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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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2
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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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Pezzolo E, Cazzaniga S, Cassalia F, Di Leo S, Naldi L. Trajectories of switching to optimise efficacy and minimising risks in patients with moderate-to-severe plaque psoriasis: results from the PsoReal registry. Arch Dermatol Res 2024; 316:263. [PMID: 38795124 DOI: 10.1007/s00403-024-02967-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2024] [Revised: 04/22/2024] [Accepted: 04/26/2024] [Indexed: 05/27/2024]
Affiliation(s)
- Elena Pezzolo
- Study Center of the Italian Group for Epidemiologic Research in Dermatology (GISED), Bergamo, Italy.
- Department of Dermatology, San Bortolo Hospital, Vicenza, Italy.
- Unità Complessa di Dermatologia, AULSS 8, Ospedale san Bortolo, viale Rodolfi 37, Vicenza, 36100, Italy.
| | - Simone Cazzaniga
- Study Center of the Italian Group for Epidemiologic Research in Dermatology (GISED), Bergamo, Italy
- Department of Dermatology, Inselspital University Hospital of Bern, Bern, Switzerland
| | - Fortunato Cassalia
- Study Center of the Italian Group for Epidemiologic Research in Dermatology (GISED), Bergamo, Italy
- Department of Dermatology, San Bortolo Hospital, Vicenza, Italy
| | - Sara Di Leo
- Department of Dermatology, San Bortolo Hospital, Vicenza, Italy
| | - Luigi Naldi
- Study Center of the Italian Group for Epidemiologic Research in Dermatology (GISED), Bergamo, Italy
- Department of Dermatology, San Bortolo Hospital, Vicenza, Italy
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4
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Degli Esposti L, Perrone V, Dovizio M, Sangiorgi D, DI Cesare A, Rosi E, Peris K, Prignano F. Estimation of patients with psoriasis potentially eligible and currently untreated with biological drugs in Italy. Ital J Dermatol Venerol 2023; 158:445-451. [PMID: 37768706 DOI: 10.23736/s2784-8671.23.07568-0] [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: 09/29/2023]
Abstract
BACKGROUND Psoriasis (PSO) patients can benefit from the growing availability of novel biological agents, that are often underused or discontinued. This real-world analysis estimated PSO patients potentially eligible and currently untreated with biologics in Italy. METHODS An observational analysis was performed on administrative databases of a pool of healthcare entities, covering 11.3% of Italian population. During the inclusion period (2010- 2020), patients were identified by: 1) at least one prescription of topical drugs for PSO; or 2) active exemption for PSO; or 3) at least one PSO hospital discharge diagnosis. The index-date was the first PSO identification across inclusion period. Eligibility for biologics was evaluated prior to index-date (characterization period) through two not-mutually exclusive criteria: Criterion A, failure of at least one systemic treatment, and/or Criterion B, onset of psoriatic arthritis (PsA). Data were re-proportioned to the Italian population. RESULTS The study sample showed a PSO prevalence of 2%. Projection to 2020 national population (N=59,236.213) estimated 1.43 million Italian patients affected by PSO: 95% treated with conventional therapies, 4% with biologics, and 1% untreated. Among those non-treated with biologics, 3.8% of overall PSO patients met one or both eligibility criteria for biologics, specifically 25% met criterion A (failure to conventional treatments), 68% criterion B (PsA co-diagnosis), and 7% met both. About half of them had 1 or 2 comorbidities and 30% above 3. CONCLUSIONS These findings from real clinical practice estimated about 4% PSO patients potentially eligible for biologics, but still untreated, with nearly one-third exhibiting a complex comorbidity profile.
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Affiliation(s)
- Luca Degli Esposti
- CliCon S.r.l., Società Benefit, Health, Economics & Outcomes Research, Bologna, Italy -
| | - Valentina Perrone
- CliCon S.r.l., Società Benefit, Health, Economics & Outcomes Research, Bologna, Italy
| | - Melania Dovizio
- CliCon S.r.l., Società Benefit, Health, Economics & Outcomes Research, Bologna, Italy
| | - Diego Sangiorgi
- CliCon S.r.l., Società Benefit, Health, Economics & Outcomes Research, Bologna, Italy
| | - Antonella DI Cesare
- Section of Dermatology, Department of Health Sciences, University of Florence, Florence, Italy
| | - Elia Rosi
- Section of Dermatology, Department of Health Sciences, University of Florence, Florence, Italy
| | - Ketty Peris
- Unit of Dermatology, Department of Translational Medicine and Surgery, Sacred Heart Catholic University, Rome, Italy
| | - Francesca Prignano
- Section of Dermatology, Department of Health Sciences, University of Florence, Florence, Italy
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Schäkel K, Reich K, Asadullah K, Pinter A, Jullien D, Weisenseel P, Paul C, Gomez M, Wegner S, Personke Y, Kreimendahl F, Chen Y, Angsana J, Leung MWL, Eyerich K. Early disease intervention with guselkumab in psoriasis leads to a higher rate of stable complete skin clearance ('clinical super response'): Week 28 results from the ongoing phase IIIb randomized, double-blind, parallel-group, GUIDE study. J Eur Acad Dermatol Venereol 2023; 37:2016-2027. [PMID: 37262309 DOI: 10.1111/jdv.19236] [Citation(s) in RCA: 21] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Accepted: 04/25/2023] [Indexed: 06/03/2023]
Abstract
BACKGROUND Guselkumab is an interleukin (IL)-23 inhibitor with demonstrated efficacy in patients with psoriasis. OBJECTIVES Evaluate the impact of early disease intervention on clinical responses following 28 weeks of guselkumab treatment in patients with moderate-to-severe plaque psoriasis. Correlate clinical response and disease duration data with serum biomarker data. METHODS GUIDE is a phase IIIb randomized, double-blind, parallel-group, multicentre study of adults with moderate-to-severe plaque psoriasis. In study part 1, patients with a short disease duration (SDD [≤2 years]) or a long disease duration (LDD [>2 years]) received guselkumab 100 mg at Week (W) 0, 4, 12, and 20. Those achieving complete skin clearance at W20 and W28 were defined as a super responder (SRe). A multivariable logistic regression analysed the association between baseline factors and the likelihood of becoming an SRe. The relationship between clinical response, disease duration and serum biomarker data was assessed at W0 and 4. RESULTS In total, 880 patients were enrolled (SDD/LDD = 40.6%/59.4% of patients). More SDD than LDD patients achieved absolute Psoriasis Area and Severity Index (PASI) = 0 at W28 (51.8% vs. 39.4%) and were SRes (43.7% vs. 28.1% [overall 34.4%]). SDD patients also achieved PASI = 0 quicker than LDD patients (median 141 vs. 200 days). Disease duration and prior biologic use had the greatest impact on becoming an SRe, with no strong association among these independent variables. At baseline, there were no significant differences in the serum biomarker levels of IL-17A, IL-17F, IL-22 and β-defensin 2 between SDD and LDD patients, or between SRe and non-SRe patients. Guselkumab rapidly decreased these markers of systemic inflammation across all patient groups analysed at W4. Guselkumab was well tolerated. CONCLUSIONS Guselkumab efficacy was consistent across subpopulations, on the skin and systemically. The proportion of SRes was higher in SDD than LDD patients, indicating early treatment intervention may improve clinical outcomes.
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Affiliation(s)
- K Schäkel
- Department of Dermatology, and Interdisciplinary Center for Inflammatory Diseases, Heidelberg University Hospital, Heidelberg, Germany
| | - K Reich
- Translational Research in Inflammatory Skin Diseases, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - K Asadullah
- Department of Dermatology, Venereology and Allergology, Charité - Universitätsmedizin Berlin, Berlin, Germany
- Prof. Dr. med. Asadullah, Dermatological Practice, Potsdam, Germany
| | - A Pinter
- University Hospital Frankfurt am Main, Frankfurt, Germany
| | - D Jullien
- Department of Dermatology, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France
| | | | - C Paul
- Toulouse University, Toulouse, France
| | - M Gomez
- Janssen-Cilag GmbH, Neuss, Germany
| | - S Wegner
- Janssen-Cilag GmbH, Neuss, Germany
| | | | | | - Y Chen
- Janssen R&D, LLC, San Diego, USA
| | | | | | - K Eyerich
- Department of Dermatology and Venereology, Medical Center, University of Freiburg, Freiburg im Breisgau, Germany
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Alabas OA, Mason KJ, Yiu ZZN, Warren RB, Lunt M, Smith CH, Griffiths CEM. Effectiveness and survival of methotrexate versus adalimumab in patients with moderate-to-severe psoriasis: a cohort study from the British Association of Dermatologists Biologics and Immunomodulators Register (BADBIR). Br J Dermatol 2023; 189:271-278. [PMID: 37226927 DOI: 10.1093/bjd/ljad179] [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: 12/02/2022] [Revised: 03/18/2023] [Accepted: 05/22/2023] [Indexed: 05/26/2023]
Abstract
BACKGROUND Most information on the comparative effectiveness and survival of methotrexate (MTX) and adalimumab (ADA) in the treatment of psoriasis is from randomized control trials and may not translate to the everyday clinical setting. OBJECTIVES To determine the real-world effectiveness and survival of MTX and ADA in patients with moderate-to-severe psoriasis registered in the British Association of Dermatologists Biologics and Immunomodulators Register (BADBIR). METHODS Eligible patients were registered in BADBIR, ≥ 16 years of age and receiving a first course of MTX or ADA between September 2007 and December 2021, with ≥ 6 months of follow-up. Effectiveness was defined as achieving an absolute Psoriasis Area and Severity Index (PASI) ≤ 2 reported ≥ 13 weeks after the treatment start date until the stop date. The average treatment effect (ATE) was estimated using inverse probability of treatment weighting with propensity score, including baseline covariates. ATE results were presented as risk ratios (RR). A flexible parametric model was used to estimate adjusted standardized average survival, defined as treatment discontinuation associated with ineffectiveness or the occurrence of adverse events (AEs) at 6, 12 and 24 months. Restricted mean survival time (RMST) at 2 years of treatment exposure was calculated. RESULTS In total, 6575 patients (median age 44 years; 44% female) were analysed; 2659 (40.4%) were prescribed MTX and 3916 (59.5%) ADA. The proportion of patients achieving PASI ≤ 2 was higher in the ADA cohort (77.4%) than in the MTX cohort (37.4%). ADA was more effective than MTX [RR 2.20, 95% confidence interval (CI) 1.98-2.45]. Overall survival associated with ineffectiveness or AEs was lower in the MTX cohort than in the ADA cohort at 6 months [survival estimate 69.7 (95% CI 67.9-71.5) vs. 90.6 (95% CI 89.8-91.4)], 1 year [survival estimate 52.5 (95% CI 50.4-54.8) vs. 80.6 (95% CI 79.5-81.8)] and 2 years [survival estimate 34.8 (95% CI 32.5-37.2) vs. 68.6 (95% CI 67.2-70.0)]. The difference in RMST (years) overall, or when stratified by ineffectiveness and AEs, was 0.53 (95% CI 0.49-0.58), 0.37 (95% CI 0.33-0.42) and 0.29 (95% CI 0.25-0.33), respectively. CONCLUSIONS Patients on ADA were twice as likely to be clear or nearly clear of psoriasis and were less likely to discontinue their medication than patients on MTX. Findings from this real-world cohort provide important information to aid clinicians managing patients with psoriasis.
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Affiliation(s)
- Oras A Alabas
- Centre for Dermatology Research, University of Manchester, NIHR Manchester Biomedical Research Centre, Manchester, UK
| | - Kayleigh J Mason
- Primary Care Centre Versus Arthritis, School of Medicine, Keele University, Keele, UK
| | - Zenas Z N Yiu
- Centre for Dermatology Research, University of Manchester, NIHR Manchester Biomedical Research Centre, Manchester, UK
| | - Richard B Warren
- Centre for Dermatology Research, University of Manchester, NIHR Manchester Biomedical Research Centre, Manchester, UK
| | - Mark Lunt
- Centre for Dermatology Research, University of Manchester, NIHR Manchester Biomedical Research Centre, Manchester, UK
| | - Catherine H Smith
- St John's Institute of Dermatology, Guy's and St Thomas' NHS Foundation Trust and King's College London, London, UK
| | - Christopher E M Griffiths
- Centre for Dermatology Research, University of Manchester, NIHR Manchester Biomedical Research Centre, Manchester, UK
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Jo SJ, Baek YS, Kim TG, Jeong KH, Kim JE, Choi YS, Kim B, Lee ES, Choe YB. Basic Therapeutic Approach for Patients with Plaque Psoriasis: Korean Expert Consensus Using the Modified Delphi Method. Ann Dermatol 2023; 35:173-182. [PMID: 37290951 DOI: 10.5021/ad.22.216] [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: 12/13/2022] [Revised: 12/29/2022] [Accepted: 01/02/2023] [Indexed: 06/10/2023] Open
Abstract
BACKGROUND Currently, there is no consensus on the treatment of psoriasis in Korean patients. OBJECTIVE This study aimed to establish a consensus on the basic therapeutic principles for Korean patients with plaque psoriasis. METHODS Using the modified Delphi method, a steering committee proposed 53 statements for the first Delphi round, which covered five subjects: (1) the goal of treatment and evaluation of disease severity, (2) topical therapy, (3) phototherapy, (4) conventional systemic therapy, and (5) biologic therapy. The panel of dermatologists scored the level of agreement for each statement on a ten-point scale with scores ranging from 1 (strongly disagree) to 10 (strongly agree). After discussing the results of the first round, the committee reformulated 41 statements. Finally, consensus was defined as more than 70% of the second round scores being ≥7. RESULTS The panel participants strongly agreed that the ideal treatment goals for Korean patients with plaque psoriasis should include complete skin clearance and high dermatological quality of life. A strong consensus was also reached on the use of topical agents for psoriasis of any severity, the consideration of phototherapy before biologics therapy, the conventional systemic agents for moderate-to-severe psoriasis, and the recommendation of biologic for retractable psoriasis to conventional systemic therapy and phototherapy. CONCLUSION This modified Delphi panel established an expert consensus on the therapeutic approach for Korean patients with plaque psoriasis. This consensus may improve the treatment outcomes for psoriasis in Korea.
