ru Mao
- Institute of Marine Biology and Pharmacology, Ocean College, Zhejiang University, Zhoushan 316021, China
| | - Yijie Lou
- Key Laboratory of Digestive Pathophysiology of Zhejiang Province, the First Affiliated Hospital of Zhejiang Chinese Medicine, Zhejiang Chinese Medical University, Hangzhou 310053, China
| | - Shuai Zhan
- Institute of Marine Biology and Pharmacology, Ocean College, Zhejiang University, Zhoushan 316021, China
| | - Zhe Chen
- Key Laboratory of Digestive Pathophysiology of Zhejiang Province, the First Affiliated Hospital of Zhejiang Chinese Medicine, Zhejiang Chinese Medical University, Hangzhou 310053, China
| | - Wanjing Ding
- Institute of Marine Biology and Pharmacology, Ocean College, Zhejiang University, Zhoushan 316021, China
- Hainan Institute of Zhejiang University, Sanya 572025, China
| | - Zhongjun Ma
- Institute of Marine Biology and Pharmacology, Ocean College, Zhejiang University, Zhoushan 316021, China
- Hainan Institute of Zhejiang University, Sanya 572025, China
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Shin JO, Shin BS, Bae KN, Shin K, Kim HS, Ko HC, Kim MB, Kim B. Review of the reasons for and effectiveness of switching biologics for psoriasis treatment in Korea. Indian J Dermatol Venereol Leprol 2023; 89:928. [PMID: 37317715 DOI: 10.25259/ijdvl_308_2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Accepted: 04/06/2023] [Indexed: 06/16/2023]
Abstract
Background Switching of biologics in patients has become common in clinical practice. Objectives This study investigated the reasons for and effectiveness of switching biologic agents during the treatment of psoriasis. Methods We retrospectively reviewed patients with psoriasis who were treated with biologics at Pusan National University Hospital and Chosun University Hospital from March 2012 to June 2020. We assessed their demographics and treatment characteristics (reasons for switching biologics and efficacy of the first- and second biologic agents). Results Of the 162 psoriatic patients treated with biologic agents for more than 52 weeks, 35 required a switch to another biologic agent. The reasons for switching biologic agents were inefficacy (n = 30), adverse events (n = 2) and others (n = 3). The mean psoriasis area and severity index (PASI) score was 12.1 at the start of the second biologic and 3.4 at 14-16 weeks later. Patients were more likely to switch to another biologic agent when they exhibited a high initial psoriasis area and severity index score and concomitant psoriatic arthritis. Limitations As a retrospective study, there were some limitations such as lack of a placebo control group and the time point of 14-16 weeks being somewhat early to judge the effect of the biologics. Conclusions The most common reason for switching biologic agents in Korea was treatment inefficacy, especially secondary failure. Despite the inefficacy of previous biologic agents, switching to a different agent may be an efficacious approach.
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Affiliation(s)
- Jun-Oh Shin
- Department of Dermatology, Pusan National University Yangsan Hospital, Yangsan, Republic of Korea
| | - Bong Seok Shin
- Department of Dermatology, Chosun University Hospital, Gwangju, Republic of Korea
| | - Kyung-Nam Bae
- Department of Dermatology, Pusan National University Hospital, Busan, Republic of Korea
| | - Kihyuk Shin
- Department of Dermatology, Pusan National University Yangsan Hospital, Yangsan, Republic of Korea
| | - Hoon-Soo Kim
- Department of Dermatology, Pusan National University Hospital, Busan, Republic of Korea
| | - Hyun-Chang Ko
- Department of Dermatology, Pusan National University Yangsan Hospital, Yangsan, Republic of Korea
| | - Moon-Bum Kim
- Department of Dermatology, Pusan National University Hospital, Busan, Republic of Korea
| | - Byungsoo Kim
- Department of Dermatology, Pusan National University Hospital, Busan, Republic of Korea
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Lee HJ, Kim M. Challenges and Future Trends in the Treatment of Psoriasis. Int J Mol Sci 2023; 24:13313. [PMID: 37686119 PMCID: PMC10487560 DOI: 10.3390/ijms241713313] [Citation(s) in RCA: 23] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Revised: 08/24/2023] [Accepted: 08/24/2023] [Indexed: 09/10/2023] Open
Abstract
Psoriasis is a chronic inflammatory skin disorder, and current treatments include topical therapies, phototherapy, systemic immune modulators, and biologics, aiming to alleviate symptoms and improve quality of life. However, challenges persist, such as adverse effects, treatment resistance, high costs, and variability in response among individuals. The future of psoriasis treatment shows promising emerging trends. New biologic agents targeting novel pathways, such as interleukin 23 inhibitors like mirikizumab, offer enhanced efficacy. Small molecule inhibitors like RORγt inhibitors and ROCK2 inhibitors provide additional treatment options. Combination therapies, including biologics with methotrexate, may improve treatment response. Advancements in topical treatments utilizing microneedles and nanoparticle-based carriers can enhance drug delivery and improve therapeutic outcomes. Biomarkers and multi-omics technologies hold potential for personalized treatment approaches, thus aiding in diagnosis, predicting treatment response, and guiding therapeutic decisions. Collaboration among researchers, clinicians, and industry stakeholders is crucial to translating these scientific breakthroughs into clinical practice. By addressing current challenges and exploring these promising trends, we can optimize psoriasis management and improve the lives of those affected by this chronic condition.
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Affiliation(s)
| | - Miri Kim
- Department of Dermatology, Yeouido St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Yeongdeungpo-gu, Seoul 07345, Republic of Korea;
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Zhan YP, Chen BS. Drug Target Identification and Drug Repurposing in Psoriasis through Systems Biology Approach, DNN-Based DTI Model and Genome-Wide Microarray Data. Int J Mol Sci 2023; 24:10033. [PMID: 37373186 DOI: 10.3390/ijms241210033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 06/08/2023] [Accepted: 06/10/2023] [Indexed: 06/29/2023] Open
Abstract
Psoriasis is a chronic skin disease that affects millions of people worldwide. In 2014, psoriasis was recognized by the World Health Organization (WHO) as a serious non-communicable disease. In this study, a systems biology approach was used to investigate the underlying pathogenic mechanism of psoriasis and identify the potential drug targets for therapeutic treatment. The study involved the construction of a candidate genome-wide genetic and epigenetic network (GWGEN) through big data mining, followed by the identification of real GWGENs of psoriatic and non-psoriatic using system identification and system order detection methods. Core GWGENs were extracted from real GWGENs using the Principal Network Projection (PNP) method, and the corresponding core signaling pathways were annotated using the Kyoto Encyclopedia of Genes and Genomes (KEGG) pathways. Comparing core signaling pathways of psoriasis and non-psoriasis and their downstream cellular dysfunctions, STAT3, CEBPB, NF-κB, and FOXO1 are identified as significant biomarkers of pathogenic mechanism and considered as drug targets for the therapeutic treatment of psoriasis. Then, a deep neural network (DNN)-based drug-target interaction (DTI) model was trained by the DTI dataset to predict candidate molecular drugs. By considering adequate regulatory ability, toxicity, and sensitivity as drug design specifications, Naringin, Butein, and Betulinic acid were selected from the candidate molecular drugs and combined into potential multi-molecule drugs for the treatment of psoriasis.
