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Kesharwani P, Jain A, Srivastava AK, Keshari MK. Systematic development and characterization of curcumin-loaded nanogel for topical application. Drug Dev Ind Pharm 2020; 46:1443-1457. [PMID: 32644836 DOI: 10.1080/03639045.2020.1793998] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Affiliation(s)
- Payal Kesharwani
- Department of Pharmaceutics, Indian Institute of Technology (Banaras Hindu University), Varanasi, India
- Department of Pharmacy, Ram-Eesh Institute of Vocational and Technical Education, Greater Noida, India
| | - Ankit Jain
- Pharmaceutics Research Projects Laboratory, Department of Pharmaceutical Sciences, Dr. Harisingh Gour Central University, Sagar, India
- Department of Materials Engineering, Indian Institute of Science, Bangalore, India
| | - Anand Kumar Srivastava
- Department of Pharmaceutics, Indian Institute of Technology (Banaras Hindu University), Varanasi, India
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2
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Esposito M, Prignano F, Rongioletti F, Hansel K, Bianchi L, Pescitelli L, Lazzeri L, Ricceri F, Mugheddu C, Bavetta M, Zangrilli A, Bianchi L, Bini V, Stingeni L. Efficacy and safety of adalimumab after failure of other anti-TNFα agents for plaque-type psoriasis: clinician behavior in real life clinical practice. J DERMATOL TREAT 2018; 30:441-445. [PMID: 30273075 DOI: 10.1080/09546634.2018.1529382] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Introduction: During treatment with biologic agents for psoriasis (Pso) in a number of patients a failure may occur and discontinuation with transitioning to another drug or an optimization strategy, consisting in a dose-adjustment or a co-medication with a traditional systemic agent, represent two possible alternatives. Objective: The SAFARI study objective was a retrospective observation of adalimumab efficacy and safety profile after switching from other anti-TNFα agents related to clinician behavior after the failure of the first-line agent. Results: The retrospective multicenter observation demonstrated that after a first-line anti-TNFα failure adalimumab efficacy was consistent at week-12 and 24 with a further significant improvement at week-48 with a proportion of patients achieving PASI75/PASI90/PASI100 of 83.3, 71.6, and 56.9.%, respectively. Clinician strategies to extend drug-survival after first-line anti-TNFα failure, such as co-medication or dose-adjustment, were irrelevant to future drug effectiveness. Conclusions: Adalimumab profile was excellent in this 5-year retrospective observation, showing the clinical validity of interclass transitioning among anti-TNFα options.
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Affiliation(s)
- Maria Esposito
- a Department of Dermatology , University of Rome 'Tor Vergata' , Rome , Italy
| | | | - Franco Rongioletti
- c Department of Medical Sciences and Public Health, Section of Dermatology , University of Cagliari , Cagliari , Italy
| | - Katharina Hansel
- d Department of Medicine, Section of Clinical, Allergological and Venereological Dermatology , University of Perugia , Perugia , Italy
| | - Leonardo Bianchi
- d Department of Medicine, Section of Clinical, Allergological and Venereological Dermatology , University of Perugia , Perugia , Italy
| | | | - Linda Lazzeri
- b Department of Dermatology , University of Florence , Firenze , Italy
| | - Federica Ricceri
- b Department of Dermatology , University of Florence , Firenze , Italy
| | - Cristina Mugheddu
- c Department of Medical Sciences and Public Health, Section of Dermatology , University of Cagliari , Cagliari , Italy
| | - Mauro Bavetta
- a Department of Dermatology , University of Rome 'Tor Vergata' , Rome , Italy
| | - Arianna Zangrilli
- a Department of Dermatology , University of Rome 'Tor Vergata' , Rome , Italy
| | - Luca Bianchi
- a Department of Dermatology , University of Rome 'Tor Vergata' , Rome , Italy
| | - Vittorio Bini
- e Department of Medicine, Medicine, Endocrine and Metabolic Sciences Section , University of Perugia , Perugia , Italy
| | - Luca Stingeni
- d Department of Medicine, Section of Clinical, Allergological and Venereological Dermatology , University of Perugia , Perugia , Italy
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3