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Affiliation(s)
- Seong Jin Jo
- Department of Dermatology, Seoul National University College of Medicine, Seoul, Korea
| | - Yoo Sang Baek
- Department of Dermatology, Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Tae-Gyun Kim
- Department of Dermatology, Severance Hospital, Cutaneous Biology Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Ki-Heon Jeong
- Department of Dermatology, College of Medicine, Kyung Hee University, Seoul, Korea
| | - Jeong Eun Kim
- Department of Dermatology, Hanyang University College of Medicine, Seoul, Korea
| | - Yu Sung Choi
- Department of Dermatology, Soonchunhyang University Hospital, Seoul, Korea
| | - Byungsoo Kim
- Department of Dermatology, Pusan National University School of Medicine, Busan, Korea
| | - Eun-So Lee
- Department of Dermatology, Ajou University School of Medicine, Suwon, Korea.
| | - Yong Beom Choe
- Department of Dermatology, Konkuk University School of Medicine, Seoul, Korea.
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Chicharro P, Llamas-Velasco M, Armesto S, Herrera Acosta E, Vidal D, Vilarrasa E, Rivera-Diaz R, De-la-Cueva P, Martorell-Calatayud A, Ballescà F, Belinchon I, Carretero G, Rodriguez L, Romero-Maté A, Pujol-Montcusí J, Salgado L, Sahuquillo-Torralba A, Coto-Segura P, Baniandrés Rodríguez O, Feltes R, Riera-Monroig J, Dauden E. Secukinumab is effective and safe in the long-term treatment of plaque psoriasis in a daily practice setting: Multicenter study in 384 Spanish patients. Dermatol Ther 2022; 35:e15929. [PMID: 36223184 DOI: 10.1111/dth.15929] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Revised: 10/03/2022] [Accepted: 10/11/2022] [Indexed: 11/30/2022]
Abstract
The aim of the study was to assess the long-term effectiveness and safety of secukinumab in Spanish patients with moderate-to-severe psoriasis in a daily practice setting. Nationwide multicenter, observational, retrospective, non-interventional, single-cohort study including patients who initiated treatment with secukinumab in daily clinical practice conditions. Subjects were followed for a minimum of 3 months and a maximum of 24 months. Psoriasis Area Severity Index (PASI), Body Surface Area and Physician's Global Assessments were collected at baseline and months 3, 6, 12, 18 and 24 during treatment. Adverse events and reasons for secukinumab withdrawal were collected and classified for analyses. A total of 384 patients were enrolled in the study. Median PASI declined rapidly from 14.3 at baseline to 2.7 at month 3, 2.1 at month 12, and remained low (2.8) at month 24. Within the group of patients with PASI ≥10 at baseline (n = 278), 58.3%, 60.4% and 56.5% achieved a PASI90 response at months 3, 12 and 24, respectively. As for absolute PASI, 86.5%, 69.5%, 42.7% and 37% achieved PASI <5, < 3, < 1 and 0, respectively, at month 3. Secukinumab was more effective in biologic-naïve patients and in those with lower Body Mass Index. Secukinumab presented a good long-term safety profile. Secukinumab was effective and safe in a routine clinical setting, in a large cohort of patients with moderate-to-severe plaque psoriasis, in the short-, medium- and long-term (up to 24 months).
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Affiliation(s)
- Pablo Chicharro
- Department of Dermatology, Hospital Universitario de la Princesa, Madrid, Spain
| | - Mar Llamas-Velasco
- Department of Dermatology, Hospital Universitario de la Princesa, Madrid, Spain
| | - Susana Armesto
- Department of Dermatology, Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | | | - David Vidal
- Department of Dermatology, Hospital de Sant Joan Despí Moisés Broggi, Barcelona, Spain
| | - Eva Vilarrasa
- Department of Dermatology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Raquel Rivera-Diaz
- Department of Dermatology, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Pablo De-la-Cueva
- Department of Dermatology, Hospital Universitario Infanta Leonor, Madrid, Spain
| | | | - Ferran Ballescà
- Department of Dermatology, Hospital Universitario Germans Trias i Pujol, Barcelona, Spain
| | - Isabel Belinchon
- Department of Dermatology, Hospital General Universitario de Alicante - ISABIAL, Alicante, Spain
| | - Gregorio Carretero
- Department of Dermatology, Hospital Universitario Doctor Negrín, Las Palmas de Gran Canaria, Spain
| | - Lourdes Rodriguez
- Department of Dermatology, Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | | | - Josep Pujol-Montcusí
- Department of Dermatology, Hospital Universitario de Tarragona "Joan XXIII", Tarragona, Spain
| | - Laura Salgado
- Department of Dermatology, Complejo Hospitalario Universitario, Pontevedra, Spain
| | - Antonio Sahuquillo-Torralba
- Department of Dermatology, Hospital Universitario y Politécnico La Fe, Instituto de Investigación Sanitária La Fe, Valencia, Spain
| | - Pablo Coto-Segura
- Department of Dermatology, Hospital Vital Alvarez-Buylla de Mieres, Asturias, Spain
| | | | - Rosa Feltes
- Department of Dermatology, Hospital Universitario la Paz, Madrid, Spain
| | - José Riera-Monroig
- Department of Dermatology, Hospital Clínic i Provincial, Barcelona, Spain
| | - Esteban Dauden
- Department of Dermatology, Hospital Universitario de la Princesa, Madrid, Spain
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9
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Egeberg A, Freilich J, Stelmaszuk MN, Kongerslev R, Apol E, Hansen JB, Levin L. Real-world dose adjustments of biologic treatments in psoriasis and their economic impact: a Swedish national population study. Clin Exp Dermatol 2022; 47:1968-1975. [PMID: 35670046 PMCID: PMC9826076 DOI: 10.1111/ced.15288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/30/2022] [Indexed: 01/11/2023]
Abstract
BACKGROUND To date, evidence on the dose adjustments of biologics in the real-world treatment of psoriasis is limited. However, dose adjustments may have important clinical and economic implications. AIMS To study the dose adjustments of individual biologics over time in real-world practice in Sweden. METHODS A retrospective observational study of adults with moderate to severe psoriasis was conducted based on Swedish national registry data from 2010 to 2018. Treatment episodes were identified for individual patients from the date of drug dispensation to the end of the supply of the drug. Dosing data were expressed as the proportion of treatment episodes with accumulated syringes/vials equal to, above or below the recommended guidelines. Real-world costs were calculated and compared with costs predicted from dosing guidelines. RESULTS The mean dose was above recommended levels for all biologics investigated. Weighted mean dose adjustments for adalimumab, etanercept, secukinumab and ustekinumab were 13%, 23%, 8% and 3%, respectively, over the entire treatment period. Higher doses translate to higher costs, including notable increases over time vs. expected costs for secukinumab. CONCLUSIONS Dose adjustments of biologics are frequent in clinical practice but differ for the various biologics. The mean observed increases in dose above guideline recommendations might indicate perceptions of suboptimal efficacy for biologics, with implications for the cost and cost-effectiveness of these treatments. Further research is warranted to understand the reasons for dose adjustments in clinical practice.
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Affiliation(s)
- Alexander Egeberg
- Department of DermatologyBispebjerg Hospital, University of CopenhagenCopenhagenDenmark
| | - Jonatan Freilich
- Department of Public Health and Clinical MedicineUmeå UniversityUmeåSweden,Parexel InternationalStockholmSweden
| | | | | | | | | | - Lars‐Åke Levin
- Department of Health, Medicine and Caring Sciences (HMV)Linköping UniversityLinköpingSweden
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10
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Mahé E, Beauchet A, Hadj‐Rabia S, Mazereeuw‐Hautier J, Mallet S, Phan A, Severino‐Freire M, Boralevi F, Aubert H, Barthélémy H, Girard C, Martin L, Piram M, Barbarot S, Balguerie X, Zitouni J, Phan C, Di Lernia V. Biologics combined with conventional systemic agents for the treatment of children with severe psoriasis. Real‐life data from the BiPe cohorts and a practice survey among French and Italian paediatric dermatologists. Dermatol Ther 2022; 35:e15828. [DOI: 10.1111/dth.15828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Revised: 09/01/2022] [Accepted: 09/13/2022] [Indexed: 11/30/2022]
Affiliation(s)
- Emmanuel Mahé
- Dermatology department Hôpital Victor Dupouy Argenteuil France
| | - Alain Beauchet
- Public Health department, Centre Hospitalier Universitaire Ambroise Paré Boulogne‐Billancourt France
| | - Smaïl Hadj‐Rabia
- Dermatology department INSERM U1163 & Institut Imagine, Centre Hospitalier Universitaire Necker‐Enfants Malades, Assistance Publique‐Hôpitaux de Paris, Université Paris Descartes ‐ Sorbonne, Paris Cité Paris France
| | - Juliette Mazereeuw‐Hautier
- Dermatology department Centre de référence des maladies rares de la peau et des muqueuses, Hôpital Larrey Toulouse France
| | - Stéphanie Mallet
- Dermatology department Hôpital de la Timone, Assistance‐publique‐Hôpitaux de Marseille Marseille France
| | - Alice Phan
- Paediatric department Hôpital Femme‐Mère‐Enfant, Hospices Civils de Lyon Bron France
| | - Maëlle Severino‐Freire
- Dermatology department Centre de référence des maladies rares de la peau et des muqueuses, Hôpital Larrey Toulouse France
| | - Franck Boralevi
- Department of Paediatric Dermatology Hôpital Pellegrin, CHU de Bordeaux Bordeaux France
| | - Hélène Aubert
- Dermatology department Centre Hospitalier Universitaire de Nantes Nantes France
| | - Hugue Barthélémy
- Dermatology department Centre Hospitalier d'Auxerre Auxerre France
| | - Céline Girard
- Dermatology department Centre Hospitalier Universitaire de Montpellier Montpellier France
| | - Ludovic Martin
- Dermatology department Centre Hospitalier Universitaire d'Angers Angers France
| | - Maryam Piram
- Service de Rhumatologie Pédiatrique, Centre Hospitalier Universitaire Bicêtre, Université Paris Sud‐Saclay, UVSQ, Assistance Publique‐Hôpitaux de Paris HP Le Kremlin Bicêtre France
| | - Sébastien Barbarot
- Dermatology department Centre Hospitalier Universitaire de Nantes Nantes France
| | - Xavier Balguerie
- Dermatology department Centre Hospitalier Universitaire Charles‐Nicolle Rouen France
| | - Jinane Zitouni
- Dermatology department Hôpital Victor Dupouy Argenteuil France
| | - Céline Phan
- Dermatology department Hôpital Victor Dupouy Argenteuil France
| | - Vito Di Lernia
- Dermatology unit, Arcispedale S. Maria Nuova IRCCS Reggio Emilia Italy
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11
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Hamed KM, Dighriri IM, Baomar AF, Alharthy BT, Alenazi FE, Alali GH, Alenazy RH, Alhumaidi NT, Alhulayfi DH, Alotaibi YB, Alhumaidan SS, Alhaddad ZA, Humadi AA, Alzahrani SA, Alobaid RH. Overview of Methotrexate Toxicity: A Comprehensive Literature Review. Cureus 2022; 14:e29518. [PMID: 36312688 PMCID: PMC9595261 DOI: 10.7759/cureus.29518] [Citation(s) in RCA: 32] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/23/2022] [Indexed: 02/05/2023] Open
Abstract
Methotrexate (MTX) is significantly more effective than and has a considerable advantage over placebo in patients with severe and persistent rheumatoid arthritis (RA). The drug is used to treat a variety of malignant disorders (leukemia and cancer of the lung, breast, and uterus) and ectopic pregnancy. As its side effects are outweighed by its effectiveness, MTX is a first-line antirheumatic drug in many countries. MTX is found in extracellular compartments, such as the synovium, as well as other organs, such as the kidney and liver. To improve treatment, increase adherence, and decrease mortality in MTX therapy, it is essential to reduce its toxicity and understand its side effects. Therefore, this comprehensive review was conducted to assist physicians and researchers in better understanding the toxicity of MTX and how to deal with this toxicity. MTX is eliminated via the kidneys, which are capable of excretion and reabsorption within the renal tubules. Although higher doses of MTX (known as high-dose MTX (HD-MTX), defined as doses of 500 mg/m2 or greater) are often more beneficial, they can produce toxicity and side effects such as bone marrow suppression, pulmonary toxicity, nephrotoxicity, hematologic toxicity, and an increased risk of infections. Treatment of severe MTX toxicity has three main goals: clearance of MTX from the bloodstream, folinic acid therapy, and organ treatment. Leucovorin is highly beneficial in preventing myelosuppression, gastric toxicity, and neurotoxic effects after HD-MTX therapy. The preferred antidote for MTX poisoning is folinic acid. Glucarpidase has been licensed for the treatment of high plasma MTX levels of >1 μmol/L in patients with compromised renal function who have delayed MTX elimination. In patients with renal deficiency, a lower initial dose is considered with an estimated glomerular filtration rate (eGFR) between 30 and 59 mL/minute. These patients need to be monitored, and a more gradual dosage increase and a lower weekly maximum should be considered regarding their general health situation. MTX is contraindicated in patients with RA if the eGFR is <30 mL/minute.
