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De Sarro C, Bosco F, Gagliardi A, Guarnieri L, Ruga S, Fabiano A, Costantino L, Leo A, Palleria C, Verduci C, Rania V, Ashour M, Gallelli L, Citraro R, Sarro GD. Prescribing Pattern and Safety Profile of Biological Agents for Psoriasis in Real-World Practice: A Four-Year Calabrian Pharmacovigilance Analysis. Pharmaceutics 2024; 16:1329. [PMID: 39458658 PMCID: PMC11510662 DOI: 10.3390/pharmaceutics16101329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2024] [Revised: 10/04/2024] [Accepted: 10/09/2024] [Indexed: 10/28/2024] Open
Abstract
BACKGROUND The treatment of psoriasis has made considerable progress with biologicals, including tumor necrosis factor inhibitors, and recently, monoclonal antibodies inhibiting directly interleukin (IL) 17, IL-23, or both IL-12/23. Newer biologicals are directed to the interleukin pathway and appear to improve complete or near-complete clearance. The newer biologicals have also been shown to have an excellent safety profile. However, despite experience with patients having confirmed the results obtained in clinical trials, there are still few data on using the newer biologicals. METHODS The present active study aimed to prospectively evaluate safety profiles and persistence of some biologicals in a multicenter pharmacovigilance study, that enrolled 733 patients treated with a biologic drug in five Calabrian hospital units. Informative and treatment persistence evaluations with predictors for suspension and occurrence of adverse events (AEs) were executed. In particular, reasons for treatment discontinuation in our program take account of primary/secondary failure or development of an AE. RESULTS AEs occurred in 187/733 patients and serious AEs (SAEs) were identified in 5/733 patients. An number of 182/733 patients showed a primary/secondary inefficacy. The AEs and SAEs were described with adalimumab, infliximab, and etanercept but not with abatacept, brodalumab, tildrakizumab, golinumab, ixekizumab, guselkumab, risankizumab, secukinumab, and ustekinumab. CONCLUSIONS Our analysis, although limited by a small sample size and a short-term follow-up period, offers suitable data on commonly used biological agents and their safety, interruption rate, and the attendance of SAEs. Real-world studies should be carried out to evaluate other safety interests.
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Affiliation(s)
- Caterina De Sarro
- Department of Health Sciences, Magna Graecia University of Catanzaro, 88100 Catanzaro, Italy; (C.D.S.); (F.B.); (A.G.); (L.G.); (S.R.); (A.F.); (L.C.); (A.L.); (C.P.); (C.V.); (V.R.); (M.A.); (L.G.); (G.D.S.)
- System and Applied Pharmacology@University Magna Grecia, (FAS@UMG) Research Center, Science of Health Department, School of Medicine, Magna Graecia University of Catanzaro, 88100 Catanzaro, Italy
| | - Francesca Bosco
- Department of Health Sciences, Magna Graecia University of Catanzaro, 88100 Catanzaro, Italy; (C.D.S.); (F.B.); (A.G.); (L.G.); (S.R.); (A.F.); (L.C.); (A.L.); (C.P.); (C.V.); (V.R.); (M.A.); (L.G.); (G.D.S.)
- System and Applied Pharmacology@University Magna Grecia, (FAS@UMG) Research Center, Science of Health Department, School of Medicine, Magna Graecia University of Catanzaro, 88100 Catanzaro, Italy
| | - Agnese Gagliardi
- Department of Health Sciences, Magna Graecia University of Catanzaro, 88100 Catanzaro, Italy; (C.D.S.); (F.B.); (A.G.); (L.G.); (S.R.); (A.F.); (L.C.); (A.L.); (C.P.); (C.V.); (V.R.); (M.A.); (L.G.); (G.D.S.)
| | - Lorenza Guarnieri
- Department of Health Sciences, Magna Graecia University of Catanzaro, 88100 Catanzaro, Italy; (C.D.S.); (F.B.); (A.G.); (L.G.); (S.R.); (A.F.); (L.C.); (A.L.); (C.P.); (C.V.); (V.R.); (M.A.); (L.G.); (G.D.S.)
| | - Stefano Ruga
- Department of Health Sciences, Magna Graecia University of Catanzaro, 88100 Catanzaro, Italy; (C.D.S.); (F.B.); (A.G.); (L.G.); (S.R.); (A.F.); (L.C.); (A.L.); (C.P.); (C.V.); (V.R.); (M.A.); (L.G.); (G.D.S.)
| | - Antonio Fabiano
- Department of Health Sciences, Magna Graecia University of Catanzaro, 88100 Catanzaro, Italy; (C.D.S.); (F.B.); (A.G.); (L.G.); (S.R.); (A.F.); (L.C.); (A.L.); (C.P.); (C.V.); (V.R.); (M.A.); (L.G.); (G.D.S.)
