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Sonkoly E, Maul JT, Megna M, Gorecki P, Crombag E, Buyze J, Savage L. Guselkumab in Patients with Scalp Psoriasis: A post hoc Analysis of the VOYAGE 2 Phase III Randomized Clinical Trial. Acta Derm Venereol 2024; 104:adv18672. [PMID: 38436429 PMCID: PMC10924269 DOI: 10.2340/actadv.v104.18672] [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: 09/11/2023] [Accepted: 12/18/2023] [Indexed: 03/05/2024] Open
Abstract
Scalp psoriasis affects approximately 80% of patients with psoriasis and can negatively impact their quality of life. This post hoc analysis of the VOYAGE 2 Phase III randomized clinical trial evaluated scalp response to guselkumab treatment and its association with skin response and patient-reported outcomes. The study included patients with moderate-to-severe plaque psoriasis and baseline scalp psoriasis who were initially randomized to receive guselkumab. Patients were divided into 3 groups based on their achievement of a Psoriasis Area and Severity Index 90 response at week 28: responder continuation, non-responder continuation and responder withdrawal. In all 3 groups, mean Psoriasis Area and Severity Index head and scalp-specific Investigator's Global Assessment scores improved through week 28. In the responder withdrawal group, these scores worsened after treatment withdrawal at week 28, but remained stable through week 48 in both continuation groups. Trends in Dermatology Life Quality Index and Psoriasis Symptoms and Signs Diary itch scores mirrored those of mean scalp-specific Investigator's Global Assessment scores through week 48. Within-subject correlations were 0.83 between scalp-specific Investigator's Global Assessment and Psoriasis Area and Severity Index head scores and 0.78 between scalp-specific Investigator's Global Assessment and Psoriasis Symptoms and Signs Diary itch scores. Through week 252, Psoriasis Area and Severity Index head scores remained stable in the responder continuation group, improved in the non-responder continuation group and rapidly improved by week 84 in the responder withdrawal group after retreatment.
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Affiliation(s)
- Enikö Sonkoly
- Department of Medical Sciences, Uppsala University, Uppsala, Sweden; Dermatology and Venereology Division, Department of Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Julia-Tatjana Maul
- Department of Dermatology, University Hospital Zürich, Zürich, Switzerland; Faculty of Medicine, University of Zürich, Zürich, Switzerland
| | - Matteo Megna
- Section of Dermatology, Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | | | | | | | - Laura Savage
- Leeds Centre for Dermatology, The Leeds Teaching Hospitals NHS Trust, Leeds, UK; Faculty of Medicine and Health, University of Leeds, Leeds, UK.
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Soni B, Shivgotra R, Trehan K, Chhina A, Saini M, Jain SK, Thakur S. An Overview of Contemporary and Future Therapeutic Strategies for Scalp Psoriasis. Curr Drug Targets 2024; 25:353-373. [PMID: 38500274 DOI: 10.2174/0113894501292755240304063020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Revised: 02/06/2024] [Accepted: 02/12/2024] [Indexed: 03/20/2024]
Abstract
Scalp psoriasis is a common manifestation of psoriasis that significantly impacts a patient's quality of life. About 80% of cases of psoriasis involve the scalp, making it the most frequently affected area of the body. The treatment of scalp psoriasis is particularly crucial because of its hard-to-treat nature and substantial adverse impacts on overall well-being. Along with the physical symptoms of discomfort and itching, psoriasis, especially when it affects the scalp, can cause severe psychological damage. Treating scalp psoriasis can be challenging due to its location and associated symptoms, such as scaling and pruritus, which is why various drugs have become widely used for refractory cases. Topical treatments like corticosteroids and vitamin D analogs manage scalp psoriasis by reducing inflammation and regulating skin cell growth. Tar-based shampoos, salicylic acid solutions, and moisturizers control scaling. Phototherapy with UVB light reduces inflammation. Severe cases may require systemic medications such as oral retinoids and immunosuppressants. While various therapies are accessible for scalp psoriasis, concerns arise due to their limited advantages and the absence of controlled studies assessing their effectiveness. Considering these challenges, there is a clear demand for innovative approaches to address this condition effectively. Recent advancements in topical therapies, phototherapy, systemic agents, and complementary therapies have shown promising results in managing scalp psoriasis. Also, the advent of biologics, specifically anti-IL-17 and anti-IL-23 drugs for scalp psoriasis, has seen significant improvements. The review highlights the lack of well-tolerated and effective treatments for scalp psoriasis and underscores the importance of further research in this area. The objective of this review is to clarify the different treatment options currently available or being investigated in clinical trials for managing scalp psoriasis.
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Affiliation(s)
- Bindu Soni
- Department of Pharmaceutical Sciences, Guru Nanak Dev University, Amritsar, Punjab, 143005, India
| | - Riya Shivgotra
- Department of Pharmaceutical Sciences, Guru Nanak Dev University, Amritsar, Punjab, 143005, India
| | - Karan Trehan
- Department of Pharmaceutical Sciences, Guru Nanak Dev University, Amritsar, Punjab, 143005, India
| | - Aashveen Chhina
- Department of Pharmaceutical Sciences, Guru Nanak Dev University, Amritsar, Punjab, 143005, India
| | - Muskaan Saini
- Department of Pharmaceutical Sciences, Guru Nanak Dev University, Amritsar, Punjab, 143005, India
| | - Subheet Kumar Jain
- Department of Pharmaceutical Sciences, Guru Nanak Dev University, Amritsar, Punjab, 143005, India
- Centre for Basic and Translational Research in Health Sciences, Guru Nanak Dev University, Amritsar, 143005, India
| | - Shubham Thakur
- Department of Pharmaceutical Sciences, Guru Nanak Dev University, Amritsar, Punjab, 143005, India
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Hwang JK, Ricardo JW, Lipner SR. Efficacy and Safety of Nail Psoriasis Targeted Therapies: A Systematic Review. Am J Clin Dermatol 2023; 24:695-720. [PMID: 37209391 DOI: 10.1007/s40257-023-00786-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/11/2023] [Indexed: 05/22/2023]
Abstract
INTRODUCTION Nail changes are frequent clinical findings in patients with cutaneous psoriasis and psoriatic arthritis, often causing significant impairments in quality of life. Numerous targeted therapies have been previously studied for treatment of nail psoriasis, however, newer agents have not been captured in prior systematic reviews. With over 25 new studies published since 2020, the landscape of nail psoriasis systemic treatments is rapidly evolving, warranting analysis of recently approved therapies. METHODS An updated systematic review of all PubMed and OVID database studies assessing efficacy and safety of targeted therapies for nail psoriasis was performed, with the goal of incorporating clinical data of recent trials and newer agents, namely brodalumab, risankizumab, and tildrakizumab. Eligibility criteria included clinical human studies reporting at least one of the nail psoriasis clinical appearance outcomes (Nail Psoriasis Severity Index, modified Nail Psoriasis Severity Index). RESULTS A total of 68 studies on 15 nail psoriasis targeted therapeutic agents were included. Biological agents and small molecule inhibitors included TNF-alpha inhibitors (adalimumab, infliximab, etanercept, certolizumab, golimumab), IL-17 inhibitors (ixekizumab, brodalumab, secukinumab), IL-12/23 inhibitors (ustekinumab), IL-23 inhibitors (guselkumab, risankizumab, tildrakizumab), PDE-4 inhibitors (apremilast), and JAK inhibitors (tofacitinib). These agents all demonstrated statistically significant improvements in nail outcome scores, compared with placebo or with baseline values, at weeks 10-16 and weeks 20-26, with some studies assessing efficacy up to week 60. Safety data for these agents were acceptable and consistent with known safety profiles within these timepoints, with nasopharyngitis, upper respiratory tract infections, injection site reactions, headache, and diarrhea being the most reported adverse events. Specifically, the newer agents, brodalumab, risankizumab, and tildrakizumab, showed promising outcomes for treatment of nail psoriasis on the basis of current data. CONCLUSION Numerous targeted therapies have shown significant efficacy in improving nail findings in patients with psoriasis and psoriatic arthritis. Data from head-to-head trials have shown greater efficacy of ixekizumab over adalimumab and ustekinumab, as well as brodalumab over ustekinumab, while prior meta-analyses have demonstrated superiority of ixekizumab and tofacitinib to other included agents at various assessed timepoints. Further studies on the long-term efficacy and safety of these agents, as well as randomized controlled trials involving comparison with placebo arms, are needed to fully analyze differences in efficacy of newer agents compared with previously established therapies.
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Affiliation(s)
- Jonathan K Hwang
- Weill Cornell Medicine, Department of Dermatology, 1305 York Avenue, New York, NY, 10065, USA
| | - Jose W Ricardo
- Weill Cornell Medicine, Department of Dermatology, 1305 York Avenue, New York, NY, 10065, USA
| | - Shari R Lipner
- Weill Cornell Medicine, Department of Dermatology, 1305 York Avenue, New York, NY, 10065, USA.
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Jo SJ, Huang YH, Tsai TF, Kim BS, Reich K, Saadoun C, Chang CL, Yang YW, Youn SW. Efficacy of guselkumab in difficult-to-treat psoriasis regions: Data from VOYAGE 1 and VOYAGE 2 Asian subpopulations. J Dermatol 2023; 50:1180-1189. [PMID: 37341137 DOI: 10.1111/1346-8138.16865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Revised: 03/27/2023] [Accepted: 06/04/2023] [Indexed: 06/22/2023]
Abstract
Patients with psoriasis were randomized to guselkumab, placebo or adalimumab in the VOYAGE 1 and VOYAGE 2 studies. In this post hoc analysis, difficult-to-treat psoriasis regions in the Asian subpopulation for both the guselkumab and adalimumab groups were compared with placebo at week 16 and the active treatment groups were compared at week 24. Endpoints included patients achieving scores of 0 or 1 (clear or near clear) or 0 (clear) on the scalp-specific Investigator's Global Assessment (ss-IGA), Physician's Global Assessment of the hands and/or feet (hf-PGA), and fingernail PGA (f-PGA), and percentage improvement in target Nail Psoriasis Severity Index (NAPSI) score through week 24. Efficacy was also assessed by prior biologic experience at baseline. A total of 199 eligible Asian patients were included. The proportion of patients achieving "clear" or "near clear" with guselkumab was superior to adalimumab at week 24 for scalp psoriasis ss-IGA (Asian patients, 72 [85.7%] vs 35 [67.3%], P = 0.004), hands and/or feet psoriasis hf-PGA (29 [82.9%] vs 16 [61.5%], P = 0.054), and similar for fingernail psoriasis f-PGA (28 [63.6%] vs 17 [54.8%], P = 0.412). Guselkumab mean improvements in NAPSI were comparable to adalimumab (39.9% vs 35.9%, P = 0.618). Overall, the complete clearance response of scalp, and hands and/or feet at week 24 occurred in a greater proportion of patients in the guselkumab group, irrespective of baseline biologic status (treatment-naïve or treatment-experienced). Guselkumab was superior to adalimumab for the treatment of scalp, and hands and/or feet psoriasis, and proportionally higher for fingernail psoriasis. Findings were comparable to the global study population.