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Affiliation(s)
| | | | | | - Baidaa T Alharthy
- Pharmaceutical Care, General Network for Healthcare Providers Hospital, Jeddah, SAU
| | | | | | - Rawan H Alenazy
- General Medicine and Surgery, Northern Border University, Arar, SAU
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12
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van Huizen AM, Sikkel R, Caron AGM, Menting SP, Spuls PI. Methotrexate Dosing Regimen for Plaque-type Psoriasis: An Update of a Systematic Review. J DERMATOL TREAT 2022; 33:3104-3118. [PMID: 36043844 DOI: 10.1080/09546634.2022.2117539] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Background Methotrexate (MTX) is a systemic treatment for plaque-type psoriasis. At the time of approval, no dose-ranging studies were performed. Nowadays, a uniform dosing regimen is lacking. This might contribute to suboptimal treatment with the drug.Objective To summarize the literature involving the MTX dosing regimens in psoriasis patients.Methods In this SR, RCTs and documents with aggregated evidence (AgEv) on the MTX dosing regimen in psoriasis were summarized. All randomized controlled trials (RCTs) in which oral, subcutaneous or intramuscular MTX was used in patients with psoriasis and AgEv, were included. The MEDLINE, EMBASE and CENTRAL databases were searched up to June 20, 2022. This SR was registered in PROSPERO.Results Thirty-nine RCTs had a high risk of bias. Test dosages were given in only 3 RCTs. In the RCTs, MTX was usually prescribed in a start dose of 7.5 mg/week (n = 13). MTX was mostly given in a start dose of 15 mg/week, in the AgEv (n = 5). One guideline recommended a test dose, in other aggregated evidence a test dose was not mentioned or even discouraged.Conclusions There is a lack of high-quality evidence and available data for dosing MTX in psoriasis is heterogeneous.
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Affiliation(s)
- Astrid M van Huizen
- Amsterdam UMC, location University of Amsterdam, Department of Dermatology, Amsterdam Public Health, Infection and Immunity, Meibergdreef 9, Amsterdam, the Netherlands
| | - Rosie Sikkel
- Amsterdam UMC, location University of Amsterdam, Department of Dermatology, Amsterdam Public Health, Infection and Immunity, Meibergdreef 9, Amsterdam, the Netherlands
| | - Anouk G M Caron
- Amsterdam UMC, location University of Amsterdam, Department of Dermatology, Amsterdam Public Health, Infection and Immunity, Meibergdreef 9, Amsterdam, the Netherlands
| | - Stef P Menting
- OLVG hospital, Department of Dermatology, Amsterdam, the Netherlands
| | - Phyllis I Spuls
- Amsterdam UMC, location University of Amsterdam, Department of Dermatology, Amsterdam Public Health, Infection and Immunity, Meibergdreef 9, Amsterdam, the Netherlands
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13
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Reich K, Gordon KB, Strober B, Langley RG, Miller M, Yang YW, Shen YK, You Y, Zhu Y, Foley P, Blauvelt A. Super-Response to Guselkumab Treatment in Patients With Moderate-to-Severe Psoriasis: Age, Body Weight, Baseline Psoriasis Area and Severity Index, and Baseline Investigator's Global Assessment Scores Predict Complete Skin Clearance. J Eur Acad Dermatol Venereol 2022; 36:2393-2400. [PMID: 35920762 DOI: 10.1111/jdv.18474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Accepted: 07/12/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND Psoriasis is a chronic immune-mediated inflammatory skin disease that often leads to a diminished quality of life. Goals of treating patients with psoriasis have shifted with more focus on achieving near or complete clearance of the skin. Guselkumab, a fully human monoclonal antibody targeting interleukin-23, is effective in treating moderate-to-severe psoriasis. OBJECTIVE To describe the baseline characteristics of patients with moderate-to-severe psoriasis achieving super-response (Psoriasis Area and Severity Index [PASI] 100 response at Weeks 20 and 28) after commencing guselkumab treatment. METHODS Pooled data from VOYAGE-1 and VOYAGE-2 studies identified super-response; baseline demographic, disease, and pharmacokinetic characteristics were compared with non-super-response. A stepwise logistic regression analysis identified which factors were potentially predictive of super-response status, with significance level of 0.1. RESULTS A subset of patients randomized to guselkumab comprised this post hoc analysis (n=664); 271 patients achieved super-response vs 393 with non-super-response. Patient age at study entry and baseline body weight (≤90 kg vs >90 kg), PASI, and Investigator's Global Assessment (IGA) score were significant predictors of super-response status, with odds ratios (95% confidence intervals) of 0.98 (0.967-0.993; p=0.003), 1.42 (1.026-1.977; p=0.034), 0.97 (0.955-0.993; p=0.007), and 0.66 (0.433-0.997; p=0.048), respectively. More patients with super-response achieved an early response: Week 2 PASI 75 (5.5% vs 1.8%) and Week 8 PASI 100 (22.5% vs 3.3%) vs non-super-response. Median serum guselkumab concentrations through Week 28 were slightly greater in patients with super-response vs non-super-response. CONCLUSION Guselkumab was more likely to achieve early clinical responses (complete skin clearance) in younger patients, less obese patients, and patients with less severe psoriasis.
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Affiliation(s)
- K Reich
- Translational Research in Inflammatory Skin Diseases, Institute for Health Services Research in Dermatology and Nursing, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - K B Gordon
- Medical College of Wisconsin, Milwaukee, WI, USA
| | - B Strober
- Yale University, New Haven, CT, USA.,Central Connecticut Dermatology Research, Cromwell, CT, USA
| | - R G Langley
- Dalhousie University, Halifax, Nova Scotia, Canada
| | - M Miller
- Janssen Research & Development, LLC, Spring House, PA, USA
| | - Y-W Yang
- Immunology Global Medical Affairs, Janssen Pharmaceutical Companies of Johnson & Johnson, LLC , Horsham, PA, USA
| | - Y-K Shen
- Janssen Research & Development, LLC, Spring House, PA, USA
| | - Y You
- Janssen Research & Development, LLC, Spring House, PA, USA
| | - Y Zhu
- Janssen Research & Development, LLC, Spring House, PA, USA
| | - P Foley
- The University of Melbourne, St. Vincent's Hospital Melbourne, Fitzroy, VIC, Australia.,Probity Medical Research Inc., Skin Health Institute, Carlton, VIC, Australia
| | - A Blauvelt
- Oregon Medical Research Center, Portland, OR, USA
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14
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Dogra S, Singh N, Kumar S, Narang T, Handa S. Comparison of overall efficacy and safety of oral versus subcutaneous methotrexate in severe psoriasis. Dermatol Ther 2022; 35:e15656. [PMID: 35730664 DOI: 10.1111/dth.15656] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2022] [Revised: 05/09/2022] [Accepted: 06/19/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Subcutaneous (SC) methotrexate(MTX) is considered to be associated with a higher and predictable linear bioavailability as compared to oral MTX. Although various studies have reported SC MTX to be safe and effective in psoriasis, prospective head-to-head comparative trials on oral vs SC MTX are limited. OBJECTIVE To compare the efficacy and safety of SC versus oral MTX in severe psoriasis. METHODS It was a prospective, single-blinded, randomized controlled trial, in 100 eligible, adult patients of severe psoriasis randomized into two groups. Group-A(n=50)patients were started on oral MTX at full dose of 0.3 mg/kg/week (maximum 25 mg/week) given for 12 weeks or till achieving PASI90 [90% reduction in psoriasis area severity index (PASI) from baseline],whichever was earlier and group-B(n=50) patients received SC MTX in the same dose and duration. MTX was then tapered gradually at 5 mg every 2 weeks and stopped. All patients were followed-up for 24 weeks post-treatment with monthly assessment of PASI and dermatology life quality index (DLQI) scores. RESULTS Baseline demographic profiles of patients in both the groups were comparable. The mean± SD baseline PASI scores were; group-A: 15.1± 3.2 vs group-B:15.7±3.3 (p= 0.35).The number of patients that achieved PASI90 at or before 12 weeks of treatment was numerically higher in group-B (39/50, 78%) versus group-A (31/50, 62%; p= 0.08) and the time to achieve PASI90 was significantly lesser (p<0.001).Also, the percentage(%) decline in DLQI was significantly higher in group-B(p= 0.003). The overall side-effect profile was comparable between groups (p= 0.31), but the frequency of gastrointestinal side-effects were significantly less in group-B (p= 0.04). Among those patients who achieved a PASI90 response by week12, relapse rates were comparable during the subsequent24week follow-up period [group-A: 12/31 (39%), group-B: 11/39 (28%), p-value= 0.33]. CONCLUSION SC MTX results in significantly faster achievement of PASI90 and greater reduction in DLQI as compared to oral MTX in patients who are candidates for systemic therapy with a comparable safety profile. CLINICAL TRIAL REGISTRATION CTRI/2018/01/011373, date of registration: 15 January, 2018; trial registered prospectively.
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Affiliation(s)
- Sunil Dogra
- Department of Dermatology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Namrata Singh
- Department of Dermatology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Sheetanshu Kumar
- Department of Dermatology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Tarun Narang
- Department of Dermatology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Sanjeev Handa
- Department of Dermatology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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15
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Damiani G, Odorici G, Pacifico A, Morrone A, Conic RRZ, Davidson T, Watad A, Pigatto PDM, Colombo D, Malagoli P, Fiore M. Secukinumab Loss of Efficacy Is Perfectly Counteracted by the Introduction of Combination Therapy (Rescue Therapy): Data from a Multicenter Real-Life Study in a Cohort of Italian Psoriatic Patients That Avoided Secukinumab Switching. Pharmaceuticals (Basel) 2022; 15:95. [PMID: 35056153 PMCID: PMC8780469 DOI: 10.3390/ph15010095] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 01/06/2022] [Accepted: 01/08/2022] [Indexed: 02/06/2023] Open
Abstract
Since psoriasis (PsO) is a chronic inflammatory disease, patients may experience a drug failure also with very effective drugs (i.e., secukinumab) and, consequently, dermatologists have two therapeutic options: switching or perform a combination therapy (rescue therapy) to save the drug that had decreased its efficacy. At the moment no studies focused on combination/rescue therapy of secukinumab, so we performed a 52-weeks multicenter retrospective observational study that involved 40 subjects with plaque psoriasis that experienced a secondary failure and were treated with combination therapy (ciclosporin (n = 11), MTX (n = 15), NB-UVB (n = 7) and apremilast (n = 7)). After 16 weeks of rescue/combination therapy, PASI and a DLQI varied respectively from 8 [7.0-9.0] and 13 [12.0-15.0], to 3 [2.8-4.0] and 3 [2.0-3.3]), suggesting a significant improvement of daily functionality and quality of life. Results were maintained at 52 weeks. No side effects were experienced during the study. Secukinumab remains a safety and effective drug for PsO patients also in the IL-23 and JAK inhibitors era. The rescue therapy is a valid therapeutic option in case of secukinumab secondary failure.
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Affiliation(s)
- Giovanni Damiani
- Clinical Dermatology, IRCCS Istituto Ortopedico Galeazzi, 20161 Milan, Italy; (G.D.); (P.D.M.P.)
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, 20122 Milan, Italy
- PhD Degree Program in Pharmacological Sciences, Department of Pharmaceutical and Pharmacological Sciences, University of Padua, 35131 Padua, Italy
| | - Giulia Odorici
- Department of Dermatology, University of Ferrara, 44124 Ferrara, Italy;
| | - Alessia Pacifico
- Clinical Dermatology Department, San Gallicano Dermatological Institute, IRCCS, 00144 Rome, Italy; (A.P.); (A.M.)
| | - Aldo Morrone
- Clinical Dermatology Department, San Gallicano Dermatological Institute, IRCCS, 00144 Rome, Italy; (A.P.); (A.M.)
| | - Rosalynn R. Z. Conic
- Department of Preventive Medicine, Maryland University, Baltimore, MD 21201, USA;
| | - Tima Davidson
- Department of Nuclear Medicine, Chaim Sheba Medical Center, Tel Hashomer 52621, Israel;
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel;
| | - Abdulla Watad
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel;
- Rheumatology Unit, Department of Medicine B, Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Ramat Gan 5265601, Israel
- Leeds Institute of Rheumatic and Musculoskeletal Medicine (LIRMM), University of Leeds, Leeds LS7 4SA, UK
| | - Paolo D. M. Pigatto
- Clinical Dermatology, IRCCS Istituto Ortopedico Galeazzi, 20161 Milan, Italy; (G.D.); (P.D.M.P.)
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, 20122 Milan, Italy
| | - Delia Colombo
- Department of Pharmacology, University of Milan, 20133 Milan, Italy;
| | | | - Marco Fiore
- Department of Women, Child and General and Specialized Surgery, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy
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16
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Rieckmann P, Centonze D, Giovannoni G, Hua LH, Oreja-Guevara C, Selchen D, Sørensen PS, Vermersch P, Wiendl H, Salloukh H, Yamout B. Expert opinion on COVID-19 vaccination and the use of cladribine tablets in clinical practice. Ther Adv Neurol Disord 2021; 14:17562864211058298. [PMID: 34899987 PMCID: PMC8655448 DOI: 10.1177/17562864211058298] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Accepted: 10/19/2021] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Gaps in current evidence and guidance leave clinicians with unanswered questions on the use of cladribine tablets for the treatment of multiple sclerosis (MS) in the era of the COVID-19 pandemic, in particular relating to COVID-19 vaccination. OBJECTIVE We describe a consensus-based program led by international MS experts with the aim of supplementing current guidelines and treatment labels by providing timely recommendations relating to COVID-19 vaccination and the use of cladribine tablets in clinical practice. METHODS A steering committee (SC) of 10 international MS experts identified 7 clinical questions to answer concerning the use of cladribine tablets and COVID-19 vaccination, which addressed issues relating to patient selection, timing and efficacy, and safety. Clinical recommendations to address each question were drafted using available evidence combined with expert opinion from the SC. An extended faculty of 28 MS experts, representing 19 countries, in addition to the 10 SC members, voted on the recommendations. Consensus on recommendations was achieved when ⩾75% of respondents expressed an agreement score of 7-9, on a 9-point scale. RESULTS Consensus was achieved on all 13 recommendations. Clinical recommendations are provided on whether all patients with MS receiving cladribine tablets should be vaccinated against COVID-19, and whether they should be prioritized; the timing of vaccination around dosing of cladribine tablets (i.e. before and after a treatment course); and the safety of COVID-19 vaccination for these patients. CONCLUSION These expert recommendations provide timely guidance on COVID-19 vaccination in patients receiving cladribine tablets, which is relevant to everyday clinical practice.