| | - Laura Costantino
- Department of Health Sciences, Magna Graecia University of Catanzaro, 88100 Catanzaro, Italy; (C.D.S.); (F.B.); (A.G.); (L.G.); (S.R.); (A.F.); (L.C.); (A.L.); (C.P.); (C.V.); (V.R.); (M.A.); (L.G.); (G.D.S.)
| | - Antonio Leo
- Department of Health Sciences, Magna Graecia University of Catanzaro, 88100 Catanzaro, Italy; (C.D.S.); (F.B.); (A.G.); (L.G.); (S.R.); (A.F.); (L.C.); (A.L.); (C.P.); (C.V.); (V.R.); (M.A.); (L.G.); (G.D.S.)
- System and Applied Pharmacology@University Magna Grecia, (FAS@UMG) Research Center, Science of Health Department, School of Medicine, Magna Graecia University of Catanzaro, 88100 Catanzaro, Italy
| | - Caterina Palleria
- Department of Health Sciences, Magna Graecia University of Catanzaro, 88100 Catanzaro, Italy; (C.D.S.); (F.B.); (A.G.); (L.G.); (S.R.); (A.F.); (L.C.); (A.L.); (C.P.); (C.V.); (V.R.); (M.A.); (L.G.); (G.D.S.)
| | - Chiara Verduci
- Department of Health Sciences, Magna Graecia University of Catanzaro, 88100 Catanzaro, Italy; (C.D.S.); (F.B.); (A.G.); (L.G.); (S.R.); (A.F.); (L.C.); (A.L.); (C.P.); (C.V.); (V.R.); (M.A.); (L.G.); (G.D.S.)
| | - Vincenzo Rania
- Department of Health Sciences, Magna Graecia University of Catanzaro, 88100 Catanzaro, Italy; (C.D.S.); (F.B.); (A.G.); (L.G.); (S.R.); (A.F.); (L.C.); (A.L.); (C.P.); (C.V.); (V.R.); (M.A.); (L.G.); (G.D.S.)
| | - Michael Ashour
- Department of Health Sciences, Magna Graecia University of Catanzaro, 88100 Catanzaro, Italy; (C.D.S.); (F.B.); (A.G.); (L.G.); (S.R.); (A.F.); (L.C.); (A.L.); (C.P.); (C.V.); (V.R.); (M.A.); (L.G.); (G.D.S.)
| | - Luca Gallelli
- Department of Health Sciences, Magna Graecia University of Catanzaro, 88100 Catanzaro, Italy; (C.D.S.); (F.B.); (A.G.); (L.G.); (S.R.); (A.F.); (L.C.); (A.L.); (C.P.); (C.V.); (V.R.); (M.A.); (L.G.); (G.D.S.)
- System and Applied Pharmacology@University Magna Grecia, (FAS@UMG) Research Center, Science of Health Department, School of Medicine, Magna Graecia University of Catanzaro, 88100 Catanzaro, Italy
| | - Rita Citraro
- Department of Health Sciences, Magna Graecia University of Catanzaro, 88100 Catanzaro, Italy; (C.D.S.); (F.B.); (A.G.); (L.G.); (S.R.); (A.F.); (L.C.); (A.L.); (C.P.); (C.V.); (V.R.); (M.A.); (L.G.); (G.D.S.)
- System and Applied Pharmacology@University Magna Grecia, (FAS@UMG) Research Center, Science of Health Department, School of Medicine, Magna Graecia University of Catanzaro, 88100 Catanzaro, Italy
| | - Giovambattista De Sarro
- Department of Health Sciences, Magna Graecia University of Catanzaro, 88100 Catanzaro, Italy; (C.D.S.); (F.B.); (A.G.); (L.G.); (S.R.); (A.F.); (L.C.); (A.L.); (C.P.); (C.V.); (V.R.); (M.A.); (L.G.); (G.D.S.)