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Affiliation(s)
- Seong Jin Jo
- Department of Dermatology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Yu-Huei Huang
- Department of Dermatology, Chang Gung Memorial Hospital and College of Medicine, Chang Gung University, Taoyuan City, Taiwan
| | - Tsen-Fang Tsai
- Department of Dermatology, National Taiwan University Hospital, Taipei, Taiwan
| | - Byung Soo Kim
- Department of Dermatology, College of Medicine, Pusan National University, Busan, Korea
| | - Kristian Reich
- Translational Research in Inflammatory Skin Diseases, Institute for Health Services Research in Dermatology and Nursing, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Carine Saadoun
- Regional Medical Affairs Janssen Asia Pacific, Janssen, a division of Johnson & Johnson Pte Ltd., Singapore, Singapore
| | - Chia-Ling Chang
- Regional Medical Affairs Janssen Asia Pacific, Janssen, a division of Johnson & Johnson Pte Ltd., Singapore, Singapore
| | - Ya-Wen Yang
- Immunology Global Medical Affairs, Janssen Pharmaceutical Companies of Johnson & Johnson, Horsham, Pennsylvania, USA
| | - Sang Woong Youn
- Department of Dermatology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seoul, Korea
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Battista T, Scalvenzi M, Martora F, Potestio L, Megna M. Nail Psoriasis: An Updated Review of Currently Available Systemic Treatments. Clin Cosmet Investig Dermatol 2023; 16:1899-1932. [PMID: 37519941 PMCID: PMC10378542 DOI: 10.2147/ccid.s417679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Accepted: 07/08/2023] [Indexed: 08/01/2023]
Abstract
Background Nail psoriasis (NP) has a prevalence that ranges from 10 to 82% among patients with psoriasis (PsO) and is one of the most common difficult to treat site of psoriasis. We performed a thorough review of the literature, exploring evidence regarding all available NP systemic treatments, describing also in detail NP dedicated clinical trials. Methods A literature search was conducted in PubMed and Embase prior to February 2023 using a combination of the terms "nail" AND "psoriasis" AND "systemic therapy" AND/OR "systemic treatment". A total of 47 original studies and case reports were reviewed in this article. Results Systemic therapies should be considered when the disorder involves more than 3 nails, has extensive skin and joint involvement, and has a significant impact on QoL, due to their best long-term efficacy. In detail, conventional and biologic systemic drugs demonstrated efficacy in recent trials, including acitretin, methotrexate, cyclosporine, apremilast, adalimumab, infliximab, etanercept, certolizumab, golimumab, ustekinumab, secukinumab, ixekizumab, brodalumab, bimekizumab, guselkumab, risankizumab and tildrakizumab. Conclusion Several therapies have demonstrated efficacy and safety in the treatment of NP; however, the choice of treatment depends not only on the severity of the nail involvement, but also on whether PsA is present, the patient's comorbidities other than PsA, previous treatment history, and the patient's drug preferences.
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Affiliation(s)
- Teresa Battista
- Section of Dermatology, Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Massimiliano Scalvenzi
- Section of Dermatology, Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Fabrizio Martora
- Section of Dermatology, Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Luca Potestio
- Section of Dermatology, Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Matteo Megna
- Section of Dermatology, Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
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Quality of Life and Body Region Affected by Psoriasis: A Systematic Review. ACTAS DERMO-SIFILIOGRAFICAS 2023; 114:T33-T38. [PMID: 36368576 DOI: 10.1016/j.ad.2022.07.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Accepted: 07/28/2022] [Indexed: 11/11/2022] Open
Abstract
PURPOSE Psoriasis is a chronic skin condition that affects approximately 1-3% of the world's population and is known to decrease patients' quality of life. However, it is yet to be ascertained whether the specific location of psoriatic lesions on the body influences one's quality of life. METHODS A systematic review was conducted with a search of MEDLINE, EMBASE, and Web of Science databases. Only non-case report and non-review studies with explicitly stated body regions affected by psoriasis were included in the review. FINDINGS Psoriatic patches and plaques in different areas of the body were not found to influence patients' quality of life to differing extents. CONCLUSIONS While the body of evidence is limited and presents unstandardized results, the results of this review point to the fact that all psoriatic patches and plaques decrease patients' quality of life, with neither one region doing so to a significantly greater extent than another.
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7
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Nabieva K, Vender R. Quality of Life and Body Region Affected by Psoriasis: A Systematic Review. ACTAS DERMO-SIFILIOGRAFICAS 2023; 114:33-38. [PMID: 36030828 DOI: 10.1016/j.ad.2022.07.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Revised: 03/20/2022] [Accepted: 07/28/2022] [Indexed: 01/11/2023] Open
Abstract
PURPOSE Psoriasis is a chronic skin condition that affects approximately 1-3% of the world's population and is known to decrease patients' quality of life. However, it is yet to be ascertained whether the specific location of psoriatic lesions on the body influences one's quality of life. METHODS A systematic review was conducted with a search of MEDLINE, EMBASE, and Web of Science databases. Only non-case report and non-review studies with explicitly stated body regions affected by psoriasis were included in the review. FINDINGS Psoriatic patches and plaques in different areas of the body were not found to influence patients' quality of life to differing extents. CONCLUSIONS While the body of evidence is limited and presents unstandardized results, the results of this review point to the fact that all psoriatic patches and plaques decrease patients' quality of life, with neither one region doing so to a significantly greater extent than another.
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Affiliation(s)
- K Nabieva
- University of Ottawa Faculty of Medicine, Ottawa, Ontario, Canada
| | - R Vender
- Dermatrials Research Inc., Hamilton, Canada.
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8
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Rigopoulos D, Rompoti N, Tsiogka A, Lipner SR. How to choose a systemic treatment for moderate-to-severe nail psoriasis. J Eur Acad Dermatol Venereol 2022; 36:e1034-e1041. [PMID: 35841301 DOI: 10.1111/jdv.18435] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
| | - Natalia Rompoti
- 2nd Department of Dermatology, University General Hospital Athinon, Athens, Greece
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Megna M, Villani A, Potestio L, Camela E, Fabbrocini G, Ocampo-Garza SS. Adalimumab biosimilar in a pediatric patient: clinical and in vivo reflectance confocal microscopy evaluation. Dermatol Ther 2022; 35:e15679. [PMID: 35770675 PMCID: PMC9541432 DOI: 10.1111/dth.15679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Revised: 05/02/2022] [Accepted: 06/28/2022] [Indexed: 12/02/2022]
Affiliation(s)
- Matteo Megna
- Section of Dermatology, Department of Clinical Medicine and Surgery, University of Naples Federico II
| | - Alessia Villani
- Section of Dermatology, Department of Clinical Medicine and Surgery, University of Naples Federico II
| | - Luca Potestio
- Section of Dermatology, Department of Clinical Medicine and Surgery, University of Naples Federico II
| | - Elisa Camela
- Section of Dermatology, Department of Clinical Medicine and Surgery, University of Naples Federico II
| | - Gabriella Fabbrocini
- Section of Dermatology, Department of Clinical Medicine and Surgery, University of Naples Federico II
| | - Sonia Sofia Ocampo-Garza
- Section of Dermatology, Department of Clinical Medicine and Surgery, University of Naples Federico II.,Universidad Autónoma de Nuevo León, University Hospital "Dr. José Eleuterio González", Dermatology Department, Monterrey, Nuevo León, México
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Galluzzo M, Talamonti M, Cioni A, Maffei V, Shumak RG, Tofani L, Bianchi L, Campione E. Efficacy of Tildrakizumab for the Treatment of Difficult-to-Treat Areas: Scalp, Nail, Palmoplantar and Genital Psoriasis. J Clin Med 2022; 11:jcm11092631. [PMID: 35566756 PMCID: PMC9100809 DOI: 10.3390/jcm11092631] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Revised: 05/04/2022] [Accepted: 05/05/2022] [Indexed: 12/14/2022] Open
Abstract
Tildrakizumab, an IL-23 inhibitor, is effective and safe for the improvement of moderate-to-severe chronic plaque psoriasis. However, little evidence is available on the use of this biologic in psoriasis in difficult-to-treat locations. In this retrospective analysis, we treated patients with 100 mg tildrakizumab at Day 0, after 4 weeks and every 12 weeks thereafter. Disease severity and treatment response was assessed by the Psoriasis Area and Severity Index (PASI), the static Physician’s Global Assessment of Genitalia (sPGA-G), the Psoriasis Scalp Severity Index (PSSI), Nail Psoriasis Severity Index (NAPSI) and the Palmoplantar Psoriasis Area and Severity Index (ppPASI) at baseline and after 4, 12 and 28 weeks. We followed 18 patients (mean age 49.1 ± 12.7 years, 61.1% male) with psoriasis localized to the genital region (N = 7), scalp (N = 6), nails (N = 5) and palmar/plantar areas (N = 7). PASI score decreased from 11.5 at baseline to 3.1 and 2.4 at 12 and 28 weeks. Tildrakizumab treatment decreased sPGA-G (3.3 to 0.2), PSSI (36.2 to 2.7), NAPSI (48.4 to 15.7) and ppPASI (5.3 to 0) from baseline to 28 weeks, respectively. Data from this real-life retrospective analysis shows that tildrakizumab is an effective option for the management of psoriasis in difficult-to-treat areas.
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Affiliation(s)
- Marco Galluzzo
- Department of Systems Medicine, University of Rome “Tor Vergata”, 00133 Rome, Italy; (M.T.); (A.C.); (V.M.); (R.G.S.); (L.T.); (L.B.); (E.C.)
- Dermatology Unit, Fondazione Policlinico “Tor Vergata”, 00133 Rome, Italy
- Correspondence: ; Tel.: +39-06-2090-2743
| | - Marina Talamonti
- Department of Systems Medicine, University of Rome “Tor Vergata”, 00133 Rome, Italy; (M.T.); (A.C.); (V.M.); (R.G.S.); (L.T.); (L.B.); (E.C.)
- Dermatology Unit, Fondazione Policlinico “Tor Vergata”, 00133 Rome, Italy
| | - Arnaldo Cioni
- Department of Systems Medicine, University of Rome “Tor Vergata”, 00133 Rome, Italy; (M.T.); (A.C.); (V.M.); (R.G.S.); (L.T.); (L.B.); (E.C.)
- Dermatology Unit, Fondazione Policlinico “Tor Vergata”, 00133 Rome, Italy
| | - Virginia Maffei
- Department of Systems Medicine, University of Rome “Tor Vergata”, 00133 Rome, Italy; (M.T.); (A.C.); (V.M.); (R.G.S.); (L.T.); (L.B.); (E.C.)
- Dermatology Unit, Fondazione Policlinico “Tor Vergata”, 00133 Rome, Italy
| | - Ruslana Gaeta Shumak
- Department of Systems Medicine, University of Rome “Tor Vergata”, 00133 Rome, Italy; (M.T.); (A.C.); (V.M.); (R.G.S.); (L.T.); (L.B.); (E.C.)
- Dermatology Unit, Fondazione Policlinico “Tor Vergata”, 00133 Rome, Italy
| | - Lorenzo Tofani
- Department of Systems Medicine, University of Rome “Tor Vergata”, 00133 Rome, Italy; (M.T.); (A.C.); (V.M.); (R.G.S.); (L.T.); (L.B.); (E.C.)
- Dermatology Unit, Fondazione Policlinico “Tor Vergata”, 00133 Rome, Italy
| | - Luca Bianchi
- Department of Systems Medicine, University of Rome “Tor Vergata”, 00133 Rome, Italy; (M.T.); (A.C.); (V.M.); (R.G.S.); (L.T.); (L.B.); (E.C.)
- Dermatology Unit, Fondazione Policlinico “Tor Vergata”, 00133 Rome, Italy
| | - Elena Campione
- Department of Systems Medicine, University of Rome “Tor Vergata”, 00133 Rome, Italy; (M.T.); (A.C.); (V.M.); (R.G.S.); (L.T.); (L.B.); (E.C.)