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Affiliation(s)
- Yu-Ping Zhan
- Laboratory of Automatic Control, Signal Processing and Systems Biology, Department of Electrical Engineering, National Tsing Hua University, Hsinchu 30013, Taiwan
| | - Bor-Sen Chen
- Laboratory of Automatic Control, Signal Processing and Systems Biology, Department of Electrical Engineering, National Tsing Hua University, Hsinchu 30013, Taiwan
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Outcomes in Ixekizumab Patients Following Exposure to Secukinumab and Other Biologics in the CorEvitas Psoriasis Registry. Dermatol Ther (Heidelb) 2022; 12:2797-2815. [DOI: 10.1007/s13555-022-00834-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Accepted: 10/11/2022] [Indexed: 11/06/2022] Open
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10
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Curmin R, Guillo S, De Rycke Y, Bachelez H, Beylot‐Barry M, Beneton N, Chosidow O, Dupuy A, Joly P, Jullien D, Richard M, Viguier M, Sbidian E, Paul C, Mahé E, Tubach F. Switches between biologics in patients with moderate-to-severe psoriasis: results from the French cohort PSOBIOTEQ. J Eur Acad Dermatol Venereol 2022; 36:2101-2112. [PMID: 35793473 PMCID: PMC9796114 DOI: 10.1111/jdv.18409] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Accepted: 05/18/2022] [Indexed: 01/01/2023]
Abstract
BACKGROUND Biologics are the cornerstone of treatment of patients with moderate-to-severe plaque psoriasis and switches between biologics are frequently needed to maintain clinical improvement over time. OBJECTIVES The main purpose of this study was to describe precisely switches between biologics and how their pattern changed over time with the recent availability of new biologic agents. METHODS We included patients receiving a first biologic agent in the Psobioteq multicenter cohort of adults with moderate-to-severe psoriasis receiving systemic treatment. We described switches between biologics with chronograms, Sankey and Sunburst diagrams, assessed cumulative incidence of first switch by competing risks survival analysis and reasons for switching. We assessed the factors associated with the type of switch (intra-class - i.e. within the same therapeutic class - vs. inter-class) in patients switching from a TNF-alpha inhibitor using multivariate logistic regression. RESULTS A total of 2153 patients was included. The cumulative incidence of switches from first biologic was 34% at 3 years. Adalimumab and ustekinumab were the most prescribed biologic agents as first and second lines of treatment. The main reason for switching was loss of efficacy (72%), followed by adverse events (11%). Patients receiving a TNF-alpha inhibitor before 2016 mostly switched to ustekinumab, whereas those switching in 2016 or after mostly switched to an IL-17 inhibitor. Patients switching from a first-line TNF-alpha inhibitor before 2016 were more likely to switch to another TNF-alpha inhibitor compared with patients switching since 2018. Patients switching from etanercept were more likely to receive another TNF-alpha inhibitor rather than another therapeutic class of bDMARD compared with patients switching from adalimumab. CONCLUSION This study described the switching patterns of biologic treatments and showed how they changed over time, due to the availability of the new biologic agents primarily IL-17 inhibitors.
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Affiliation(s)
- R. Curmin
- Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé PubliqueParisFrance
| | - S. Guillo
- INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, AP‐HP, Hôpital Pitié Salpêtrière, Département de Santé Publique, Centre de Pharmacoépidémiologie (Cephepi)Sorbonne UniversitéParisFrance
| | - Y. De Rycke
- INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, AP‐HP, Hôpital Pitié Salpêtrière, Département de Santé Publique, Centre de Pharmacoépidémiologie (Cephepi)Sorbonne UniversitéParisFrance
| | - H. Bachelez
- Dermatologie, AP‐HP Hôpital Saint LouisParisFrance,Sorbonne Paris Cité Universitaire Paris DiderotParisFrance,UMR INSERM 1163, Institut ImagineParisFrance
| | - M. Beylot‐Barry
- Dermatologie CHU Bordeaux & INSERM U 1053Bordeaux UniversityBordeauxFrance
| | | | - O. Chosidow
- Dermatologie, AP‐HP, Hôpitaux universitaires Henri Mondor, Département de Dermatologie, UPEC, INSERM, Centre d'Investigation Clinique 1430, EA 7379 EpidermEUniversité Paris‐Est Créteil, UPECCréteilFrance
| | - A. Dupuy
- DermatologieCHU PontchaillouRennesFrance
| | - P. Joly
- DermatologieCHU RouenRouenFrance
| | - D. Jullien
- Dermatologie, Hospices Civils de Lyon, Hôpital E. HerriotUniversité Lyon‐1LyonFrance
| | - M.A. Richard
- Dermatologie, EA 3279: CEReSS ‐ Health Service Research and Quality of Life Center, Timone Hospital, Assistance Publique Hôpitaux de MarseilleAix‐Marseille UniversityMarseilleFrance
| | - M. Viguier
- Dermatologie‐VénéréologieHôpital Robert DebréReimsFrance
| | - E. Sbidian
- Dermatologie, AP‐HP, Hôpitaux universitaires Henri Mondor, Département de Dermatologie, UPEC, INSERM, Centre d'Investigation Clinique 1430, EA 7379 EpidermEUniversité Paris‐Est Créteil, UPECCréteilFrance
| | - C. Paul
- DermatologieCHU and Toulouse UniversityToulouseFrance
| | - E. Mahé
- DermatologieHôpital Victor DupouyArgenteuilFrance
| | - F. Tubach
- INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, AP‐HP, Hôpital Pitié Salpêtrière, Département de Santé Publique, Centre de Pharmacoépidémiologie (Cephepi)Sorbonne UniversitéParisFrance
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11
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Use of Biological Drugs for Psoriasis: A Drug-Utilization Study Using Tuscan Administrative Databanks. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19116799. [PMID: 35682382 PMCID: PMC9180218 DOI: 10.3390/ijerph19116799] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Revised: 05/18/2022] [Accepted: 05/31/2022] [Indexed: 12/05/2022]
Abstract
Our study aims at providing evidence on patterns of use of biologic drugs for psoriasis in Tuscany, Italy. We conducted a drug-utilization study based on administrative databanks of Tuscany (EUPAS45365) from 2011 to 2019. We selected new users of etanercept, infliximab, adalimumab, ustekinumab, or secukinumab between 1 January 2011 and 31 December 2016. We considered subjects with psoriasis and followed subjects until the end of the study period (three years after the first dispensation of biologic drug for psoriasis) or the patient’s death, whichever came first. We censored subjects for pregnancy or neoplasia. For each subject, we defined the state as the weekly coverage of one of the biologic drugs of interest. We then defined the switch as the change from a state to another one. A total of 7062 subjects with a first dispensation of a PSObio drug in the inclusion period was identified, and 1839 (52.9% female, 51.6 mean age) patients were included in the analysis. Among new users of adalimumab (N = 770, 41.9%), one third showed a continuous behaviour whereas the others moved to etanercept and ustekinumab. New users of etanercept (N = 758, 41.2%), had the highest proportion of switchers, with adalimumab most often being the second choice. New users of infliximab (N = 159, 8.6%) experienced the highest proportion of treatment discontinuation. The present study suggests that the majority of patients treated with PSObio drugs do not switch from one active ingredient to another. However, patients who started biological therapy with etanercept had the highest frequency of switching to other PSObio drugs, whereas those who started with secukinumab or ustekinumab had the lowest.
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12
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Kim M, Yang S, Kim BR, Youn SW. Epidermal Hyperproliferation With Less Prominent Dermal Inflammation Is the Unique Histopathological Feature of the Refractory Lesions in Psoriasis Treated With Ustekinumab. Am J Dermatopathol 2022; 44:267-271. [PMID: 34726183 DOI: 10.1097/dad.0000000000002094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
ABSTRACT Although ustekinumab (UST) shows excellent efficacy in treating psoriasis, not all patients have a complete clearance rate. The purpose of this study was to investigate the histopathological characteristics of refractory psoriasis lesions in patients with excellent response to UST. Fifty-seven patients with newly diagnosed psoriasis and 66 patients with a 75% reduction in the Psoriasis Area and Severity Index score after UST treatment were included. Computer-aided image analysis was performed to measure the epidermal thickness, horny layer thickness, number of dermal vessels, and dermal inflammatory cell infiltration rate. Parakeratosis was scored using a 4-point scale. These measurements were compared between the refractory lesions of UST-treated patients and the untreated lesions of newly diagnosed patients after the adjustment for confounding factors. The dermal inflammatory cell infiltration rate was significantly lower in the refractory lesions (P = 0.022). Meanwhile, the epidermal thickness, horny layer thickness, grade of parakeratosis, and dermal vessel count did not differ between the groups (P = 0.125, 0.719, 0.542, and 0.758, respectively). Subgroup analyses were performed within the UST-treated group after dividing them into 2 groups according to the number of treatments or treatment response rates. None of these features were significantly different between the subgroups. This study suggests that the reduction of dermal inflammation by UST was not sufficient to ameliorate the epidermal changes and implies the role of the interleukin-23-independent downstream cytokine pathway in causing the refractory lesions among patients who responded well to UST. The continuation of UST treatment might not further improve epidermal alterations.