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Strand V, Elaine Husni M, Betts KA, Song Y, Singh R, Griffith J, Beppu M, Zhao J, Ganguli A. Network meta-analysis and cost per responder of targeted Immunomodulators in the treatment of active psoriatic arthritis. BMC Rheumatol 2018; 2:3. [PMID: 30886954 PMCID: PMC6390550 DOI: 10.1186/s41927-018-0011-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2017] [Accepted: 01/23/2018] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Multiple targeted immunomodulators (TIMs) for psoriatic arthritis (PsA) treatment are available, but limited studies have directly compared these agents. This study indirectly compared the efficacy of TNF-α, interleukins, and phosphodiesterase-4 inhibitors for treatment of active PsA. METHODS A systematic literature review was conducted to identify phase III randomized controlled trials (RCTs) for adalimumab, certolizumab pegol, etanercept, golimumab, infliximab, ustekinumab, secukinumab, and apremilast in active PsA. Joint (ACR20/50/70) and skin outcomes (PASI75/90) at Week 24 with each TIM were estimated via a Bayesian network meta-analysis, and the incremental cost per responder over the first 24 weeks of treatment was calculated. Similar analyses were conducted in a subgroup of biologic-naïve patients. RESULTS Seventeen RCTs were identified; 13 included ACR and/or PASI responses at Week 24. Among the overall population, patients receiving adalimumab, golimumab, and infliximab showed higher ACR20/50/70 (adalimumab: 61.2/42.8/40.8%, golimumab: 61.6/39.8/27.4%, infliximab: 56.2/57.1/34.2%) and PASI75/90 (72.7/55.5%, 74.1/57.2%, and 77.1/61.0%, respectively) responses at Week 24 compared with other TIMs. In terms of cost-effectiveness, these treatments were also associated with the lowest incremental cost per responder for both skin and joint outcomes. Similar rankings of efficacy and incremental cost per responder were observed in the analysis among biologic-naive patients. CONCLUSIONS Adalimumab, golimumab, and infliximab were associated with higher efficacy and lower incremental costs per responder for both joint and skin responses in active PsA.
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Affiliation(s)
| | | | - Keith A. Betts
- Analysis Group Inc., 333 South Hope Street, 27th Floor, Los Angeles, CA 90071 USA
| | - Yan Song
- Analysis Group Inc., Boston, MA USA
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4
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Esposito M, Gisondi P, Conti A, Giunta A, del Giglio M, Di Mercurio M, Veneziano L, Ferrucci G, Bianchi L, Chimenti S, Girolomoni G. Dose adjustment of biologic therapies for psoriasis in dermatological practice: a retrospective study. J Eur Acad Dermatol Venereol 2017; 31:863-869. [DOI: 10.1111/jdv.14145] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2016] [Accepted: 12/12/2016] [Indexed: 12/01/2022]
Affiliation(s)
- M. Esposito
- Department of Dermatology; University of Rome ‘Tor Vergata’; Rome Italy
| | - P. Gisondi
- Department of Dermatology; University of Verona; Verona Italy
| | - A. Conti
- Department of Dermatology; University of Modena and Reggio Emilia; Modena Italy
| | - A. Giunta
- Department of Dermatology; University of Rome ‘Tor Vergata’; Rome Italy
| | - M. del Giglio
- Department of Dermatology; University of Verona; Verona Italy
| | - M. Di Mercurio
- Department of Dermatology; University of Verona; Verona Italy
| | - L. Veneziano
- Department of Dermatology; University of Modena and Reggio Emilia; Modena Italy
| | | | - L. Bianchi
- Department of Dermatology; University of Rome ‘Tor Vergata’; Rome Italy
| | - S. Chimenti
- Department of Dermatology; University of Rome ‘Tor Vergata’; Rome Italy
| | - G. Girolomoni
- Department of Dermatology; University of Verona; Verona Italy
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5
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Zhang J, Lin Y, Li C, Zhang X, Cheng L, Dai L, Wang Y, Wang F, Shi G, Li Y, Yang Q, Cui X, Liu Y, Wang H, Zhang S, Yang Y, Xiang R, Li J, Yu D, Wei Y, Deng H. IL-35 Decelerates the Inflammatory Process by Regulating Inflammatory Cytokine Secretion and M1/M2 Macrophage Ratio in Psoriasis. THE JOURNAL OF IMMUNOLOGY 2016; 197:2131-44. [PMID: 27527600 DOI: 10.4049/jimmunol.1600446] [Citation(s) in RCA: 75] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/15/2016] [Accepted: 07/12/2016] [Indexed: 02/05/2023]
Abstract