- System and Applied Pharmacology@University Magna Grecia, (FAS@UMG) Research Center, Science of Health Department, School of Medicine, Magna Graecia University of Catanzaro, 88100 Catanzaro, Italy
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Foley P, Mahar PD, Smith SD, Gupta M, Manuelpillai N, Orchard D, Wong LC, Su JC, James A, Fischer G, Marshman G, Rawlin M, Turner M, King E, Kennedy R, Baker C. Australian consensus: Treatment goals for moderate to severe psoriasis in the era of targeted therapies - Considerations for paediatric patients. Australas J Dermatol 2024; 65:e134-e144. [PMID: 38741474 DOI: 10.1111/ajd.14303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2024] [Revised: 04/14/2024] [Accepted: 04/28/2024] [Indexed: 05/16/2024]
Abstract
BACKGROUND Treatment goals have been established in Australia to facilitate the management of adults with moderate to severe psoriasis. The Australasian College of Dermatologists sought to determine if and how these adult treatment goals could be modified to accommodate the needs of paediatric and adolescent patients. METHODS A modified Delphi approach was used. Comprehensive literature review and guideline evaluation resulted in the development of statements and other questions to establish current clinical practices. Two rounds of anonymous voting were undertaken, with a collaborative meeting held in between to discuss areas of discordance. Overall, consensus was defined as achievement of ≥75% agreement in the range 7-9 on a 9-point scale (1 strongly disagree; 9 strongly agree). RESULTS Consensus was achieved on 23/29 statements in round 1 and 17/18 statements in round 2. There was a high level of concordance with treatment criteria in the adult setting. The limitations of applying assessment tools developed for use in adult patients to the paediatric setting were highlighted. Treatment targets in the paediatric setting should include objective metrics for disease severity and psychological impact on the patients and their family, and be based on validated, age-appropriate tools. CONCLUSION While the assessment, classification and management of moderate to severe psoriasis in paediatric patients aligns with metrics established for adults, it is vital that nuances in the transition from childhood to adolescence be taken into account. Future research should focus on psoriasis severity assessment scales specific to the paediatric setting.
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Affiliation(s)
- Peter Foley
- Skin Health Institute, Carlton, Victoria, Australia
- Department of Dermatology, St Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia
- The University of Melbourne, Melbourne, Victoria, Australia
| | - Patrick D Mahar
- Skin Health Institute, Carlton, Victoria, Australia
- The University of Melbourne, Melbourne, Victoria, Australia
- Department of Dermatology, The Royal Children's Hospital, Parkville, Victoria, Australia
| | - Saxon D Smith
- Sydney Adventist Hospital Clinical School, ANU College of Health and Medicine, The Australian National University, Canberra, Australian Capital Territory, Australia
- The Dermatology and Skin Cancer Centre, St Leonards, New South Wales, Australia
| | - Monisha Gupta
- Department of Dermatology, Liverpool Hospital, Liverpool, New South Wales, Australia
- The Skin Hospital, Westmead, New South Wales, Australia
- The University of New South Wales, Sydney, New South Wales, Australia
- Western Sydney University, Sydney, New South Wales, Australia
| | - Nicholas Manuelpillai
- Department of Dermatology, St Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia
| | - David Orchard
- Department of Dermatology, The Royal Children's Hospital, Parkville, Victoria, Australia
- Barkers Road Dermatology, Kew, Victoria, Australia
| | - Li-Chuen Wong
- Royal Prince Alfred Hospital Medical Centre, Newtown, New South Wales, Australia
- Department of Dermatology, Children's Hospital, Westmead, New South Wales, Australia
- The University of Sydney, Camperdown, New South Wales, Australia
| | - John C Su
- The University of Melbourne, Melbourne, Victoria, Australia
- Department of Dermatology, The Royal Children's Hospital, Parkville, Victoria, Australia
- Eastern Health, Melbourne, Victoria, Australia
- Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Amelia James
- Department of Dermatology, The Alfred Hospital, Melbourne, Victoria, Australia
| | - Gayle Fischer
- The University of Sydney, Camperdown, New South Wales, Australia
- Department of Dermatology, Royal North Shore Hospital, St Leonards, New South Wales, Australia
| | - Gillian Marshman
- Dermatology Clinic, Flinders Medical Centre, Adelaide, South Australia, Australia
- Willan House Dermatology, Brighton, South Australia, Australia
- College of Medicine and Public Health, Flinders University, Bedford Park, South Australia, Australia
| | - Morton Rawlin
- Macedon Medical Centre, Templestowe Lower, Victoria, Australia
| | | | - Emma King
- Department of Dermatology, The Royal Children's Hospital, Parkville, Victoria, Australia
| | - Robyn Kennedy
- Department of Dermatology, The Royal Children's Hospital, Parkville, Victoria, Australia
| | - Christopher Baker
- Skin Health Institute, Carlton, Victoria, Australia
- Department of Dermatology, St Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia
- The University of Melbourne, Melbourne, Victoria, Australia
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Guelimi R, Afach S, Bettuzzi T, Meyer A, Padern G, Yiu Z, Naudet F, Sbidian E, Le-Cleach L. Funding and conclusions of network meta-analyses on targeted therapies in inflammatory diseases: an overview. J Clin Epidemiol 2024; 172:111411. [PMID: 38852893 DOI: 10.1016/j.jclinepi.2024.111411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2024] [Revised: 05/08/2024] [Accepted: 06/03/2024] [Indexed: 06/11/2024]