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Affiliation(s)
- Peter Rieckmann
- Center for Clinical Neuroplasticity, Medical Park Loipl, Bischofswiesen, Germany
- Department of Neurology, University of Erlangen, Erlangen, Germany
| | - Diego Centonze
- Unit of Neurology and Neurorehabilitation, IRCCS Neuromed, Pozzilli (IS), Italy
| | - Gavin Giovannoni
- Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Le H. Hua
- Cleveland Clinic Lou Ruvo Center for Brain Health, Las Vegas, NV, USA
| | - Celia Oreja-Guevara
- Neurology, Hospital Clínico San Carlos, IdISSC, Madrid, Spain
- Departamento de Medicina, Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain
| | - Daniel Selchen
- Division of Neurology, St. Michael’s Hospital, University of Toronto, Toronto, ON, Canada
| | - Per Soelberg Sørensen
- Danish Multiple Sclerosis Center, Department of Neurology, University of Copenhagen and Rigshospitalet, Copenhagen, Denmark
| | - Patrick Vermersch
- Université de Lille, INSERM-U1172, Centre Hospitalier Universitaire de Lille, Fédératif Hospitalo-Universitaire Precise, Lille, France
| | - Heinz Wiendl
- Department of Neurology, Institute of Translational Neurology, University of Münster, Münster, Germany
| | - Hashem Salloukh
- Ares Trading SA, Eysins, Switzerland (an affiliate of Merck KGaA)
| | - Bassem Yamout
- Neurology Institute, Harley Street Medical Center, Abu Dhabi, UAE
- Nehme and Therese Tohme Multiple Sclerosis Center, American University of Beirut, 1107 2020 Beirut, Lebanon
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17
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Aubert H, Mahé E, Fougerousse AC, Maccari F, Beneton N. Dose spacing and reduction strategies in biotherapies for stable, clear or almost clear psoriasis: A survey of practices in France. Ann Dermatol Venereol 2021; 149:68-70. [PMID: 34887084 DOI: 10.1016/j.annder.2021.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 05/12/2021] [Accepted: 07/01/2021] [Indexed: 11/26/2022]
Affiliation(s)
- H Aubert
- Department of Dermatology, Centre Hospitalier Universitaire, 1, avenue Alexis-Ricordeau, 44000 Nantes, France.
| | - E Mahé
- Department of Dermatology, Hôpital Victor Dupouy, 69, rue du Lieutenant-Colonel Prud'hon, 95100 Argenteuil, France
| | - A-C Fougerousse
- Department of Dermatology, 69, Avenue de Paris, 94160 Saint-Mandé, France
| | | | - N Beneton
- Department of Dermatology, Centre Hospitalier, 194, Avenue Rubillard, 72037 Le Mans, France
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18
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Rajagopalan M, Chatterjee M, De A, Dogra S, Ganguly S, Kar BR, Madnani N, Neema S, Parasramani SG, Patel K, Tahiliani S. Systemic Management of Psoriasis Patients in Indian Scenario: An Expert Consensus. Indian Dermatol Online J 2021; 12:674-682. [PMID: 34667752 PMCID: PMC8456263 DOI: 10.4103/idoj.idoj_113_21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Revised: 07/07/2021] [Accepted: 08/19/2021] [Indexed: 01/14/2023] Open
Abstract
Background: Psoriasis is a common inflammatory disease with significant comorbidities, and regardless of its extent, it affects the patients' quality of life. The various modalities of treating psoriasis comprise topical or systemic medications, phototherapy, and an array of biologic agents. There is a lack of Indian recommendations on the management of psoriasis with these different modalities and challenges faced by the clinicians in day-to-day practice. Aim: To develop India-specific consensus for systemic management of patients with moderate-to-severe psoriasis. Method and Results: A panel of dermatology experts, based on the evidence and international recommendations, coupled with their own clinical experience, developed recommendations for systemic management of patients with moderate-to-severe psoriasis. Conclusion: These recommendations are meant to provide guidance in terms of choice of systemic therapies, dosing, effectiveness, and safety. It also addresses clinical challenges that may be experienced during psoriasis management.
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Affiliation(s)
| | - Manas Chatterjee
- Department of Dermatology, Command Hospital, Kolkata, West Bengal, India
| | - Abhishek De
- Department of Dermatology, Calcutta National Medical College, Kolkata, West Bengal, India
| | - Sunil Dogra
- Department of Dermatology, Venereology and Leprology, Postgraduate Institute of Medical Education and Research, Raipur, Chhattisgarh, India
| | - Satyaki Ganguly
- Department of Dermatology, All India Institute of Medical Sciences, Raipur, Chhattisgarh, India
| | - Bikash Ranjan Kar
- Department of Dermatology, Institute of Medical Sciences and Sum Hospital, Siksha 'O' Anusandhan, Bhubaneshwar, Odisha, India
| | - Nina Madnani
- Visiting Dermatology Consultant, P. D. Hinduja National Hospital and Medical Research Centre, Mumbai, Maharashtra, India
| | - Shekhar Neema
- Department of Dermatology, Armed Forces Medical College, Pune, Maharashtra, India
| | - S G Parasramani
- Department of Dermacosmetology, Lilavati Hospital, Mumbai, Maharashtra, India
| | - Krina Patel
- Department of Dermatology, Gujarat Medical Education and Research Society Medical College, Sola, Gujarat, India
| | - Sushil Tahiliani
- Consultant Skin and S.T.D. Specialist, Dermatosurgeon, Dr. Tahiliani's Clinic, Bandra West, Mumbai, Maharashtra, India
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19
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Eyerich K, Weisenseel P, Pinter A, Schäkel K, Asadullah K, Wegner S, Muñoz-Elias EJ, Bartz H, Taut FJH, Reich K. IL-23 blockade with guselkumab potentially modifies psoriasis pathogenesis: rationale and study protocol of a phase 3b, randomised, double-blind, multicentre study in participants with moderate-to-severe plaque-type psoriasis (GUIDE). BMJ Open 2021; 11:e049822. [PMID: 34518264 PMCID: PMC8438891 DOI: 10.1136/bmjopen-2021-049822] [Citation(s) in RCA: 40] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Guselkumab is an interleukin (IL)-23 pathway blocker with proven efficacy in patients with moderate-to-severe plaque psoriasis. Early intervention with guselkumab may result in changes to the clinical disease course versus later intervention. METHODS AND ANALYSIS Here we present the rationale and design of a phase 3b, randomised, double-blind, multicentre study (GUIDE), comparing treatment effects of guselkumab in patients with short (≤2 years) or longer (>2 years) duration of plaque-type psoriasis, measured from first appearance of psoriatic plaques. Participants achieving skin clearance (Psoriasis Area and Severity Index (PASI)=0) by week 20 and maintaining complete clearance at week 28 visit ('super-responders' (SRe)) will be randomised to continue approved maintenance dosing every 8 weeks (q8w) versus an investigational maintenance dosing interval of 16 weeks (q16w) until week 68. Primary endpoint: proportion of participants in the q8w vs q16w arms with absolute PASI <3 at week 68. Participants with PASI <3 at week 68 will be withdrawn from guselkumab treatment for up to 48 weeks. Participants not achieving SRe criteria (non-SRe) will remain in the study with q8w guselkumab dosing through week 68. Additional to serum samples obtained from all patients, skin biopsies and whole-blood samples will be taken from SRe and non-SRe participants at various time points in optional substudies. Analyses include: genetics; immunophenotyping (fluorescence-activated cell sorting); gene and protein expression profiling; immunohistology. By merging clinical endpoints with mechanistic findings, this study aims to elucidate how IL-23 blockade with guselkumab can modify the disease course by altering molecular and cellular drivers that cause relapse after treatment withdrawal, particularly among SRe. ETHICS AND DISSEMINATION Approval obtained from ethics committee Medical Council Hamburg, Germany (PVN5925). GUIDE is compliant with the Declaration of Helsinki. TRIAL REGISTRATION NUMBER Registered at ClinicalTrials.gov (NCT03818035). All primary endpoint results (prespecified analyses) will be submitted to peer-reviewed, international journals within 18 months after primary completion date.
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Affiliation(s)
- Kilian Eyerich
- Department of Medicine, Division of Dermatology and Venereology, Karolinska Institute, Stockholm, Sweden
| | | | - Andreas Pinter
- University Hospital Frankfurt am Main, Frankfurt, Germany
| | - Knut Schäkel
- Department of Dermatology, and Interdisciplinary Center for Chronic Inflammatory Diseases, University Hospital Heidelberg, Heidelberg, Germany
| | | | | | | | | | | | - Kristian Reich
- Institute for Health Services Research in Dermatology and Nursing, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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20
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Aschoff R, Bewley A, Dattola A, De Simone C, Lahfa M, Llamas-Velasco M, Martorell A, Pavlovic M, Sticherling M. Beyond-Mild Psoriasis: A Consensus Statement on Calcipotriol and Betamethasone Dipropionate Foam for the Topical Treatment of Adult Patients. Dermatol Ther (Heidelb) 2021; 11:1791-1804. [PMID: 34510404 PMCID: PMC8484344 DOI: 10.1007/s13555-021-00600-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Accepted: 08/19/2021] [Indexed: 11/29/2022] Open
Abstract
Introduction There are clear treatment options for mild psoriasis where topical therapies are the mainstay, and for severe psoriasis where systemic therapy (biologic or non-biologic) is necessary. However, there is less clarity in the ‘grey zone’ of patients in the moderate or so-called ‘beyond-mild’ segment. There are frequent delays to the initiation, discontinuation, switching and dose change in treatment, and many patients fail to continue treatment because of concerns about safety or lack of efficacy. Treatment with topical therapies, such as calcipotriol and betamethasone dipropionate (Cal/BD) combinations, may be suitable for these patients. Method These consensus recommendations on the use of topical therapies including Cal/BD foam for beyond-mild psoriasis originated from a modified Delphi process of European clinical experts. In the process, the experts iteratively refined a series of draft statements, which had to receive ≥ 80% approval to be incorporated into the consensus. Results The experts identified three main themes: Cal/BD foam as monotherapy, as an add-on to non-biologic systemic therapies and as an add-on to systemic biologics. The consensus emphasises disease factors and patient preference in treatment choice, summarises the evidence base for Cal/BD foam monotherapy for flare treatment as well as long-term management, and identifies the potential for improved treatment outcomes, such as reduced time to onset of action and reduced systemic dose to minimise side effects for add-on Cal/BD therapy to non-biologic systemics. The recommendations regarding add-on Cal/BD foam to biologics are similar to those for non-biologic systemic therapies, but also include suggestions for patients on biologics who are late responders. As clinical choices of Cal/BD combination vary, we have here often used ‘Cal/BD’ without reference to any particular formulation. Conclusions These recommendations aim to give practical guidance to those treating patients with beyond-mild psoriasis, to support patients’ use of topical preparations and to optimise treatment outcomes.
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Affiliation(s)
- Roland Aschoff
- Department of Dermatology, University Hospital Carl Gustav Carus, Technical University of Dresden, Fetscherstraße 74, 01307, Dresden, Germany.
| | - Anthony Bewley
- Barts Health NHS Trust and Queen Mary University London, London, UK
| | - Annunziata Dattola
- Department of Dermatology, University of Rome "Tor Vergata", Rome, Italy
| | - Clara De Simone
- Department of Dermatology, Catholic University of the Sacred Heart Policlinico "A. Gemelli", IRCCS, Rome, Italy
| | | | - Mar Llamas-Velasco
- Department of Dermatology, Hospital Universitario de La Princesa, Madrid, Spain
| | | | - Mira Pavlovic
- Medicines Development and Training Services and Department of Dermatology, Saint-Louis Hospital, Paris, France
| | - Michael Sticherling
- Department of Dermatology, Psoriasis Center, University Medical Center, Erlangen, Germany
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21
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Fatani MIA, Hamadah IRA, Alajlan MA, Binamer Y, Alharbi AHS, Alruwaili AFS, Aldayel MAA, Alenzi KAO, Mubarki SM, Khardaly AM, Alomari BAA, Almudaiheem HY, Al-Jedai A, Eshmawi MTY. Saudi consensus statement on biologic treatment of chronic plaque psoriasis (2020). J DERMATOL TREAT 2021; 33:1916-1930. [PMID: 34284704 DOI: 10.1080/09546634.2021.1950601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Psoriasis is a common chronic and complex inflammatory skin disease that affects over 125 million people worldwide. Management of psoriasis in daily clinical practice in Saudi Arabia is variable. Local preferences for management differ, which may have a bearing on the treatment selection. Biologic therapy is now a well-established strategy for managing moderate-to-severe plaque psoriasis. There is a clear need for national consensus statements due to the extended role and high availability of literature on these agents. As a result of an initiative of the Ministry of Health, a multidisciplinary expert panel of dermatologists and pharmacists with practical experience in the clinical management of psoriasis were invited to be part of a work group to update the previous practical guidelines on the biologic treatment of psoriasis published in the Journal of Dermatological Treatment, 2014. The overall aim of this consensus document is to deliver evidence-based recommendations on the use, screening, and monitoring of biologic therapy in patients with moderate-to-severe plaque psoriasis. These recommendations also address the use of biologic therapy in special patient populations. They were developed after rigorous evaluation of existing international guidelines as well as the latest emerging evidence. Updates of the present consensus document will be provided as needed to incorporate new data or agents.