- Dermatology Unit, Fondazione Policlinico “Tor Vergata”, 00133 Rome, Italy
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Canal-García E, Bosch-Amate X, Belinchón I, Puig L. Psoriasis ungueal. ACTAS DERMO-SIFILIOGRAFICAS 2022; 113:481-490. [DOI: 10.1016/j.ad.2022.01.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2021] [Revised: 01/11/2022] [Accepted: 01/15/2022] [Indexed: 10/19/2022] Open
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12
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Canal-García E, Bosch-Amate X, Belinchón I, Puig L. [Translated article] Nail Psoriasis. ACTAS DERMO-SIFILIOGRAFICAS 2022. [DOI: 10.1016/j.ad.2022.01.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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13
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Papadimitriou I, Bakirtzi K, Katoulis A, Ioannides D. Scalp Psoriasis and Biologic Agents: A Review. Skin Appendage Disord 2021; 7:439-448. [PMID: 34901174 DOI: 10.1159/000517806] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2021] [Accepted: 06/06/2021] [Indexed: 01/10/2023] Open
Abstract
Scalp-localized psoriasis is common among patients affected with plaque psoriasis, rendering its treatment exceedingly difficult. Furthermore, the symptoms caused by the disease like scaling, erythema, and pruritus, among others, pose a major psychological impact and a significant regression in the quality of life of the affected patients. Biologics have proved their efficacy in assuaging the symptoms, in terms of Psoriasis Area and Severity Index (PASI) reduction, and offering optimum quality of life, by decreasing the Dermatology Life Quality Index (DLQI) in the patients suffering from plaque psoriasis. Herein, we sought to evaluate the efficacy of biologics and small molecules in controlling the symptoms and their ability to offer long-term maintenance in the disease activity.
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Affiliation(s)
- Ilias Papadimitriou
- First Dermatology and Venereology Department, School of Medicine Faculty of Health Sciences, Aristotle University, Thessaloniki, Greece
| | - Katerina Bakirtzi
- First Dermatology and Venereology Department, School of Medicine Faculty of Health Sciences, Aristotle University, Thessaloniki, Greece
| | - Alexander Katoulis
- Second Department of Dermatology and Venereology, National and Kapodistrian University of Athens Medical School, "Attikon" University Hospital, Athens, Greece
| | - Dimitrios Ioannides
- First Dermatology and Venereology Department, School of Medicine Faculty of Health Sciences, Aristotle University, Thessaloniki, Greece
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Nail Psoriasis and Quality-of-Life Measurement in Clinical Trials: Call for the Use of Nail-Specific Instruments. Am J Clin Dermatol 2021; 22:747-755. [PMID: 34383273 PMCID: PMC8566428 DOI: 10.1007/s40257-021-00622-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/27/2021] [Indexed: 11/03/2022]
Abstract
Nail involvement is frequent in people with psoriasis. It can considerably impair health-related quality of life (HRQoL) beyond the impairments due to other psoriasis symptoms, for example, because patients feel ashamed of visible nail defects or because of the functional impairment in manual activities and walking. In clinical trials on nail psoriasis, it is therefore crucial to assess whether the treatment reduces HRQoL impairments that are specific to nail psoriasis. For this purpose, two validated patient questionnaires are available, the Nail Psoriasis Quality of Life Scale (NPQ10) and the Nail Assessment in Psoriasis and Psoriatic Arthritis-Quality of Life (NAPPA-QOL). The ten-item NPQ10 has the advantage of being short and thus quick to administer. The 20-item NAPPA-QOL, in contrast, assesses the different dimensions of HRQoL which is considered a multi-dimensional construct. Yet most randomized controlled trials on nail psoriasis do not evaluate HRQoL improvement. If they do, a number of different instruments are used, most of which are not nail specific. This makes comparison of trial outcomes difficult. Harmonizing the measurement of HRQoL in future clinical trials on nail psoriasis would improve comparability across studies and would also enhance the reliability of meta-analyses.
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15
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Ji C, Wang H, Bao C, Zhang L, Ruan S, Zhang J, Gong T, Cheng B. Challenge of Nail Psoriasis: An Update Review. Clin Rev Allergy Immunol 2021; 61:377-402. [PMID: 34478047 DOI: 10.1007/s12016-021-08896-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/24/2021] [Indexed: 12/11/2022]
Abstract
Nail psoriasis is a refractory disease that affects 50-79% skin psoriasis patients and up to 80% of patients with psoriatic arthritis (PsA). The pathogenesis of nail psoriasis is still not fully illuminated, although some peculiar inflammatory cytokines and chemokines seems to be the same as described in psoriatic skin lesions. Psoriatic nail involving matrix can cause pitting, leukonychia, red spots in lunula, and nail plate crumbling, while nail bed involvement can result in onycholysis, oil-drop discoloration, nail bed hyperkeratosis, and splinter hemorrhages. The common assessment methods of evaluating nail psoriasis includes Nail Psoriasis Severity Index (NAPSI), Nail Assessment in Psoriasis and Psoriatic Arthritis (NAPPA), Nail Psoriasis Quality of life 10 (NPQ10), and so on. Treatment of nail psoriasis should be individualized according to the number of involving nail, the affected site of nail and presence of skin and/or joint involvement. Generally, topical therapies are used for mild nail psoriasis, while biologic agents such as etanercept are considered for severe nail disease and refractory nail psoriasis. Even though the current literature has shown some support for the pathogenesis, clinical presentation, or therapies of nail psoriasis, systemic review of this multifaceted disease is still rare to date. We elaborate recent developments in nail psoriasis epidemiology, pathogenesis, anatomy, clinical manifestation, diagnosis, differential diagnosis, and therapies to raise better awareness of the complexity of nail psoriasis and the need for early diagnosis or intervention.
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Affiliation(s)
- Chao Ji
- Department of Dermatology, the First Affiliated Hospital of Fujian Medical University, 20 Chazhong Road, Fuzhou, 350000, Fujian, China
| | - Haiqing Wang
- Department of Dermatology, the First Affiliated Hospital of Fujian Medical University, 20 Chazhong Road, Fuzhou, 350000, Fujian, China
| | - Chengbei Bao
- Department of Dermatology, the First Affiliated Hospital of Fujian Medical University, 20 Chazhong Road, Fuzhou, 350000, Fujian, China
| | - Liangliang Zhang
- Department of Dermatology, the First Affiliated Hospital of Fujian Medical University, 20 Chazhong Road, Fuzhou, 350000, Fujian, China
| | - Shifan Ruan
- Department of Dermatology, the First Affiliated Hospital of Fujian Medical University, 20 Chazhong Road, Fuzhou, 350000, Fujian, China
| | - Jing Zhang
- Department of Dermatology, the First Affiliated Hospital of Fujian Medical University, 20 Chazhong Road, Fuzhou, 350000, Fujian, China
| | - Ting Gong
- Central Laboratory, the First Affiliated Hospital of Fujian Medical University, 20 Chazhong Road, Fuzhou, 350000, Fujian, China.
| | - Bo Cheng
- Department of Dermatology, the First Affiliated Hospital of Fujian Medical University, 20 Chazhong Road, Fuzhou, 350000, Fujian, China.
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Hadeler E, Mosca M, Hong J, Brownstone N, Bhutani T, Liao W. Nail Psoriasis: A Review of Effective Therapies and Recommendations for Management. Dermatol Ther (Heidelb) 2021; 11:799-831. [PMID: 33978917 PMCID: PMC8163925 DOI: 10.1007/s13555-021-00523-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Indexed: 11/24/2022] Open
Abstract
Nail psoriasis has a prevalence that ranges from 10 to 82% and can significantly impact the quality of life of patients. Nail psoriasis is one of the most challenging areas to treat, and multiple therapies have been explored. Topical and injectable therapies are recommended for few-nail disease. Systemic therapies, including biologics, can be considered for patients with multiple and resistant nail disease, impaired quality of life, and severe skin and joint involvement, due to their long-term efficacy. Although outcome data are difficult to compare, interleukin (IL)-17 inhibitors may have superior short-term efficacy when compared to IL-23 inhibitors and tumor necrosis factor (TNF)-alpha inhibitors, although long-term efficacy is similar to TNF-alpha inhibitors. IL-23 inhibitors and TNF-alpha inhibitors have a similar efficacy for nail psoriasis.
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Affiliation(s)
- Edward Hadeler
- Department of Dermatology, Psoriasis and Skin Treatment Center, University of California San Francisco, 515 Spruce Street, San Francisco, CA, 94118, USA.
| | - Megan Mosca
- Department of Dermatology, Psoriasis and Skin Treatment Center, University of California San Francisco, 515 Spruce Street, San Francisco, CA, 94118, USA
| | - Julie Hong
- Department of Dermatology, Psoriasis and Skin Treatment Center, University of California San Francisco, 515 Spruce Street, San Francisco, CA, 94118, USA
| | - Nicholas Brownstone
- Department of Dermatology, Psoriasis and Skin Treatment Center, University of California San Francisco, 515 Spruce Street, San Francisco, CA, 94118, USA
| | - Tina Bhutani
- Department of Dermatology, Psoriasis and Skin Treatment Center, University of California San Francisco, 515 Spruce Street, San Francisco, CA, 94118, USA
| | - Wilson Liao
- Department of Dermatology, Psoriasis and Skin Treatment Center, University of California San Francisco, 515 Spruce Street, San Francisco, CA, 94118, USA
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Mosca M, Hong J, Hadeler E, Brownstone N, Bhutani T, Liao W. Scalp Psoriasis: A Literature Review of Effective Therapies and Updated Recommendations for Practical Management. Dermatol Ther (Heidelb) 2021; 11:769-797. [PMID: 33893995 PMCID: PMC8163911 DOI: 10.1007/s13555-021-00521-z] [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: 02/17/2021] [Indexed: 11/23/2022] Open
Abstract
The scalp is one of the most commonly affected regions in psoriasis. However, scalp psoriasis can be difficult to treat because of challenges in the delivery of therapy. Effective therapeutic regimens for scalp psoriasis are essential to improving the quality of life of patients. Recent data on topical therapies, phototherapy, systemic agents, and complementary therapy have demonstrated that it is possible to achieve and maintain significant improvement in scalp psoriasis. In this review, efficacy data for these modalities and an algorithm for the practical management of scalp psoriasis are presented.
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Affiliation(s)
- Megan Mosca
- Department of Dermatology, Psoriasis and Skin Treatment Center, University of California San Francisco, 515 Spruce Street, San Francisco, CA, 94118, USA.
| | - Julie Hong
- Department of Dermatology, Psoriasis and Skin Treatment Center, University of California San Francisco, 515 Spruce Street, San Francisco, CA, 94118, USA
| | - Edward Hadeler
- Department of Dermatology, Psoriasis and Skin Treatment Center, University of California San Francisco, 515 Spruce Street, San Francisco, CA, 94118, USA
| | - Nicholas Brownstone
- Department of Dermatology, Psoriasis and Skin Treatment Center, University of California San Francisco, 515 Spruce Street, San Francisco, CA, 94118, USA
| | - Tina Bhutani
- Department of Dermatology, Psoriasis and Skin Treatment Center, University of California San Francisco, 515 Spruce Street, San Francisco, CA, 94118, USA
| | - Wilson Liao
- Department of Dermatology, Psoriasis and Skin Treatment Center, University of California San Francisco, 515 Spruce Street, San Francisco, CA, 94118, USA
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18
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Camela E, Ocampo-Garza SS, Cinelli E, Villani A, Fabbrocini G, Megna M. Therapeutic update of biologics and small molecules for scalp psoriasis: a systematic review. Dermatol Ther 2021; 34:e14857. [PMID: 33559275 DOI: 10.1111/dth.14857] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2020] [Revised: 01/17/2021] [Accepted: 02/04/2021] [Indexed: 12/11/2022]
Abstract
Scalp psoriasis represents the most common difficult-to-treat area in psoriasis patients. Its presence is linked to severe discomfort and impairment of quality of life given the associated symptoms (most of all, scaling and pruritus) and the location in a highly visible area, thus a prompt treatment is required. Its management may be challenging as the scalp is quite sensitive to long-term treatment with topical corticosteroids and usually resistant to topical and systemic agents. Likely, the currently available therapeutic armamentarium has been enriched with biologicals and small molecules that revolutionized psoriasis treatment and that of scalp psoriasis. Nevertheless, the lack of international dedicated guidelines pushed us to perform a comprehensive review on the efficacy and safety of biologics and small molecules on scalp psoriasis with the aim to put the basis for a therapeutic algorithm. After reviewing all the available evidence on the short-term and long-term efficacy of biologics and small molecules on scalp psoriasis the use of the newest biologics (anti-IL-17 and anti-IL-23) seems to be linked to the highest clinical performances in controlling scalp psoriasis. However, head-to-head comparisons between different biologics or biologics and small molecules are lacking. Hence, treatment selection should always be individualized.
