1
|
Vyas J, Johns JR, Ali FM, Singh RK, Ingram JR, Salek S, Finlay AY. A systematic review of 454 randomized controlled trials using the Dermatology Life Quality Index: experience in 69 diseases and 43 countries. Br J Dermatol 2024; 190:315-339. [PMID: 36971254 DOI: 10.1093/bjd/ljad079] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Revised: 01/31/2023] [Accepted: 03/14/2023] [Indexed: 02/18/2024]
Abstract
BACKGROUND Over 29 years of clinical application, the Dermatology Life Quality Index (DLQI) has remained the most used patient-reported outcome (PRO) in dermatology due to its robustness, simplicity and ease of use. OBJECTIVES To generate further evidence of the DLQI's utility in randomized controlled trials (RCTs) and to cover all diseases and interventions. METHODS The methodology followed PRISMA guidelines and included seven bibliographical databases, searching articles published from 1 January 1994 until 16 November 2021. Articles were reviewed independently by two assessors, and an adjudicator resolved any opinion differences. RESULTS Of 3220 screened publications, 454 articles meeting the eligibility criteria for inclusion, describing research on 198 190 patients, were analysed. DLQI scores were primary endpoints in 24 (5.3%) of studies. Most studies were of psoriasis (54.1%), although 69 different diseases were studied. Most study drugs were systemic (85.1%), with biologics comprising 55.9% of all pharmacological interventions. Topical treatments comprised 17.0% of total pharmacological interventions. Nonpharmacological interventions, mainly laser therapy and ultraviolet radiation treatment, comprised 12.2% of the total number of interventions. The majority of studies (63.7%) were multicentric, with trials conducted in at least 42 different countries; 40.2% were conducted in multiple countries. The minimal clinically importance difference (MCID) was reported in the analysis of 15.0% of studies, but only 1.3% considered full score meaning banding of the DLQI. Forty-seven (10.4%) of the studies investigated statistical correlation of the DLQI with clinical severity assessment or other PRO/quality of life tools; and 61-86% of studies had within-group scores differences greater than the MCID in 'active treatment arms'. The Jadad risk-of-bias scale showed that bias was generally low, as 91.8% of the studies had Jadad scores of ≥ 3; only 0.4% of studies showed a high risk of bias from randomization. Thirteen per cent had a high risk of bias from blinding and 10.1% had a high risk of bias from unknown outcomes of all participants in the studies. In 18.5% of the studies the authors declared that they followed an intention-to-treat protocol; imputation for missing DLQI data was used in 34.4% of studies. CONCLUSIONS This systematic review provides a wealth of evidence of the use of the DLQI in clinical trials to inform researchers' and -clinicians' decisions for its further use. Recommendations are also made for improving the reporting of data from future RCTs using the DLQI.
Collapse
Affiliation(s)
| | - Jeffrey R Johns
- Division of Infection and Immunity, School of Medicine, Cardiff University, Cardiff, UK
| | - Faraz M Ali
- Division of Infection and Immunity, School of Medicine, Cardiff University, Cardiff, UK
| | - Ravinder K Singh
- Division of Infection and Immunity, School of Medicine, Cardiff University, Cardiff, UK
| | - John R Ingram
- Division of Infection and Immunity, School of Medicine, Cardiff University, Cardiff, UK
| | - Sam Salek
- School of Life and Medical Sciences, University of Hertfordshire, Hatfield, UK
| | - Andrew Y Finlay
- Division of Infection and Immunity, School of Medicine, Cardiff University, Cardiff, UK
| |
Collapse
|
2
|
Chiricozzi A, Megna M, Giunta A, Carrera CG, Dapavo P, Balato A, Malagoli P, Mazzoccoli S, Parodi A, Sabatino S, Buzzoni C, Huang CH, Narcisi A. Ixekizumab is effective in the long-term management in moderate-to-severe plaque psoriasis: results from an Italian retrospective cohort study (the LOTIXE study). J DERMATOL TREAT 2023; 34:2246606. [PMID: 37587870 DOI: 10.1080/09546634.2023.2246606] [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: 07/17/2023] [Accepted: 08/04/2023] [Indexed: 08/18/2023]
Abstract
PURPOSE Ixekizumab is a high-affinity monoclonal antibody that selectively targets interleukin (IL)-17A approved for the treatment of moderate-to-severe plaque psoriasis. The objective of this study was to describe the real-world long-term effectiveness of ixekizumab in patients with plaque psoriasis in Italy. MATERIALS AND METHODS A retrospective study was conducted in patients affected by moderate-to-severe plaque psoriasis who were continuously treated with ixekizumab for at least 12 months. Patient data was obtained at 4-weeks, 12-weeks and 6-, 12-, 18- and 24-months after baseline (June 2017 and September 2019) from 10 sites. Results were analyzed by complete case approach, with sensitivity analysis performed to evaluate the impact of missing data. RESULTS A total of 198 patients were enrolled in the study. At Month 24, 94.3% of patients achieved PASI75 response, while 85.1 and 71.8% achieved PASI90 and PASI100, respectively; and 91.1% of the patients achieved absolute PASI score ≤2. Patients experienced psoriasis improvement at 4 weeks after starting treatment, and improvement was maintained with continued ixekizumab use. The quality of life of patients also improved significantly starting at Week 12, with sustained effect in the long term. CONCLUSION This 24-month observational cohort study confirmed that ixekizumab is effective in the long-term management of patients with moderate-to-severe plaque psoriasis.