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Affiliation(s)
| | - Issam Ribhi Ahmad Hamadah
- King Faisal Specialist Hospital & Research Centre, Riyadh, Saudi Arabia.,Alfaisal University, Riyadh, Saudi Arabia
| | | | - Yousef Binamer
- King Faisal Specialist Hospital & Research Centre, Riyadh, Saudi Arabia.,Alfaisal University, Riyadh, Saudi Arabia
| | | | | | | | | | - Sultan Mohammed Mubarki
- Pharmaceutical Care Department, King Fahd Central Hospital, Ministry of Health, Jazan, Saudi Arabia
| | | | | | | | - Ahmed Al-Jedai
- Deputyship of Therapeutic Affairs, Ministry of Health, Riyadh, Saudi Arabia
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22
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Zangrilli A, Caldarola G, Bernardini N, Bavetta M, Graceffa D, Bonifati C, Cantoresi F, Faleri S, Giordano D, Mariani M, Micheli A, Moretta G, Pirro F, Pagnanelli G, Panasiti V, Provini A, Richetta A, Sacchelli L, Bianchi L, Peris K. Predictive factors of lack of response to adalimumab among bio-naive patients suffering from moderate-to severe psoriasis: analysis of a multicenter data collection in Italy. Expert Opin Biol Ther 2021; 21:1291-1298. [PMID: 34278889 DOI: 10.1080/14712598.2021.1948530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Efficacy of anti-TNF-a agents seems inferior to IL-17 and IL-23 inhibitors. Nevertheless, after biosimilars approval, anti TNF-a agents are recommended as first-line for psoriatic patients, for economic reasons. METHODS Predictive factors of response or non-response to adalimumab in bionaive patients who started adalimumab (originator or biosimilar) over 12 years in 9 dermatologic centers in Italy. Effectiveness was assessed with Psoriasis Area and Severity Index (PASI75 and PASI90) at weeks 12, 24 and 48. Multiple logistic regressions were used for variables predicting clinical response; Kaplan-Meier survival curves and Cox regression for drug survival. RESULTS The drug survival analysis showed reduced hazard ratio of overall discontinuation with male gender and scalp localization. In contrast, baseline PASI and genital psoriasis were significantly associated with increased risk of overall discontinuation. Predictive factors of non-response seemed elevated in patients with baseline PASI, older age groups, previously treated patients with phototherapy, females or patients with palmo-plantar while scalp psoriasis, previous cyclosporine and acitretin appeared as a positive predictive factor. CONCLUSIONS This real-life analysis might be useful for clinicians in case of bio-naive patients with moderate-to-severe psoriasis and various comorbidities.
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Affiliation(s)
- Arianna Zangrilli
- Department of Dermatology, University of Rome Tor Vergata, Rome, Italy
| | - Giacomo Caldarola
- Department of Dermatology, Università Cattolica Del Sacro Cuore, Rome, Italy.,Department of Dermatology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Nicoletta Bernardini
- Department of Medical-Surgical Sciences and Biotechnologies, Dermatology Unit "Daniele Innocenzi," Sapienza University of Rome, Rome, Italy
| | - Mauro Bavetta
- Department of Dermatology, University of Rome Tor Vergata, Rome, Italy
| | - Dario Graceffa
- Department of Dermatology, Istituto Dermatologico San Gallicano - IRCCS, Roma, Italy
| | - Claudio Bonifati
- Department of Dermatology, Istituto Dermatologico San Gallicano - IRCCS, Roma, Italy
| | - Franca Cantoresi
- Unit of Dermatology, Department of Internal Medicine and Medical Specialties, Sapienza University of Rome, Rome, Italy
| | - Sara Faleri
- Department of Dermatology, UOC DERMATOLOGIA dell'Ospedale Di Belcolle, Viterbo, Italy
| | - Domenico Giordano
- NESMOS Department, Dermatology Unit, Sant'Andrea Hospital, University of Rome Sapienza, Italy
| | - Marco Mariani
- Section of Hygiene, University Department of Health Sciences and Public Health, Università Cattolica Del Sacro Cuore, Rome, Italy
| | - Adriana Micheli
- Unità Di Dermatologia, Ospedale Nuovo Regina Magherita, Roma, Italy
| | - Gaia Moretta
- Department of Dermatology, Istituto Dermopatico dell'Immacolata - IRCCS, Roma, Italy
| | - Federico Pirro
- Department of Dermatology, Università Cattolica Del Sacro Cuore, Rome, Italy.,Department of Dermatology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Gianluca Pagnanelli
- Department of Dermatology, Istituto Dermopatico dell'Immacolata - IRCCS, Roma, Italy
| | - Vincenzo Panasiti
- Plastic and Reconstructive Surgery Unit, Campus Bio-Medico University, Rome, Italy
| | - Alessia Provini
- Department of Dermatology, Istituto Dermopatico dell'Immacolata - IRCCS, Roma, Italy
| | - Antonio Richetta
- Unit of Dermatology, Department of Internal Medicine and Medical Specialties, Sapienza University of Rome, Rome, Italy
| | - Lidia Sacchelli
- Department of Experimental, Diagnostic and Specialty Medicine, Dermatology Unit, University of Bologna, Bologna, Italy.,Dermatology, IRCCS Policlinico Di Sant'Orsola, University of Bologna, Bologna, Italy
| | - Luca Bianchi
- Department of Dermatology, University of Rome Tor Vergata, Rome, Italy
| | - Ketty Peris
- Department of Dermatology, Università Cattolica Del Sacro Cuore, Rome, Italy.,Department of Dermatology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
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Deterioration of Health-Related Quality of Life After Withdrawal of Risankizumab Treatment in Patients with Moderate-to-Severe Plaque Psoriasis: A Machine Learning Predictive Model. Dermatol Ther (Heidelb) 2021; 11:1291-1304. [PMID: 34019229 PMCID: PMC8322223 DOI: 10.1007/s13555-021-00550-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Accepted: 05/06/2021] [Indexed: 12/27/2022] Open
Abstract
INTRODUCTION Risankizumab has demonstrated efficacy in treating moderate-to-severe psoriasis. The phase-3 IMMhance trial (NCT02672852) examined the effect of continuing versus withdrawing from risankizumab treatment on psoriasis severity, including the Psoriasis Area and Severity Index (PASI) and static Physician Global Assessment (sPGA). However, the effect of withdrawal on health-related quality of life (HRQL) was not assessed. Therefore, this study was conducted to evaluate the impact of risankizumab withdrawal on HRQL measured by the Dermatology Life Quality Index (DLQI). Because DLQI was not measured beyond week 16 in IMMhance, a machine learning predictive model for DLQI was developed. METHODS A machine learning model for DLQI was fitted using repeated measures data from three phase-3 trials (NCT02684370, NCT02684357, NCT02694523) (pooled N = 1602). An elastic-net algorithm performed automated variable selection among candidate predictors including concurrent PASI and sPGA, demographics, and interaction terms. The machine learning model was used to predict DLQI at weeks 28-104 of IMMhance among patients re-randomized to continue (N = 111) or withdraw from (N = 225) risankizumab after achieving response (sPGA = 0/1) at week 28. RESULTS The machine learning predictive model demonstrated good statistical fit during tenfold cross-validation and external validation against observed DLQI at weeks 0-16 of IMMhance (N = 507). Predicted improvements in DLQI from baseline were lower in the withdrawal versus the continuation cohort (mean DLQI change at week 104, -5.9 versus -11.5, difference [95% CI] = 5.6 [4.1, 7.3]). Predicted DLQI deteriorated more extensively than PASI (49.7% versus 36.4%) after treatment withdrawal. CONCLUSIONS The predicted DLQI score deteriorated more rapidly after risankizumab withdrawal than the PASI score, an objective measure of disease. These findings suggest that the deterioration in HRQL reflects more substantial impacts after risankizumab discontinuation than those measured by PASI only.
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24
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Zhu W, Ai L, Feng Y, Yuan H, Wang Y, Wang M, Mei Z. Factors predicting successful vaginal birth after caesarean section: protocol for evidence-based consensus recommendations using a Delphi survey. BMJ Open 2021; 11:e047433. [PMID: 33952555 PMCID: PMC8103394 DOI: 10.1136/bmjopen-2020-047433] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
INTRODUCTION With the wide adoption of the two-child policy in China since 2016, a large percentage of women with a history of caesarean delivery plan to have a second child. Accordingly, the rate of vaginal birth after caesarean (VBAC) delivery is increasing. Women attempting repeat VBAC may experience multiple morbidities, which is also one of the leading causes of maternal and perinatal mortality. However, it remains to be addressed how we evaluate factors for successful VBAC. This study aims to use a novel approach to identify a set of potential predictive factors for successful VBAC, especially for Chinese women, to be included in prediction models which can be most applicable to pregnant women in China. We plan to assess all potential predictive factors collected through a comprehensive literature review. Then the certainty of the evidence for the identified potential predictive factors will be assessed using the Grading of Recommendations Assessment, Development and Evaluation process. Finally, a two-round international Delphi survey will be conducted to determine the level of consensus. METHODS AND ANALYSIS This study will apply a methodology through an evidence-based approach. A long list of potential predictive factors for successful VBAC will be extracted and identified through the following stages: First, an up-to-date systematic review of the published literature will be conducted to extract identified potential predictive factors for successful VBAC. Second, an online Delphi survey will be performed to achieve expert consensus on which factors should be included in future prediction models. The online questionnaires will be developed in the field of patient, maternal and fetal-related factors. A two-round international Delphi survey will be distributed to the expert panel in the field of perinatal medicine using Google Forms. Experts will be asked to score each factor using the 9-point Likert rating scale to establish potential predictive factors for the successful VBAC. The expert panel will determine on whether to include, potentially include or exclude predictive factors, based on a systematic review of clinical evidence and the Delphi method. ETHICS AND DISSEMINATION The study was approved by the Institutional Review Board of the Jiaxing Maternity and Children Healthcare Hospital (approval number: 2019-79). The results of this study will be submitted to international peer-reviewed journals or conferences in perinatal medicine or obstetrics.
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Affiliation(s)
- Weiying Zhu
- Department of Obstetric, Maternity and Child Health Care Affiliated Hospital,Jiaxing University, Jiaxing, China
| | - Ling Ai
- Department of Obstetric, Maternity and Child Health Care Affiliated Hospital,Jiaxing University, Jiaxing, China
| | - Ying Feng
- Department of Obstetric, Maternity and Child Health Care Affiliated Hospital,Jiaxing University, Jiaxing, China
| | - Haiyan Yuan
- Department of Obstetric, Maternity and Child Health Care Affiliated Hospital,Jiaxing University, Jiaxing, China
| | - Yu Wang
- Science and Education Division, Maternity and Child Health Care Affiliated Hospital,Jiaxing University, Jiaxing, China
| | - Meitang Wang
- Emergency Department, Changhai Hospital, Navy Medical University, Shanghai, China
| | - Zubing Mei
- Department of Anorectal Surgery, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China
- Anorectal Disease Institute, Shuguang Hospital, Shanghai, China
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25
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Xie X, Wang Y, Yao S, Xia Y, Luo H, Li L, Lu C. Biologics recommendations for patients with psoriasis: a critical appraisal of clinical practice guidelines for psoriasis. J DERMATOL TREAT 2021; 33:2038-2050. [PMID: 33849360 DOI: 10.1080/09546634.2021.1914306] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
PURPOSE This review article serves to assess the consistency of recommendations from guidelines on biologic agents for psoriasis, based on the quality evaluation of psoriasis Clinical Practice Guidelines (CPGs). METHODS We conducted a systematic literature search to identify CPGs that provide recommendations on diagnosis and treatment for psoriasis. Four reviewers performed a quality assessment of the included CPGs with the Appraisal of Guidelines Research and Evaluation II (AGREE II) Instrument. RESULTS A total of 51 sets of CPGs from 22 medical societies or separate working groups fulfilled the inclusion criteria. The overall quality of the eligible sets of guidelines was moderate to high, with an overall average score of 55%The highest domain scores were Score and Purpose (70%) and Clarity of Presentation (68%). A total of 95 biologic agent recommendations were extracted from the 18 recommended CPGs.Three biologic agents (Etanercept, Adalimumab, Ustekinumab) were recommended for pediatric patients. Three biologic agents (Adalimumab, Ustekinumab, Secukinumab) were recommended as first-line biologic agents for adults with psoriasis. CONCLUSION The overall methodological quality of CPGs for psoriasis is medium to high. More attention should be paid to applicability in guideline development. The recommendations and the basis for them among various sets guidelines were almost consistent.