Abstract
OBJECTIVES To explore the association between industry funding and network meta-analyses' (NMAs) conclusion, and the use in Clinical Practice Guidelines (CPGs) of NMAs. STUDY DESIGN AND SETTING This was an overview of NMAs and CPGs. We searched PubMed/MEDLINE, Epistemonikos, and several guideline databases up to February 18th 2023. We included CPGs from the last 5 years and NMAs of randomized controlled trials that evaluated targeted therapies in immune-mediated inflammatory diseases. Data extraction and outcome assessments were done in duplicate by independent authors. RESULTS We included 216 NMAs and 99 CPGs. 31% (67/216) were industry-funded. The proportion of industry-funded NMAs that cited one treatment as being best was 44% (25/57) compared to 26% (30/116) for nonindustry-funded (OR = 2.24 [1.15-4.39]; aOR = 1.76 [0.81-3.81]). The abstract's conclusion of 39/67 (58%) industry-funded and 69/149 (46%) nonindustry-funded NMAs were considered unsupported by the results (OR = 1.61 [0.90-2.89]; aOR = 1.40 [0.71-2.78]). All industry-funded NMAs that cited one treatment as best cited their own sponsored drug. 59/99 (60%) CPGs included at least one NMA, with 23/59 (39%) of them citing industry-funded NMAs. CONCLUSIONS We did not find evidence that industry-funded NMAs were more likely to have unsupported conclusions or to cite only one treatment as being best in their conclusions compared to non-industry-funded NMAs. However, almost all industry-funded NMAs favored their own treatments. Even though 40% of the CPGs did not rely on NMA, over a third of those who did used industry-funded NMAs. Limitations include the possible misclassification due to undisclosed funding and potential confounders that have not been accounted for.
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Affiliation(s)
- Robin Guelimi
- EpiDermE EA 7379, Université Paris Est Créteil, Créteil, F-94010, France; Department of Dermatology, Assistance Publique-Hôpitaux de Paris, Henri Mondor Hospital, Créteil, F-94010, France.
| | - Sivem Afach
- EpiDermE EA 7379, Université Paris Est Créteil, Créteil, F-94010, France
| | - Thomas Bettuzzi
- EpiDermE EA 7379, Université Paris Est Créteil, Créteil, F-94010, France; Department of Dermatology, Assistance Publique-Hôpitaux de Paris, Henri Mondor Hospital, Créteil, F-94010, France
| | - Antoine Meyer
- Department of Gastroenterology, University Hospital of Bicêtre, Assistance Publique-Hôpitaux de Paris and Université Paris-Saclay, Le Kremlin Bicêtre, France
| | - Guillaume Padern
- IRMB, University of Montpellier, Inserm U1183, CHU Montpellier, Montpellier, France
| | - Zenas Yiu
- Faculty of Biology, Medicine and Health, Division of Musculoskeletal and Dermatological Sciences, School of Biological Sciences, The University of Manchester, Manchester, United Kingdom; Salford Royal Hospital, Northern Care Alliance NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, M6 8HD, United Kingdom
| | - Florian Naudet
- Univ Rennes, CHU Rennes, Inserm, Irset (Institut de Recherche en Santé, Environnement et Travail) - UMR_S 1085, CIC 1414 [(Centre d'Investigation Clinique de Rennes)], F-35000, Rennes, France; Institut Universitaire de France (IUF), Paris, France
| | - Emilie Sbidian
- EpiDermE EA 7379, Université Paris Est Créteil, Créteil, F-94010, France; Department of Dermatology, Assistance Publique-Hôpitaux de Paris, Henri Mondor Hospital, Créteil, F-94010, France
| | - Laurence Le-Cleach
- EpiDermE EA 7379, Université Paris Est Créteil, Créteil, F-94010, France; Department of Dermatology, Assistance Publique-Hôpitaux de Paris, Henri Mondor Hospital, Créteil, F-94010, France
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van Zuuren EJ, Arents BWM, Vermeulen S, Schoones JW, Fedorowicz Z. Global Guidelines in Dermatology Mapping Project (GUIDEMAP)-A systematic review of the methodological quality of contact dermatitis clinical practice guidelines. Contact Dermatitis 2024; 90:543-555. [PMID: 38403277 DOI: 10.1111/cod.14530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Revised: 02/11/2024] [Accepted: 02/13/2024] [Indexed: 02/27/2024]
Abstract
The Global Guidelines in Dermatology Mapping Project (GUIDEMAP) assesses the methodological quality of clinical practice guidelines (CPGs) for high-burden skin diseases. This review focuses on contact dermatitis. We searched MEDLINE, Embase, PubMed, Web of Science, Cochrane Library, Emcare, Epistemonikos, PsycINFO and Academic Search Premier for CPGs published between 1 November 2018 and 1 November 2023. Prespecified guideline resources were hand searched. Two authors independently undertook screening, data extraction and quality assessments. Instruments used were the Appraisal of Guidelines for Research and Evaluation (AGREE) II Reporting Checklist, the U.S. Institute of Medicine's (IOM) criteria of trustworthiness, The Agency for Healthcare Research and Quality's National Guideline Clearinghouse Extent Adherence to Trustworthy Standards (NEATS) Instrument and Lenzer's Red Flags. Twenty five CPGs were included, exhibiting heterogeneity in both the topics they addressed and their methodological quality. Whereas the CPGs on management of hand eczema from Denmark, Europe and the Netherlands scored best, most CPGs fell short of being clear, unbiased, trustworthy and evidence-based. Disclosure of conflicts of interest scored well, and areas needing improvement include 'strength and wording of recommendations', 'applicability', 'updating' and 'external review'. Adhering to AGREE II and Grading of Recommendations, Assessment, Development and Evaluations (GRADE) enhances methodological quality.