Collapse
Affiliation(s)
- Andrea Chiricozzi
- U.O.C. di Dermatologia, Dipartimento Scienze Mediche e Chirurgiche, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Dermatologia, Dipartimento Universitario di Medicina e Chirurgia Traslazionale, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Matteo Megna
- Department of Clinical Medicine and Surgery, Section of Dermatology, University of Naples Federico II, Naples, Italy
| | - Alessandro Giunta
- Department of Dermatology, University of Rome Tor Vergata, Rome, Italy
| | - Carlo Giovanni Carrera
- Dermatology Unit, Department of Internal Medicine, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Paolo Dapavo
- Department of Biomedical Science and Human Oncology, Second Dermatologic Clinic, University of Turin, Turin, Italy
| | - Anna Balato
- Unit of Dermatology, Department of Mentals and Physical Health and Preventive Medicine, Luigi Vanvitelli University of Campania, Naples, Italy
| | | | - Stella Mazzoccoli
- Department of Biomedical Science and Human Oncology, Section of Dermatology, University of Bari, Bari, Italy
| | - Aurora Parodi
- DiSSal Section of Dermatology, University of Genoa, University- Hospital San Martino IRCCS Genoa, Genoa, Italy
| | | | | | | | - Alessandra Narcisi
- Dermatology Unit, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
| |
Collapse
|
3
|
Carmona-Rocha E, Puig L. Ixekizumab for the treatment of moderate-to-severe plaque psoriasis: the first septennium. Immunotherapy 2023; 15:1209-1225. [PMID: 37609785 DOI: 10.2217/imt-2023-0013] [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] [Indexed: 08/24/2023] Open
Abstract
Ixekizumab is a humanized monoclonal antibody that specifically inhibits IL-17A. It has been approved for the treatment of adult and pediatric psoriasis, psoriatic arthritis and axial spondyloarthropathies by the US FDA and the EMA. Phase III trials, post hoc analyses and real-life data have reported its efficacy, effectiveness and safety. This review summarizes the latest evidence on the clinical efficacy, pharmacology and safety profile of ixekizumab for the treatment of moderate-to-severe psoriasis. A literature search was performed for articles published through December 2022. Ixekizumab is one of the most efficacious biologics for psoriasis, with a rapid onset of response, favorable long-term outcomes and an adequate safety profile.
Collapse
Affiliation(s)
- Elena Carmona-Rocha
- Dermatology Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Lluís Puig
- Dermatology Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| |
Collapse
|
4
|
Honma M, Kanai Y, Murotani K, Ito K, Ohata C, Yamazaki F, Saeki H, Seishima M, Mizutani Y, Kitabayashi H, Imafuku S. Effectiveness of brodalumab in improving itching and skin pain in Japanese patients with psoriasis: The
ProLOGUE
study. J Dermatol 2022; 50:453-461. [PMID: 36540010 DOI: 10.1111/1346-8138.16682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 10/31/2022] [Accepted: 12/02/2022] [Indexed: 12/24/2022]
Abstract
Itching and skin pain are bothersome symptoms of psoriasis, but evidence is limited regarding the treatment effectiveness on these symptoms in daily clinical settings. We assessed the changes in the levels of itching and skin pain after brodalumab treatment in Japanese patients with psoriasis using patient-reported outcomes (PROs). Patients with psoriasis who have inadequate response to existing treatments were enrolled in the single-arm, open-label, multicenter, prospective ProLOGUE study and received brodalumab 210 mg subcutaneously in daily clinical practice. Psoriasis Area and Severity Index (PASI) and PRO assessments were performed at baseline and weeks 12 and 48. Seventy-three patients (men, 82.2%; median age, 54.0 years) were enrolled. The Itch Numeric Rating Scale (NRS; p < 0.0001 at weeks 12 and 48) and Skin Pain NRS (week 12, p = 0.0004; week 48, p < 0.0001) scores significantly decreased from baseline. The Itch NRS score was significantly higher in patients with a Dermatology Life Quality Index (DLQI) score of ≥2 (vs. 0/1; p < 0.0001 at weeks 12 and 48) and in patients with a Treatment Satisfaction Questionnaire for Medication-9 (TSQM-9) global satisfaction domain score of ≤70% (vs. >70%; week 12, p = 0.0120; week 48, p = 0.0348). The Itch NRS score cutoff value for achieving a PASI score of ≤2, DLQI score of 0/1, and TSQM-9 global satisfaction domain score of >70% was 1 at week 12 and 0 at week 48. Brodalumab treatment was associated with improvement in itching and skin pain in Japanese patients with psoriasis. An Itch NRS score of 0 can be a long-term treatment goal for psoriasis (Japan Registry of Clinical Trials identifier: jRCTs031180037).
Collapse
Affiliation(s)
- Masaru Honma
- Department of Dermatology Asahikawa Medical University Asahikawa Japan
| | | | | | - Kei Ito
- Department of Dermatology JR Sapporo Hospital Sapporo Japan
| | - Chika Ohata
- Department of Dermatology Osaka General Medical Center Osaka Japan
| | | | - Hidehisa Saeki
- Department of Dermatology Nippon Medical School Tokyo Japan
| | - Mariko Seishima
- Department of Dermatology Gifu University Graduate School of Medicine Gifu Japan
| | - Yoko Mizutani
- Department of Dermatology Gifu University Graduate School of Medicine Gifu Japan
| | | | - Shinichi Imafuku
- Department of Dermatology Fukuoka University Faculty of Medicine Fukuoka Japan
| |
Collapse
|
5
|
Hawkes JE, Reis P, Lin CY, Muram T, Eastman WJ. Value of PASI90 Versus Merit-Based Incentive Payment System Efficacy Measures. JOURNAL OF PSORIASIS AND PSORIATIC ARTHRITIS 2022; 7:140-149. [PMID: 39296534 PMCID: PMC11361529 DOI: 10.1177/24755303221082623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 09/21/2024]
Abstract
Background Achieving ≥90% improvement in Psoriasis Area and Severity Index (PASI90) is achievable with newer biologic therapies, such as ixekizumab. Standard of care payment systems such as the Merit-based Incentive Payment System (MIPS) responder criteria could lead to under treatment and lower quality of life (QoL) outcomes compared with PASI90. Objective Show PASI90 is a higher standard than MIPS and is associated with greater improvements in QoL and other PRO outcomes. Methods Patients with moderate-to-severe psoriasis meeting PASI90 and MIPS criteria were compared in 3 phase 3 clinical trials of the interleukin-17A inhibitor ixekizumab (pooled UNCOVER-2/3 and IXORA-S). Patients satisfying MIPS criteria met either static Physician Global Assessment score ≤2, body surface area <3%, PASI <3, or Dermatology Life Quality Index ≤5. Improvements in QoL were compared between patients meeting PASI90 and MIPS criteria. Results All PASI90 responders were also MIPS responders (PASI90 responders). Not all MIPS responders met PASI90 (MIPS-only responders). Significantly larger change from baseline improvements for all health (skin pain, Itch NRS, DLQI, PtGA, WPAI-PsO work productivity loss, and WPAI-PsO activity impairment) and quality of life (EQ-5D 5L VAS and acute SF-36 PCS/MCS) outcome measures were observed in the PASI90 responders vs the MIPS-only responders. Conclusion PASI90 is a higher standard of response than MIPS and is associated with greater improvements in health and quality of life outcome measures.