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Affiliation(s)
- Minsu Kim
- Department of Dermatology, Seoul National University Bundang Hospital, Seongnam, Korea; and
| | - Seungkeol Yang
- Department of Dermatology, Seoul National University Bundang Hospital, Seongnam, Korea; and
| | - Bo Ri Kim
- Department of Dermatology, Seoul National University Bundang Hospital, Seongnam, Korea; and
| | - Sang Woong Youn
- Department of Dermatology, Seoul National University Bundang Hospital, Seongnam, Korea; and
- Department of Dermatology, Seoul National University College of Medicine, Seoul, Korea
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13
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Phan C, Beauchet A, Reguiai Z, Severino-Freire M, Mazereeuw-Hautier J, Bursztejn AC, Barbarot S, Hadj-Rabia S, Girard C, Phan A, Lacour JP, Lasek A, Abasq C, Brenaut E, Perrussel M, Droitcourt C, Mallet S, Piram M, Fougerousse AC, Barthélémy H, Balguérie X, Mahé E. Switching biologics in children with psoriasis: Results from the BiPe cohort. Pediatr Dermatol 2022; 39:35-41. [PMID: 34888920 DOI: 10.1111/pde.14845] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Revised: 09/28/2021] [Accepted: 10/09/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND There is currently little information on switching biologics in pediatric psoriasis. OBJECTIVE To evaluate the real-world clinical practice and safety of switching biologics in the "Biological Treatments for Pediatric Psoriasis" (BiPe) cohort. METHODS Data for all 134 patients included in the BiPe cohort were analyzed. A further evaluation of the subpopulation of patients who switched from a first-line biologic to a second-line biologic was then conducted. Drug survival rates were also compared between biologics given as first-line or second-line agents. RESULTS Overall, 29 patients (female: 55%; mean age: 16.6 ± 3.0 years) switched between two biologics. Etanercept (ETN) was the first-line biologic used in 23 patients: 16 (69.6%) switched to adalimumab (ADA) and seven (30.4%) to ustekinumab (UST). Six patients received first-line ADA and switched to UST. Loss of efficacy (62.1%), primary inefficacy (20.7%), and parental choice (6.9%) were the main reasons for switching biologics. One (3.4%) of the switches was performed because of adverse events or intolerance. For UST and ADA, the 18-month drug survival rate did not differ according to whether the agent was given as a first-line or second-line biologic (UST: P = .24; ADA: P = .68). No significant differences in drug survival rates were observed between the three different switches (ADA to UST, ETN to ADA, and ETN to UST). CONCLUSION Our study provided key insights into the real-life clinical practice of switching biologics in pediatric psoriasis patients. However, more information and guidance on switching biologics in pediatric psoriasis are needed to improve real-life practice and outcomes.
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Affiliation(s)
- Céline Phan
- Service de Dermatologie, Hôpital Victor Dupouy, Argenteuil, France
| | - Alain Beauchet
- Service de Santé Publique, Centre Hospitalier Universitaire Ambroise Paré, Assistance Publique-Hôpitaux de Paris, Boulogne-Billancourt, France
| | - Ziad Reguiai
- Service de Dermatologie, Polyclinique Courlancy, Hôpital Robert Debré, Reims, France
| | | | | | | | | | - Smaïl Hadj-Rabia
- Service de Dermatologie, INSERM U1163 & Institut Imagine, Centre Hospitalier Universitaire Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Université Paris Descartes - Sorbonne, Paris, France
| | - Céline Girard
- Service de Dermatologie, Centre Hospitalier Universitaire de Montpellier, Montpellier, France
| | - Alice Phan
- Service de Pédiatrie, Hôpital Femme-Mère-Enfant, Hospices Civils de Lyon, Bron, France
| | | | - Audrey Lasek
- Service de Dermatologie, Hôpital Saint Vincent de Paul, Université Catholique de Lille, Lille, France
| | - Claire Abasq
- Service de Dermatologie, Centre Hospitalier Universitaire de Brest, Brest, France
| | - Emilie Brenaut
- Service de Dermatologie, Centre Hospitalier Universitaire de Brest, Brest, France
| | - Marc Perrussel
- Service de Dermatologie, Centre Hospitalier Universitaire Pontchaillou, Université de Rennes, Rennes, France
| | - Catherine Droitcourt
- Service de Dermatologie, Centre Hospitalier Universitaire Pontchaillou, Université de Rennes, Rennes, France
| | - Stéphanie Mallet
- Service de Dermatologie, Vénéréologie et Cancérologie Cutanée, Hôpital de la Timone, Assistance-publique-Hôpitaux de Marseille, Marseille, France
| | - Maryam Piram
- Service de Dermatologie, Centre Hospitalier Universitaire de Bicêtre, Le Kremlin Bicêtre, France
| | | | | | - Xavier Balguérie
- Service de Dermatologie, Centre Hospitalier Universitaire Charles-Nicolle, Rouen, France
| | - Emmanuel Mahé
- Service de Dermatologie, Hôpital Victor Dupouy, Argenteuil, France
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14
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Gooderham MJ, Lynde C, Turchin I, Avadisian M, Labelle M, Papp KA. Real-world, long-term treatment patterns of commonly used biologics in Canadian patients with moderate-to-severe chronic plaque psoriasis. J Dermatol 2021; 49:95-105. [PMID: 34747071 PMCID: PMC9298415 DOI: 10.1111/1346-8138.16214] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Revised: 10/05/2021] [Accepted: 10/18/2021] [Indexed: 01/05/2023]
Abstract
Real‐world and long‐term data on biologic treatment changes – including switching, discontinuation, dose escalation, and interval change (both increasing and decreasing) – are required to understand treatment patterns for psoriasis (PsO) in Canada. The study objectives were to evaluate the time to first biologic treatment change and to document these changes in Canadian patients with moderate‐to‐severe chronic plaque PsO. Charts from 13 Canadian sites were queried retrospectively (2005–2019); a period covering all biologic classes commonly used for PsO in Canada. Included were patients diagnosed with, and currently using biologics for, moderate‐to‐severe chronic plaque PsO. Time to first treatment change, nature of treatment change, number of lines of treatment, proportion of patients on each drug, and drug survival were collected. Based on 1149 medical charts, adalimumab had the longest time to first treatment change (49.3 months; 95% confidence interval, 37.4–67.4). Approximately half of the patients had a treatment change, and nearly 75% of these changes were either an interval change or a biologic switch. Lack of efficacy was the most prevalent primary reason for biologic switch (67.3%), whereas 6.7% of patients switched due to adverse events. Drug survival for etanercept and infliximab was approximately twice as long for patients who had dose optimization (i.e., dose escalation or interval change) than patients without dose optimization. The survival curve of adalimumab was similar to the one of ustekinumab after 48 months of treatment, showing approximately 60% of patients remaining on treatment after 132 months, with or without dose optimization. Assessing treatment patterns of all commonly used biologics for moderate‐to‐severe chronic plaque PsO in Canada between 2005 and 2019 showed that approximately half of the patients required a treatment change (mainly interval change or biologic switch) while the other half remained on treatment.
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Affiliation(s)
- Melinda J Gooderham
- Probity Medical Research Inc., Waterloo, Ontario, Canada.,SkiN Centre for Dermatology, Peterborough, Ontario, Canada.,Queen's University, Kingston, Ontario, Canada
| | - Charles Lynde
- Probity Medical Research Inc., Waterloo, Ontario, Canada.,Lynderm Research Inc., Markham, Ontario, Canada.,University of Toronto, Toronto, Ontario, Canada
| | - Irina Turchin
- Probity Medical Research Inc., Waterloo, Ontario, Canada.,Brunswick Dermatology Center, Fredericton, New Brunswick, Canada.,Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | | | | | - Kim A Papp
- Probity Medical Research Inc., Waterloo, Ontario, Canada.,K. Papp Clinical Research, Waterloo, Ontario, Canada
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15
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Akdogan N, Dogan S, Bostan E, Gulseren D, Yalici-Armagan B, Elcin G, Evans SE, Karaduman A, Atakan N. Age and psoriatic arthritis are important predictors of biologic agent switch in psoriasis. Expert Rev Clin Pharmacol 2021; 14:1535-1541. [PMID: 34519227 DOI: 10.1080/17512433.2021.1979394] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND The demand of biologic switching is increasing for different reasons.We aimed to define reasons for switching biologics and possible predictors for switching risk,and to estimate data on drug survival. METHODS 115 patients treated with biologics who switched to a second, third,and/or fourth biologic were eligible for this retrospective study.Patients were divided into 2 groups as switched once,and switched twice or more.Drug survival rates were calculated using the Kaplan-Meier method. RESULTS All patients switched at least one, 36 patients switched twice, and 9 switched thrice. First-, second-, and third-line biologics were mostly switched due to secondary lack of efficacy for skin disease.Each unit increase in age decreased the risk of having ≥2 switches 4% (p=0.038,OR:0.964,95%CI:0.93-0.998),whereas PsA increased the risk of having ≥2 switches 2.69-fold (p=0.026,OR:2.69,95%CI:1.12-6.44).There was significant difference between biologics in terms of drug survival(p=0.001).Adalimumab had a lower drug survival compared to ustekinumab(p<0.001) and secukinumab(p=0.003) in transition from second-line biologic to third-line biologic. CONCLUSION Switching biologics was most commonly due to secondary lack of efficacy for skin disease.Lower ages and the presence of PsA were associated with a higher need for switching in long-term.Ustekinumab and secukinumab are superior to adalimumab in clinical practice in terms of drug survival of second-line biologics.