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Affiliation(s)
- Esther J van Zuuren
- Dermatology Department, Leiden University Medical Centre, Leiden, The Netherlands
| | - Bernd W M Arents
- Dutch Association for People with Atopic Dermatitis, Nijkerk, The Netherlands
| | - Sofieke Vermeulen
- Department of Dermatology, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Jan W Schoones
- Directorate of Research Policy (formerly: Walaeus Library), Leiden University Medical Centre, Leiden, The Netherlands
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Yatsuzuka K, Muto J, Shiraishi K, Murakami M, Fujisawa Y. A Successful Switch From Ustekinumab to an Extended Dosing Interval of Guselkumab Without Induction in a Patient With Psoriasis Vulgaris. Cureus 2024; 16:e61567. [PMID: 38962596 PMCID: PMC11221387 DOI: 10.7759/cureus.61567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/03/2024] [Indexed: 07/05/2024] Open
Abstract
Psoriasis vulgaris, also known as plaque-type psoriasis, is the most common form of psoriasis. It is characterized by erythematous plaques covered with scales. Among the available treatments, the fully human monoclonal antibodies ustekinumab (UST) and guselkumab (GUS) have low immunogenicity. Additionally, GUS has not been found to have a significant risk of inducing the development of clinically relevant neutralizing antibodies. Therefore, we sometimes consider switching to GUS when UST is insufficiently effective. However, switching to another biological agent usually requires an induction phase, potentially incurring additional costs. We herein present the first case of a successful transition from UST 90 mg to an extended dosing interval of GUS without an induction phase. This approach may be a viable and cost-saving option, especially for patients with relatively low disease activity.
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Affiliation(s)
- Kazuki Yatsuzuka
- Department of Dermatology, Ehime University Graduate School of Medicine, Toon, JPN
| | - Jun Muto
- Department of Dermatology, Ehime University Graduate School of Medicine, Toon, JPN
| | - Ken Shiraishi
- Department of Dermatology, Ehime University Graduate School of Medicine, Toon, JPN
| | - Masamoto Murakami
- Department of Dermatology, Ehime University Graduate School of Medicine, Toon, JPN
| | - Yasuhiro Fujisawa
- Department of Dermatology, Ehime University Graduate School of Medicine, Toon, JPN
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Schwarz CW, Skov L, Egeberg A, Passey A, Lee J, Gorecki P, Loft N. Characteristics of Patients With Psoriasis Treated With Various Biologics - A Danish Cohort Study. JOURNAL OF PSORIASIS AND PSORIATIC ARTHRITIS 2024; 9:51-60. [PMID: 39301091 PMCID: PMC11361497 DOI: 10.1177/24755303241234292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/22/2024]
Abstract
Background Psoriasis is associated with several comorbidities and patients with psoriasis are more often obese than individuals without psoriasis. The excess disease burden is important to consider in choice of and response to treatment at the individual level. Objective To investigate whether patient characteristics differ across biologics for patients initiating biologic therapy and for patients still on biologic therapy after 1 year. Also, to quantify and compare the use of topical therapy among patients still on biologic therapy after 1 year. Methods This nationwide cohort study compared characteristics of patients prescribed adalimumab, etanercept, infliximab, secukinumab or ustekinumab for treatment of psoriasis by using data from the Danish registries. Results In the ustekinumab group, patients were younger and fewer had psoriatic arthritis. Patients treated with secukinumab and ustekinumab were less frequently co-treated with conventional systemics and topical therapy. All other patient characteristics such as sex, smoking and comorbidities other than psoriatic arthritis were similar across the biologic cohorts. Conclusion These results highlight the need to better understand which factors to consider when prescribing biologics to patients with psoriasis.