Collapse
Affiliation(s)
- Jason E Hawkes
- Department of Dermatology, University of California-Davis, Sacramento, CA USA
| | - Paulo Reis
- Eli Lilly and Company, Indianapolis, IN USA
| | | | | | | |
Collapse
|
6
|
Egeberg A, Iversen L, Kimball AB, Kelly S, Grace E, Patel H, Xu W, Gallo G, Riedl E, Feldman SR. Pregnancy outcomes in patients with psoriasis, psoriatic arthritis, or axial spondyloarthritis receiving ixekizumab. J DERMATOL TREAT 2021; 33:2503-2509. [PMID: 34547967 DOI: 10.1080/09546634.2021.1976375] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND Psoriasis, psoriatic arthritis (PsA) and axial spondyloarthritis (axSpA) are chronic inflammatory diseases that often affect women of childbearing age. Detailed information about pregnancy and related outcomes across these indications in patients exposed to ixekizumab is lacking. OBJECTIVES To evaluate pregnancy outcomes after maternal or paternal exposure to ixekizumab in patients with psoriasis, PsA, or axSpA. METHODS Pregnancy cases from clinical trials and post-marketing reports, associated with either maternal or paternal exposure to ixekizumab cumulatively through 22 March 2019, were identified in the Eli Lilly Global Safety Database and described separately. RESULTS One hundred and ninety-three ixekizumab-exposed pregnancies were identified. Maternal exposure occurred in 51.3% of pregnancies (clinical trials: n = 58; post-marketing: n = 41). The majority of paternal exposure pregnancies occurred in clinical trials (91 of 94). Live births were reported for 53.8 and 61.1% of known outcomes in maternal exposure pregnancies during clinical trials and post-marketing surveillance, respectively. No congenital malformations resulting from maternal exposure were reported in clinical trials: one case, not causally related to ixekizumab therapy, was recorded in the post-marketing setting. CONCLUSIONS This integrated safety analysis provides relevant information for clinicians treating patients with psoriasis, PsA, or axSpA with ixekizumab. No new safety signals were identified in patients receiving ixekizumab.
Collapse
Affiliation(s)
- A Egeberg
- Department of Dermatology, Bispebjerg Hospital, Copenhagen, Denmark
| | - L Iversen
- Department of Dermatology, Aarhus University Hospital, Aarhus, Denmark
| | - A B Kimball
- Harvard Medical School and Beth Israel Deaconess Hospital, Boston, MA, USA
| | - S Kelly
- Eli Lilly and Company, Indianapolis, IN, USA
| | - E Grace
- Eli Lilly and Company, Indianapolis, IN, USA
| | - H Patel
- Eli Lilly and Company, Indianapolis, IN, USA
| | - W Xu
- Eli Lilly and Company, Indianapolis, IN, USA
| | - G Gallo
- Eli Lilly and Company, Indianapolis, IN, USA
| | - E Riedl
- Eli Lilly and Company, Indianapolis, IN, USA
| | - S R Feldman
- Department of Dermatology, Wake Forest School of Medicine, Winston-Salem, NC, USA
| |
Collapse
|
7
|
Wiseman J, Simons M, Kimble R, Ware RS, McPhail SM, Tyack Z. Effectiveness of topical silicone gel and pressure garment therapy for burn scar prevention and management in children 12-months postburn: A parallel group randomised controlled trial. Clin Rehabil 2021; 35:1126-1141. [PMID: 34107792 DOI: 10.1177/02692155211020351] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE The longer-term effectiveness of silicone and pressure burn scar interventions was evaluated at 12-months postburn. DESIGN Parallel group, randomised trial. SETTING Hospital outpatient clinics, research centre. PARTICIPANTS Children referred for burn scar management following grafted or spontaneously healed acute burn injuries or scar reconstruction surgery. INTERVENTIONS Participants were randomised to: (1) topical silicone gel only, (2) pressure garment only, or (3) combined topical silicone gel and pressure garment. MAIN MEASURES Primary outcomes were scar thickness (blinded ultrasound measurement) and itch intensity (caregiver proxy-report, numeric rating scale). RESULTS Of 153 participants randomised who received the interventions (silicone n = 51, pressure garment n = 49, combined n = 53), 86 were followed-up at 12-months postburn (n = 34, n = 28, n = 24). No differences were identified for the primary outcomes using intention-to-treat analysis. Scar thickness mean difference (95% confidence interval) = 0.00 cm (-0.04, 0.05); -0.03 cm (-0.07, 0.02); 0.03 cm (-0.02, 0.08) and scar itch = 0.09 (-0.88, 1.06); -0.21 (-1.21, 0.79); 0.30 (-0.73, 1.32) for silicone vs pressure; silicone vs combined and combined vs pressure respectively. No serious adverse effects occurred. CONCLUSION Similar to short-term results, the combined intervention offered no statistically or clinically significant benefit for improving the primary outcomes compared to each intervention alone. No differences in the primary outcomes were identified between the silicone and pressure alone groups.