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Affiliation(s)
- Elisa Camela
- Dermatology Unit, Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Sonia Sofía Ocampo-Garza
- Dermatology Unit, Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy.,Department of Dermatology, Universidad Autónoma de Nuevo León, University Hospital "Dr. José Eleuterio González", Monterrey, Nuevo León, Mexico
| | - Eleonora Cinelli
- Dermatology Unit, Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Alessia Villani
- Dermatology Unit, Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Gabriella Fabbrocini
- Dermatology Unit, Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Matteo Megna
- Dermatology Unit, Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
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19
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Abstract
Nail psoriasis is a chronic nail disorder that requires personalized treatment. General prophylactic measures are suggested for all patients. Topical treatment is considered when treating a few-nail disease, with involvement of 3 or fewer nails, without joint involvement and without (or with mild) skin psoriasis. The ideal formulation should be ointment, solution, or foam. When moderate to severe skin psoriasis or psoriatic arthritis coexists, systemic treatment is suggested. This also should be considered when more than 3 nails are affected or significant impairment of quality of life is present. Conventional systemic agents, biologics, and small molecules are highly efficacious.
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20
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Torres T, Barcelos A, Filipe P, Fonseca JE. A Systematic Review With Network Meta-Analysis of the Available Biologic Therapies for Psoriatic Disease Domains. Front Med (Lausanne) 2021; 7:618163. [PMID: 33521024 PMCID: PMC7843938 DOI: 10.3389/fmed.2020.618163] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Accepted: 11/26/2020] [Indexed: 11/13/2022] Open
Abstract
Introduction: Several new treatments have been developed for psoriatic disease, an inflammatory condition that involves skin and joints. Notwithstanding, few studies have made direct comparisons between treatments and therefore it is difficult to select the ideal treatment for an individual patient. The aim of this systematic review with network meta-analysis (NMA) was to analyze available and approved biologic therapies for each domain of psoriatic disease: skin, peripheral arthritis, axial arthritis, enthesitis, dactylitis, and nail involvement. Methods: Data from randomized clinical trials (RCTs) were included. A systematic review was performed using the MEDLINE database (July 2020) using PICO criteria. Bayesian NMA was conducted to compare the clinical efficacy of biological therapy in terms of the American College of Rheumatology criteria (ACR, 24 weeks) and Psoriasis Area and Severity Index (PASI, 10-16 weeks). Results: Fifty-four RCTs were included in the systematic review. Due to the design of the RCTs, namely, outcomes and time points, network meta-analysis was performed for skin and peripheral arthritis domains. For the skin domain, 30 studies reporting PASI100 were included. The peripheral arthritis domain was analyzed through ACR70 in 12 studies. From the therapies approved for both domains, secukinumab and ixekizumab were the ones with the highest probability of reaching the proposed outcomes. There is a lack of outcome uniformization in the dactylitis, enthesitis, and nail domains, and therefore, an objective comparison of the studies was not feasible. Nevertheless, secukinumab was the treatment with the best compromise between the number of studies in each domain and the results obtained in the different outcomes. Conclusion: Secukinumab and ixekizumab were the treatments with the highest probability of reaching both PASI100 and ACR70 outcomes. Due to the lack of a standard evaluation of outcomes of the other psoriatic disease domains, a network meta-analysis for all the domains was not possible to perform.
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Affiliation(s)
- Tiago Torres
- Department of Dermatology, Centro Hospitalar Universitário do Porto, Porto, Portugal
- Multidisciplinar Medical Research Unit, Instituto de Ciências Biomédicas Abel Salazar, University of Porto, Porto, Portugal
| | - Anabela Barcelos
- Rheumatology Department, Centro Hospitalar do Baixo Vouga, Aveiro, Portugal
- NOVA National School of Public Health, Public Health Research Centre, Universidade NOVA de Lisboa – Portugal, Lisbon, Portugal
- Comprehensive Health Research Center (CHRC), Universidade NOVA de Lisboa – Portugal, Lisbon, Portugal
| | - Paulo Filipe
- Serviço de Dermatologia e Venereologia, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Lisbon, Portugal
- Unidade de Investigação em Dermatologia, Instituto de Medicina Molecular João Lobo Antunes, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
- Clínica Universitária de Dermatologia, Faculdade de Medicina da Universidade de Lisboa, Lisbon, Portugal
| | - João Eurico Fonseca
- Serviço de Reumatologia e Doenças Ósseas Metabólicas, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Lisbon, Portugal
- Unidade de Investigação em Reumatologia, Instituto de Medicina Molecular João Lobo Antunes, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
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21
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Reich K, Sullivan J, Arenberger P, Jazayeri S, Mrowietz U, Augustin M, Elewski B, You R, Regnault P, Frueh JA. Secukinumab shows high and sustained efficacy in nail psoriasis: 2.5-year results from the randomized placebo-controlled TRANSFIGURE study. Br J Dermatol 2020; 184:425-436. [PMID: 32479641 DOI: 10.1111/bjd.19262] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/27/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Secukinumab, a fully human monoclonal antibody that selectively neutralizes interleukin-17A, a cornerstone cytokine in psoriasis, has shown long-lasting efficacy and safety in the complete spectrum of psoriasis manifestations. OBJECTIVES To report the long-term (2·5-year) efficacy and safety of secukinumab in nail psoriasis. METHODS TRANSFIGURE, a double-blind, randomized, placebo-controlled, parallel-group, multicentre phase IIIb study in 198 patients, investigated secukinumab 150 mg and 300 mg in patients with moderate-to-severe nail psoriasis. RESULTS At week 16, the primary endpoint Nail Psoriasis Severity Index (NAPSI) was met, demonstrating superiority of secukinumab to placebo. The effect was sustained over 2·5 years with a large benefit for nail clearance, with mean NAPSI improvement of -73·3% and -63·6% with secukinumab 300 mg and 150 mg, respectively. At 2·5 years, secukinumab demonstrated sustained clinically significant reductions in total mean Nail Assessment in Psoriasis and Psoriatic Arthritis (NAPPA) quality-of-life (QoL) scores of -52·4% and -18·1%, and 70% and 71% of patients achieved a weighted NAPPA Patient Benefit Index global score of ≥ 2 with secukinumab 300 mg and 150 mg, respectively. Patients showed considerable improvements in the EuroQol 5-Dimension health status questionnaire at 2·5 years, reporting a decrease in pain and discomfort. No new safety findings were observed. CONCLUSIONS Secukinumab demonstrated strong and clinically meaningful efficacy for up to 2·5 years in nail psoriasis, with significant sustained QoL improvements and a favourable safety profile.
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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.,Skinflammation® Center, Hamburg, Germany
| | - J Sullivan
- Sutherland Hospital, University of New South Wales, Sydney, NSW, Australia
| | - P Arenberger
- Department of Dermatovenereology, Third Faculty of Medicine, Charles University, Prague, Czech Republic
| | - S Jazayeri
- Alliance Dermatology and Mohs Center, Phoenix, AZ, USA
| | - U Mrowietz
- Psoriasis Center at the Department of Dermatology, University Medical Center Schleswig-Holstein, Kiel, Germany
| | | | - B Elewski
- Department of Dermatology, University of Alabama, Birmingham, AL, USA
| | - R You
- China Novartis Institutes for BioMedical Research, Shanghai, China
| | | | - J A Frueh
- Novartis Pharma AG, Basel, Switzerland
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22
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Yesudian PD, de Berker DAR. Inflammatory nail conditions. Part 1: nail changes in psoriasis. Clin Exp Dermatol 2020; 46:9-15. [PMID: 33220008 DOI: 10.1111/ced.14351] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Accepted: 05/29/2020] [Indexed: 01/15/2023]
Abstract
Nail changes are visible in a variety of inflammatory dermatoses. The commonest dermatological condition with nail manifestations is chronic plaque psoriasis. This two-part article reviews the nail signs in psoriasis in Part 1, and the nail changes in cutaneous lichen planus and alopecia areata in Part 2. It provides a brief summary of the salient points in the clinical features, management and prognosis of these entities, with practical recommendations that may be beneficial to all dermatologists.
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Affiliation(s)
- P D Yesudian
- Department of Dermatology, Wrexham Maelor Hospital, Wrexham, UK
| | - D A R de Berker
- Department of Dermatology, Bristol Royal Infirmary, Bristol, UK
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23
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Rigopoulos D, Stathopoulou A, Gregoriou S. Small Molecules and Biologics in the Treatment of Nail Psoriasis. Skin Appendage Disord 2020; 6:134-141. [PMID: 32656230 DOI: 10.1159/000507298] [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: 01/25/2020] [Accepted: 03/13/2020] [Indexed: 11/19/2022] Open
Abstract
Nail psoriasis (PsO) is a disorder with profound impact on patients' quality of life. Several challenges and unmet needs remain in the treatment of nail PsO. Introduction of biologics and small molecules in the treatment of nail PsO has allowed for rapid control of the disease and high efficacy. The aim of this review was to present the published studies on nail PsO therapy with biologics and small molecules and illuminate the results in the studies where the design and outcome evaluation had nail PsO in the forefront.