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Affiliation(s)
- Christopher Willy Schwarz
- Department of Dermatology and Allergy, Copenhagen University Hospital - Herlev and Gentofte, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- Copenhagen Research Group for Inflammatory Skin, Copenhagen University Hospital - Herlev and Gentofte, Copenhagen, Denmark
| | - Lone Skov
- Department of Dermatology and Allergy, Copenhagen University Hospital - Herlev and Gentofte, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- Copenhagen Research Group for Inflammatory Skin, Copenhagen University Hospital - Herlev and Gentofte, Copenhagen, Denmark
| | - Alexander Egeberg
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- Department of Dermatology, Copenhagen University Hospital - Bispebjerg, Copenhagen, Denmark
| | | | | | | | - Nikolai Loft
- Department of Dermatology and Allergy, Copenhagen University Hospital - Herlev and Gentofte, Copenhagen, Denmark
- Copenhagen Research Group for Inflammatory Skin, Copenhagen University Hospital - Herlev and Gentofte, Copenhagen, Denmark
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Du H, Yang J, Li M, Xia Y, Li Y, Zhu J, Zhang L, Tao J. Microneedle-assisted percutaneous delivery of methotrexate-loaded nanoparticles enabling sustained anti-inflammatory effects in psoriasis therapy. J Mater Chem B 2024; 12:2618-2627. [PMID: 38376394 DOI: 10.1039/d3tb02643d] [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: 02/21/2024]
Abstract
Methotrexate (MTX) is one of the first-line drugs used for the treatment of moderate to severe psoriasis. However, low bioavailability and systemic side effects of traditional oral and injectable MTX greatly limit its clinical application. Delivering MTX using dissolving microneedles (MNs) into psoriasis-like skin lesion could improve the in situ therapeutic effects with higher bioavailability and less side effects. Here, we propose a novel therapeutic approach for psoriasis involving MN-assisted percutaneous delivery of chitosan-coated hollow mesoporous silica nanoparticles containing MTX (MTX@HMSN/CS). The MTX@HMSN/CS-loaded MNs were strong enough to successfully penetrate the psoriasiform thickened epidermis, allowing MTX@HMSN/CS to be accurately delivered to the site of skin lesion following the rapid dissolution of MNs. MTX was then released continuously from HMSN/CS for at least one week to maintain effective therapeutic drug concentration for skin lesion with long-term anti-proliferative and anti-inflammatory effects. Incubation with MTX@HMSN/CS not only inhibited the proliferation of human immortalized keratinocytes (HaCaT cells), but also significantly reduced the expression of proinflammatory cytokines and chemokines. In addition, MTX@HMSN/CS-loaded MNs showed better efficacy in alleviating psoriasis-like skin inflammation than MTX-loaded MNs at the same dose. Compared to psoriasiform mice treated with 15.8 μg MTX-loaded MNs every day, 47.4 μg MTX@HMSN/CS-loaded MNs reduce the frequency of treatment to once every 3 days and achieve comparable amelioration. Therefore, MTX@HMSN/CS loaded MNs are a promising treatment strategy for psoriasis due to their durability, efficacy, convenience, and safety in relieving psoriasis-like skin inflammation.
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Affiliation(s)
- Hongyao Du
- Hubei Engineering Research Center for Skin Repair and Theranostics, Department of Dermatology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology (HUST), Wuhan 430022, China.
| | - Jing Yang
- Hubei Engineering Research Center for Skin Repair and Theranostics, Department of Dermatology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology (HUST), Wuhan 430022, China.
| | - Mo Li
- Key Laboratory of Material Chemistry for Energy Conversion and Storage (HUST), Ministry of Education, School of Chemistry and Chemical Engineering, HUST, Wuhan 430074, China.
| | - Yuting Xia
- Hubei Engineering Research Center for Skin Repair and Theranostics, Department of Dermatology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology (HUST), Wuhan 430022, China.
| | - Yan Li
- Hubei Engineering Research Center for Skin Repair and Theranostics, Department of Dermatology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology (HUST), Wuhan 430022, China.
| | - Jintao Zhu
- Key Laboratory of Material Chemistry for Energy Conversion and Storage (HUST), Ministry of Education, School of Chemistry and Chemical Engineering, HUST, Wuhan 430074, China.
| | - Lianbin Zhang
- Key Laboratory of Material Chemistry for Energy Conversion and Storage (HUST), Ministry of Education, School of Chemistry and Chemical Engineering, HUST, Wuhan 430074, China.
| | - Juan Tao
- Hubei Engineering Research Center for Skin Repair and Theranostics, Department of Dermatology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology (HUST), Wuhan 430022, China.