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Affiliation(s)
- Neslihan Akdogan
- Department of Dermatology and Venereology, Hacettepe University, School of Medicine, Ankara, Turkey
| | - Sibel Dogan
- Department of Dermatology and Venereology, Hacettepe University, School of Medicine, Ankara, Turkey
| | - Ecem Bostan
- Department of Dermatology and Venereology, Hacettepe University, School of Medicine, Ankara, Turkey
| | - Duygu Gulseren
- Department of Dermatology and Venereology, Hacettepe University, School of Medicine, Ankara, Turkey
| | - Basak Yalici-Armagan
- Department of Dermatology and Venereology, Hacettepe University, School of Medicine, Ankara, Turkey
| | - Gonca Elcin
- Department of Dermatology and Venereology, Hacettepe University, School of Medicine, Ankara, Turkey
| | - Sibel Ersoy Evans
- Department of Dermatology and Venereology, Hacettepe University, School of Medicine, Ankara, Turkey
| | - Aysen Karaduman
- Department of Dermatology and Venereology, Hacettepe University, School of Medicine, Ankara, Turkey
| | - Nilgun Atakan
- Department of Dermatology and Venereology, Hacettepe University, School of Medicine, Ankara, Turkey
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16
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Shi Z, Garcia-Melchor E, Wu X, Getschman AE, Nguyen M, Rowland DJ, Wilson M, Sunzini F, Akbar M, Huynh M, Law T, Kundu-Raychaudhuri SK, Raychaudhuri SP, Volkman BF, Millar NL, Hwang ST. Targeting the CCR6/CCL20 axis in entheseal and cutaneous inflammation. Arthritis Rheumatol 2021; 73:2271-2281. [PMID: 34081845 DOI: 10.1002/art.41882] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Accepted: 05/18/2021] [Indexed: 11/12/2022]
Abstract
OBJECTIVES To assess the involvement of the CCR6/CCL20 axis in psoriatic arthritis (PsA) and psoriasis (PsO) and to evaluate its potential as a therapeutic target. METHODS First, we quantified CCL20 levels in peripheral blood and synovial fluid of PsA patients and the presence of CCR6+ cells in synovial and tendon tissue. Utilizing an IL-23 minicircle DNA (MC) mouse model exhibiting key features of both PsO and PsA, we investigated CCR6 and CCL20 expression and the preventive and therapeutical effect of CCL20 blockade. Healthy tendon stromal cells were stimulated in vitro with IL-1β to assess the production of CCL20 by qPCR and ELISA. The effect of conditioned media from stimulated tenocytes in inducing T cell migration was interrogated with a transwell system. RESULTS We observed an upregulation of both CCR6 and CCL20 in the enthesis of IL-23 MC-treated mice, which was confirmed in human biopsies. Specific targeting of the CCR6/CCL20 axis with a CCL20 locked dimer (CCL20LD) blocked entheseal inflammation, leading to profound reductions in clinical and proinflammatory markers in the joints and skin of IL-23 MC-treated mice. The stromal compartment in the tendon was the main source of CCL20 in this model and accordingly, in vitro activated human tendon cells were able to produce this chemokine and to induce CCR6+ T cell migration, the latter of which could be blocked by CCL20LD. CONCLUSIONS Our studies highlight the pathogenic role of CCR6-CCL20 axis in enthesitis and raise the prospect of a novel therapeutic approach for treating patients with PsO and PsA.
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Affiliation(s)
- Zhenrui Shi
- Department of Dermatology, University of California, Davis, Sacramento, CA, USA.,Department of Dermatology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, China
| | - Emma Garcia-Melchor
- Institute of Infection, Immunity and Inflammation, College of Medicine, Veterinary and Life Sciences, University of Glasgow, UK
| | - Xuesong Wu
- Department of Dermatology, University of California, Davis, Sacramento, CA, USA
| | | | - Mimi Nguyen
- Department of Dermatology, University of California, Davis, Sacramento, CA, USA
| | - Douglas J Rowland
- Center for Molecular and Genomic Imaging, University of California, Davis, Sacramento, CA, USA
| | - Machelle Wilson
- Division of Biostatistics, Clinical and Translational Science Center, University of California, Davis, Sacramento, CA, USA
| | - Flavia Sunzini
- Institute of Infection, Immunity and Inflammation, College of Medicine, Veterinary and Life Sciences, University of Glasgow, UK
| | - Moeed Akbar
- Institute of Infection, Immunity and Inflammation, College of Medicine, Veterinary and Life Sciences, University of Glasgow, UK
| | - Mindy Huynh
- Department of Dermatology, University of California, Davis, Sacramento, CA, USA
| | - Timothy Law
- Department of Dermatology, University of California, Davis, Sacramento, CA, USA
| | - Smriti K Kundu-Raychaudhuri
- Department of Internal Medicine, Division of Rheumatology, Allergy and Clinical Immunology, University of California at Davis, CA, USA
| | - Siba P Raychaudhuri
- Department of Internal Medicine, Division of Rheumatology, Allergy and Clinical Immunology, University of California at Davis, CA, USA
| | - Brian F Volkman
- Department of Biochemistry, Medical College of Wisconsin, WI, USA
| | - Neal L Millar
- Institute of Infection, Immunity and Inflammation, College of Medicine, Veterinary and Life Sciences, University of Glasgow, UK
| | - Sam T Hwang
- Department of Dermatology, University of California, Davis, Sacramento, CA, USA
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Zhou H, Wu R, Kong Y, Zhao M, Su Y. Impact of smoking on psoriasis risk and treatment efficacy: a meta-analysis. J Int Med Res 2020; 48:300060520964024. [PMID: 33121308 PMCID: PMC7780610 DOI: 10.1177/0300060520964024] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
Objective Psoriasis is an immune-mediated chronic inflammatory disease with skin and
joint manifestations. Smoking is considered an unfavorable lifestyle factor
for psoriasis. We aimed to explore the association between smoking, disease
risk, and treatment efficacy in relation to psoriasis. Methods We searched the Cochrane Library, Embase, and PubMed databases for studies
examining the relationship between smoking and psoriasis, up to 12 April
2020. We then conducted a meta-analysis using a fixed-effects model to
obtain odds ratios (ORs) with 95% confidence intervals (CIs). Results Ever, current, and former smokers all had higher risks of developing
psoriasis than non-smokers (pooled ORs (95% CIs): 1.60 (1.51–1.69), 1.63
(1.48–1.80), and 1.36 (1.13–1.64), respectively). Ever smokers were less
likely to show disease improvement at 6 months following treatment with
biologic agents than non-smokers (pooled OR (95% CI): 0.80 (0.67–0.95)). Conclusions Smoking increases psoriasis risk and negatively impacts the benefits of
biologic agents. However, the number of reports is limited and more studies
are needed to confirm the effects of smoking and smoking cessation on
therapeutic response in patients with psoriasis. Education to encourage a
healthy lifestyle remains a valuable approach in clinical practice.
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Affiliation(s)
- Hang Zhou
- Department of Dermatology, Hunan Key Laboratory of Medical Epigenomes, Second Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Ruifang Wu
- Department of Dermatology, Hunan Key Laboratory of Medical Epigenomes, Second Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Yi Kong
- Department of Dermatology, Hunan Key Laboratory of Medical Epigenomes, Second Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Ming Zhao
- Department of Dermatology, Hunan Key Laboratory of Medical Epigenomes, Second Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Yuwen Su
- Department of Dermatology, Hunan Key Laboratory of Medical Epigenomes, Second Xiangya Hospital of Central South University, Changsha, Hunan, China
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18
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Menter A, Armstrong A, Van Voorhees A, Liu C, Jacobson A. Brodalumab to the Rescue: Efficacy and Safety of Brodalumab in Patients with Psoriasis and Prior Exposure or Inadequate Response to Biologics. Dermatol Ther (Heidelb) 2020; 10:615-621. [PMID: 32533554 PMCID: PMC7367951 DOI: 10.1007/s13555-020-00411-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Indexed: 11/16/2022] Open
Abstract
While biologic therapies for psoriasis are effective for many patients, some patients may lose response, have inadequate control of disease, or develop intolerance to certain biologic agents. It may therefore be beneficial for patients whose psoriasis fails to respond to one biologic to switch to a different biologic therapy, in particular one with a different mechanism of action. However, it remains unclear how prior biologic exposure or lack of response affects the efficacy and safety of subsequent biologics in patients with moderate-to-severe psoriasis. Brodalumab, a fully human anti-interleukin-17 receptor A monoclonal antibody, has previously been shown to be efficacious in treating moderate-to-severe psoriasis in three large phase 3 trials (AMAGINE-1, AMAGINE-2, and AMAGINE-3). In this review, we summarize the efficacy and safety of brodalumab in patients with moderate-to-severe psoriasis and a history of biologic exposure. Further, we describe improvements in skin clearance and quality of life measures as well as safety in patients who had inadequate response to ustekinumab and who were rescued with brodalumab therapy. Lastly, we discuss improvements in skin clearance following rescue with brodalumab in patients whose disease failed to respond to secukinumab and ixekizumab. The findings of our review suggest that brodalumab is a safe and efficacious treatment regardless of past biologic use or lack of response to prior biologic therapy.