IL-35 downregulates Th17 cell development and suppresses certain types of autoimmune inflammation such as collagen-induced arthritis and experimental autoimmune uveitis. Psoriasis is thought to be initiated by abnormal interactions between cutaneous keratinocytes and systemic immune cells. However, the role of IL-35 in psoriasis remains unclear. In this study, we assessed IL-35 in three well-known psoriasis models: a human keratinocyte cell line (HaCaT), a keratin 14 (K14)-vascular endothelial growth factor A (VEGF-A)-transgenic (Tg) mouse model, and an imiquimod-induced psoriasis mouse model. First, we found that IL-35 suppressed the expression of IL-6, CXCL8, and S100A7, which are highly upregulated by a mixture of five proinflammatory cytokines in HaCaT. Second, a plasmid coding for the human IL-35 sequence coated with cationic liposomes showed potent immunosuppressive effects on K14-VEGF-A-Tg and imiquimod-induced psoriasis mouse models. In the K14-VEGF-A-Tg model, our results showed that several types of proinflammatory cytokines were significantly reduced, whereas IL-10 was remarkably induced by IL-35. Compared with pcDNA3.1, there was a small number of CD4(+)IL-17(+) T cells and a large number of CD4(+)IL-10(+) and CD4(+)CD25(+)Foxp3(+) T cells in the IL-35 group. Most importantly, we found that IL-35 decreased the total number of macrophages and ratio of M1/M2 macrophages, which has not been reported previously. In addition, compared with dexamethasone, IL-35 showed long-term therapeutic efficacy. In summary, our results strongly indicate that IL-35 plays a potent immunosuppressive role in psoriasis. Thus, IL-35 has potential for development as a new therapeutic strategy for patients with chronic psoriasis and other cutaneous inflammatory diseases.
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Affiliation(s)
- Junfeng Zhang
- State Key Laboratory of Biotherapy/Collaborative Innovation Center for Biotherapy, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, China; Provincial Key Discipline of Medical Immunology, Jining Medical University, Jining 272067, Shandong, China
| | - Yi Lin
- State Key Laboratory of Biotherapy/Collaborative Innovation Center for Biotherapy, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, China
| | - Chunlei Li
- State Key Laboratory of Biotherapy/Collaborative Innovation Center for Biotherapy, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, China; Department of Biochemistry, Faculty of Basic Medicine, Chongqing Three Gorges Medical College, Chongqing 400715, China
| | - Xiaomei Zhang
- Laboratory Animal Center, Sichuan University, Chengdu 610040, Sichuan, China
| | - Lin Cheng
- State Key Laboratory of Biotherapy/Collaborative Innovation Center for Biotherapy, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, China
| | - Lei Dai
- State Key Laboratory of Biotherapy/Collaborative Innovation Center for Biotherapy, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, China
| | - Youcui Wang
- State Key Laboratory of Biotherapy/Collaborative Innovation Center for Biotherapy, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, China
| | - Fangfang Wang
- Hematology Research Laboratory, Department of Hematology, West China Hospital, Sichuan University, Chengdu 610041, Sichuan, China; and
| | - Gang Shi
- State Key Laboratory of Biotherapy/Collaborative Innovation Center for Biotherapy, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, China
| | - Yiming Li
- State Key Laboratory of Biotherapy/Collaborative Innovation Center for Biotherapy, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, China
| | - Qianmei Yang
- State Key Laboratory of Biotherapy/Collaborative Innovation Center for Biotherapy, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, China
| | - Xueliang Cui
- State Key Laboratory of Biotherapy/Collaborative Innovation Center for Biotherapy, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, China
| | - Yi Liu
- State Key Laboratory of Biotherapy/Collaborative Innovation Center for Biotherapy, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, China
| | - Huiling Wang
- State Key Laboratory of Biotherapy/Collaborative Innovation Center for Biotherapy, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, China
| | - Shuang Zhang
- State Key Laboratory of Biotherapy/Collaborative Innovation Center for Biotherapy, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, China