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Yen H, Yen H, Huang CH, Huang IH, Hung WK, Su HJ, Tai CC, Haw WWY, Flohr C, Yiu ZZN, Chi CC. Systematic Review and Critical Appraisal of Urticaria Clinical Practice Guidelines: A Global Guidelines in Dermatology Mapping Project (GUIDEMAP). THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2023; 11:3213-3220.e11. [PMID: 37451615 DOI: 10.1016/j.jaip.2023.07.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Revised: 06/12/2023] [Accepted: 07/05/2023] [Indexed: 07/18/2023]
Abstract
BACKGROUND Management of urticaria can be optimized with clinical practice guidelines (CPGs). However, the quality of recent urticaria CPGs remains unclear. OBJECTIVE To identify and appraise urticaria CPGs worldwide published in the last 5 years. METHODS A search for relevant urticaria CPGs was conducted between January 1, 2017, and May 31, 2022, using the following databases: MEDLINE, Embase, National Institute for Health and Care Excellence (NICE) Evidence Search, Guidelines International Network, ECRI Guidelines Trust, Australian Clinical Practice Guidelines, Trip Medical Database, and DynaMed. The included CPGs were critically appraised using the Appraisal of Guidelines for Research and Evaluation (AGREE) II instrument, Lenzer et al's red flags, and the Institute of Medicine (IOM) criteria of trustworthiness. RESULTS We included 21 urticaria CPGs. Most guidelines reviewed treatment recommendations of chronic spontaneous urticaria. The majority of guidelines were from European and Asian countries with high and high-middle sociodemographic index, written in English, and openly accessible. Seventeen guidelines (81%) had at least 1 AGREE II domain rated poor quality. Applicability, rigor of development, and stakeholder involvement were the 3 AGREE II domains that scored the lowest across guidelines. Appraisal with Lenzer et al's red flags showed that 18 guidelines (86%) raised at least 1 red flag indicating potential bias. The top 3 domains raising red flags were: no inclusion of nonphysician experts/patient representative/community stakeholders, no or limited involvement of a methodologist in the evaluation of evidence, and lack of external review. Based on IOM's criteria of trustworthiness, 20 guidelines (95%) had 1 or more criteria that did not meet best practice standards. The 3 domains with the highest number of best practice standards not met were updating procedures, rating strength of recommendations, and external review. Guidelines scored highest for the AGREE II domains of defining scope and purpose and clarity of presentation, and had the most fully met IOM's best practice standard for articulation of recommendations. However, only 1 urticaria CPG by NICE was identified as rigorously developed across all 3 appraisal tools. CONCLUSIONS The quality of urticaria CPGs in the last 5 years varied widely. Only the NICE urticaria guideline consistently demonstrated excellent quality, high trustworthiness, and low risk of bias. Use of a rigorous framework to rate certainty of evidence and grade strength of recommendation, involvement of methodologists, stakeholder engagement with external review, and clear guidance for updating can help improve the quality of future CPGs.
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Affiliation(s)
- Hsi Yen
- Department of Dermatology, Chang Gung Memorial Hospital, Linkou, Taoyuan, Taiwan; School of Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan; Department of Dermatology, Division of Pediatric Dermatology, Medical College of Wisconsin, Milwaukee, Wis
| | - Hsuan Yen
- Department of Dermatology, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
| | - Chun-Hsien Huang
- Department of Dermatology, Chang Gung Memorial Hospital, Linkou, Taoyuan, Taiwan
| | - I-Hsin Huang
- Department of Dermatology, Chang Gung Memorial Hospital, Linkou, Taoyuan, Taiwan
| | - Wei-Kai Hung
- Department of Dermatology, Chang Gung Memorial Hospital, Linkou, Taoyuan, Taiwan
| | - Hsing-Jou Su
- Department of Dermatology, Chang Gung Memorial Hospital, Linkou, Taoyuan, Taiwan
| | - Cheng-Chen Tai
- Medical Library, Department of Medical Education, Chang Gung Memorial Hospital, Linkou, Taoyuan, Taiwan
| | - William W Y Haw
- Northern Care Alliance NHS Foundation Trust, Manchester, UK; Division of Musculoskeletal and Dermatological Sciences, School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Carsten Flohr
- Unit for Paediatric and Population-Based Dermatology Research, St. John's Institute of Dermatology, King's College London and Guy's & St. Thomas' Hospital NHS Foundation Trust, London, UK
| | - Zenas Z N Yiu
- Northern Care Alliance NHS Foundation Trust, Manchester, UK; Division of Musculoskeletal and Dermatological Sciences, School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Ching-Chi Chi
- Department of Dermatology, Chang Gung Memorial Hospital, Linkou, Taoyuan, Taiwan; School of Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan.