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Affiliation(s)
- Dimitrios Rigopoulos
- 1st Department of Dermatology-Venereology, Andreas Sygros Hospital, Faculty of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Anna Stathopoulou
- 1st Department of Dermatology-Venereology, Andreas Sygros Hospital, Faculty of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Stamatios Gregoriou
- 1st Department of Dermatology-Venereology, Andreas Sygros Hospital, Faculty of Medicine, National and Kapodistrian University of Athens, Athens, Greece
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24
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Alsenaid A, Ezmerli M, Srour J, Heppt M, Illigens BM, Prinz JC. Biologics and small molecules in patients with scalp psoriasis: a systematic review. J DERMATOL TREAT 2020; 33:473-482. [DOI: 10.1080/09546634.2020.1770167] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- Adel Alsenaid
- College of Medicine, Shaqra University, Dawadmi, Saudi Arabia
- Division of Health Care Sciences Center for Clinical Research and Management Education Dresden, Dresden International University, Dresden, Germany
| | - Mohammad Ezmerli
- Department of Dermatology, Dr. Samir Abbas Hospital, Jeddah, Saudi Arabia
| | - Jerome Srour
- Department of Dermatology and Allergology, Ludwig-Maximilian University Munich, Munich, Germany
| | - Markus Heppt
- Department of Dermatology and Allergology, Ludwig-Maximilian University Munich, Munich, Germany
| | - Ben M. Illigens
- Division of Health Care Sciences Center for Clinical Research and Management Education Dresden, Dresden International University, Dresden, Germany
- Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, USA
| | - Joerg C. Prinz
- Department of Dermatology and Allergology, Ludwig-Maximilian University Munich, Munich, Germany
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25
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Lanna C, Galluzzi C, Zangrilli A, Bavetta M, Bianchi L, Campione E. Psoriasis in difficult to treat areas: treatment role in improving health-related quality of life and perception of the disease stigma. J DERMATOL TREAT 2020; 33:531-534. [PMID: 32419527 DOI: 10.1080/09546634.2020.1770175] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Background: When psoriasis affects scalp, nails, palms and soles, it is considered difficult to treat and causes severe impairment of life quality.Objective: We evaluated which difficult site most impacts on the patient's quality of life and how quality of life changes during treatment.Methods: We conducted a prospective observational study in patients receiving adalimumab over a 24 weeks period, through assessment at weeks 0, 4 and 24 using PASI, PAIN VAS, ITCH VAS, DLQI, NAPSI, PSSI. Pearson correlation was used to evaluate the relationship between the various measurements on the basis of three different deltas (between T0 and T24, between T0 and T4, between T0 and average between T4 and T24)Results: The correlation matrix between T0 and T24 shows a significant correlation between delta PASI and delta ITCH and delta ITCH and delta DLQI and a significant correlation between ITCH delta and DLQI delta and a correlation close to significance between DLQI and NAPSI.Conclusion: We identified itching as a mediator between the cutaneous extension of psoriasis and the impact on quality of life. We also documented the predominant role of nail psoriasis in defining the impact on the quality of life of the psoriatic patient.
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Affiliation(s)
- Caterina Lanna
- Dermatology Unit, System Medicine Department, University of Tor Vergata, Rome, Italy
| | | | - Arianna Zangrilli
- Dermatology Unit, System Medicine Department, University of Tor Vergata, Rome, Italy
| | - Mauro Bavetta
- Dermatology Unit, System Medicine Department, University of Tor Vergata, Rome, Italy
| | - Luca Bianchi
- Dermatology Unit, System Medicine Department, University of Tor Vergata, Rome, Italy
| | - Elena Campione
- Dermatology Unit, System Medicine Department, University of Tor Vergata, Rome, Italy
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26
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Lanna C, Zangrilli A, Bavetta M, Campione E, Bianchi L. Efficacy and safety of adalimumab in difficult‐to‐treat psoriasis. Dermatol Ther 2020; 33:e13374. [DOI: 10.1111/dth.13374] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2019] [Revised: 03/26/2020] [Accepted: 04/01/2020] [Indexed: 12/18/2022]
Affiliation(s)
- Caterina Lanna
- Dermatologic Unit, Department of Systems Medicine University of Rome Tor Vergata Rome Italy
| | - Arianna Zangrilli
- Dermatologic Unit, Department of Systems Medicine University of Rome Tor Vergata Rome Italy
| | - Mauro Bavetta
- Dermatologic Unit, Department of Systems Medicine University of Rome Tor Vergata Rome Italy
| | - Elena Campione
- Dermatologic Unit, Department of Systems Medicine University of Rome Tor Vergata Rome Italy
| | - Luca Bianchi
- Dermatologic Unit, Department of Systems Medicine University of Rome Tor Vergata Rome Italy
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27
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Kogan N, Raimondo N, Gusis SE, Izcovich A, Abarca Duran JA, Barahona-Torres L, Blanco O, Quintana GB, Briones MC, Castro C, Castro Vargas EG, Criniti J, Diez de Medina JC, Franco M, Gómez M, Levrero VP, Martínez López JE, Valenzuela F. Latin American Clinical Practice Guidelines on the Systemic Treatment of Psoriasis SOLAPSO - Sociedad Latinoamericana de Psoriasis (Latin American Psoriasis Society). Int J Dermatol 2019; 58 Suppl 1:4-28. [PMID: 31282026 DOI: 10.1111/ijd.14471] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
This Clinical Practice Guideline on the systemic treatment of Psoriasis includes the recommendations elaborated by a panel of experts from the Latin American Psoriasis Society SOLAPSO, who assessed the quality of the available evidence using the GRADE system and the PICO process to guide the literature search. To answer each question, the experts discussed the results of randomized controlled trials, observational studies and metanalysis evaluating the interventions identified (non-biologics, biologics and phototherapy) in different populations of patients with moderate to severe plaque-psoriasis, which was summarized in Tables ad-hoc. The main end-points considered to assess efficacy were PASI 50, 75, 90 and 100, PGA 0-1 and significant improvement of health-related quality of life. Specific adverse events, either severe or leading to treatment interruption, were also evaluated. The 31 recommendations included in this CPG follow the structure proposed by GRADE: direction (for or against) and strength (strong or weak). The goal of this CPG is to improve the management of patients with psoriasis by recommending interventions of proved benefit and providing a reference standard for the treating physician. Adhering to the contents of this CPG does not guarantee therapeutic success. The final decision on the specific treatment is the responsibility of the physician based on the individual circumstances and considering the values, the preferences and the opinions of the patient or caregivers.
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Affiliation(s)
- Nora Kogan
- Dermatology, Hospital Ramos Mejía, Buenos Aires, Argentina
| | | | - Simon E Gusis
- Rheumatology, Hospital Ramos Mejía, Buenos Aires, Argentina
| | - Ariel Izcovich
- Program on Evidence Based Medicine, Hospital Aleman, Buenos Aires, Argentina
| | | | | | - Orestes Blanco
- Parasitology, Institute of Tropical Medicine Pedro Kouri, La Habana, Cuba
| | | | - María C Briones
- Centro Privado de Piel "Dr. Enrique Uraga", Guayaquil, Ecuador
| | - Carla Castro
- Pediatric Dermatology, Hospital Universitario Austral, Pilar, Argentina
| | | | - Juan Criniti
- Program on Evidence Based Medicine, Hospital Aleman, Buenos Aires, Argentina
| | | | | | - Minerva Gómez
- Dermatology, University Hospital, Monterrey, Nueva León, Mexico
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Elewski B, Baker C, Crowley J, Poulin Y, Okun M, Calimlim B, Geng Z, Reyes Servin O, Rich P. Adalimumab for nail psoriasis: efficacy and safety over 52 weeks from a phase-3, randomized, placebo-controlled trial. J Eur Acad Dermatol Venereol 2019; 33:2168-2178. [PMID: 31304993 PMCID: PMC6899987 DOI: 10.1111/jdv.15793] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Accepted: 06/13/2019] [Indexed: 01/08/2023]
Abstract
BACKGROUND Few clinical trials have evaluated long-term treatment of nail psoriasis with biologics. OBJECTIVE Safety and efficacy of adalimumab [ADA; Humira AbbVie Inc, North Chicago, IL, USA)] long-term treatment (52 weeks) was evaluated in a phase-3, randomized trial in patients with moderate-to-severe plaque psoriasis and concomitant moderate-to-severe fingernail psoriasis. Results from the first 26 weeks (Period A) have been reported. METHODS Patients receiving 40 mg ADA every other week or placebo in Period A, continued with or switched to 40 mg ADA every-other-week treatment in the subsequent 26-week open-label extension (OLE) period. Main efficacy evaluations were ≥75% improvement in total-fingernail modified Nail Psoriasis Severity Index (mNAPSI 75) and achievement of Physician's Global Assessment for Fingernail Psoriasis of clear or minimal disease (PGA-F 0/1) with a ≥2-grade improvement from baseline, across the trial for patients who continued ADA from Period A through the OLE (Continuous-ADA Population). Safety was evaluated during the OLE and for patients receiving ADA at any time during the study (All-ADA Population). RESULTS Of the 217 patients initially randomized in Period A, 188 (86.6%; 94 in each treatment group) entered the OLE after completion of or early escape from Period A. For the Continuous-ADA Population (N = 109), endpoint achievement rates improved from OLE entry (Week 26) to Week 52, including total-fingernail mNAPSI 75 (47.4-54.5%); PGA-F 0/1 (51.1-55.6%) and total-fingernail mNAPSI = 0 (6.6-17.9%). Serious adverse event and serious infection rates for the All-ADA Population (N = 203) were 6.9% and 3.4%, respectively. CONCLUSIONS In this population of psoriasis patients with concomitant, moderate-to-severe nail psoriasis, long-term efficacy and improvement in signs and symptoms of nail disease were demonstrated after every-other-week ADA treatment, including incremental improvements in rate of total clearance of nail disease. No new safety risks were identified for patients receiving at least one ADA dose across 52 weeks.
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Affiliation(s)
- B.E. Elewski
- School of MedicineUniversity of Alabama at BirminghamBirminghamALUSA
| | - C.S. Baker
- Skin & Cancer Foundation Inc and Probity Medical ResearchCarltonVic.Australia
| | | | - Y. Poulin
- Centre de Recherche Dermatologique du Québec MétropolitainQuébec CityQCCanada
| | | | | | - Z. Geng
- AbbVie IncNorth ChicagoILUSA
| | | | - P.A. Rich
- Oregon Health and Science University HospitalPortlandORUSA
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29
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Foley P, Gordon K, Griffiths CEM, Wasfi Y, Randazzo B, Song M, Li S, Shen YK, Blauvelt A. Efficacy of Guselkumab Compared With Adalimumab and Placebo for Psoriasis in Specific Body Regions: A Secondary Analysis of 2 Randomized Clinical Trials. JAMA Dermatol 2019; 154:676-683. [PMID: 29799960 DOI: 10.1001/jamadermatol.2018.0793] [Citation(s) in RCA: 70] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Importance Psoriasis of the scalp, palms and/or soles, and nails is challenging to treat. Objective To evaluate the effect of guselkumab on psoriasis in specific body regions. Design, Setting, and Participants VOYAGE 1 and VOYAGE 2 were, double-blind, placebo- and adalimumab-controlled studies of guselkumab conducted at 101 and 115 global sites, respectively, from November 3, 2014, to May 19, 2016. Patients had moderate to severe plaque psoriasis (Psoriasis Area and Severity Index score ≥12, Investigator's Global Assessment [IGA] score ≥3, and ≥10% body surface area with psoriasis). This post hoc data analysis was performed from February 10 through November 15, 2017. Exposures Patients were randomized to guselkumab, 100 mg (weeks 0 and 4, then every 8 weeks); placebo followed by guselkumab, 100 mg, starting at week 16; or adalimumab (80 mg [week 0] and 40 mg [week 1, then every 2 weeks]). Main Outcomes and Measures Efficacy was assessed through week 24. End points included numbers of patients achieving scores of 0 or 1 (clear or near clear) or 0 (clear) on the scalp-specific IGA (ss-IGA), Physician's Global Assessment of the hands and/or feet (hf-PGA), and fingernail PGA (f-PGA) and percentage of improvement in target Nail Psoriasis Severity Index score. Results Of 1829 randomized patients (mean [SD] age, 43.6 [12.4] years; 1300 [71.1%] male, 1498 [81.9%] white), 1576 (86.2%) had psoriasis of the scalp; 501 (27.4%), palms and/or soles; and 1049 (57.4%), fingernails. At baseline, 1512 (82.7%), 461 (25.2%), and 928 (50.7%) patients had a score of 2 or higher on the ss-IGA, hf-PGA, and f-PGA, respectively, and were included in the analysis. Guselkumab was superior to placebo based on the proportion of patients achieving an ss-IGA score of 0 or 1 (560 [81.8%] vs 43 [12.4%]) at week 16 and to adalimumab (582 [85.0%] vs 329 [68.5%]) at week 24 (both P < .001); 479 (69.9%) in the guselkumab group vs 270 (56.3%) in the adalimumab group achieved an ss-IGA score of 0 (all P < .001). An hf-PGA score of 0 or 1 was achieved by 154 patients (75.5%) in the guselkumab group vs 15 (14.2%) in the placebo group at week 16 and 164 (80.4%) in the guselkumab group vs 91 (60.3%) in the adalimumab group at week 24; 153 (75.0%) in the guselkumab group vs 76 (50.3%) in the adalimumab group achieved an hf-PGA score of 0 (all P < .001). An f-PGA score of 0 or 1 was achieved by 196 patients (46.7%) in the guselkumab group vs 32 (15.2%) in the placebo group at week 16 (P < .001) and 252 (60.0%) in the guselkumab group vs 191 (64.3%) in the adalimumab group at week 24 (P = .11); 115 (27.4%) in the guselkumab group vs 83 (27.9%) in the adalimumab group achieved an f-PGA score of 0 (P = .63). Conclusions and Relevance Compared with adalimumab, guselkumab was associated with significant improvement in psoriasis on the scalp and palms and/or soles; magnitude of improvement in fingernails did not differ between treatments. These results may help dermatologists make treatment decisions for patients with psoriasis in difficult-to-treat body regions. Trial Registration ClinicalTrials.gov Identifiers: NCT02207231 and NCT02207244.