| | - Yang Yang
- State Key Laboratory of Biotherapy/Collaborative Innovation Center for Biotherapy, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, China
| | - Rong Xiang
- Department of Immunology, College of Medicine, Key Laboratory of Bioactive Materials, Ministry of Education, Nankai University, Tianjin 300071, China
| | - Jiong Li
- State Key Laboratory of Biotherapy/Collaborative Innovation Center for Biotherapy, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, China
| | - Dechao Yu
- State Key Laboratory of Biotherapy/Collaborative Innovation Center for Biotherapy, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, China
| | - Yuquan Wei
- State Key Laboratory of Biotherapy/Collaborative Innovation Center for Biotherapy, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, China
| | - Hongxin Deng
- State Key Laboratory of Biotherapy/Collaborative Innovation Center for Biotherapy, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, China;
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Langley RG, Gupta AK, Cherman AM, Inniss KA. Biologic Therapeutics in the Treatment of Psoriasis. Part 1: Review. J Cutan Med Surg 2016; 11:99-122. [PMID: 17511926 DOI: 10.2310/7750.2006.00060a] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Background: Psoriasis is a chronic inflammatory skin disease principally mediated by activated T cells, which release proinflammatory cytokines with reactive epidermal changes in the skin, producing the characteristic lesions of psoriasis. New research into possible treatment options has been inspired by increased understanding of the pathophysiology of psoriasis and advances in immunology and molecular biology permitting the development of targeted, highly active biologic agents. Objective: The aim of this article is to review the efficacy and safety of five biologic therapeutics in the treatment of moderate to severe psoriasis and to provide practical guidelines for integration of these agents in the management of psoriasis. Methods: We searched MEDLINE (1966–2005) for articles containing the key words: alefacept, efalizumab, etanercept, infliximab, and adalimumab and searched recent conference abstracts. Results: Emerging immunotherapeutic agents (fusion proteins, recombinant cytokines, fusion toxins, or antibodies) target T cells or cytokines responsible for plaque formation that is characteristic of psoriasis. Alefacept is the first biologic to be approved in both the United States and Canada. More recently, efalizumab and etanercept and infliximab have been approved in the United States and Canada for plaque-type psoriasis. Adalimumab is currently in phase III clinical trials. Conclusion: These novel biologics offer an intriguing and effective treatment option for patients with moderate to severe psoriasis.
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Esposito M, Giunta A, Mazzotta A, Babino G, Talamonti M, Chimenti M, Chimenti S. Continuous Treatment of Plaque-Type Psoriasis with Etanercept: An Observational Long-Term Experience. Int J Immunopathol Pharmacol 2010; 23:503-9. [DOI: 10.1177/039463201002300212] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
To assess the long-term efficacy and safety profile and the patient-reported outcomes (PRO) in patients with moderate-to-severe plaque-type psoriasis receiving continuous etanercept treatment. An open-label study was conducted to evaluate etanercept as long-term treatment for moderate-to-severe plaque psoriasis. Continuous therapy was administered at a dose of 50 mg subcutaneously twice weekly for 12 weeks followed by a continuous treatment with 50 mg subcutaneously once weekly or 25 mg twice weekly throughout a 96-week study. The primary measure of efficacy was the proportion of patients with PASI 75 at week 24, 48 and 96. Patient-reported outcomes (PRO) were also assessed during the study, at week 24, 48 and 96, including the Dermatology Life Quality Index (DLQI) and the Psoriasis Disability Index (PDI). At baseline, mean PASI score, DLQI and PDI for patients eligible to initiate treatment with etanercept showed significant disease severity, quality-of-life impairment and psoriasis-related disability. At week 96, patients showed statistically significant and meaningful improvements. The continuous etanercept regimen provided a consistent improvement in both clinical disease parameters and PRO measures.