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Affiliation(s)
| | | | | | - Clive Liu
- Bellevue Dermatology, Bellaire, TX, USA
| | - Abby Jacobson
- Ortho Dermatologics (a division of Bausch Health US, LLC), Bridgewater, NJ, USA
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19
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A Six-Year Analysis of Biological Therapy for Severe Psoriasis in a Lithuanian Reference Centre of Dermatovenereology. ACTA ACUST UNITED AC 2020; 56:medicina56060275. [PMID: 32512854 PMCID: PMC7353857 DOI: 10.3390/medicina56060275] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 05/29/2020] [Accepted: 06/02/2020] [Indexed: 12/23/2022]
Abstract
Background and Objectives: Biological therapy is widely used for the treatment of severe psoriasis. The objective of this study was to evaluate the efficacy and safety of biological therapy for patients with severe psoriasis. Materials and Methods: A retrospective study of 79 patients with severe psoriasis, who have been treated with biological therapy between 2012 and 2018, was conducted. During this study, the following data were collected and evaluated: sex, age, body mass index (BMI), duration of illness, the results of treatment with biological therapy, concomitant therapy, Psoriasis Area and Severity Index (PASI) and adverse events. Results: In total, 74.7% (n = 59) of subjects were male. Their overall average age was 47.4 ± 11.4 (range: 18–73) years. Their baseline BMI was 27.6 ± 5.9, which increased to 29.6 ± 4.5 after 6 years of treatment. The mean duration of psoriasis was 25.7 ± 12.5 years. In total, 39.2% (n = 31) of subjects received infliximab, 36.7% (n = 29)—etanercept, 24.1% (n = 19)—ustekinumab. The treatment duration for infliximab, etanercept and ustekinumab was 201.6 ± 86.8, 156.2 ± 137.4 and 219.1 ± 95.7 weeks (p < 0.01), respectively. Overall, 65.8% (n = 52) of subjects were also on methotrexate; 30.8% (n = 16) of them discontinued it due to clinical improvement (31.3% (n = 5)), impaired liver function (31.3% (n = 5)), and intolerance (25% (n = 4)). Baseline PASI was 20.8 ± 8.8. PASI 50 was achieved by 96.2% (n = 76) of patients at week 11, PASI 75 by 86.1% (n = 68) at week 16, PASI 90 by 54.4% (n = 43) at week 35, and PASI 100 by 13.9% (n = 11) at week 33. The overall incidence rate of adverse events was 0.362 per patient year of follow-up. Conclusion: Biological therapy is an effective and safe treatment for patients with severe psoriasis.
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20
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Abstract
Aim: No guidelines exist for biologic switch in psoriasis after treatment failure. Although, switching between TNF-α antagonists has been reviewed, switching information about newer biologics is limited. Materials & methods: We did a thorough systematic review from 'PubMed' and 'Embase', which includes new biologics such as IL-12/IL-23 antagonists, IL-17A antagonists and IL-23 antagonists. Results & conclusion: New biologics such as IL-17 antagonist or IL-23 antagonist show greater responses in bio-experienced patients and could even be used for patients in whom previous treatments failed.
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Affiliation(s)
- Ting-Shun Wang
- Department of Dermatology, Chung Shan Medical University Hospital, Taichung, Taiwan.,Department of Dermatology, Chung Shan Medical University, Taichung, Taiwan.,Department of Dermatology, National Taiwan University Hospital & National Taiwan University College of Medicine, Taipei, Taiwan
| | - Tsen-Fang Tsai
- Department of Dermatology, National Taiwan University Hospital & National Taiwan University College of Medicine, Taipei, Taiwan
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Takamura S, Sugai S, Taguchi R, Teraki Y. Combination therapy of apremilast and biologics in patients with psoriasis showing biologic fatigue. J Dermatol 2019; 47:290-294. [DOI: 10.1111/1346-8138.15193] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Accepted: 11/19/2019] [Indexed: 12/25/2022]
Affiliation(s)
- Saori Takamura
- Department of Dermatology Saitama Medical Center Saitama Medical University Saitama Japan
| | - Sora Sugai
- Department of Dermatology Saitama Medical Center Saitama Medical University Saitama Japan
| | - Ryokichi Taguchi
- Department of Dermatology Saitama Medical Center Saitama Medical University Saitama Japan
| | - Yuichi Teraki
- Department of Dermatology Saitama Medical Center Saitama Medical University Saitama Japan
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Özkur E, Kıvanç Altunay İ, Oğuz Topal İ, Aytekin S, Topaloğlu Demir F, Özkök Akbulut T, Kara Polat A, Karadağ AS. Switching Biologics in the Treatment of Psoriasis: A Multicenter Experience. Dermatology 2019; 237:22-30. [PMID: 31865339 DOI: 10.1159/000504839] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Accepted: 11/16/2019] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND/OBJECTIVE The purpose of our study was to provide evidence on the treatment choices, reasons, and results of switching between biologic agents in treating patients with psoriasis. METHODS We conducted a retrospective database search of six tertiary referral centers for pso-riasis patients between January 2007 and May 2019. We analyzed patient and treatment characteristics of all patients in the registry. RESULTS We enrolled 427 psoriatic patients treated with biologics, and 145 (34%) required a switch to another biologic. The reasons for discontinuing the first biologic agent were inefficacy (n = 106, 62.4%), adverse events (n = 28, 16.5%), and others (n = 36, 21.2%). At week 12, there was a 67.7% reduction in the Psoriasis Area and Severity Index (PASI) score of patients treated with their first biologic, and 51.4% reduction for the second. A drug survival analysis showed no statistically significant difference between the drug survival of first-line biologic agents, but ustekinumab had the highest survival rate among second-line biologics (log-rank p = 0.010). Multivariate analyses for overall drug discontinuation showed that the occurrence of psoriatic arthritis (OR: 1.883, 95% CI: 1.274-2.782, p = 0.001), nail involvement (OR: 2.334, 95% CI: 1.534-3.552, p < 0.001), and use of concomitant treatment (OR: 2.303, 95% CI: 1.403 -3.780, p = 0.001) are predictors for discontinuation. CONCLUSION Discontinuation of treatment was most commonly due to inefficacy. Patients who switched to a different biologic agent showed a similar improvement in PASI scores compared to biologic-naive patients. Switching to a second biologic therapy due to inefficacy or adverse events caused by the first one may improve psoriasis.