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Affiliation(s)
- Peter Foley
- Department of Medicine, The University of Melbourne, St Vincent's Hospital, Melbourne, Victoria, Australia.,Skin & Cancer Foundation Inc, Carlton, Victoria, Australia
| | - Kenneth Gordon
- Department of Dermatology, Medical College of Wisconsin, Milwaukee
| | - Christopher E M Griffiths
- Dermatology Centre, Salford Royal Hospital, University of Manchester, Manchester Academic Health Science Centre, Manchester, England
| | - Yasmine Wasfi
- Janssen Research & Development, LLC, Spring House, Pennsylvania
| | - Bruce Randazzo
- Janssen Research & Development, LLC, Spring House, Pennsylvania
| | - Michael Song
- Janssen Research & Development, LLC, Spring House, Pennsylvania
| | - Shu Li
- Janssen Research & Development, LLC, Spring House, Pennsylvania
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30
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Kivelevitch D, Amin S, Menter A. Clinical utility of secukinumab in moderate-to-severe scalp psoriasis: evidence to date. Clin Cosmet Investig Dermatol 2019; 12:249-253. [PMID: 31118728 PMCID: PMC6498391 DOI: 10.2147/ccid.s165040] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Accepted: 03/13/2019] [Indexed: 11/23/2022]
Abstract
Psoriasis is an immune-mediated inflammatory dermatosis commonly affecting the scalp and fringes of the face, neck and ears. It may be difficult to treat and the presence of extensive and highly visible lesions may significantly influence psychosocial well-being. Secukinumab, a monoclonal antibody that selectively targets interleukin-17A and has been shown to provide robust and sustained efficacy for whole body psoriasis. In this review, we evaluate the evidence to date of secukinumab in patients with moderate-to-severe scalp psoriasis. A comprehensive Cochrane database and PubMed searches of all available literature in English through September 2018 was performed using the search terms: “psoriasis”, “scalp” and “secukinumab”. Based on current evidence, we conclude that secukinumab is efficacious and well-tolerated treatment for patients with moderate-to-severe scalp psoriasis. Further studies are however warranted.
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Affiliation(s)
| | - Sima Amin
- Texas A&M College of Medicine, Bryan, TX, USA
| | - Alan Menter
- Baylor University Medical Center, Dallas, TX, USA
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31
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Abstract
Psoriatic arthritis (PsA) affects up to one-third of patients with psoriasis. It is the major comorbidity of psoriasis because of the likelihood that loss of function and permanent disability will develop if initiation of treatment is delayed. Dermatologists are uniquely positioned to recognize early signs of PsA and be the first-line healthcare practitioners to detect PsA in patients with psoriasis. PsA can affect six clinical domains: peripheral arthritis, dactylitis, enthesitis, psoriasis, psoriatic nail disease, and axial disease. However, not every patient will have involvement of all domains and the domains affected can change over time. Complicating the diagnosis is the condition's similarity with other arthritic diseases and potential heterogeneity. In this article, we provide practical guidance for dermatologists for detecting PsA in patients with psoriasis. We also review the available treatment options by each clinical domain of PsA and give advice on how to interpret the results of PsA clinical trials. Through early recognition of PsA in patients with psoriasis and initiation of proper treatment, dermatologists can help to prevent PsA disease progression, irreversible joint damage, and resultant permanent disability, and improve quality of life.
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Affiliation(s)
- Alice Gottlieb
- Department of Dermatology, Icahn School of Medicine at Mt Sinai, New York, NY, USA
| | - Joseph F Merola
- Department of Medicine, Division of Rheumatology and Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
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32
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Menter A, Strober BE, Kaplan DH, Kivelevitch D, Prater EF, Stoff B, Armstrong AW, Connor C, Cordoro KM, Davis DMR, Elewski BE, Gelfand JM, Gordon KB, Gottlieb AB, Kavanaugh A, Kiselica M, Korman NJ, Kroshinsky D, Lebwohl M, Leonardi CL, Lichten J, Lim HW, Mehta NN, Paller AS, Parra SL, Pathy AL, Rupani RN, Siegel M, Wong EB, Wu JJ, Hariharan V, Elmets CA. Joint AAD-NPF guidelines of care for the management and treatment of psoriasis with biologics. J Am Acad Dermatol 2019; 80:1029-1072. [PMID: 30772098 DOI: 10.1016/j.jaad.2018.11.057] [Citation(s) in RCA: 465] [Impact Index Per Article: 93.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2018] [Revised: 11/26/2018] [Accepted: 11/27/2018] [Indexed: 12/29/2022]
Abstract
Psoriasis is a chronic, inflammatory multisystem disease that affects up to 3.2% of the US population. This guideline addresses important clinical questions that arise in psoriasis management and care, providing recommendations based on the available evidence. The treatment of psoriasis with biologic agents will be reviewed, emphasizing treatment recommendations and the role of the dermatologist in monitoring and educating patients regarding benefits as well as associated risks.
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Affiliation(s)
| | - Bruce E Strober
- University of Connecticut, Farmington, Connecticut; Probity Medical Research, Waterloo, Ontario, Canada
| | | | | | | | | | | | | | - Kelly M Cordoro
- University of California, San Francisco School of Medicine, Department of Dermatology, San Francisco, California
| | | | | | - Joel M Gelfand
- University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | | | - Alice B Gottlieb
- Department of Dermatology, Icahn School of Medicine at Mt. Sinai, New York
| | | | | | - Neil J Korman
- University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | | | - Mark Lebwohl
- Department of Dermatology, Icahn School of Medicine at Mt. Sinai, New York
| | | | | | - Henry W Lim
- Department of Dermatology, Henry Ford Hospital, Detroit, Michigan
| | - Nehal N Mehta
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | - Amy S Paller
- Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | | | - Arun L Pathy
- Colorado Permanente Medical Group, Centennial, Colorado
| | | | | | - Emily B Wong
- San Antonio Uniformed Services Health Education Consortium, Joint-Base San Antonio
| | - Jashin J Wu
- Dermatology Research and Education Foundation, Irvine, California
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Rigopoulos D, Baran R, Chiheb S, Daniel CR, Di Chiacchio N, Gregoriou S, Grover C, Haneke E, Iorizzo M, Pasch M, Piraccini BM, Rich P, Richert B, Rompoti N, Rubin AI, Singal A, Starace M, Tosti A, Triantafyllopoulou I, Zaiac M. Recommendations for the definition, evaluation, and treatment of nail psoriasis in adult patients with no or mild skin psoriasis: A dermatologist and nail expert group consensus. J Am Acad Dermatol 2019; 81:228-240. [PMID: 30731172 DOI: 10.1016/j.jaad.2019.01.072] [Citation(s) in RCA: 70] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2018] [Revised: 01/10/2019] [Accepted: 01/30/2019] [Indexed: 12/25/2022]
Abstract
Nail involvement in psoriasis is common, and the severity of it does not always parallel the intensity of cutaneous disease. We created a consensus group, of which the aim was to provide practical recommendations for the treatment of nail psoriasis in patients without skin psoriasis or with mild skin lesions with no indication for a systemic treatment. This collaborative process was conducted by an international panel of dermatologists with special expertise in nail disorders, using formal consensus methods. During this process, the panel strived to establish an agreement regarding the definition of nail psoriasis, the severity of nail psoriasis, and treatment response. Treatment recommendations are provided regarding nail psoriasis severity and matrix or bed involvement. Few-nail disease was considered as nail psoriasis affecting ≤3 nails. In the case of matrix involvement only, intralesional steroid injections were considered the treatment of choice. Topical steroids alone or in combination with topical vitamin D analogues were suggested for nail psoriasis limited to the nail bed. For the systemic treatment of nail psoriasis acitretin, methotrexate, cyclosporine, small molecules, and biologics may be employed.
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Affiliation(s)
| | - Robert Baran
- University of Franche-Comté, Nail Disease Center, Cannes, France
| | - Soumiya Chiheb
- Faculty of Medicine and Pharmacy, University Hassan II, Casablanca, Morocco
| | - Carlton Ralph Daniel
- University of Mississippi Medical Center, Jackson, Mississippi; University of Alabama, Birmingham, Alabama
| | - Nilton Di Chiacchio
- Department of Dermatology, Hospital do Servidor Público Municipal de São Paulo, São Paulo, Brazil
| | - Stamatis Gregoriou
- University Hospital of Venereal and Skin Diseases A. Sygros, Athens, Greece
| | - Chander Grover
- Department of Dermatology and STD, University College of Medical Sciences and GTB Hospital, Delhi, India
| | - Eckart Haneke
- Department of Dermatology, Inselspital, University Bern, Bern, Switzerland; Centro de Dermatología, Instituto CUF, Porto, Portugal
| | | | - Marcel Pasch
- Department of Dermatology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Bianca Maria Piraccini
- Department of Specialized, Experimental, and Diagnostic Medicine, University of Bologna, Bologna, Italy
| | - Phoebe Rich
- Oregon Health and Science University, Portland, Oregon
| | - Bertrand Richert
- Saint Pierre-Brugmann and Queen Fabiola Children's University Hospitals, Université Libre de Bruxelles, Brussels, Belgium
| | - Natalia Rompoti
- University Hospital of Venereal and Skin Diseases A. Sygros, Athens, Greece.