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Affiliation(s)
| | | | | | | | | | - M.S. Chimenti
- Department of Rheumatology, University of Rome “Tor Vergata”
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8
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Mazzotta A, Esposito M, Schipani C, Chimenti S. Long-term experience with etanercept in psoriatic arthritis patients: A 3-year observational study. J DERMATOL TREAT 2009; 20:354-8. [DOI: 10.3109/09546630902936752] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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9
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Wolf P, Nghiem DX, Walterscheid JP, Byrne S, Matsumura Y, Matsumura Y, Bucana C, Ananthaswamy HN, Ullrich SE. Platelet-activating factor is crucial in psoralen and ultraviolet A-induced immune suppression, inflammation, and apoptosis. THE AMERICAN JOURNAL OF PATHOLOGY 2006; 169:795-805. [PMID: 16936256 PMCID: PMC1579250 DOI: 10.2353/ajpath.2006.060079] [Citation(s) in RCA: 77] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Psoralen plus UVA (PUVA) is used as a very effective treatment modality for various diseases, including psoriasis and cutaneous T-cell lymphoma. PUVA-induced immune suppression and/or apoptosis are thought to be responsible for the therapeutic action. However, the molecular mechanisms by which PUVA acts are not well understood. We have previously identified platelet-activating factor (PAF), a potent phospholipid mediator, as a crucial substance triggering ultraviolet B radiation-induced immune suppression. In this study, we used PAF receptor knockout mice, a selective PAF receptor antagonist, a COX-2 inhibitor (presumably blocking downstream effects of PAF), and PAF-like molecules to test the role of PAF receptor binding in PUVA treatment. We found that activation of the PAF pathway is crucial for PUVA-induced immune suppression (as measured by suppression of delayed type hypersensitivity to Candida albicans) and that it plays a role in skin inflammation and apoptosis. Downstream of PAF, interleukin-10 was involved in PUVA-induced immune suppression but not inflammation. Better understanding of PUVA's mechanisms may offer the opportunity to dissect the therapeutic from the detrimental (ie, carcinogenic) effects and/or to develop new drugs (eg, using the PAF pathway) that act like PUVA but have fewer side effects.
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MESH Headings
- Animals
- Apoptosis/drug effects
- Apoptosis/radiation effects
- Candida albicans/immunology
- Candidiasis/drug therapy
- Candidiasis/immunology
- Candidiasis/pathology
- Combined Modality Therapy/methods
- Female
- Ficusin/pharmacology
- Humans
- Hypersensitivity, Delayed/drug therapy
- Hypersensitivity, Delayed/immunology
- Hypersensitivity, Delayed/pathology
- Immune Tolerance/drug effects
- Immune Tolerance/immunology
- Immune Tolerance/radiation effects
- Immunosuppression Therapy/methods
- Inflammation/drug therapy
- Inflammation/immunology
- Inflammation/pathology
- Interleukin-10/immunology
- Lymphoma, T-Cell, Cutaneous/drug therapy
- Lymphoma, T-Cell, Cutaneous/immunology
- Lymphoma, T-Cell, Cutaneous/pathology
- Male
- Mice
- Mice, Knockout
- PUVA Therapy/adverse effects
- PUVA Therapy/methods
- Platelet Activating Factor/immunology
- Platelet Membrane Glycoproteins/deficiency
- Platelet Membrane Glycoproteins/immunology
- Psoriasis/drug therapy
- Psoriasis/immunology
- Psoriasis/pathology
- Receptors, G-Protein-Coupled/deficiency
- Receptors, G-Protein-Coupled/immunology
- Signal Transduction/drug effects
- Signal Transduction/immunology
- Signal Transduction/radiation effects
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Affiliation(s)
- Peter Wolf
- Research Unit for Photodermatology, Department of Dermatology, Medical University Graz, Auenbrugger Platz 8, A-8036 Graz, Austria.