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Affiliation(s)
- Ezgi Özkur
- Department of Dermatology, University of Health Sciences, Şişli Hamidiye Etfal Training and Research Hospital, Istanbul, Turkey,
| | - İlknur Kıvanç Altunay
- Department of Dermatology, University of Health Sciences, Şişli Hamidiye Etfal Training and Research Hospital, Istanbul, Turkey
| | - İlteriş Oğuz Topal
- Department of Dermatology, University of Health Sciences, Okmeydanı Training and Research Hospital, Istanbul, Turkey
| | - Sema Aytekin
- Department of Dermatology, University of Health Sciences, Haydarpaşa Numune Training and Research Hospital, Istanbul, Turkey
| | - Filiz Topaloğlu Demir
- Department of Dermatology, University of Health Sciences, Haseki Training and Research Hospital, Istanbul, Turkey
| | - Tuğba Özkök Akbulut
- Department of Dermatology, University of Health Sciences, Haseki Training and Research Hospital, Istanbul, Turkey
| | - Asude Kara Polat
- Department of Dermatology, University of Health Sciences, Istanbul Training and Research Hospital, Istanbul, Turkey
| | - Ayşe Serap Karadağ
- Istanbul Medeniyet University, Göztepe Training and Research Hospital, Istanbul, Turkey
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Chua CKT, Teng GG, Cheung PP, Fong WWS, Leong KH, Leung YY, Lim AYN, Lui NL, Manghani M, Santosa A, Sriranganathan MK, Suresh E, Tan TC, Lahiri M. Singapore chapter of rheumatologists' updated consensus statement on the eligibility for government subsidization of biologic and targeted therapy for the treatment of psoriatic arthritis. Int J Rheum Dis 2019; 23:153-164. [DOI: 10.1111/1756-185x.13754] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Revised: 10/25/2019] [Accepted: 10/29/2019] [Indexed: 12/25/2022]
Affiliation(s)
- Cheryl K. T. Chua
- Division of Rheumatology University Medicine Cluster National University Health System Singapore Singapore
| | - Gim Gee Teng
- Division of Rheumatology University Medicine Cluster National University Health System Singapore Singapore
- Department of Medicine Yong Loo Lin School of Medicine Singapore Singapore
| | - Peter P. Cheung
- Division of Rheumatology University Medicine Cluster National University Health System Singapore Singapore
- Department of Medicine Yong Loo Lin School of Medicine Singapore Singapore
| | - Warren Weng Seng Fong
- Department of Rheumatology and Immunology Singapore General Hospital Singapore Singapore
| | - Keng Hong Leong
- Leong Keng Hong Arthritis and Medical Clinic Singapore Singapore
| | - Ying Ying Leung
- Department of Rheumatology and Immunology Singapore General Hospital Singapore Singapore
| | - Anita Y. N. Lim
- Division of Rheumatology University Medicine Cluster National University Health System Singapore Singapore
- Department of Medicine Yong Loo Lin School of Medicine Singapore Singapore
| | - Nai Lee Lui
- Lui Centre for Arthritis & Rheumatology Gleneagles medical Centre Singapore Singapore
| | - Mona Manghani
- Department of Rheumatology, Allergy and Immunology Tan Tock Seng Hospital Singapore Singapore
| | - Amelia Santosa
- Division of Rheumatology University Medicine Cluster National University Health System Singapore Singapore
- Department of Medicine Yong Loo Lin School of Medicine Singapore Singapore
| | | | - Ernest Suresh
- Department of Medicine Ng Teng Fong Hospital Singapore Singapore
| | - Teck Choon Tan
- Department of Medicine Khoo Teck Puat Hospital Singapore Singapore
| | - Manjari Lahiri
- Division of Rheumatology University Medicine Cluster National University Health System Singapore Singapore
- Department of Medicine Yong Loo Lin School of Medicine Singapore Singapore
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24
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Serial biologic therapies in psoriasis patients: A 12-year, single-center, retrospective observational study. J Am Acad Dermatol 2019; 82:37-44. [PMID: 31150706 DOI: 10.1016/j.jaad.2019.05.064] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Revised: 05/22/2019] [Accepted: 05/23/2019] [Indexed: 12/14/2022]
Abstract
BACKGROUND Biologic therapy for psoriasis is effective but not always long-lasting and sometimes needs to be switched. OBJECTIVE We aimed to evaluate the drug survival (ie, the time from initiation to discontinuation) of each biologic and the factors affecting survival to identify better switching strategies and improve drug survival. METHODS In total, 195 psoriasis patients treated in our unit during 2006-2018 were retrospectively observed. Descriptive statistical analyses and logistic regression models were performed. Kaplan-Meier survival curves and multivariate Cox models adjusted for confounding variables were used to estimate and compare drug survival. RESULTS Overall, 90.6% of patients achieved an ≥75% reduction in their baseline Psoriasis Area and Severity Index score. In 2018, the most frequently used biologic was ustekinumab (47/169, 27.8%). Patients with higher baseline Psoriasis Area and Severity Index scores were more likely to be switched (P = .0399, odds ratio 1.08). In naive patients, ustekinumab showed longer drug survival (>7.0 years), but in biologic-experienced patients, we found no significant differences in drug survival. Previous biologic therapies increased the need for switching (P = .014, hazard ratio 1.20). Switching between biologic classes yielded longer drug survival than switching within biologic classes (P = .003, hazard ratio 0.48). LIMITATIONS As a single-center, retrospective real-life study, the data were not perfectly homogeneous. CONCLUSION Switching between biologic classes might increase drug survival but retrospective studies designed ad hoc are needed to confirm this better switching strategy.
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Feldman SR, Tian H, Wang X, Germino R. Health Care Utilization and Cost Associated with Biologic Treatment Patterns Among Patients with Moderate to Severe Psoriasis: Analyses from a Large U.S. Claims Database. J Manag Care Spec Pharm 2019; 25:479-488. [PMID: 30556761 PMCID: PMC10398133 DOI: 10.18553/jmcp.2018.18308] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Discontinuation or switching of biologic treatment among patients with psoriasis imposes a great economic burden. OBJECTIVE To assess the health care utilization and costs associated with nonswitchers, switchers, and discontinuers of biologics among patients with moderate to severe psoriasis. METHODS Patients aged ≥ 18 years with ≥ 1 pharmacy claim for a biologic (adalimumab, etanercept, infliximab, and ustekinumab) between January 1, 2012, and June 30, 2015 (identification period), were identified in the Truven Health Analytics MarketScan Commercial and Medicare Supplemental databases. At the time of biologic initiation (index date), eligible patients were continuously enrolled with medical and pharmacy claims for ≥ 1 year before (baseline period) and ≥ 1 year after the index date (follow-up period). Patients had ≥ 1 psoriasis diagnosis and had no pharmacy claims for the index biologic during the baseline period. Patients were categorized into 3 mutually exclusive groups based on their biologic treatment pattern during the 1-year follow-up period: nonswitchers (patients who remained on their index biologic), switchers (patients who had a prescription for a biologic therapy other than their index biologic), and discontinuers (patients who had gaps in prescription claims [> 90 days for adalimumab, infliximab, and etanercept; > 120 days for ustekinumab]). Descriptive analyses were used to summarize baseline patient demographics, clinical characteristics, resource utilization, and health care costs (inflated to 2016 costs) across the 3 groups. Adjusted health care resource utilization and costs during the 1-year follow-up were estimated, controlling for age, sex, geographic region, insurance plan type, index drug, index year, Charlson Comorbidity Index score, resource utilization, total health care costs, and nonbiologic medications during the baseline period. RESULTS Of the 8,710 patients with psoriasis included in the study, 5,000 (57.4%) were categorized as nonswitchers, 1,001 (11.5%) as switchers, and 2,709 (31.1%) as discontinuers. Emergency department and inpatient visits, respectively, were more common among switchers (adjusted incidence rate ratio [95% CI]: 1.10 [0.93-1.30] and 1.13 [0.84-1.53]) and discontinuers (1.50 [1.34-1.63] and 2.05 [1.70-2.48]) than among nonswitchers. Compared with nonswitchers, switchers had higher adjusted mean total health care costs (mean difference [95% CI]: $10,120 [$8,235-$12,033]), which were driven by increased prescription costs ($8,988 [$7,535-$10,610]) and medical costs ($2,746 [$1,090-$4,677]). Conversely, the adjusted mean total health care cost for discontinuers was lower than that for nonswitchers (mean difference [95% CI]: -$18,611 [-$20,254, -$17,025]) due to reduced prescription costs (-$20,486 [-$21,319, -$19,636]); however, discontinuers had a higher mean medical cost ($3,729 [$1,970-$5,527]). CONCLUSIONS Switching or discontinuing biologics resulted in higher health care utilization and increased medical costs than remaining on the same biologic. These updated findings highlight the clinical and economic effects of discontinuing or switching biologic therapies in patients with psoriasis in clinical practice and may inform treatment and/or formulary decision making. DISCLOSURES This study was sponsored by Novartis Pharmaceuticals Corporation. Feldman has received consulting, speaking, and/or research support from Novartis, AbbVie, Celgene, Sun Pharma, Janssen, Lilly, and Ortho. Tian and Germino are employees of Novartis. Wang was an employee of KMK Consulting and worked as a consultant for Novartis at the time of this study. Portions of this work were presented at the 2017 Fall Clinical Dermatology Conference; October 12-15, 2017; Las Vegas, NV; the 2017 Las Vegas Dermatology Seminar; November 2-4, 2017; Las Vegas, NV; and the 2018 American Academy of Dermatology Annual Meeting; February 16-20, 2018; San Diego, CA.