Collapse
Affiliation(s)
- Jodie Wiseman
- Centre for Children's Burns and Trauma Research, Child Health Research Centre, the University of Queensland, Brisbane, QLD, Australia
| | - Megan Simons
- Department of Occupational Therapy, Queensland Children's Hospital, Brisbane, QLD, Australia.,Pegg Leditschke Children's Burns Centre, Queensland Children's Hospital, Brisbane, QLD, Australia
| | - Roy Kimble
- Centre for Children's Burns and Trauma Research, Child Health Research Centre, the University of Queensland, Brisbane, QLD, Australia.,Pegg Leditschke Children's Burns Centre, Queensland Children's Hospital, Brisbane, QLD, Australia
| | - Robert S Ware
- Menzies Health Institute Queensland, Griffith University, Nathan, QLD, Australia
| | - Steven M McPhail
- Australian Centre for Health Services Innovation (AusHSI) and Centre for Healthcare Transformation, School of Public Health and Social Work, Queensland University of Technology, Kelvin Grove, QLD, Australia.,Clinical Informatics Directorate, Metro South Health, Woolloongabba, QLD, Australia
| | - Zephanie Tyack
- Centre for Children's Burns and Trauma Research, Child Health Research Centre, the University of Queensland, Brisbane, QLD, Australia.,Australian Centre for Health Services Innovation (AusHSI) and Centre for Healthcare Transformation, School of Public Health and Social Work, Queensland University of Technology, Kelvin Grove, QLD, Australia
| |
Collapse
|
8
|
Wu JJ, Harrison RW, Zhu B, Goldblum OM, Malatestinic WN, Burge R, Murage MJ. Understanding characteristics of patients newly initiating ixekizumab: findings from the Corrona Psoriasis Registry. J Comp Eff Res 2020; 10:157-167. [PMID: 33355477 DOI: 10.2217/cer-2020-0113] [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] [Indexed: 12/14/2022] Open
Abstract
Background: Real-world data on patients newly initiating ixekizumab is limited. Our study describes the characteristics of patients who initiated ixekizumab and other biologics for psoriasis treatment in North American dermatological practices. Materials & methods: Characteristics of patients ascertained at registry enrollment are described via means and frequencies. Results: Compared with other biologic initiators, ixekizumab initiators had: longer disease duration (17.1 vs 15.1 years); more were considered least severe by body surface area (33 vs 26%); moderate-to-severe by IGA (56 vs 48%); were biologic-experienced (80 vs 52%); obese (54 vs 47%); and experienced greater impact in work productivity (5.3 vs 2.9%) versus other biologic initiators. Conclusion: Psoriasis patients initiating ixekizumab had more severe disease, biologic experience, and worse patient-reported outcomes than those initiating other biologics.
Collapse
Affiliation(s)
- Jashin J Wu
- Dermatology Research & Education Foundation, Irvine, CA 92620, USA
| | | | - Baojin Zhu
- Eli Lilly & Company, Indianapolis, IN 46225, USA
| | | | | | - Russel Burge
- Eli Lilly & Company, Indianapolis, IN 46225, USA.,Division of Pharmaceutical Sciences, Winkle College of Pharmacy, University of Cincinnati, Cincinnati, OH 45229, USA
| | | |
Collapse
|
9
|
Shahriari M, Harrison RW, Burge R, Lin CY, Malatestinic WN, Goldblum OM, McLean RR, Crabtree MM, O'Brien J, Grace EL, Murage MJ. Disease response and patient-reported outcomes among initiators of ixekizumab. J DERMATOL TREAT 2020; 33:1538-1546. [PMID: 33267635 DOI: 10.1080/09546634.2020.1853023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVES There is limited real-world evidence on using ixekizumab in psoriasis patients. Therefore, we characterized patients with psoriasis initiating ixekizumab and report 6-month changes in disease and patient-reported outcomes. METHODS Adult patients with psoriasis who initiated ixekizumab and completed a 6-month follow-up visit were enrolled from the Corrona Psoriasis Registry. Disease characteristics and outcomes were assessed at ixekizumab initiation. Outcomes included the mean 6-month change in Psoriasis Area and Severity Index (PASI), body surface area (BSA), Investigator Global Assessment (IGA), and IGA*BSA. RESULTS From baseline to follow-up in all patients (n = 136), means decreased for IGA*BSA (-45.5) and BSA (-12.4), and a higher % achieved an absolute PASI ≤ 5 (84.6%), BSA 0-3 (72.1%), and IGA 0/1 (50.7%). Within stratified groups, means decreased for PASI <12 for IGA*BSA (-21.1) and BSA (-6.3); PASI≥12 for IGA*BSA (-94.8) and BSA (-24.6); weight <100 kg for IGA*BSA (-45.1) and BSA (-12.4); weight ≥100 kg for IGA*BSA (-46.2) and BSA (-12.3); concomitant PsA for IGA*BSA (-56.0) and BSA (-15.3); and in no concomitant PsA for IGA*BSA (-36.9) and BSA (-10.0). CONCLUSIONS We provide real-world evidence on the benefits of ixekizumab for treating psoriasis, regardless of baseline disease severity, weight, or concomitant PsA.