| | - Adam I Rubin
- Department of Dermatology, Hospital of the University of Pennsylvania, Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Archana Singal
- Department of Dermatology and STD, University College of Medical Sciences and GTB Hospital, Delhi, India
| | - Michela Starace
- Department of Specialized, Experimental, and Diagnostic Medicine, University of Bologna, Bologna, Italy
| | - Antonella Tosti
- University of Miami Miller School of Medicine, Miami, Florida
| | | | - Martin Zaiac
- Greater Miami Skin and Laser Center, Department of Dermatology, Herbert Wertheim College of Medicine, Florida International University, Miami, Florida
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Reich K, Sullivan J, Arenberger P, Mrowietz U, Jazayeri S, Augustin M, Parneix A, Regnault P, You R, Milutinovic M. Effect of secukinumab on the clinical activity and disease burden of nail psoriasis: 32‐week results from the randomized placebo‐controlled
TRANSFIGURE
trial. Br J Dermatol 2019; 181:954-966. [DOI: 10.1111/bjd.17351] [Citation(s) in RCA: 55] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/21/2018] [Indexed: 12/14/2022]
Affiliation(s)
- K. Reich
- Dermatologikum Berlin Friedrichstraße 89 10117 Berlin Germany
- SCIderm Research Institute Hamburg Germany
| | - J. Sullivan
- Kingsway Dermatology & Aesthetics Miranda NSW Australia
| | - P. Arenberger
- Department of Dermatology Charles University Third Faculty of Medicine Prague Czech Republic
| | - U. Mrowietz
- Psoriasis Center at the Department of Dermatology University Medical Center Schleswig‐Holstein Campus Kiel Germany
| | - S. Jazayeri
- Alliance Dermatology and Mohs Center Phoenix AZ U.S.A
| | | | - A. Parneix
- Novartis Pharmaceuticals Corporation East Hanover NJ U.S.A
| | | | - R. You
- Beijing Novartis Pharma Co. Ltd Beijing China
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35
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A Review for Physician Assistants and Nurse Practitioners on the Considerations for Diagnosing and Treating Psoriatic Arthritis. Rheumatol Ther 2018; 6:5-21. [PMID: 30570707 PMCID: PMC6393269 DOI: 10.1007/s40744-018-0133-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2018] [Indexed: 02/08/2023] Open
Abstract
Psoriatic arthritis (PsA) is a clinically heterogeneous form of progressive inflammatory arthritis that affects up to 30% of patients with psoriasis. The rapid rate of progression associated with PsA makes early-disease diagnosis and treatment crucial to patients' quality of life and long-term health. With the aim of providing clinical guidance to physician assistants and nurse practitioners, this article gives an overview of the different PsA clinical domains, including peripheral arthritis, axial disease, enthesitis, dactylitis, skin disease, and nail dystrophy, which should be considered as part of diagnosis and treatment strategies. The efficacy of different therapies across these PsA domains is reviewed within the context of current PsA treatment guidelines while considering more recent data on newly approved therapies for PsA.Funding: Novartis Pharmaceuticals Corp., East Hanover, NJ, USA.
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36
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Therapeutics for Adult Nail Psoriasis and Nail Lichen Planus: A Guide for Clinicians. Am J Clin Dermatol 2018; 19:559-584. [PMID: 29488102 DOI: 10.1007/s40257-018-0350-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Nail psoriasis (NP) and nail lichen planus (NLP) can be limiting, stigmatizing and difficult to treat. Dermatologists commonly treat psoriasis and lichen planus but when associated onychodystrophy is present or is an isolated finding, some develop apprehension. The goal of this review is to develop therapeutic ladders to be used as a guide for the management of NP and NLP in everyday clinical practice. Evidence-based therapies for NP are robust and range from topical treatments to conventional systemic therapies (i.e., methotrexate, cyclosporine), new oral agents (i.e., apremilast and tofacitinib), and biologics. The literature for treatment of NLP is severely limited, with therapy mainly consisting of topical, intralesional, or systemic corticosteroids or methotrexate.
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Kivelevitch D, Frieder J, Watson I, Paek SY, Menter MA. Pharmacotherapeutic approaches for treating psoriasis in difficult-to-treat areas. Expert Opin Pharmacother 2018; 19:561-575. [PMID: 29565192 DOI: 10.1080/14656566.2018.1448788] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
INTRODUCTION Despite great therapeutic advancements in psoriasis, four notable difficult-to-treat areas including the scalp, nails, intertriginous (including genitals), and palmoplantar regions, pose a challenge to both physicians and patients. Localized disease of these specific body regions inflicts a significant burden on patients' quality of life and requires an adequate selection of treatments. AREAS COVERED This manuscript discusses appropriate therapies and important treatment considerations for these difficult-to-treat areas based on the available clinical data from the literature. EXPERT OPINION Clinical trials assessing therapies for the difficult-to-treat areas have been inadequate. With the first biological clinical trial for genital psoriasis pending publication, it is with hope that other biological agents will be evaluated for region-specific psoriasis. A greater understanding of the genetic and immunologic aspects of regional psoriasis, as well as identification of unique biomarkers, will further guide management decisions. For example, the recent discovery of the IL-36 receptor gene for generalized pustular psoriasis may prove valuable for other forms of psoriasis. Ultimately, identification of the most beneficial treatments for each psoriasis subtype and difficult-to-treat area will provide patients with maximal quality of life.
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Affiliation(s)
- Dario Kivelevitch
- a Division of Dermatology , Baylor Scott and White , Dallas , TX , USA
| | - Jillian Frieder
- a Division of Dermatology , Baylor Scott and White , Dallas , TX , USA
| | - Ian Watson
- b Texas A&M Health Sciences Center College of Medicine , Bryan , TX , USA
| | - So Yeon Paek
- a Division of Dermatology , Baylor Scott and White , Dallas , TX , USA.,b Texas A&M Health Sciences Center College of Medicine , Bryan , TX , USA
| | - M Alan Menter
- a Division of Dermatology , Baylor Scott and White , Dallas , TX , USA
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38
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Merola JF, Qureshi A, Husni ME. Underdiagnosed and undertreated psoriasis: Nuances of treating psoriasis affecting the scalp, face, intertriginous areas, genitals, hands, feet, and nails. Dermatol Ther 2018; 31:e12589. [PMID: 29512290 PMCID: PMC6901032 DOI: 10.1111/dth.12589] [Citation(s) in RCA: 82] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2017] [Revised: 12/01/2017] [Accepted: 12/14/2017] [Indexed: 12/11/2022]
Abstract
Psoriasis of the scalp, face, intertriginous areas, genitals, hands, feet, and nails is often underdiagnosed, and disease management can be challenging. Despite the small surface area commonly affected by psoriasis in these locations, patients have disproportionate levels of physical impairment and emotional distress. Limitations in current disease severity indices do not fully capture the impact of disease on a patient's quality of life, and, combined with limitations in current therapies, many patients do not receive proper or adequate care. In this review, we discuss the clinical manifestations of psoriasis in these less commonly diagnosed areas and its impact on patient quality of life. We also examine clinical studies evaluating the effectiveness of therapies on psoriasis in these regions. This article highlights the need to individualize treatment strategies for psoriasis based on the area of the body that is affected and the emerging role of biologic therapy in this regard.
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Affiliation(s)
- Joseph F Merola
- Department of Dermatology, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Abrar Qureshi
- Department of Dermatology, The Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - M Elaine Husni
- Department of Rheumatic and Immunologic Diseases, Cleveland Clinic, Cleveland, Ohio
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39
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Elewski BE, Okun MM, Papp K, Baker CS, Crowley JJ, Guillet G, Sundaram M, Poulin Y, Gu Y, Geng Z, Williams DA, Rich PA. Adalimumab for nail psoriasis: Efficacy and safety from the first 26 weeks of a phase 3, randomized, placebo-controlled trial. J Am Acad Dermatol 2018; 78:90-99.e1. [DOI: 10.1016/j.jaad.2017.08.029] [Citation(s) in RCA: 50] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2017] [Revised: 08/09/2017] [Accepted: 08/13/2017] [Indexed: 11/30/2022]
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40
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Tsentemeidou A, Vyzantiadis TA, Kyriakou A, Sotiriadis D, Patsatsi A. Prevalence of onychomycosis among patients with nail psoriasis who are not receiving immunosuppressive agents: Results of a pilot study. Mycoses 2017; 60:830-835. [DOI: 10.1111/myc.12681] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2017] [Revised: 08/02/2017] [Accepted: 08/12/2017] [Indexed: 01/19/2023]
Affiliation(s)
- Aikaterini Tsentemeidou
- 2nd Department of Dermatology; Faculty of Medicine; Aristotle University; Papageorgiou General Hospital; Thessaloniki Greece
| | | | - Aikaterini Kyriakou
- 2nd Department of Dermatology; Faculty of Medicine; Aristotle University; Papageorgiou General Hospital; Thessaloniki Greece
| | - Dimitrios Sotiriadis
- 2nd Department of Dermatology; Faculty of Medicine; Aristotle University; Papageorgiou General Hospital; Thessaloniki Greece
| | - Aikaterini Patsatsi
- 2nd Department of Dermatology; Faculty of Medicine; Aristotle University; Papageorgiou General Hospital; Thessaloniki Greece
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41
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Abstract
Nail psoriasis is often found in patients with plaque psoriasis and can greatly impact quality of life. This is particularly true in more severe cases, as it affects the structure and function of the patient's nail. Treatment for nail psoriasis is often challenging, involving topical medications, injections, and systematic therapies. This article aims to give an overview of the varied clinical presentations of nail psoriasis and the current treatments available for patients with this condition. Risks and efficacies of these treatments will be evaluated to determine the best treatment protocols.
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Affiliation(s)
| | | | - Morgan Rabach
- Mount Sinai Department of Dermatology, New York, New York
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42
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Bagel J, Duffin KC, Moore A, Ferris LK, Siu K, Steadman J, Kianifard F, Nyirady J, Lebwohl M. The effect of secukinumab on moderate-to-severe scalp psoriasis: Results of a 24-week, randomized, double-blind, placebo-controlled phase 3b study. J Am Acad Dermatol 2017; 77:667-674. [PMID: 28780364 DOI: 10.1016/j.jaad.2017.05.033] [Citation(s) in RCA: 64] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2017] [Revised: 05/19/2017] [Accepted: 05/21/2017] [Indexed: 11/25/2022]
Abstract
BACKGROUND Moderate-to-severe scalp psoriasis has not been evaluated in prospective trials of patients without moderate-to-severe body psoriasis. OBJECTIVE Evaluate the efficacy and safety of secukinumab in moderate-to-severe scalp psoriasis. METHODS In this 24-week, double-blind, phase 3b study, 102 patients were randomized 1:1 to subcutaneous secukinumab 300 mg or placebo at baseline, weeks 1, 2, and 3, and then every 4 weeks from week 4 to 20. The primary efficacy variable was 90% improvement of Psoriasis Scalp Severity Index (PSSI 90) score from baseline to week 12. RESULTS At week 12, PSSI 90 (secukinumab 300 mg vs placebo, 52.9% vs 2.0%) and Investigator's Global Assessment modified 2011 scalp responses of 0 or 1 (secukinumab 300 mg vs placebo, 56.9% vs 5.9%) were significantly greater with secukinumab 300 mg than placebo (P < .001 for both). In addition, significantly more patients achieved complete clearance of scalp psoriasis at week 12 with secukinumab 300 mg than placebo (35.3% vs 0%; P < .001). The median time to 50% reduction in PSSI score was 3.29 weeks with secukinumab 300 mg. The safety profile of secukinumab was consistent with previous phase 3 studies. LIMITATIONS There was no active comparator arm. CONCLUSION Secukinumab is efficacious and well-tolerated for patients with extensive moderate-to-severe scalp psoriasis.