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Affiliation(s)
- Steven R. Feldman
- Department of Dermatology, Wake Forest Baptist Medical Center, Winston-Salem, North Carolina
| | - Haijun Tian
- Center of Excellence for Real World Evidence, Novartis Pharmaceuticals Corporation, East Hanover, New Jersey
| | | | - Rebecca Germino
- Health Economics & Outcomes Research, Novartis Pharmaceuticals Corporation, East Hanover, New Jersey
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Bayaraa B, Imafuku S. Sustainability and switching of biologics for psoriasis and psoriatic arthritis at Fukuoka University Psoriasis Registry. J Dermatol 2019; 46:389-398. [PMID: 30861182 DOI: 10.1111/1346-8138.14834] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Accepted: 01/29/2019] [Indexed: 12/16/2022]
Abstract
Biologics are efficacious for treating psoriasis vulgaris (PsV) and psoriatic arthritis (PsA), but sometimes must be terminated or changed for various reasons including ineffectiveness or adverse events. To find the optimal choice of biologics for treating psoriasis, we analyzed the real-world data on drug survival and the reason for terminating or switching biologics. Medical records from patients with PsV or PsA, who visited the Department of Dermatology, Fukuoka University Hospital from 2010 to 2017, were analyzed. Two hundred and eleven patients received biologics, and 147 patients (69.7%) were treated with only one biologic, while 64 patients (30.3%) were switched to different products. Frequently used biologics in PsV were ustekinumab (UST), infliximab and adalimumab when calculated by patient-year. Tumor necrosis factor inhibitor (TNFi) use decreased while UST and interleukin (IL)-17 inhibitors increased in newly introduced patients. UST showed the highest survival rate as a first-line drug, but the advantage was lost in the second reagent's group. The major reasons for terminating/switching biologics were as follows: primary ineffectiveness (26.4%), secondary loss of efficacy (36.5%), patient's preference, including referral to nearby hospital, or stopped visiting (22.6%), side-effects (7.7%), comorbidities (3.4%) and economic burden (2.4%). In PsA patients, TNFi are more frequently employed than in PsV patients, although switching to UST or IL-17 inhibitors showed an increasing trend. Biologic reagents were changed mostly because of primary or secondary loss of efficacy, which affected drug survival. Further research is needed to find the optimal choice of biologics with larger samples at multiple facilities.
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Affiliation(s)
- Bolortuya Bayaraa
- Department of Dermatology, Fukuoka University Faculty of Medicine, Fukuoka, Japan
| | - Shinichi Imafuku
- Department of Dermatology, Fukuoka University Faculty of Medicine, Fukuoka, Japan
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27
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Menter A, Strober BE, Kaplan DH, Kivelevitch D, Prater EF, Stoff B, Armstrong AW, Connor C, Cordoro KM, Davis DMR, Elewski BE, Gelfand JM, Gordon KB, Gottlieb AB, Kavanaugh A, Kiselica M, Korman NJ, Kroshinsky D, Lebwohl M, Leonardi CL, Lichten J, Lim HW, Mehta NN, Paller AS, Parra SL, Pathy AL, Rupani RN, Siegel M, Wong EB, Wu JJ, Hariharan V, Elmets CA. Joint AAD-NPF guidelines of care for the management and treatment of psoriasis with biologics. J Am Acad Dermatol 2019; 80:1029-1072. [PMID: 30772098 DOI: 10.1016/j.jaad.2018.11.057] [Citation(s) in RCA: 476] [Impact Index Per Article: 95.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2018] [Revised: 11/26/2018] [Accepted: 11/27/2018] [Indexed: 12/29/2022]
Abstract
Psoriasis is a chronic, inflammatory multisystem disease that affects up to 3.2% of the US population. This guideline addresses important clinical questions that arise in psoriasis management and care, providing recommendations based on the available evidence. The treatment of psoriasis with biologic agents will be reviewed, emphasizing treatment recommendations and the role of the dermatologist in monitoring and educating patients regarding benefits as well as associated risks.
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Affiliation(s)
| | - Bruce E Strober
- University of Connecticut, Farmington, Connecticut; Probity Medical Research, Waterloo, Ontario, Canada
| | | | | | | | | | | | | | - Kelly M Cordoro
- University of California, San Francisco School of Medicine, Department of Dermatology, San Francisco, California
| | | | | | - Joel M Gelfand
- University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | | | - Alice B Gottlieb
- Department of Dermatology, Icahn School of Medicine at Mt. Sinai, New York
| | | | | | - Neil J Korman
- University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | | | - Mark Lebwohl
- Department of Dermatology, Icahn School of Medicine at Mt. Sinai, New York
| | | | | | - Henry W Lim
- Department of Dermatology, Henry Ford Hospital, Detroit, Michigan
| | - Nehal N Mehta
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | - Amy S Paller
- Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | | | - Arun L Pathy
- Colorado Permanente Medical Group, Centennial, Colorado
| | | | | | - Emily B Wong
- San Antonio Uniformed Services Health Education Consortium, Joint-Base San Antonio
| | - Jashin J Wu
- Dermatology Research and Education Foundation, Irvine, California
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28
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Kamiya K, Karakawa M, Komine M, Kishimoto M, Sugai J, Ohtsuki M. Results of a retrospective study on the efficacy and safety of adalimumab 80 mg administrated every other week in patients with psoriasis at a single Japanese institution. J Dermatol 2019; 46:199-205. [DOI: 10.1111/1346-8138.14782] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Accepted: 12/18/2018] [Indexed: 11/30/2022]
Affiliation(s)
- Koji Kamiya
- Department of Dermatology; Jichi Medical University; Shimotsuke Japan
| | - Masaru Karakawa
- Department of Dermatology; Jichi Medical University; Shimotsuke Japan
| | - Mayumi Komine
- Department of Dermatology; Jichi Medical University; Shimotsuke Japan
| | - Megumi Kishimoto
- Department of Dermatology; Jichi Medical University; Shimotsuke Japan
| | - Junichi Sugai
- Department of Dermatology; Jichi Medical University; Shimotsuke Japan
| | - Mamitaro Ohtsuki
- Department of Dermatology; Jichi Medical University; Shimotsuke Japan
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29
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Heath MS, Kolli SS, Dowling JR, Cline A, Feldman SR. Pharmacotherapeutic strategies for standard treatment-resistant psoriasis. Expert Opin Pharmacother 2018; 20:443-454. [DOI: 10.1080/14656566.2018.1559819] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Affiliation(s)
- Michael S. Heath
- Center for Dermatology Research, Department of Dermatology, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Sree S. Kolli
- Center for Dermatology Research, Department of Dermatology, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Jessica R. Dowling
- Center for Dermatology Research, Department of Dermatology, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Abigail Cline
- Center for Dermatology Research, Department of Dermatology, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Steven R. Feldman
- Center for Dermatology Research, Department of Dermatology, Wake Forest School of Medicine, Winston-Salem, NC, USA
- Department of Pathology, Wake Forest School of Medicine, Winston-Salem, NC, USA
- Department of Social Sciences & Health Policy, Wake Forest School of Medicine, Winston-Salem, NC, USA
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30
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Damiani G, Conic RRZ, de Vita V, Costanzo A, Regazzini R, Pigatto PDM, Bragazzi NL, Pacifico A, Malagoli P. When IL-17 inhibitors fail: Real-life evidence to switch from secukinumab to adalimumab or ustekinumab. Dermatol Ther 2018; 32:e12793. [PMID: 30515970 DOI: 10.1111/dth.12793] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Accepted: 11/28/2018] [Indexed: 01/04/2023]
Abstract
Psoriasis is a chronic, systemic inflammatory disease that in the moderate to severe forms may benefit of biologics, namely TNF and IL-12/23 and IL-17 inhibitors. Loss of response, lack of response, or discontinuation due to adverse events represent a concrete therapeutic challenge for dermatologists that have to switch patients to other treatments. Although some evidences already exist toward the switch from IL-12/23 and TNF inhibitors to IL-17 inhibitors, conversely nothing is present toward the switch from IL-17 inhibitors to IL-12/23 and TNF inhibitors. We performed a real-life study enrolling 50 patients randomly switched to adalimuamb, a TNF inhibitor, or ustekinumab, an IL-12/23 inhibitor. Our observational study suggests that switching from IL-17i to TNFi and IL-12/23i is a safe and effective therapeutic strategy.