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10
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Liao YH, Jee SH, Sheu BC, Huang YL, Tseng MP, Hsu SM, Tsai TF. Increased expression of the natural killer cell inhibitory receptor CD94/NKG2A and CD158b on circulating and lesional T cells in patients with chronic plaque psoriasis. Br J Dermatol 2006; 155:318-24. [PMID: 16882169 DOI: 10.1111/j.1365-2133.2006.07301.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Psoriasis is a common inflammatory cutaneous disorder characterized by activated T-cell infiltration. T lymphocytes bearing natural killer cell receptors (NKRs) have been suggested to play an important role in the pathogenesis of psoriasis. However, the expression pattern of activating and inhibitory NKRs on T lymphocytes from psoriatic patients and its significance in psoriasis needs further study. OBJECTIVES To investigate the pathogenesis of NKR-expressing T cells in psoriasis. MATERIALS AND METHODS Thirty patients with chronic plaque psoriasis and 20 healthy controls were enrolled in this study. The immunophenotypic profiles of NKRs, including CD56, CD16 (activating NKRs), CD158a, CD158b, CD94 and NKG2A (inhibitory NKRs), were analysed in peripheral blood T lymphocytes, as well as psoriatic lesional infiltrating T cells, by triple-fluorescence flow cytometry. RESULTS A significant increase of inhibitory CD8+ CD158b+, CD4 CD8 CD158b+ and CD8+ CD94/NKG2A+ T cells was found in the peripheral blood of patients with psoriasis when compared with controls. Tissue-infiltrating T lymphocytes expressing inhibitory receptors CD158b, CD94 and NKG2A were found in psoriatic lesions. There was a significant positive correlation between the increased percentage of circulating CD8+ CD94/NKG2A+ T cells and the Psoriasis Area and Severity Index. CONCLUSIONS In the present study, we demonstrated increased proportions of particular subsets of inhibitory CD158b+ and/or CD94/NKG2A+ T cells in patients with psoriasis. The elevation of these inhibitory NKR-expressing T cells was correlated with disease severity, which may signify the possibility of chronic antigen-driven stimulation and dysregulated cytokine production in the pathogenesis of psoriasis.
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Affiliation(s)
- Y H Liao
- Department of Obsterics and Gynecology, National Taiwan University Hospital, National Taiwan University College of Medicine, 7, Chung-Shan South Road, Taipei 100, Taiwan
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11
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Esposito M, Mazzotta A, de Felice C, Papoutsaki M, Chimenti S. Treatment of erythrodermic psoriasis with etanercept. Br J Dermatol 2006; 155:156-9. [PMID: 16792768 DOI: 10.1111/j.1365-2133.2006.07217.x] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Severe variants of psoriasis, such as erythrodermic psoriasis, may be associated with serious morbidity and mortality. Current treatment options for erythrodermic psoriasis are limited, unsatisfactory and potentially associated with organ-specific toxicity. Recently, a new class of agents, targeted biological therapies, has emerged. Etanercept is a recombinant human fusion protein acting as a competitive inhibitor of tumour necrosis factor-alpha. The safety and efficacy of etanercept have been widely demonstrated in psoriatic arthritis and moderate to severe plaque-type psoriasis. OBJECTIVES To assess the efficacy and tolerability of etanercept in the treatment of erythrodermic psoriasis over a period of 24 weeks. METHODS Ten patients, eight men and two women, were selected to receive etanercept 25 mg subcutaneously twice weekly. The Psoriasis Area and Severity Index (PASI) score, ranging from 0 to 72, was used to assess the severity of disease. RESULTS Etanercept was well tolerated and led to a significant reduction in the severity of disease over the period of treatment. After 24 weeks, the mean PASI score decreased from 39.1 (baseline) to 5.1. At week 12, five of 10 (50%) patients achieved an improvement of PASI score from baseline exceeding 75%. At week 24, six of 10 patients (60%) achieved or maintained an improvement of PASI score from baseline exceeding 75% while two patients (20%) maintained an improvement of between 50% and 75%. CONCLUSIONS In this study, etanercept has been demonstrated to be an effective treatment for erythrodermic psoriasis, providing a safe and convenient alternative to current therapies.