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Affiliation(s)
- Jerry Bagel
- Psoriasis Treatment Center of Central New Jersey, East Windsor, New Jersey.
| | | | - Angela Moore
- Arlington Research Center, Arlington, Texas; Baylor Medical Center, Dallas, Texas
| | - Laura K Ferris
- Department of Dermatology, University of Pittsburgh Medical Center, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Kimberly Siu
- Novartis Pharmaceuticals Corporation, East Hanover, New Jersey
| | | | - Farid Kianifard
- Department of Dermatology, University of Pittsburgh Medical Center, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Judit Nyirady
- Novartis Pharmaceuticals Corporation, East Hanover, New Jersey
| | - Mark Lebwohl
- Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, New York
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Abstract
BACKGROUND Scalp psoriasis is commonly the initial presentation of psoriasis, and almost 80 % of patients with psoriasis will eventually experience it. OBJECTIVE Although several systematic reviews and guidelines exist, an up-to-date evidence-based review including more recent progress on the use of biologics and new oral small molecules was timely. METHODS Of the 475 studies initially retrieved from PubMed and the 845 from Embase (up to May 2016), this review includes 27 clinical trials, four papers reporting pooled analyses of other clinical trials, ten open-label trials, one case series, and two case reports after excluding non-English literature. RESULTS To our knowledge, few randomized controlled trials (RCTs) are conducted specifically in scalp psoriasis. Topical corticosteroids provide good effects and are usually recommended as first-line treatment. Calcipotriol-betamethasone dipropionate is well tolerated and more effective than either of its individual components. Localized phototherapy is better than generalized phototherapy on hair-bearing areas. Methotrexate, cyclosporine, fumaric acid esters, and acitretin are well-recognized agents in the treatment of psoriasis, but we found no published RCTs evaluating these agents specifically in scalp psoriasis. Biologics and new small-molecule agents show excellent effects on scalp psoriasis, but the high cost of these treatments mean they may be limited to use in extensive scalp psoriasis. CONCLUSIONS More controlled studies are needed for an evidence-based approach to scalp psoriasis.
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Sarma N. Evidence and Suggested Therapeutic Approach in Psoriasis of Difficult-to-treat Areas: Palmoplantar Psoriasis, Nail Psoriasis, Scalp Psoriasis, and Intertriginous Psoriasis. Indian J Dermatol 2017; 62:113-122. [PMID: 28400628 PMCID: PMC5363132 DOI: 10.4103/ijd.ijd_539_16] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
Psoriasis is resistant to treatment and it shows frequent relapse; systemic treatment is often associated with toxicities, and long-term safety data are lacking for most of the newer drugs like biologics. Moreover, some body areas such as hands, feet, intertriginous areas, scalp, and nails are even more resistant. Frequently, systemic treatments are necessary considering the higher psychological impact on the patient. There is a lack of agreement on the best therapeutic modalities in the management of psoriasis involving difficult-to-treat locations. At present, there are no Indian guidelines for these conditions. Available literature has been reviewed extensively on the treatment of psoriasis involving difficult-to-treat locations; level of evidence has been evaluated as per the Oxford Centre for Evidence-Based Medicine 2011 guideline, and therapeutic suggestions have been developed. Best care has been employed to consider socioeconomic, cultural, genetic, and ethnic factors to prepare a therapeutic suggestion that is appropriate and logical to be used among Indian population and people of similar ethnic and socioeconomic background.
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Affiliation(s)
- Nilendu Sarma
- Department of Dermatology, Dr B. C. Roy Post Graduate Institute of Pediatric Sciences, Kolkata, West Bengal, India
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Reich K, Leonardi C, Lebwohl M, Kerdel F, Okubo Y, Romiti R, Goldblum O, Dennehy EB, Kerr L, Sofen H. Sustained response with ixekizumab treatment of moderate-to-severe psoriasis with scalp involvement: results from three phase 3 trials (UNCOVER-1, UNCOVER-2, UNCOVER-3). J DERMATOL TREAT 2016; 28:282-287. [DOI: 10.1080/09546634.2016.1249820] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Kristian Reich
- Dermatologikum Hamburg and SCIderm GmbH, Hamburg, Germany
| | - Craig Leonardi
- Department of Dermatology, Saint Louis University School of Medicine, St Louis, MO, USA
| | - Mark Lebwohl
- Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | | | - Yukari Okubo
- Department of Dermatology, Tokyo Medical University, Shinjuku, Tokyo, Japan
| | - Ricardo Romiti
- Department of Dermatology Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | | | | | - Lisa Kerr
- Eli Lilly and Company, Indianapolis, IN, USA
| | - Howard Sofen
- Department of Medicine, Division of Dermatology, UCLA David Geffen School of Medicine, Los Angeles, CA, USA
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46
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Carrascosa JM, Galán M, de Lucas R, Pérez-Ferriols A, Ribera M, Yanguas I. Expert Recommendations on Treating Psoriasis in Special Circumstances (Part II). ACTAS DERMO-SIFILIOGRAFICAS 2016; 107:712-729. [PMID: 27344068 DOI: 10.1016/j.ad.2016.04.017] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2016] [Revised: 04/15/2016] [Accepted: 04/19/2016] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND There is insufficient information on how best to treat moderate to severe psoriasis in difficult clinical circumstances. MATERIAL AND METHODS We considered 5 areas where there is conflicting or insufficient evidence: pediatric psoriasis, risk of infection in patients being treated with biologics, psoriasis in difficult locations, biologic drug survival, and impact of disease on quality of life. Following discussion of the issues by an expert panel of dermatologists specialized in the management of psoriasis, participants answered a questionnaire survey according to the Delphi method. RESULTS Consensus was reached on 66 (70.9%) of the 93 items analyzed; the experts agreed with 49 statements and disagreed with 17. It was agreed that body mass index, metabolic comorbidities, and quality of life should be monitored in children with psoriasis. The experts also agreed that the most appropriate systemic treatment for this age group was methotrexate, while the most appropriate biologic treatment was etanercept. Although it was recognized that the available evidence was inconsistent and difficult to extrapolate, the panel agreed that biologic drug survival could be increased by flexible, individualized dosing regimens, continuous treatment, and combination therapies. Finally, consensus was reached on using the Dermatology Quality of Life Index to assess treatment effectiveness and aid decision-making in clinical practice. CONCLUSIONS The structured opinion of experts guides decision-making regarding aspects of clinical practice for which there is incomplete or conflicting information.
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Affiliation(s)
- J M Carrascosa
- Servei de Dermatologia, Hospital Universitari GermansTrias i Pujol, Universitat Autònoma de Barcelona, Badalona, Barcelona, España.
| | - M Galán
- Servicio de Dermatología, Hospital de Jaén, Jaén, España
| | - R de Lucas
- Servicio de Dermatología, Hospital Universitario La Paz, Madrid, España
| | - A Pérez-Ferriols
- Servicio de Dermatología, Hospital General de Valencia, Valencia, España
| | - M Ribera
- Servicio de Dermatología, Hospital Universitari Parc Taulí, Universitat Autònoma de Barcelona, Sabadell, Barcelona, España
| | - I Yanguas
- Servicio de Dermatología, Hospital Universitario de Navarra, Pamplona, España
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Expert Recommendations on Treating Psoriasis in Special Circumstances (Part II). ACTAS DERMO-SIFILIOGRAFICAS 2016. [DOI: 10.1016/j.adengl.2016.08.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Bardazzi F, Lambertini M, Chessa MA, Magnano M, Patrizi A, Piraccini BM. Nail involvement as a negative prognostic factor in biological therapy for psoriasis: a retrospective study. J Eur Acad Dermatol Venereol 2016; 31:843-846. [PMID: 27658350 DOI: 10.1111/jdv.13979] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2016] [Accepted: 09/06/2016] [Indexed: 11/27/2022]
Abstract
BACKGROUND Psoriasis (Pso) has a strong impact on quality of life and a positive association has been reported between nail psoriasis (NP) and more severe disease, together with a longer duration of skin lesions. The treatment of NP represents a challenge and biological therapy can be recommended for severe disease. OBJECTIVE The first end point of this retrospective study was to evaluate the time to achieve Psoriasis Area Severity Index (PASI) 75 in patients with and without NP treated with biological therapy. The second end point was to evaluate the efficacy of biological therapy to improve NP. METHODS A total of 127 patients (88 men and 39 women) with moderate to severe Pso referring to our Service between 2007 and 2014 were included. Inclusion criteria were age ≥18 years and a 24 week treatment. The outcome variable was achievement of PASI 75 at 24 weeks with and without NP. All patients were treated with topical therapy and one of four different biological treatments: adalimumab (44.09%), etanercept (18.11%), infliximab (13.39%) and ustekinumab (24.41%). Physical examinations were performed every 4 weeks, and at each visit, the clinician assessed the PASI and Nail Psoriasis Severity Index (NAPSI). RESULTS At multivariate Cox regression analysis, a smaller proportion of patients with NP achieved PASI 75 at 24 weeks than patients without NP when adjusted for the epidemiological, clinical features and biological treatment received. With all biological drugs, the NAPSI score began to improve already after 8 weeks (from 18.53 at week 0-2.83 at week 24). CONCLUSION Patients with NP reach PASI 75 more slowly than patients without NP. Clinicians should therefore consider that treatment with a biological agent may require a longer period before reaching a satisfying therapeutical goal. Nevertheless, adalimumab, infliximab, ustekinumab and etanercept demonstrated their equal effectiveness in reducing the NAPSI score.
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Affiliation(s)
- F Bardazzi
- Dermatology, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy
| | - M Lambertini
- Dermatology, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy
| | - M A Chessa
- Dermatology, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy
| | - M Magnano
- Dermatology, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy
| | - A Patrizi
- Dermatology, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy
| | - B M Piraccini
- Dermatology, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy
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Fotiadou C, Lazaridou E, Sotiriou E, Kyrgidis A, Apalla Z, Ioannides D. Scalp psoriasis and biologic agents: a retrospective, comparative study from a tertiary psoriasis referral centre. J Eur Acad Dermatol Venereol 2016; 30:2091-2096. [DOI: 10.1111/jdv.13780] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2016] [Accepted: 04/13/2016] [Indexed: 12/28/2022]
Affiliation(s)
- C. Fotiadou
- First Department of Dermatology-Venereology; Aristotle University Medical School; Thessaloniki Greece
| | - E. Lazaridou
- First Department of Dermatology-Venereology; Aristotle University Medical School; Thessaloniki Greece
| | - E. Sotiriou
- First Department of Dermatology-Venereology; Aristotle University Medical School; Thessaloniki Greece
| | - A. Kyrgidis
- Department of Oral Maxillofacial Surgery; Aristotle University Medical School; Thessaloniki Greece
| | - Z. Apalla
- First Department of Dermatology-Venereology; Aristotle University Medical School; Thessaloniki Greece
| | - D. Ioannides
- First Department of Dermatology-Venereology; Aristotle University Medical School; Thessaloniki Greece
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50
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Abstract
A large proportion of patients with plaque psoriasis suffer from psoriatic lesions of the scalp, nails, and intertrigines. These locations can also be soley or predominantly affected. Scalp psoriasis, nail psoriasis, and inverse psoriasis are often perceived as particularly stigmatizing. Involvement of these parts of the body is associated with an increased risk of psoriatic arthritis. Location-specific features must be considered when choosing treatment. Evidence for topical therapy of scalp psoriasis with steroids and combinations of steroids and vitamin D analogues is high. These agents are regarded as safe and effective treatments of first choice. Efficacy of TNF antagonists and apremilast is well documented for refractory scalp psoriasis. Nail psoriasis often responds insufficiently to topical therapy. Several effective systemic medications including methotrexate and TNF antagonists are available for treatment of severe forms. Controlled trials for treatment of inverse psoriasis are scarce. Topical steroids, vitamin D analogues, dithranol, and off-label calcineurin inhibitors are used in clinical practice. This review provides a survey on the clinical presentation and current evidence for treatment of psoriasis in challenging locations.
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Affiliation(s)
- A Schmieder
- Klinik für Dermatologie, Venerologie und Allergologie, Universitätsmedizin Mannheim, Medizinische Fakultät Mannheim der Universität Heidelberg, Mannheim, Deutschland
| | - W K Peitsch
- Klinik für Dermatologie und Phlebologie, Vivantes Klinikum im Friedrichshain, Landsberger Allee 49, 10249, Berlin, Deutschland.
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