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Affiliation(s)
- Xiuli Xie
- Department of Standardization of Chinese Medicine, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China.,Department of Standardization of Traditional Chinese Medicine, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, Guangdong, China.,Engineering and Technology Research Center of Standardization of Traditional Chinese Medicine, Guangzhou, Guangdong, China
| | - Yangyang Wang
- Department of Standardization of Chinese Medicine, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China.,Department of Standardization of Traditional Chinese Medicine, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, Guangdong, China.,Engineering and Technology Research Center of Standardization of Traditional Chinese Medicine, Guangzhou, Guangdong, China
| | - Sha Yao
- Department of Standardization of Chinese Medicine, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
| | - Yun Xia
- School of Basic Medical Sciences, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Hao Luo
- School of Basic Medical Sciences, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Lui Li
- Department of Standardization of Chinese Medicine, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China.,Department of Standardization of Traditional Chinese Medicine, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, Guangdong, China.,Engineering and Technology Research Center of Standardization of Traditional Chinese Medicine, Guangzhou, Guangdong, China
| | - Chuanjian Lu
- School of Basic Medical Sciences, Guangzhou University of Chinese Medicine, Guangzhou, China.,Department of Dermatology, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China.,Department of Dermatology, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, Guangdong, China
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26
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Nast A, Smith C, Spuls P, Avila Valle G, Bata‐Csörgö Z, Boonen H, De Jong E, Garcia‐Doval I, Gisondi P, Kaur‐Knudsen D, Mahil S, Mälkönen T, Maul J, Mburu S, Mrowietz U, Reich K, Remenyik E, Rønholt K, Sator P, Schmitt‐Egenolf M, Sikora M, Strömer K, Sundnes O, Trigos D, Van Der Kraaij G, Yawalkar N, Dressler C. EuroGuiDerm Guideline on the systemic treatment of Psoriasis vulgaris – Part 1: treatment and monitoring recommendations. J Eur Acad Dermatol Venereol 2020; 34:2461-2498. [DOI: 10.1111/jdv.16915] [Citation(s) in RCA: 62] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Accepted: 08/13/2020] [Indexed: 12/14/2022]
Affiliation(s)
- A. Nast
- Department of Dermatology, Venereology and Allergology Charité – Universitätsmedizin BerlinCorporate Member of Freie Universität BerlinHumboldt‐Universität zu BerlinBerlin Institute of Health Berlin Germany
| | - C. Smith
- St John’s Institute of Dermatology London UK
| | - P.I. Spuls
- Academic Medical Centre Amsterdam Amsterdam Netherlands
| | - G. Avila Valle
- Department of Dermatology, Venereology and Allergology Charité – Universitätsmedizin BerlinCorporate Member of Freie Universität BerlinHumboldt‐Universität zu BerlinBerlin Institute of Health Berlin Germany
| | | | - H. Boonen
- Office‐Based Dermatology Practice Geel Belgium
| | - E. De Jong
- Radboud University medical centre Nijmegen Netherlands
| | - I. Garcia‐Doval
- Unidad de InvestigaciónFundación Piel Sana AEDV Madrid España
| | | | | | - S. Mahil
- Guy's and St Thomas' NHS Foundation Trust London UK
| | - T. Mälkönen
- Helsinki University Central Hospital Helsinki Finland
| | - J.T. Maul
- Department of Dermatology University Hospital of Zürich Zürich Switzerland
| | - S. Mburu
- International Federation of Psoriasis Associations (IFPA)
| | - U. Mrowietz
- Universitätsklinikum Schleswig‐Holstein Kiel Germany
| | - K. Reich
- Translational Research in Inflammatory Skin Diseases Institute for Health Services Research in Dermatology and Nursing University Medical Center Hamburg‐Eppendorf Hamburg Germany
| | | | | | - P.G. Sator
- Municipal Hospital Hietzing Vienna Austria
| | - M. Schmitt‐Egenolf
- Dermatology Department of Public Health & Clinical Medicine Umeå University Umeå Sweden
| | - M. Sikora
- Department of Dermatology Medical University of Warsaw Warszawa Poland
| | - K. Strömer
- Office‐Based Dermatology Practice Mönchengladbach Germany
| | | | - D. Trigos
- International Federation of Psoriasis Associations (IFPA)
| | | | - N. Yawalkar
- Department of Dermatology, Inselspital Bern University HospitalUniversity of Bern Bern Switzerland
| | - C. Dressler
- Department of Dermatology, Venereology and Allergology Charité – Universitätsmedizin BerlinCorporate Member of Freie Universität BerlinHumboldt‐Universität zu BerlinBerlin Institute of Health Berlin Germany
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27
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Armesto S, González Vela C, Sánchez J, Illaro A, Mayorga J, López Sundh AE, Naharro Fernández C, Palmou N, Gómez-Fernández C, González López MA, González-Gay MA. Treating multidrug-resistant psoriasis with brodalumab, apremilast, methotrexate and prednisone combination therapy in the COVID-19 pandemic. Dermatol Ther 2020; 33:e14464. [PMID: 33112014 DOI: 10.1111/dth.14464] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Revised: 10/16/2020] [Accepted: 10/23/2020] [Indexed: 11/30/2022]
Affiliation(s)
- Susana Armesto
- Department of Dermatology, Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | - Carmen González Vela
- Department of Pathology, Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | - Julia Sánchez
- Department of Pharmacy, Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | - Aitziber Illaro
- Department of Pharmacy, Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | - Jesús Mayorga
- Department of Pharmacy, Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | - Ana E López Sundh
- Department of Dermatology, Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | | | - Natalia Palmou
- Department of Rheumatology, Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | | | | | - Miguel A González-Gay
- Department of Rheumatology, Hospital Universitario Marqués de Valdecilla, Santander, Spain
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28
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Olisova OY, Anpilogova EM. Systemic treatment of psoriasis: from methotrexate to biologics. VESTNIK DERMATOLOGII I VENEROLOGII 2020. [DOI: 10.25208/vdv1162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
Psoriasis is one of the most frequent chronic inflammatory skin diseases and it has been of interest to many scientists for ages. The review presents data on all systemic treatment options, that are to date officially registered in Russian Federation for moderate-to-severe psoriasis. Aspects of the mechanism of action, efficacy and tolerability of both basic drugs (methotrexate, cyclosporine, acitretin) and biologics (infliximab, adalimumab, etanercept, certolizumab pegol, ustekinumab, guselkumab, secukinumab, ixekizumab, netakimab) and small molecules (tofacitinib, apremilast) are considered in detail. Special emphasis is placed on the important nuances of biological therapy: immunogenicity, drugs' survival and switch due to lack of efficacy. Invention of biologics signified a new era of moderate-to-severe psoriasis treatment. It became possible to achieve complete clinical remission more safely, which significantly improved the quality of life of patients. However, due to the unknown etiology of psoriasis, there is still no universal remedy that would allow to cure every patient, this fact makes scientists from all over the world keep conducting numerous clinical trials to find even more effective and safe therapeutic options.
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Llamas-Velasco M, Daudén E. Reduced doses of biological therapies in psoriasis may increase efficiency without decreasing drug survival. Dermatol Ther 2020; 33:e14134. [PMID: 32761730 DOI: 10.1111/dth.14134] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 07/19/2020] [Accepted: 07/25/2020] [Indexed: 11/27/2022]
Abstract
Off-label treatment with reduced doses of biological therapies for moderate-severe psoriasis is used, but its efficacy, safety, and persistence are not well known. We have compared reduced doses with standard an escalated doses and study predictive factors for a successful reduction of doses lasting more than 6 months. We included 303 subcutaneous treatments (33% with reduced doses and 29% with escalated doses). Eighty (80.8%) reduced treatments were successful. Patients with longer evolution of the disease or patients treated with drugs different from adalimumab presented an increased risk of failure. Median drug survival did not differ between the different dosing schedules. Adverse events percentage was higher in the group treated with standard doses. Unlike previous literature, ustekinumab is the drug most commonly used at reduced doses in the present study. We have found similar efficacy rates in patients with dose modification compared with patients with standard dose, without further persistence problems. Our results suggest that reduction of dose should be done early, at the time of reaching a good response (PASI 90 or PASI <3 in two consecutive visits) as this dosing seems to be safe and portends no problems regarding persistence or adverse effects.
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Affiliation(s)
- Mar Llamas-Velasco
- Department of Dermatology, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria de La Princesa, Madrid, Spain
| | - Esteban Daudén
- Department of Dermatology, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria de La Princesa, Madrid, Spain
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Grünwald P, Krebs S, Troitzsch P, Roewer J, Emmert S, Thiem A. Etablierung des Schwerpunktes Psoriasis an der Universitätshautklinik Rostock und eine praxisbezogene Übersicht über die Biologikatherapie der Psoriasis. AKTUELLE DERMATOLOGIE 2020. [DOI: 10.1055/a-1147-4666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
ZusammenfassungDie Diagnostik und Behandlung der Psoriasis stellt einen Schwerpunkt an der Universitätshautklinik Rostock dar. Aufgrund des breiten Spektrums verfügbarer Biologikatherapien für die Behandlung der Psoriasis werden in diesem Artikel praxisbezogene Ratschläge für diese Therapieform gegeben. Dabei wird aufgezeigt, wie das optimale Biologikum für einen individuellen Patienten unter Berücksichtigung möglicher Kontraindikationen, krankheitsspezifischer Aspekte und unerwünschter Wirkungen ausgewählt werden kann. Außerdem wird ein mögliches Vorgehen bei Unterbrechung, Wiederaufnahme oder Umstellung von Biologika erwähnt.
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Affiliation(s)
- P. Grünwald
- Klinik und Poliklinik für Dermatologie und Venerologie, Universitätsmedizin Rostock
| | - S. Krebs
- Klinik und Poliklinik für Dermatologie und Venerologie, Universitätsmedizin Rostock
| | - P. Troitzsch
- Klinik und Poliklinik für Dermatologie und Venerologie, Universitätsmedizin Rostock
| | - J. Roewer
- Klinik und Poliklinik für Dermatologie und Venerologie, Universitätsmedizin Rostock
| | - S. Emmert
- Klinik und Poliklinik für Dermatologie und Venerologie, Universitätsmedizin Rostock
| | - A. Thiem
- Klinik und Poliklinik für Dermatologie und Venerologie, Universitätsmedizin Rostock
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Patients' demographic and socioeconomic characteristics influence the therapeutic decision-making process in psoriasis. PLoS One 2020; 15:e0237267. [PMID: 32785291 PMCID: PMC7423114 DOI: 10.1371/journal.pone.0237267] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Accepted: 07/22/2020] [Indexed: 02/06/2023] Open
Abstract
Background Knowledge regarding differences in care for psoriatic patients is limited. The aim of this study was to investigate factors influencing prescription of systemic treatments for patients with psoriasis with a special focus on socioeconomic factors. Methods and findings This was a non-interventional, cross-sectional study, conducted in 18 Italian University and/or hospital centers with psoriasis-specialized units. Questionnaires evaluating demographic and socioeconomic characteristics were administered to participants. Overall, 1880 consecutive patients affected by mild-to-severe psoriasis were recruited. Univariate and multivariable logistic regression analyses of systemic therapy prescription, with a special focus on biologics, accounting for the above mentioned characteristics were performed. Our analysis showed that all analyzed patients’ characteristics were significantly associated with biological therapy compared to non-biological systemic one. Particularly, women were less likely to receive biologics than men (OR = 0.66; 95% CI, 0.57–0.77). Elderly patients (≥65 years) and subjects with a BMI ≥30 had lower odds to receive biologics respect to adults (≥35–64 years) (OR = 0.33; 95% CI, 0.25–0.40), and subjects with BMI≥25<30 (OR = 0.64; 95% CI, 0.53–0.77), respectively. Northern and Southern patients were both less likely to receive biologics than Central patients (OR = 0.75; 95% CI, 0.63–0.89, and OR = 0.56; 95% CI,0.47–0.68, respectively). Lower economic profile and never reading books were both associated with decreased odds of receiving biological therapy. Conclusions This study shows that sex, age, comorbidities, and socioeconomic characteristics influence the prescription of systemic treatments in psoriasis, highlighting that there are still unmet needs influencing the therapeutic decision-making process that have to be addressed.
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Sørensen PS, Centonze D, Giovannoni G, Montalban X, Selchen D, Vermersch P, Wiendl H, Yamout B, Salloukh H, Rieckmann P. Expert opinion on the use of cladribine tablets in clinical practice. Ther Adv Neurol Disord 2020; 13:1756286420935019. [PMID: 32636933 PMCID: PMC7318823 DOI: 10.1177/1756286420935019] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Accepted: 05/12/2020] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Gaps in current product labels and a lack of detailed clinical guidelines leaves clinicians' questions on the practical management of patients receiving cladribine tablets for the treatment of relapsing multiple sclerosis (MS) unanswered. We describe a consensus-based programme led by international MS experts with the aim of providing recommendations to support the use of cladribine tablets in clinical practice. METHODS A steering committee (SC) of nine international MS experts led the programme and developed 11 clinical questions concerning the practical use of cladribine tablets. Statements to address each question were drafted using available evidence, expert experiences and perspectives from the SC and an extended faculty of 33 MS experts, representing 19 countries. Consensus on recommendations was achieved when ⩾75% of respondents expressed an agreement score of 7-9, on a 9-point scale. RESULTS Consensus was achieved on 46 out of 47 recommendations. Expert-agreed practical recommendations are provided on topics including: the definition of highly active disease; patterns of treatment response and suboptimal response with cladribine tablets; management of pregnancy planning and malignancy risk, infection risk and immune function, and switching to and from cladribine tablets. CONCLUSION These expert recommendations provide up-to-date relevant guidance on the use of cladribine tablets in clinical practice.
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Affiliation(s)
- Per Soelberg Sørensen
- Department of Neurology, Danish Multiple Sclerosis Center, University of Copenhagen, 2082, Rigshospitalet, 9, Blegdamsvej, Copenhagen, 2100, Denmark
| | - Diego Centonze
- Unit of Neurology and Neurorehabilitation, IRCCS Neuromed, Pozzilli (IS), Italy
| | - Gavin Giovannoni
- Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Xavier Montalban
- Department of Neurology, Neuroimmunology, Multiple Sclerosis Centre of Catalonia (Cemcat), Vall d'Hebron University Hospital, Barcelona, Spain
| | - Daniel Selchen
- Division of Neurology, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada
| | | | - Heinz Wiendl
- Department of Neurology, Institute of Translational Neurology, University of Münster, Münster, Germany
| | - Bassem Yamout
- Nehme and Therese Tohme Multiple Sclerosis Center, American University of Beirut, Beirut, Lebanon
| | - Hashem Salloukh
- Ares Trading S.A., and affiliate of Merck Serono S.A., Eysins, Switzerland
| | - Peter Rieckmann
- Department of Neurology, Center for Clinical Neuroplasticity, Medical Park Loipl, Bischofswiesen, University of Erlangen, Germany
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Saeki H, Terui T, Morita A, Sano S, Imafuku S, Asahina A, Komine M, Etoh T, Igarashi A, Torii H, Abe M, Nakagawa H, Watanabe A, Yotsuyanagi H, Ohtsuki M. Japanese guidance for use of biologics for psoriasis (the 2019 version). J Dermatol 2020; 47:201-222. [PMID: 31916326 DOI: 10.1111/1346-8138.15196] [Citation(s) in RCA: 53] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2019] [Accepted: 11/26/2019] [Indexed: 12/11/2022]
Abstract
As the first biologics for psoriasis in Japan, infliximab and adalimumab, anti-tumor necrosis factor-α antibodies, became available in the field of dermatology in 2010, followed by ustekinumab, an anti-interleukin (IL)-12/IL-23p40 antibody, which was launched in Japan in 2011. Since 2015, three IL-17 inhibitors of secukinumab and ixekizumab, anti-IL-17A antibodies, and brodalumab, an anti-IL-17 receptor antibody, and two anti-IL-23p19 antibodies of guselkumab and risankizumab, have also been launched. It is important for physicians to select appropriate biologic therapy for each psoriatic patient after due consideration of disease factors, treatment factors and patient background factors, sharing such information with patients. The following can be listed as points to be considered for the selection of biologics: drug effects (e.g. strength of effectiveness, time to onset of effectiveness, effectiveness against arthritis, primary failure, secondary failure), safety (e.g. infections, administration-related reactions and relationships with other comorbidities), convenience for patients (e.g. hospital visit intervals, self-injection, maintenance therapy at clinics, feasibility of drug discontinuation/re-administration) and payment (medical costs) borne by patients. This guidance has been prepared with the aim of allowing dermatologists experienced in the treatment of psoriasis to use biologics appropriately according to the circumstances of individual patients after consideration of the above-mentioned factors.