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Babiker Mohamed MA, El-Malky AM, Abdelkarim WAA, Abdulmonem Salih Aabdeen M, Hassan Elobid Ahmed T, Sarsour HHH, Mohammed Mosa M, Amer YS, Khormi AAM, Alajlan A. Evidence-based clinical practice guidelines for the management of psoriasis: systematic review, critical appraisal, and quality assessment with the AGREE II instrument. J DERMATOL TREAT 2022; 33:2771-2781. [PMID: 35737878 DOI: 10.1080/09546634.2022.2083545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Accepted: 05/22/2022] [Indexed: 10/17/2022]
Abstract
BACKGROUND Psoriasis is considered one of the stubborn lifelong dermatologic diseases, making the patients seized in their social cage. Evidence-based clinical practice guidelines (CPGs) and expert opinions ensure that patients with psoriasis render the most recent and developed care. This systematic review assessed and compared the most recently approved international CPGs with the AGREE II instrument. METHODS After we identified our research question, we searched the bibliographic international databases to identify and screen for relevant and eligible guidelines that address the topic of interest. Four independent reviewers (Senior Expert Dermatologist in Psoriasis) have critically appraised the selected guidelines via the AGREE II instrument. We conducted inter-rater analysis and percent agreement among raters and calculation of intra-class correlation coefficient (ICC) 'Kappa'. RESULTS Out of 33 articles for CPGs, only Four eligible CPGs fulfill the inclusion criteria. Selected CPGs were critically appraised; first from the American College of Rheumatology that is also National Psoriasis Foundation (ACR/NPF-2018), second from the UK's National Institute for Health and Care Excellence (NICE-2017) for Psoriasis: Assessment and Management, third from the Saudi practical guidelines on the biologic treatment for Psoriasis (Saudi CPGs, 2015), and lastly from the American Academy of Dermatology (AAD/NPF-2019) Management and Treatment of Psoriasis with Awareness and Attention to Comorbidities. The complete assessments (OA) of two CPGs (AAD/NPF and NICE) scored greater than 80%; 'six domains' of AGREE II had greater score that is congruent with results; (1) scope and motive, (2) shareholder involvement, (3) rigor of growth, (4) clarity of speech, (5) validity, and (6) journalistic independence domains. Domain (3) scored (84, 71, and 90%), domain (5) (51%, 47, and 90%), domain (6) (70, 52, and 90%) for (Saudi CPGs, AAD/NPF, and NICE), respectively. Generally, the clinical recommendations were significantly better for NICE CPGs. CONCLUSIONS Four evidence-based 'CPGs' introduced a high-quality methodological analysis. NICE indicated the greatest quality followed by Saudi CPGs and AAD/NPF and all four CPGs were suggested for practice.
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Affiliation(s)
| | - Ahmed M El-Malky
- Public Health and Community Medicine Department, Theodor Bilharz Research Institute, Academy of Scientific Research, Ministry of Higher Education, Cairo, Egypt
- Morbidity and Mortality Review Unit, King Saud University Medical City, King Saud University, Riyadh, Saudi Arabia
| | | | | | | | | | - Munirah Mohammed Mosa
- College of Medicine, King Saud University, King Saud University Medical City, Riyadh, Saudi Arabia
| | - Yasser S Amer
- Pediatric Department, King Khalid University Hospital, Riyadh, Saudi Arabia
- Research Chair for Evidence-Based Health Care and Knowledge Translation, King Saud University, Riyadh, Saudi Arabia
- Quality Management Department, Clinical Practice Guidelines and Quality Research Unit, King Saud University Medical City, Riyadh, Saudi Arabia
- Alexandria Center for Evidence-Based Clinical Practice Guidelines, Alexandria University, Alexandria, Egypt
- Adaptation Working Group, Guidelines International Network, Perth, Scotland
| | - Abdulrahman Ali M Khormi
- Internal Medicine and Rheumatology - Prince Sattam University Medical College, Al-Kharj, Saudi Arabia
| | - Abdulmajeed Alajlan
- Dermatology Department, Faculty of Medicine, King Saud University Medical City, King Saud University, Riyadh, Saudi Arabia
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Florez ID. Clinical practice guidelines for psoriasis: which ones are the best? Br J Dermatol 2022; 187:136-137. [PMID: 35484939 DOI: 10.1111/bjd.21605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Ivan D Florez
- Departamento de Pediatria y Puericultura, Universidad de Antioquia, Medellin, Colombia.,School of Rehabilitation Science, McMaster University, Hamilton, Canada.,Clinica Las Américas-AUNA, Medellin, Colombia
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