Collapse
Affiliation(s)
- Mona Shahriari
- Department of Dermatology, Yale University, New Haven, CT, USA.,Central Connecticut Dermatology Research, Cromwell, CT, USA
| | | | - Russel Burge
- Eli Lilly and Company, Indianapolis, IN, USA.,Department of Sciences and Health, University of Cincinnati, Cincinnati, OH, USA
| | | | | | | | | | | | | | | | | |
Collapse
|
10
|
Blauvelt A, Lebwohl MG, Mabuchi T, Leung A, Garrelts A, Crane H, ElMaraghy H, Patel H, Ridenour T, See K, Gallo G, Paul C. Long-term efficacy and safety of ixekizumab: A 5-year analysis of the UNCOVER-3 randomized controlled trial. J Am Acad Dermatol 2020; 85:360-368. [PMID: 33253833 DOI: 10.1016/j.jaad.2020.11.022] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 11/10/2020] [Accepted: 11/11/2020] [Indexed: 02/06/2023]
Abstract
OBJECTIVE To report the efficacy and safety of the approved ixekizumab (IXE) dose over 5 years from UNCOVER-3 (NCT01646177). METHODS Patients (N = 1346) were randomized 1:2:2:2 to receive subcutaneous injections of placebo, etanercept 50 mg twice weekly, or IXE 80 mg every 2 weeks or every 4 weeks after an initial dose of IXE 160 mg, respectively. At week 12, patients entered the long-term extension period with dosing of IXE every 4 weeks and could escalate to every 2 weeks after week 60. Efficacy was reported for the IXE every 2 weeks/every 4 weeks group of the intent-to-treat population. Safety was reported for patients who received at least 1 dose of IXE every 2 or every 4 weeks. RESULTS Using modified nonresponder imputation, 78.8%/67.1%/46.2% of patients receiving the approved dose of IXE every 2 weeks/every 4 weeks (n = 385) achieved ≥75%, ≥90%, or 100% improvement from baseline in the Psoriasis Area and Severity Index, respectively, at week 264; static Physician's Global Assessment score of 0/1 and 0 responses were 69.2% and 45.3%, respectively. Infections were the most observed treatment-emergent adverse event (72.7% of patients). LIMITATIONS Lack of comparison treatment group after week 12. CONCLUSION IXE demonstrates sustained efficacy and consistent safety through 264 weeks in patients using the approved dose.
Collapse
Affiliation(s)
| | - Mark G Lebwohl
- Icahn School of Medicine at Mount Sinai, New York, New York
| | | | - Ann Leung
- Syneos Health, Morrisville, North Carolina
| | | | - Heidi Crane
- Eli Lilly and Company, Indianapolis, Indiana
| | | | | | | | | | - Gaia Gallo
- Eli Lilly and Company, Indianapolis, Indiana
| | - Carle Paul
- Toulouse University and Larrey Hospital, Toulouse, France
| |
Collapse
|
11
|
Azhar A, Zaayman M, Silfvast-Kaiser A, Kivelevitch D, Menter A, Paek SY. Ixekizumab in the treatment of moderate-to-severe plaque psoriasis: Patient adherence, satisfaction, and preferences. Dermatol Ther 2020; 34:e14486. [PMID: 33135231 DOI: 10.1111/dth.14486] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Accepted: 10/15/2020] [Indexed: 12/26/2022]
Abstract
Ixekizumab is a humanized monoclonal antibody that exhibits its immunomodulatory effects by binding to interleukin 17A (IL-17A), a proinflammatory cytokine. It was approved for the treatment of plaque psoriasis by the Food and Drug Administration in 2016. Ixekizumab has demonstrated superiority in clinical trials against etanercept, with no significant difference in the side effect profile. The chronicity of psoriasis requires continual treatment to achieve disease clearance. Many factors may affect adherence to treatment including patient satisfaction, patient preferences, medication cost, and medication side effects. Limited data on patient adherence, satisfaction, and preference exists in formal literature. Often, surrogate measures must be used to extrapolate information regarding these measures. In this narrative review, we describe patient adherence, satisfaction, and preferences via both direct and surrogate measures as they relate to ixekizumab treatment for moderate-to-severe plaque psoriasis.
Collapse
Affiliation(s)
- Aaminah Azhar
- College of Medicine, Texas A&M University, Dallas, Texas, USA
| | - Marcus Zaayman
- Division of Dermatology, Baylor Scott & White, Dallas, Texas, USA
| | | | - Dario Kivelevitch
- College of Medicine, Texas A&M University, Dallas, Texas, USA.,Division of Dermatology, Baylor Scott & White, Dallas, Texas, USA
| | - Alan Menter
- College of Medicine, Texas A&M University, Dallas, Texas, USA.,Division of Dermatology, Baylor Scott & White, Dallas, Texas, USA
| | - So Yeon Paek
- College of Medicine, Texas A&M University, Dallas, Texas, USA.,Division of Dermatology, Baylor Scott & White, Dallas, Texas, USA
| |
Collapse
|
12
|
Blauvelt A, Papp K, Gottlieb A, Jarell A, Reich K, Maari C, Gordon KB, Ferris LK, Langley RG, Tada Y, Lima RG, Elmaraghy H, Gallo G, Renda L, Park SY, Burge R, Bagel J. A head-to-head comparison of ixekizumab vs. guselkumab in patients with moderate-to-severe plaque psoriasis: 12-week efficacy, safety and speed of response from a randomized, double-blinded trial. Br J Dermatol 2020; 182:1348-1358. [PMID: 31887225 PMCID: PMC7317420 DOI: 10.1111/bjd.18851] [Citation(s) in RCA: 81] [Impact Index Per Article: 20.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/27/2019] [Indexed: 12/28/2022]
Abstract