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Affiliation(s)
- M Esposito
- Department of Dermatology, University of Rome Tor Vergata, Viale Oxford 81, 00133 Rome, Italy
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12
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Abstract
Psoriasis is a common, persistent, inflammatory skin disorder that can have a major effect on patient quality of life. Conventional psoriasis treatment fail to meet the clinical needs for a save and remittive therapy. The implication of an immunological lymphocyte T phenomena in the pathogenesis of psoriasis has led to research for new treatment options over the past few years. With advances in molecular research and technology, several biological therapies may be employed in the treatment of psoriasis. Biological treatments are designed to modulate key steps in the pathogenesis of psoriasis. They act by: inhibition of activation of antigen-presenting cells, inhibition of activation and proliferation of lymphocytes, immune deviation (from a T1 immune response to a T2 immune response) and reduction of pathogenic T cells and blocking the activity of inflammatory cytokines. Different biological treatments are discussed in this article.
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Affiliation(s)
- Reyes Gamo
- Servicio de Dermatología, Hospital Fundación de Alcorcón, Madrid, Spain.
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13
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Abstract
Psoriasis is a disease characterized by scaly skin lesions secondary to keratinocyte hyperplasia. The presence of active T cells in the lesions, experimental observations on disease transfer, and therapeutic efficacy of specific immunosuppressive drugs have led to the identification of the activated T lymphocyte as the primary factor for keratinocyte stimulation. Understanding the pathways of pathogenesis is fundamental in evolving therapies for intervention at different points in the pathogenic model and for curtailing the process. Advances in biotechnological methods have helped to create designer molecules and proteins that specifically recognize target receptors and chemicals that modify their actions. These drugs, termed "biologic response modifiers," are now being studied as specific immunosuppressive agents producing different T-cell and cytokine effects in psoriasis.
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Affiliation(s)
- Ibrahim Galadari
- Department of Dermatology, Al Ain Hospital, Al Ain, United Arab Emirates.
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14
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Abstract
Psoriasis is a chronic, incurable, disabling skin disease characterised by red, scaly plaques. Approximately 23% of psoriasis patients also have an accompanying arthritis that can become debilitating. Psoriasis has a stigmatising effect on its victims, who often feel socially isolated. Although the exact aetiology of psoriasis is still unknown, it is clearly an immune-mediated disease. Traditional therapies for psoriasis include topical drugs, such as corticosteroids, retinoids and vitamin D3 analogues; systemic drugs, such as methotrexate, ciclosporin and retinoids; and phototherapy. These mainstays of treatment are efficacious for the treatment of severe disease; however, most are associated with toxicities or are inconvenient. Recent advances in biotechnology have produced new pharmaceuticals that interfere with immune responses thought to be involved in the pathogenesis of psoriasis and other inflammatory diseases. The immunobiologicals, one new family of drugs, consist of monoclonal antibodies and fusion proteins. Many have demonstrated efficacy in treating psoriasis. Some appear to offer safety benefits over traditional therapies; further monitoring and surveillance of these agents is required to adequately establish safety profiles. This article discusses existing and emerging treatments for moderate-to-severe psoriasis.
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Affiliation(s)
- Melissa A Magliocco
- UMDNJ-Robert Wood Johnson Medical School, Clinical Research Center, 51 French Street, New Brunswick, NJ 08901-0019, USA.
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Abstract
Psoriasis is a chronic inflammatory skin disorder that is characterized by thickened, scaly plaques, and is estimated to affect approximately 1-3% of the Caucasian population. Traditional treatments, although effective in patients with limited disease, have numerous shortcomings, including inconvenience and toxicity. These drawbacks mean that many patients experience cycles of disease clearance, in which normal quality of life alternates with active disease and poor quality of life. However, as this review discusses, recent advances have highlighted the key role of the immune system in the pathogenesis of psoriasis, and have provided new defined targets for therapeutic intervention, offering hope for safe and effective psoriasis treatment.
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Affiliation(s)
- Alice B Gottlieb
- Clinical Research Center, UMDNJ-Robert Wood Johnson Medical School, 51 French Street, New Brunswick, New Jersey 08901-0019, USA.
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