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Affiliation(s)
- Giovanni Damiani
- Young Dermatologists Italian Network (YDIN), Centro Studi GISED, Bergamo, Italy.,Clinical Dermatology, IRCCS Galeazzi Orthopaedic Institute, Milan, Italy.,Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy.,Department of Dermatology, Case Western Reserve University, Cleveland, Ohio
| | - Rosalynn R Z Conic
- Department of Dermatology, Case Western Reserve University, Cleveland, Ohio
| | - Valerio de Vita
- Young Dermatologists Italian Network (YDIN), Centro Studi GISED, Bergamo, Italy
| | - Antonio Costanzo
- Unit of Dermatology, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | | | - Paolo D M Pigatto
- Clinical Dermatology, IRCCS Galeazzi Orthopaedic Institute, Milan, Italy.,Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy
| | - Nicola L Bragazzi
- School of Public Health, Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
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Bokor-Billmann T, Schäkel K. No need to change the drug class: ixekizumab- following secukinumab-therapy in psoriasis. J DERMATOL TREAT 2018; 30:216-220. [PMID: 30051725 DOI: 10.1080/09546634.2018.1506081] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
BACKGROUND Regarding treatment of psoriasis, dermatologists now use new, highly effective targeted therapies. Among such, biologic therapies have become a mainstay in patients with moderate to severe psoriasis; yet, a substantial proportion of patients show insufficient or no treatment response. Current literature has insufficient evidence for successful treatment when switching biologics after multiple failures, in particular when the biologics share a common mechanism of action. OBJECTIVES To compile a case series of patients with moderate to severe psoriasis who had primary or secondary loss of response to multiple previous systemic treatments. We specifically focused on patients recently treated with the anti-IL-17A antibody secukinumab, who further received the anti-IL-17A antibody ixekizumab as subsequent therapy. PATIENTS AND METHODS We performed a retrospective cohort analysis. Inclusion criteria were patients with moderate to severe psoriasis vulgaris (as defined by European consensus and the German guidelines), who have previously been treated with systemic therapies including three or more biological therapies. All patients treated with anti-IL-17A antibody secukinumab experienced a primary and/or secondary treatment failure and subsequently received the anti-IL-17A antibody ixekizumab. The primary outcome was treatment response to ixekizumab using PASI score; the secondary outcome was incidence of adverse events. RESULTS Twelve patients were included. At week 6 of ixekizumab treatment, PASI 75 was achieved in 91.7%, PASI 90 in 66.7%, PASI 100 in 8.3% of patients. At week 12, PASI 75 was achieved in 100%, PASI 90 in 100%, PASI 100 in 58.3% of the cohort. Throughout the observation period, no severe adverse events were observed. CONCLUSIONS Ixekizumab proved to be an effective and safe therapeutic option for patients with prior systemic therapies, including biological treatments with the same mechanism of action. Thus, failure of secukinumab does not preclude future therapy success with a second IL-17A-directed therapy.
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Affiliation(s)
| | - Knut Schäkel
- a Department of Dermatology , Ruprecht-Karls-University Heidelberg , Heidelberg , Germany
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32
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Aleshaki JS, Cardwell LA, Muse ME, Feldman SR. Adherence and resource use among psoriasis patients treated with biologics. Expert Rev Pharmacoecon Outcomes Res 2018; 18:609-617. [DOI: 10.1080/14737167.2018.1512408] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Affiliation(s)
- Joseph S. Aleshaki
- Center for Dermatology Research, Department of Dermatology, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Leah A. Cardwell
- Center for Dermatology Research, Department of Dermatology, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Mikél E. Muse
- Center for Dermatology Research, Department of Dermatology, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Steven R. Feldman
- Center for Dermatology Research, Department of Dermatology, Wake Forest School of Medicine, Winston-Salem, NC, USA
- Department of Pathology, Wake Forest School of Medicine, Winston-Salem, NC, USA
- Department of Social Sciences & Health Policy, Wake Forest School of Medicine, Winston-Salem, NC, USA
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33
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Yamamoto T, Ohtsuki M, Sano S, Morita A, Igarashi A, Okuyama R, Kawada A. Switching biologics in the treatment of psoriatic arthritis in Japan. J Dermatol 2018; 46:e113-e114. [PMID: 30156313 DOI: 10.1111/1346-8138.14622] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- Toshiyuki Yamamoto
- Department of Dermatology, Fukushima Medical University, Fukushima, Japan
| | - Mamitaro Ohtsuki
- Department of Dermatology, Jichi Medical University, Shimotsuke, Japan
| | | | - Akimichi Morita
- Department of Dermatology, Nagoya City University Graduate School of Medical Science, Nagoya, Japan
| | | | - Ryuhei Okuyama
- Department of Dermatology, Shinshu University, Matsumoto, Japan
| | - Akira Kawada
- Department of Dermatology, Kinki University Faculty of Medicine, Osakasayama, Japan
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Differential efficacy of biologic treatments targeting the TNF-α/IL-23/IL-17 axis in psoriasis and psoriatic arthritis. Cytokine 2018; 111:182-188. [PMID: 30172115 DOI: 10.1016/j.cyto.2018.08.025] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2018] [Revised: 08/20/2018] [Accepted: 08/24/2018] [Indexed: 02/08/2023]
Abstract
Psoriasis and psoriatic arthritis cause significant physical and psychological burdens for afflicted individuals. An accelerated TNF-α/IL-23/IL-17 axis is their major pathomechanism; therefore, anti-TNF-α/IL-23/IL-17 biologics are very effective for the treatment of skin and joint lesions in psoriasis and psoriatic arthritis. Given that the IL-17 signature is more upregulated in the skin than in synovium in psoriatic arthritis, anti-IL-23/IL-17 agents seem to be superior to anti-TNF-α remedies in the treatment of skin lesions. In this review, we focus on the differential efficacy of anti-TNF-α/IL-23/IL-17 biologics in psoriasis and psoriatic arthritis.
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Talamonti M, Galluzzo M, Bernardini N, Caldarola G, Persechino S, Cantoresi F, Egan C, Potenza C, Peris K, Bianchi L. Psoriasis Area and Severity Index response in moderate-severe psoriatic patients switched to adalimumab: results from the OPPSA study. J Eur Acad Dermatol Venereol 2018; 32:1737-1744. [DOI: 10.1111/jdv.15077] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Accepted: 05/04/2018] [Indexed: 01/13/2023]
Affiliation(s)
- M. Talamonti
- Department of Dermatology; University of Rome ‘Tor Vergata’; Rome Italy
| | - M. Galluzzo
- Department of Dermatology; University of Rome ‘Tor Vergata’; Rome Italy
| | - N. Bernardini
- Department of Medical and Surgical Sciences and Biotechnologies; Division of Dermatology ‘Daniele Innocenzi’; University of Rome ‘La Sapienza’; Polo Pontino Italy
| | - G. Caldarola
- Institute of Dermatology; Catholic University of the Sacred Heart; Rome Italy
| | - S. Persechino
- Department of Dermatology; NESMOS Unit; Sant'Andrea Hospital; Sapienza University of Rome; Rome Italy
| | - F. Cantoresi
- Department of Dermatology; Policlinico Umberto I; ‘Sapienza’ University of Rome; Rome Italy
| | | | - C. Potenza
- Department of Medical and Surgical Sciences and Biotechnologies; Division of Dermatology ‘Daniele Innocenzi’; University of Rome ‘La Sapienza’; Polo Pontino Italy
| | - K. Peris
- Institute of Dermatology; Catholic University of the Sacred Heart; Rome Italy
| | - L. Bianchi
- Department of Dermatology; University of Rome ‘Tor Vergata’; Rome Italy
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Furue K, Ito T, Tsuji G, Kadono T, Nakahara T, Furue M. Autoimmunity and autoimmune co-morbidities in psoriasis. Immunology 2018; 154:21-27. [PMID: 29315555 PMCID: PMC5904708 DOI: 10.1111/imm.12891] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2017] [Revised: 12/18/2017] [Accepted: 12/29/2017] [Indexed: 12/12/2022] Open
Abstract
Psoriasis is characterized by widespread scaly erythematous plaques that cause significant physical and psychological burdens for the affected individuals. Accelerated inflammation driven by the tumour necrosis factor-α/interleukin-23/interleukin-17 axis is now known to be the major mechanism in the development of psoriasis. In addition, psoriasis has an autoimmune nature that manifests as autoreactive T cells and is co-morbid with other autoimmune diseases, such as autoimmune bullous diseases, vitiligo, alopecia and thyroiditis. In this article, we review the recent topics on autoimmunity and autoimmune co-morbidities in psoriasis.
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Affiliation(s)
| | - Takamichi Ito
- Department of DermatologyKyushu UniversityFukuokaJapan
| | - Gaku Tsuji
- Department of DermatologyKyushu UniversityFukuokaJapan
| | - Takafumi Kadono
- Department of DermatologySt Marianna University School of MedicineKawasakiJapan
| | - Takeshi Nakahara
- Department of DermatologyKyushu UniversityFukuokaJapan
- Division of Skin Surface SensingDepartment of DermatologyKyushu UniversityFukuokaJapan
| | - Masutaka Furue
- Department of DermatologyKyushu UniversityFukuokaJapan
- Division of Skin Surface SensingDepartment of DermatologyKyushu UniversityFukuokaJapan
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