BACKGROUND Patients with psoriasis value rapid and complete skin clearance. No head-to-head studies have focused on early responses to interleukin (IL)-17 vs. IL-23 inhibitors. OBJECTIVES To compare early and complete skin clearance by the IL-17A inhibitor ixekizumab vs. the IL-23p19 inhibitor guselkumab. METHODS IXORA-R, a 24-week, randomized, double-blinded study, enrolled adults with moderate-to-severe plaque psoriasis [static Physician's Global Assessment of Disease (sPGA) score of ≥ 3, Psoriasis Area and Severity Index (PASI) ≥ 12, and ≥ 10% body surface area]. Patients were randomized (1 : 1) to receive the approved dose of subcutaneous ixekizumab or guselkumab. Primary end point was 100% improvement in PASI (PASI 100) at week 12. Major secondary end points included other levels of improved PASI and sPGA at different time points. Comparisons were made using the Cochran-Mantel-Haenszel test with a multiple testing strategy. Nonresponder imputation was used for missing data. After the completion of the study, the final secondary end point (PASI 100 at 24 weeks) and safety data through week 24 will be reported. RESULTS In total, 1027 patients were randomized. The primary end point PASI 100 at week 12 was met [215/520 ixekizumab (41%); 126/507 guselkumab (25%); P < 0·001]. All major secondary end points measured up to week 12 were met, including PASI 50 at week 1 and PASI 75 at week 2. Serious adverse event frequency was 3% for each group; no new safety signals were identified. CONCLUSIONS Ixekizumab was superior to guselkumab for rapidly improving signs and symptoms in patients with moderate-to-severe plaque psoriasis by week 12. Adverse events were similar to previous ixekizumab and guselkumab studies. Compared with the IL-23 inhibitor guselkumab, ixekizumab can offer complete skin clearance more rapidly to patients with moderate-to-severe plaque psoriasis. What's already known about this topic? Patients with plaque psoriasis desire both high levels of clearance and rapid onset of treatment effects. Ixekizumab, a high-affinity monoclonal antibody that selectively targets interleukin (IL)-17A, has demonstrated greater and faster skin clearance than etanercept and ustekinumab, with consistent long-term efficacy, safety and durability of response. Clinical trial data and systematic reviews have suggested that IL-17 inhibitors can improve a patient's psoriasis more rapidly than IL-23 inhibitors. What does this study add? The head-to-head study design directly compares the efficacy and speed of response of ixekizumab and the IL-23 inhibitor guselkumab in moderate-to-severe plaque psoriasis. The primary end point was met, showing superiority of ixekizumab over guselkumab for achieving complete skin clearance at week 12. The safety profile of ixekizumab was consistent with previous studies. Ixekizumab can deliver patients complete skin clearance and improved quality of life more rapidly than guselkumab.
Collapse
Affiliation(s)
- A Blauvelt
- Oregon Medical Research Center, Portland, OR, U.S.A
| | - K Papp
- Probity Medical Research, Inc., Waterloo, Ontario, Canada
| | - A Gottlieb
- Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, NY, U.S.A
| | - A Jarell
- Northeast Dermatology Associates, Portsmouth, NH, U.S.A
| | - 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
| | - C Maari
- Innovaderm Research, Montreal, QC, Canada
| | - K B Gordon
- Medical College of Wisconsin, Milwaukee, WI, U.S.A
| | - L K Ferris
- Department of Dermatology, University of Pittsburgh, Pittsburgh, PA, U.S.A
| | - R G Langley
- Dalhousie University, Halifax, Nova Scotia, Canada
| | - Y Tada
- Department of Dermatology, Teikyo University School of Medicine, Tokyo, Japan
| | - R G Lima
- Eli Lilly and Company, Indianapolis, IN, U.S.A
| | - H Elmaraghy
- Eli Lilly and Company, Indianapolis, IN, U.S.A
| | - G Gallo
- Eli Lilly and Company, Indianapolis, IN, U.S.A
| | - L Renda
- Eli Lilly and Company, Indianapolis, IN, U.S.A
| | - S Y Park
- Eli Lilly and Company, Indianapolis, IN, U.S.A
| | - R Burge
- Eli Lilly and Company, Indianapolis, IN, U.S.A
| | - J Bagel
- Psoriasis Treatment Center of Central New Jersey, East Windsor, NJ, U.S.A
| | | |
Collapse
|
13
|
Warren RB, Gooderham M, Burge R, Zhu B, Amato D, Liu KH, Shrom D, Guo J, Brnabic A, Blauvelt A. Comparison of cumulative clinical benefits of biologics for the treatment of psoriasis over 16 weeks: Results from a network meta-analysis. J Am Acad Dermatol 2019; 82:1138-1149. [PMID: 31884091 DOI: 10.1016/j.jaad.2019.12.038] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Revised: 12/06/2019] [Accepted: 12/19/2019] [Indexed: 12/17/2022]
Abstract
BACKGROUND Cumulative clinical improvement and speed of improvement are important to psoriasis patients. OBJECTIVE Compare cumulative benefits of biologics over 12 to 16 weeks in the treatment of moderate to severe psoriasis. METHODS A systematic literature review identified phase III trial data on Psoriasis Area and Severity Index (PASI) responses for biologics during 12 and 16 weeks of treatment. Cumulative clinical benefit, measured by the area under the curve for PASI ≥75% improvement (PASI 75), ≥90% improvement (PASI 90), and 100% improvement (PASI 100), was compared using the network meta-analysis and Bayesian methodology on the relative probability of achieving percentage of maximum area under the curve. RESULTS Among biologics approved for psoriasis treatment, anti-interleukin-17 biologics demonstrated consistently greater cumulative clinical benefits on PASI 75, PASI 90, and PASI 100 over the 12- or 16-week period than anti-interleukin-23 and other biologics. For biologics with 12-week data, ixekizumab and brodalumab showed greater cumulative benefits for PASI 75, PASI 90, and PASI 100 than secukinumab, followed by guselkumab, infliximab, adalimumab, ustekinumab, and etanercept. Ixekizumab showed greater cumulative benefits than all other biologics reporting 16-week data. LIMITATIONS Recently approved biologics were not included. CONCLUSION Ixekizumab (at 12 weeks and 16 weeks) and brodalumab (at 12 weeks) had greater cumulative clinical benefit than all of other biologics studied.