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Affiliation(s)
- Hidehisa Saeki
- Department of Dermatology, Nippon Medical School, Tokyo, Japan
| | - Tadashi Terui
- Department of Dermatology, Nihon University School of Medicine, Tokyo, Japan
| | - Akimichi Morita
- Department of Geriatric and Environmental Dermatology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Shigetoshi Sano
- Department of Dermatology, Kochi Medical School, Kochi University, Kochi, Japan
| | - Shinichi Imafuku
- Department of Dermatology, Faculty of Medicine, Fukuoka University, Fukuoka, Japan
| | - Akihiko Asahina
- Department of Dermatology, The Jikei University School of Medicine, Tokyo, Japan
| | - Mayumi Komine
- Department of Dermatology, Jichi Medical University, Shimotsuke, Japan
| | - Takafumi Etoh
- Division of Dermatology, Tokyo Postal Services Agency Hospital, Tokyo, Japan
| | | | - Hideshi Torii
- Division of Dermatology, Tokyo Yamate Medical Center, Tokyo, Japan
| | | | - Hidemi Nakagawa
- Department of Dermatology, The Jikei University School of Medicine, Tokyo, Japan
| | - Akira Watanabe
- Research Division for Development of Anti-Infective Agents, Faculty of Medical Science and Welfare, Tohoku Bunka Gakuen University, Sendai, Japan
| | - Hiroshi Yotsuyanagi
- Division of Infectious Diseases, Advanced Clinical Research Center, Institute of Medical Science, The University of Tokyo, Tokyo, Japan
| | - Mamitaro Ohtsuki
- Department of Dermatology, Jichi Medical University, Shimotsuke, Japan
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Ludwig CM, Krase JM, Price KN, Lio PA, Shi VY. A practical guide for transitioning from classical immunosuppressants to dupilumab in atopic dermatitis. J DERMATOL TREAT 2019; 32:503-506. [PMID: 31619094 DOI: 10.1080/09546634.2019.1682498] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
| | - Jeffrey M Krase
- Department of Medicine, Division of Dermatology, University of Arizona, Tucson, AZ, USA
| | - Kyla N Price
- University of Illinois Chicago College of Medicine, Chicago, IL, USA
| | - Peter A Lio
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA.,Medical Dermatology Associates of Chicago, Chicago, IL, USA
| | - Vivian Y Shi
- Department of Medicine, Division of Dermatology, University of Arizona, Tucson, AZ, USA
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Thaçi D, Körber A, Kiedrowski R, Bachhuber T, Melzer N, Kasparek T, Duetting E, Kraehn‐Senftleben G, Amon U, Augustin M. Secukinumab is effective in treatment of moderate‐to‐severe plaque psoriasis: real‐life effectiveness and safety from the PROSPECT study. J Eur Acad Dermatol Venereol 2019; 34:310-318. [DOI: 10.1111/jdv.15962] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2019] [Accepted: 08/21/2019] [Indexed: 01/04/2023]
Affiliation(s)
- D. Thaçi
- Comprehensive Centre of Inflammation Medicine University of Lübeck Lübeck Germany
| | - A. Körber
- Department of Dermatology University Hospital Essen Essen Germany
| | | | | | - N. Melzer
- Novartis Pharma GmbH Nürnberg Germany
| | | | | | | | - U. Amon
- International Centre for Skin Disease DermAllegra Hohenstadt/Nürnberg Germany
| | - M. Augustin
- Institute for Health Services Research in Dermatology and Nursing (IVDP) German Centre for Health Services Research in Dermatology (CVderm) University Medical Center Hamburg‐Eppendorf (UKE) Hamburg Germany
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Kim B, Maverakis E, Raychaudhuri SP. Is It Possible to Discontinue Tumor Necrosis Factor Antagonists after Psoriasis Remission? Ann Dermatol 2019; 31:495-501. [PMID: 33911640 PMCID: PMC7992562 DOI: 10.5021/ad.2019.31.5.495] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Accepted: 03/18/2019] [Indexed: 11/30/2022] Open
Abstract
Tumor necrosis factor (TNF) antagonists are highly effective treatments for psoriasis. These agents provide the opportunity to improve disease activity and achieve clinical remission. Despite its efficacy, long-term use of biologics is associated with high financial costs and possibly life-threatening adverse events. Recently, there has been an increasing interest in discontinuing TNF antagonists in patients with psoriasis who have achieved a positive clinical response. However, there is a paucity of data and clinical guidelines concerning the cessation TNF antagonists in psoriasis treatment. Several factors, including cost, subsequent treatment efficacy, relative risks, and tolerability, should be considered before the decision is made to discontinue TNF antagonists. Well-designed clinical trials are necessary to identify factors that may trigger disease exacerbation after medication discontinuation in order to recognize the potential disadvantages of discontinuing treatment in patients who are previously successfully managed on TNF antagonists.
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Affiliation(s)
- Byungsoo Kim
- Department of Dermatology, Pusan National University School of Medicine, Yangsan, Korea.,Biomedical Research Institute, Pusan National University Hospital, Busan, Korea
| | - Emanual Maverakis
- Department of Dermatology, School of Medicine, University of California Davis, Sacramento, CA, USA
| | - Siba P Raychaudhuri
- Division of Rheumatology and Immunology, Veterans Affairs Medical Center Sacramento, Sacramento, CA, USA.,Division of Rheumatology, Allergy and Clinical Immunology, Department of Internal Medicine, School of Medicine, University of California Davis, Sacramento, CA, USA
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37
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Gupta A, Sardana K, Gautam RK. Switching to secukinumab in difficult-to-treat psoriasis recalcitrant to methotrexate, cyclosporine and leflunomide, in a tuberculosis-endemic country. Trop Doct 2019; 49:215-217. [DOI: 10.1177/0049475519838400] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Several biological agents have been approved for the treatment of recalcitrant psoriasis. However, there is a lack of a consensus algorithm guiding the drug selection for patients who have failed conventional drugs. In cases not improving with cyclosporine, direct switching to a biological therapy usually leads to a disease flare owing to increased production of interleukin (IL)-17A. Thus, secukinumab, a rapidly acting anti-IL-17A drug, may be ideal in such situations.
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Affiliation(s)
- Aastha Gupta
- Senior Resident, Department of Dermatology, Dr Ram Manohar Lohia Hospital, New Delhi, India
| | - Kabir Sardana
- Professor, Department of Dermatology, Dr Ram Manohar Lohia Hospital, New Delhi, India
| | - Ram K Gautam
- Professor, Department of Dermatology, Dr Ram Manohar Lohia Hospital, New Delhi, India
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Sacchelli L, Patrizi A, Loi C, Bardazzi F. Combination therapy of apremilast and secukinumab in patients with moderate‐to‐severe, recalcitrant plaque psoriasis. Clin Exp Dermatol 2019; 44:e243-e244. [DOI: 10.1111/ced.14000] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/29/2019] [Indexed: 11/30/2022]
Affiliation(s)
- L. Sacchelli
- Department of Specialized, Clinical and Experimental Medicine Division of Dermatology University of Bologna Bologna Italy
| | - A. Patrizi
- Department of Specialized, Clinical and Experimental Medicine Division of Dermatology University of Bologna Bologna Italy
| | - C. Loi
- Department of Specialized, Clinical and Experimental Medicine Division of Dermatology University of Bologna Bologna Italy
| | - F. Bardazzi
- Department of Specialized, Clinical and Experimental Medicine Division of Dermatology University of Bologna Bologna Italy
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Tada Y, Ishii K, Kimura J, Hanada K, Kawaguchi I. Patient preference for biologic treatments of psoriasis in Japan. J Dermatol 2019; 46:466-477. [PMID: 30985030 PMCID: PMC6594072 DOI: 10.1111/1346-8138.14870] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Accepted: 03/06/2019] [Indexed: 01/03/2023]
Abstract
Psoriasis is a chronic autoimmune disease affecting skin which may also manifest in nails and joints. Several biologic treatments have been approved in Japan for psoriasis. Each biologic has a different profile for efficacy and safety, including different dosing regimens and co‐payment considerations which may complicate treatment decisions made by patients and physicians during short consultations. Elucidating patient preference is expected to contribute to shared decision‐making between patients and physicians to optimize treatment satisfaction and outcomes. However, the number of studies investigating this in Japan is very limited. The study used a discrete choice experiment methodology to elicit patient preferences for hypothetical options in an experimental framework. Participants were asked to choose their preferred treatment option from two hypothetical choices, defined by different levels of six attributes (i.e. early onset of efficacy, long‐term efficacy, sustained efficacy after drug withdrawal, dosing convenience, co‐payment and risk of serious infection). The survey included 16 treatment choice scenarios and was completed by 395 participants. Across all participants, the attribute regarded as most important was sustained efficacy after drug withdrawal, followed by dosing convenience, co‐payment, long‐term efficacy, early onset of efficacy and risk of serious infection. The study found that patients prefer treatments which have durable efficacy and lower treatment burden characterized as fewer injection frequency and lower co‐payment. These results may be helpful to understand patient preference for biologic treatments used for psoriasis in Japan and contribute to shared decision‐making between patients and physicians to improve patient satisfaction and treatment outcomes.
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Affiliation(s)
- Yayoi Tada
- Department of Dermatology, Teikyo University School of Medicine, Tokyo, Japan
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40
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Xu Q, Chen B, Jin D, Yin L, Huang Y. An assessment for health education and health promotion in chronic disease demonstration districts: a comparative study from Hunan Province, China. PeerJ 2019; 7:e6579. [PMID: 30867995 PMCID: PMC6409084 DOI: 10.7717/peerj.6579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2018] [Accepted: 02/06/2019] [Indexed: 11/20/2022] Open
Abstract
Background Cost-effective strategies of chronic disease control, integrated health education and health promotion play important roles in the programs of chronic disease demonstration districts in China. The performance of these districts can be directly assessed by their health education and promotion work. However, there have been only a few performance assessments done on these programs, most of which made without the inclusion of proper quality indicators. This study was designed to establish a framework of indicators for outcome evaluation of health education and promotion efforts in Chinese districts, and explore the factors involved in promoting these efforts. Methods A modified two-round Delphi survey was first used to construct quality indicators on a nine-point Likert scale. With those indicators, the rank sum ratio (RSR) method was then conducted through rank conversion and parametric statistics, to assess and classify the performance of ten districts or counties randomly chosen both from demonstration and non-demonstration districts in the Hunan province. Results The Delphi process produced seven themes and 25 sub-themes as quality indicators. The seven themes included organizational management, financial support, professional personnel, health education and promotion, residents' health awareness and behaviors, residents' satisfaction, and residents' health literacy. The districts were classified into four levels by RSR as follows: One demonstration district at the first-ranked level, five other demonstration districts at the second-ranked level, all non-demonstration districts at the third-ranked level. None were at the fourth-qualified level. Discussion Chronic disease demonstration districts performed better on the work of health education and health promotion than the non-demonstration districts. The work should be focused on the following measures of chronic diseases: organizational management, financial support, media-related broadcasting, technical support, community-based promotion and supportive environment, and people's enhanced awareness and health literacy.
