1
|
Wang WM, Jin HZ. Biologics in pediatric psoriasis. J Dermatol 2023; 50:415-421. [PMID: 36651087 DOI: 10.1111/1346-8138.16702] [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: 10/12/2022] [Revised: 11/30/2022] [Accepted: 12/17/2022] [Indexed: 01/19/2023]
Abstract
Psoriasis is a chronic inflammatory skin disorder with a chronic relapsing course. Biologics have revolutionized the treatment of adult psoriasis with higher efficacy and favorable safety profile. Recently, more studies have focused on the use of biologics in pediatric psoriasis, and several biologics have been approved for use therein. This review is divided into two sections: the first part focuses on real-world studies on the use of biologics in pediatric psoriasis and the second part summarizes the findings of other clinical trials related to biologics in pediatric psoriasis. Case reports have been excluded from this review. Several biologics were used for treating pediatric psoriasis and the efficacy is encouraging. According to the studies included in this review, anti-IL-12/23 and anti-IL-17A for treating pediatric psoriasis might have a better efficacy than anti-TNF-α, but more data are needed.
Collapse
Affiliation(s)
- Wen-Ming Wang
- Department of Dermatology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Hong-Zhong Jin
- Department of Dermatology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| |
Collapse
|
2
|
Zheng YX, Ye LR, Yan BX, Chen SQ, Cai SQ, Man XY. Biologics for psoriasis patients under 18 years of age: Real-world evidence from the Chinese psoriasis real world evidence research group. Front Med (Lausanne) 2022; 9:1009991. [PMID: 36160145 PMCID: PMC9490006 DOI: 10.3389/fmed.2022.1009991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Accepted: 08/22/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundTreatment for pediatric psoriasis is challenging because of the lack of real-world evidence, especially for biological therapies.ObjectivesThis study evaluated the efficacy and safety of biologics in children with psoriasis based on real-world evidence.MethodsPediatric psoriasis patients aged <18 years who were treated with biologics in our hospital (2020–2022) were prospectively analyzed. Patients treated with adalimumab, secukinumab, or ixekizumab were followed up for at least 16 weeks, and 22 of 38 patients completed the 52-week observation period. Dermatologist raters were blinded to ensure the reliability of the PASI, BSA, and PGA score assessments. PASI 75 or PGA 0/1 at week 12 represented an efficient indicator.ResultsThirty-eight patients (20 males and 18 females; median age, 12.6 ± 4.1 years) were enrolled, and none were lost to follow-up. All participants were diagnosed with psoriasis, including plaque psoriasis (n = 36), nail psoriasis (n = 1), and pustular psoriasis (n = 1). Within 12 weeks, all patients achieved scores above PASI 75 and PGA 0/1. The average time to reach PASI 75 was 4.3 ± 2.0, 3.2 ± 1.8, and 2.4 ± 0.4 weeks in patients using adalimumab, secukinumab, and ixekizumab, respectively, and, 27.2% (3/11), 86.4% (19/22), and 75.0% (3/4) of these patients achieved PASI 100 at week 12, respectively. Moreover, 18 of 20 patients with plaque psoriasis maintained ≥PASI 75 after 52 weeks. The most commonly reported adverse effect was upper respiratory tract infection, and no severe adverse effects were reported.ConclusionsOur real-world data demonstrated the safety and effectiveness of adalimumab, secukinumab, and ixekizumab in children with psoriasis.
Collapse
|
3
|
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.
Collapse
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
| | | |
Collapse
|
4
|
Abstract
Psoriasis is an inflammatory immune-mediated skin disease that affects both adults and children. Increased understanding of its pathogenesis has led to the development of highly effective therapeutic solutions in the form of biological drugs for adult patients with severe forms of the disease. The unpredictability of the action of adult-approved drugs in pediatric populations limited their usage in these patients for several years. However, this scenario has been changing, particularly in the last decade, increasing our knowledge of the clinical efficacy and safety of these drugs in pediatric populations. The approval/extensions to approvals of several biological agents throughout the year 2020 makes it important to update the topic. Five biological agents (etanercept, adalimumab, ustekinumab, secukinumab, and ixekizumab) have been approved by the European Medicines Agency for the treatment of psoriasis in pediatric populations, and three of them (etanercept, ustekinumab, and ixekizumab) were also approved by the US FDA for the same purpose. In total, 17 clinical trials of several distinct targeted therapies (tumor necrosis factor, interleukin [IL]-17 and IL-23, and phosphodiesterase-4 inhibitors) are ongoing in pediatric patients and will certainly provide crucial data on the subject, which could ultimately improve the armamentarium we have to target psoriasis in this special population.
Collapse
Affiliation(s)
- Miguel Nogueira
- Department of Dermatology, Centro Hospitalar Universitário do Porto, Porto, Portugal
| | - Amy S Paller
- Feinberg Medical School, Northwestern University, Chicago, IL, USA
| | - Tiago Torres
- Department of Dermatology, Centro Hospitalar Universitário do Porto, Porto, Portugal. .,Instituto de Ciências Biomédicas Abel Salazar, University of Porto, Porto, Portugal.
| |
Collapse
|