Collapse
Affiliation(s)
- Richard B Warren
- Salford Royal NHS Foundation Trust, The University of Manchester, National Institute for Health Research Manchester Biomedical Research Centre, Manchester, United Kingdom
| | | | - Russel Burge
- Lilly Corporate Center, Indianapolis, Indiana; University of Cincinnati.
| | - Baojin Zhu
- Lilly Corporate Center, Indianapolis, Indiana
| | - David Amato
- Lilly Corporate Center, Indianapolis, Indiana
| | | | - David Shrom
- Lilly Corporate Center, Indianapolis, Indiana
| | - Jiaying Guo
- Lilly Corporate Center, Indianapolis, Indiana
| | | | | |
Collapse
|
14
|
Yosipovitch G, Berger T, Fassett MS. Neuroimmune interactions in chronic itch of atopic dermatitis. J Eur Acad Dermatol Venereol 2019; 34:239-250. [PMID: 31566796 PMCID: PMC7027518 DOI: 10.1111/jdv.15973] [Citation(s) in RCA: 84] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Accepted: 09/11/2019] [Indexed: 12/30/2022]
Abstract
Itch is a defining symptom of atopic dermatitis. Crosstalk between keratinocytes, the immune system and non‐histaminergic sensory nerves is responsible for the pathophysiology of chronic itch in atopic dermatitis. An expanding understanding of the contribution of the nervous system and its interaction with immune pathways in atopic itch are helping to identify new therapeutic strategies.
Collapse
Affiliation(s)
- G Yosipovitch
- Department of Dermatology and Cutaneous Surgery and Miami Itch Center, Miller School of Medicine, University of Miami, Miami, FL, USA
| | - T Berger
- Department of Dermatology, School of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - M S Fassett
- Department of Dermatology, School of Medicine, University of California San Francisco, San Francisco, CA, USA
| |
Collapse
|
15
|
Lebwohl MG, Gordon KB, Gallo G, Zhang L, Paul C. Ixekizumab sustains high level of efficacy and favourable safety profile over 4 years in patients with moderate psoriasis: results from UNCOVER-3 study. J Eur Acad Dermatol Venereol 2019; 34:301-309. [PMID: 31479549 PMCID: PMC7028252 DOI: 10.1111/jdv.15921] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Accepted: 08/12/2019] [Indexed: 12/26/2022]
Abstract
Background Psoriasis, a chronic disease usually requires long‐term disease management. Objective This study evaluates the efficacy and safety of recommended ixekizumab (IXE) dose over 4 years (204 weeks) from UNCOVER‐3 study. Methods UNCOVER‐3 was a randomised, double‐blind, multicenter, phase 3 study wherein patients with moderate‐to‐severe plaque psoriasis received placebo, IXE 80 mg every 2 weeks (Q2W), IXE 80 mg every 4 weeks (Q4W) (both IXE groups had 160 mg starting dose) or etanercept 50 mg twice weekly. At week 12, all patients switched to IXE Q4W dose for the long‐term extension (264 weeks). After week 60 and at investigator's discretion, patients could receive dose adjustment to IXE Q2W. The efficacy endpoints at week 204 were percentage of patients achieving PASI 75/90/100, sPGA score of 1 or 0, and those achieving PSSI = 0, NAPSI = 0 and PPASI 100. Efficacy data were summarised through 204 weeks using as‐observed, multiple imputation (MI) and modified non‐responder imputation (mNRI) methods. Results The proportion of patients achieving PASI 75/90/100 at week 204 using mNRI method were 82.8%, 66.4% and 48.3%, respectively. Using as‐observed and MI methods, 98.2% and 94.8% patients achieved PASI 75, 87.8% and 73.3% achieved PASI 90, and 67.1% and 52.7% achieved PASI 100 response, respectively, at week 204. The response rates for sPGA (0, 1) were 88.7%, 76.2% and 68.5% and for sPGA (0) were 68.9%, 54.6% and 49.7% using as‐observed, MI and mNRI methods, respectively. Similar trends were observed with NAPSI = 0, PSSI = 0, PPASI 100 and itch NRS = 0. There were no new safety concerns through year 4. Conclusions This study demonstrated sustained high‐efficacy response through 4 years of continuous treatment with ixekizumab in patients with moderate‐to‐severe plaque psoriasis. The safety profile remained consistent with prior findings, with no new or unexpected safety concerns.