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Affiliation(s)
- Qiaohua Xu
- Department of Chronic Diseases Control and Prevention, Hunan Provincial Center for Diseases Control and Prevention, Changsha, Hunan, China
| | - Biyun Chen
- Department of Chronic Diseases Control and Prevention, Hunan Provincial Center for Diseases Control and Prevention, Changsha, Hunan, China
| | - Donghui Jin
- Department of Chronic Diseases Control and Prevention, Hunan Provincial Center for Diseases Control and Prevention, Changsha, Hunan, China
| | - Li Yin
- Department of Chronic Diseases Control and Prevention, Hunan Provincial Center for Diseases Control and Prevention, Changsha, Hunan, China
| | - Yuelong Huang
- Department of Chronic Diseases Control and Prevention, Hunan Provincial Center for Diseases Control and Prevention, Changsha, Hunan, China
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41
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Wu JJ, Lu M, Veverka KA, Smulders M, Papademetriou E, Yu J, Feldman SR. The journey for US psoriasis patients prescribed a topical: a retrospective database evaluation of patient progression to oral and/or biologic treatment. J DERMATOL TREAT 2018; 30:446-453. [PMID: 30554541 DOI: 10.1080/09546634.2018.1529386] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- Jashin J. Wu
- Department of Dermatology, Kaiser Permanente Los Angeles Medical Center, Los Angeles, CA
| | - Minyi Lu
- LEO Pharma Inc., Madison, NJ, USA
| | | | | | | | - Junhua Yu
- SmartAnalyst Inc., New York City, NY, USA
| | - Steven R. Feldman
- Department of Dermatology, Wake Forest University School of Medicine, Winston-Salem, NC, USA
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Dabouz F, Khemis A, Barbe C, Lahfa M, Maccari F, Chaby G, Beneton N, Boye T, Esteve E, Mahé E, Begon E, Pauwels C, Bernard P, Taieb C, Reguiai Z. Factors associated with successful switching between biologic therapies for the treatment of psoriasis in daily dermatological real-life practice: The Resoswitch study. Dermatol Ther 2018; 32:e12789. [PMID: 30488520 DOI: 10.1111/dth.12789] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2018] [Revised: 07/25/2018] [Accepted: 11/26/2018] [Indexed: 11/27/2022]
Affiliation(s)
- Fadia Dabouz
- Dermatology Department, Reims University Hospital, Reims, France
| | - Abdallah Khemis
- Dermatology Department, Nice University Hospital, Nice, France
| | - Christine Barbe
- Clinical Research Unit, Reims University Hospital, Reims, France
| | - Mourad Lahfa
- Dermatology Department, Larrey Hospital, University Hospital, Toulouse, France
| | - Francois Maccari
- Dermatology Department, Bégin Military Hospital, Saint-Mandé, France
| | - Guillaume Chaby
- Dermatology Department, South Hospital, Amiens University Hospital, Amiens, France
| | | | - Thierry Boye
- Dermatology Department, Sainte Anne Military Hospital, Toulon, France
| | - Eric Esteve
- Dermatology Department, Orléans Regional Hospital, Orléans, France
| | - Emmanuel Mahé
- Dermatology Department, Victor Dupouy Hospital, Argenteuil, France
| | - Edouard Begon
- Dermatology Department, René Dubos Hospital, Pontoise, France
| | | | - Philippe Bernard
- Dermatology Department, Reims University Hospital, Reims, France
| | - Charles Taieb
- Public Health, Hôpital Necker-Enfants Malades, Paris, France
| | - Ziad Reguiai
- Dermatology Department, Reims University Hospital, Reims, France
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Umezawa Y, Torisu-Itakura H, Morisaki Y, ElMaraghy H, Nakajo K, Akashi N, Saeki H. Long-term efficacy and safety results from an open-label phase III study (UNCOVER-J) in Japanese plaque psoriasis patients: impact of treatment withdrawal and retreatment of ixekizumab. J Eur Acad Dermatol Venereol 2018; 33:568-576. [PMID: 30325534 PMCID: PMC6587494 DOI: 10.1111/jdv.15292] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Accepted: 08/07/2018] [Indexed: 12/29/2022]
Abstract
Background Long‐term management of moderate‐to‐severe psoriasis is usually discussed in terms of continuous administration; however, there are many situations in clinical practice where treatment may be withdrawn with subsequent retreatment. Objective To assess the clinical course after ixekizumab treatment withdrawal and retreatment, as well as the effectiveness of ixekizumab retreatment, in Japanese patients with plaque psoriasis. Methods This single‐arm, open‐label study (UNCOVER‐J; NCT01624233) comprised 78 patients with plaque psoriasis. After ixekizumab treatment (160‐mg loading dose, 80 mg every 2 weeks for the first 12 weeks, and then 80 mg every 4 weeks (IXE Q4W) until Week 52), 70 patients achieved a Psoriasis Area Severity Index (PASI)75 response at Week 52. These 70 patients withdrew from ixekizumab treatment from Weeks 52 to 100. Patients who relapsed (PASI ≤50) during the Treatment Withdrawal Period were retreated with IXE Q4W for 192 weeks. Results At Weeks 52, 76 and 100, PASI75 response rates were 100%, 26% and 7%; PASI90 response rates were 87%, 11% and 3%; and PASI100 response rates were 53%, 0% and 0%. After treatment withdrawal, 87% of patients relapsed; median time to relapse was 143 days. After 12 weeks of retreatment with IXE Q4W, 83% of relapsed patients achieved PASI75, 68% achieved PASI90 and 25% achieved PASI100; improvements were maintained up to 120 weeks of retreatment. Treatment‐emergent adverse events and serious adverse events were reported in 56% and 4% of patients during the Treatment Withdrawal Period, and in 88% and 14% of patients during the Retreatment Period. Conclusion In patients withdrawn from ixekizumab after achieving PASI75, approximately half relapsed within 5 months of withdrawal; however, most patients recaptured response within 12 weeks, and response was maintained for up to 120 weeks of retreatment.
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Affiliation(s)
- Y Umezawa
- Department of Dermatology, The Jikei University School of Medicine, Tokyo, Japan
| | | | | | - H ElMaraghy
- Eli Lilly and Company, Indianapolis, IN, USA
| | - K Nakajo
- Eli Lilly Japan K.K., Kobe, Japan
| | - N Akashi
- Eli Lilly Japan K.K., Kobe, Japan
| | - H Saeki
- Department of Dermatology, Nippon Medical School, Tokyo, Japan
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Johansson E, Nuñez M, Svedbom A, Dilla T, Hartz S. Cost effectiveness of ixekizumab versus secukinumab in the treatment of moderate-to-severe plaque psoriasis in Spain. CLINICOECONOMICS AND OUTCOMES RESEARCH 2018; 10:747-759. [PMID: 30519064 PMCID: PMC6237133 DOI: 10.2147/ceor.s167727] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Currently, several biologic agents are available for the treatment of moderate-to-severe plaque psoriasis, including newer agents with similar mechanisms of action and efficacy; therefore, there is a need to evaluate their efficiency in terms of cost effectiveness. OBJECTIVE This study evaluates the cost effectiveness of recently approved interleukin (IL)-17A antagonists, ixekizumab and secukinumab, for the treatment of moderate-to-severe plaque psoriasis from the perspective of the Spanish National Health System (NHS). MATERIALS AND METHODS A Markov model with a lifetime horizon was developed to compare the cost effectiveness of ixekizumab vs. secukinumab in a hypothetical cohort of patients with moderate-to-severe plaque psoriasis. The model used monthly cycles and included four health states: a 12-week induction period, treatment maintenance, best supportive care (BSC), and death. Patients meeting response criteria at the end of the induction period transitioned to maintenance therapy, whereas non-responders transitioned to BSC. It was assumed that, each year, 20% of patients receiving maintenance therapy would discontinue treatment. The model incorporated data from various sources, including published literature, a network meta-analysis, and expert opinion for some variables. RESULTS Ixekizumab was dominant over secukinumab in that it gained 0.037 more quality-adjusted life years (QALYs) and saved €1951 in total costs over the lifetime horizon. Probabilistic sensitivity analysis showed a 96.6% likelihood that ixekizumab would be cost effective at a threshold of €30,000 per QALY gained. CONCLUSION For the treatment of moderate-to-severe plaque psoriasis in Spain, ixekizumab provided additional QALYs and potential savings for the Spanish NHS compared with secukinumab. Since the magnitude of the differences in costs and QALYs was modest, other factors such as patient preferences (eg, for number of injections) and long-term safety (eg, related to time on the market) may also be important for guiding clinical decisions.
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Affiliation(s)
- Erin Johansson
- Access, Commercialisation & Communications, ICON plc, Stockholm, Sweden,
| | - Mercedes Nuñez
- Health Outcomes and Real World Evidence, Eli Lilly, Madrid, Spain
| | - Axel Svedbom
- Access, Commercialisation & Communications, ICON plc, Stockholm, Sweden,
| | - Tatiana Dilla
- Health Outcomes and Real World Evidence, Eli Lilly, Madrid, Spain
| | - Susanne Hartz
- Global Patient Outcomes and Real World Evidence International, Eli Lilly, Surrey, UK
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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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Johansson EC, Hartz S, Kiri SH, Kumar G, Svedbom A. Cost-effectiveness analysis of sequential biologic therapy with ixekizumab versus secukinumab as first-line treatment of moderate-to-severe psoriasis in the UK. J Med Econ 2018; 21:810-820. [PMID: 29873270 DOI: 10.1080/13696998.2018.1474747] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
AIMS Patients with psoriasis often undergo treatment with a sequence of biologic agents because of poor/loss of response to initial therapy. With the availability of newer agents like ixekizumab and secukinumab, there is a need for cost-effectiveness analyses to better reflect current clinical practice. This study aimed to assess the cost-effectiveness of a sequence of biologic therapies containing first-line ixekizumab vs first-line secukinumab in patients with moderate-to-severe plaque psoriasis in the UK. MATERIALS AND METHODS A Markov model with a lifetime horizon was developed to compare the cost-effectiveness of ixekizumab and secukinumab treatment sequences: ixekizumab → ustekinumab → infliximab → best supportive care (BSC) vs secukinumab → ustekinumab → infliximab → BSC. The model used monthly cycles, and included four health states: trial period, treatment maintenance, BSC, and death. At the end of the trial period, responders transitioned to maintenance therapy; non-responders transitioned to the next biologic in the sequence. An annual discontinuation rate of 20% was assumed for maintenance therapy. RESULTS The ixekizumab sequence provided cost savings of £898 (£176,203 vs 177,101) [year 2015 values] and gained 0.03 more quality-adjusted life-years (QALYs: 1.45 vs 1.42) vs the secukinumab sequence over the lifetime horizon. Probabilistic sensitivity analysis showed an 89.8% likelihood that the ixekizumab sequence would be cost-effective at a threshold of £20,000 per QALY gained. LIMITATIONS The analysis used list prices for drugs rather than confidential, preferentially priced Patient Access Scheme costs. In addition, efficacy input data were based on a network meta-analysis, as there were no head-to-head trials comparing ixekizumab and secukinumab. CONCLUSION First-line treatment with ixekizumab as part of a specific sequential biologic therapy for moderate-to-severe plaque psoriasis in the UK provided slight advantages in cost savings and QALYs gained over a similar treatment sequence initiated with secukinumab. In view of the small magnitude of these differences, factors such as patient preferences (e.g. for number of injections) and long-term safety (e.g. related to time on the market) may also be important for clinical decision-making.
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Hu Y, Chen Z, Gong Y, Shi Y. A Review of Switching Biologic Agents in the Treatment of Moderate-to-Severe Plaque Psoriasis. Clin Drug Investig 2018; 38:191-199. [PMID: 29249053 DOI: 10.1007/s40261-017-0603-3] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Psoriasis is an immune-mediated polygenic inherited skin disease. Many biologic agents have been approved for the treatment of moderate-to-severe plaque psoriasis. The most commonly utilized biologics include TNF-α antagonists (etanercept, infliximab, and adalimumab), IL-12/23P40 antagonist (ustekinumab), IL-23P19 antagonist (guselkumab), IL-17A antagonist (secukinumab and ixekizumab), and IL-17RA antagonist (brodalumab). However, some patients may fail to respond well to their first biologic agent. Reasons for failure include primary failure (lack of initial efficacy), secondary failure (loss of efficacy over time) or the development of adverse effects. For patients desiring maximum skin clearance and better quality of life, switching to a second biologic agent might be a worthwhile option. This review discusses recent clinical studies on switching therapies in treating psoriasis, and found that switching biologic agents can significantly improve outcomes for patients. Some clinical guidelines are also discussed. This research provides some advice on establishing individualized treatment regimens based on clinical needs and pharmacologic characteristics.
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Affiliation(s)
- Yifan Hu
- Department of Dermatology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, 200072, China
| | - Zeyu Chen
- Department of Dermatology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, 200072, China
| | - Yu Gong
- Department of Dermatology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, 200072, China
| | - Yuling Shi
- Department of Dermatology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, 200072, China.
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Olszewska B, Adamski Z, Czarnecka-Operacz M. Quo vadis, biological treatment for psoriasis and psoriatic arthritis? Postepy Dermatol Alergol 2018; 35:231-237. [PMID: 30008638 PMCID: PMC6041715 DOI: 10.5114/ada.2018.76086] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2017] [Accepted: 11/26/2017] [Indexed: 12/30/2022] Open
Abstract
Psoriasis is a chronic autoimmune disease that affects approximately 2-3% of the world's population. Although the cutaneous manifestations of the disease are the most prevalent, psoriasis is also associated with a systemic inflammation and various co-morbidities linked with autoinflammatory processes. One of those processes is psoriatic arthritis, an inflammatory, seronegative spondyloarthropathy that develops in 13.8-30% of psoriatic patients at some point of their lives. Over the past 15 years the therapeutic options for severe and generalized psoriasis have broadened immensely with the introduction of biological agents to everyday practice. We present a quick overview of current biological therapies in the treatment of psoriasis and prospects for forthcoming advancements in biological treatment.
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Affiliation(s)
- Barbara Olszewska
- Department of Dermatology, Poznan University of Medical Sciences, Poznan, Poland
| | - Zygmunt Adamski
- Department of Dermatology, Poznan University of Medical Sciences, Poznan, Poland
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Gerdes S, Krakor M, Anger T, Hutt H, Körber A. Prospective, Observational, Non-Interventional, Multicentre Study on the Efficacy and Tolerability of a New Calcipotriol/Betamethasone Aerosol Foam (Enstilar®) in Patients with Plaque Psoriasis under Daily Practice Conditions. Dermatology 2018; 233:425-434. [DOI: 10.1159/000486700] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2017] [Accepted: 12/20/2017] [Indexed: 12/31/2022] Open
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A Challenging Case of Severe Ulcerative Colitis following the Initiation of Secukinumab for Ankylosing Spondylitis. Case Rep Gastrointest Med 2018; 2018:9679287. [PMID: 29666723 PMCID: PMC5832071 DOI: 10.1155/2018/9679287] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2017] [Accepted: 01/18/2018] [Indexed: 01/11/2023] Open
Abstract
Secukinumab is an interleukin-17 inhibitor used for the treatment of ankylosing spondylitis (AS), psoriasis, and psoriatic arthritis. The risk of exacerbating underlying inflammatory bowel disease (IBD) in patients being treated with secukinumab for other conditions is controversial. We document a patient with AS and previously undiagnosed IBD, found to be in a severe ulcerative colitis flare shortly after receiving the loading dose of secukinumab. There are no guidelines regarding biologic salvage therapy for IBD in the setting of active treatment with another biologic agent. After waiting one half-life of secukinumab, our patient had an excellent response to initiation of infliximab.
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