Collapse
Affiliation(s)
- M G Lebwohl
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - K B Gordon
- Medical College of Wisconsin, Milwaukee, WI, USA
| | - G Gallo
- Eli Lilly and Company, Indianapolis, IN, USA
| | - L Zhang
- Eli Lilly and Company, Indianapolis, IN, USA
| | - C Paul
- Toulouse University and Larrey Hospital, Toulouse, France
| |
Collapse
|
16
|
Egeberg A, Andersen Y, Halling‐Overgaard A, Alignahi F, Thyssen J, Burge R, Mallbris L. Systematic review on rapidity of onset of action for interleukin‐17 and interleukin‐23 inhibitors for psoriasis. J Eur Acad Dermatol Venereol 2019; 34:39-46. [DOI: 10.1111/jdv.15920] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Accepted: 08/16/2019] [Indexed: 12/15/2022]
Affiliation(s)
- A. Egeberg
- Department of Dermatology and Allergy Herlev and Gentofte Hospital University of Copenhagen Hellerup Denmark
| | - Y.M.F. Andersen
- Department of Dermatology and Allergy Herlev and Gentofte Hospital University of Copenhagen Hellerup Denmark
| | - A.‐S. Halling‐Overgaard
- Department of Dermatology and Allergy Herlev and Gentofte Hospital University of Copenhagen Hellerup Denmark
| | - F. Alignahi
- Department of Dermatology and Allergy Herlev and Gentofte Hospital University of Copenhagen Hellerup Denmark
| | - J.P. Thyssen
- Department of Dermatology and Allergy Herlev and Gentofte Hospital University of Copenhagen Hellerup Denmark
| | - R. Burge
- Eli Lilly and Company Indianapolis INUSA
- Division of Pharmaceutical Sciences University of Cincinnati Cincinnati OH USA
| | | |
Collapse
|
17
|
Strober BE, van der Walt JM, Armstrong AW, Bourcier M, Carvalho AVE, Chouela E, Cohen AD, de la Cruz C, Ellis CN, Finlay AY, Gottlieb AB, Gudjonsson JE, Iversen L, Kleyn CE, Leonardi CL, Lynde CW, Ryan C, Theng CT, Valenzuela F, Vender R, Wu JJ, Young HS, Kimball AB. Clinical Goals and Barriers to Effective Psoriasis Care. Dermatol Ther (Heidelb) 2019; 9:5-18. [PMID: 30578464 PMCID: PMC6380974 DOI: 10.1007/s13555-018-0279-5] [Citation(s) in RCA: 50] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2018] [Indexed: 12/18/2022] Open
Abstract
Engaging global key opinion leaders, the International Psoriasis Council (IPC) held a day-long roundtable discussion with the primary purpose to discuss the treatment goals of psoriasis patients and worldwide barriers to optimal care. Setting clear expectations might ultimately encourage undertreated psoriasis patients to seek care in an era in which great gains in therapeutic efficacy have been achieved. Here, we discuss the option for early treatment of all categories of psoriasis to alleviate disease impact while emphasizing the need for more focused attention for psoriasis patients with mild and moderate forms of this autoimmune disease. In addition, we encourage policy changes to keep pace with the innovative therapies and clinical science and highlight the demand for greater understanding of treatment barriers in resource-poor countries.
Collapse
Affiliation(s)
- Bruce E Strober
- University of Connecticut Health Center, Farmington, CT, USA.
- Probity Medical Research, Waterloo, ON, Canada.
| | | | | | - Marc Bourcier
- Faculty of Medicine, Sherbrooke University, Sherbrooke, QC, Canada
| | | | | | - Arnon D Cohen
- Siaal Research Center for Family Medicine and Primary Care, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
- Department of Quality Measurements and Research, Chief Physician's Office, Clalit Health Services, Tel Aviv, Israel
| | | | - Charles N Ellis
- Department of Dermatology, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Andrew Y Finlay
- Department of Dermatology and Academic Wound Healing, Division of Infection and Immunity, School of Medicine, Cardiff University, Cardiff, UK
| | | | - Johann E Gudjonsson
- Department of Dermatology, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Lars Iversen
- Department of Dermatology, Aarhus University Hospital, 8000, Aarhus C, Denmark
| | - C Elise Kleyn
- The Dermatology Centre, Manchester Academic Health Science Centre, Salford Royal NHS Foundation Trust, Barnes Building, Manchester, UK
| | | | | | - Caitriona Ryan
- Blackrock Clinic Dublin and University College Dublin, Dublin, Ireland
| | - Colin T Theng
- Department of Dermatology, National Skin Centre, Singapore, Republic of Singapore
| | | | - Ronald Vender
- Dermatrials Research Inc & Venderm Innovations in Psoriasis, Hamilton, ON, Canada
| | - Jashin J Wu
- Dermatology Research and Education Foundation, Irvine, CA, USA
| | - Helen S Young
- The Dermatology Centre, Manchester Academic Health Science Centre, Salford Royal NHS Foundation Trust, Barnes Building, Manchester, UK
| | - Alexa B Kimball
- Harvard Medical Faculty Physicians, Beth Israel Deaconess Medical Center, Boston, MA, USA
| |
Collapse
|
18
|
|
19
|
Blegvad C, Skov L, Zachariae C. Ixekizumab for the treatment of psoriasis: an update on new data since first approval. Expert Rev Clin Immunol 2018; 15:111-121. [PMID: 30589394 DOI: 10.1080/1744666x.2019.1559730] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Introduction: Psoriasis is a chronic immune-mediated skin disease with a multifactorial etiology. Studies have shown that the inflammatory cytokine interleukin-17A (IL-17A) is a key mediator in the pathogenesis. Targeted biologics have changed the outcome for patients in a variety of diseases including psoriasis. Ixekizumab is a humanized monoclonal antibody directed against IL-17A and it has been approved for the treatment of moderate-to-severe plaque psoriasis, and recently also psoriatic arthritis. Areas covered: In this review, we summarize the latest clinical study results on ixekizumab. Long-term Phase III study data on efficacy and safety are now available for both plaque psoriasis and psoriatic arthritis. Additionally, new indications for ixekizumab are under investigation. Expert commentary: Overall, the efficacy and safety of ixekizumab are promising. In plaque psoriasis, the efficacy of ixekizumab was superior to etanercept and ustekinumab, while the efficacy was comparable to adalimumab in psoriatic arthritis. The safety profile has also been found very tolerable and similar to other biologics; however, vigilance regarding non-invasive Candida infections is necessary. Also, caution is advised when treating patients with concomitant inflammatory bowel disease, since ixekizumab could cause exacerbations. Long-term studies in real-life treatment settings are needed to decide the actual potential and safety of ixekizumab.
Collapse
Affiliation(s)
- Christoffer Blegvad
- a Copenhagen Research Group for Inflammatory Skin (CORGIS), Department of Dermatology and Allergy, Herlev and Gentofte Hospital , University of Copenhagen , Hellerup , Denmark
| | - Lone Skov
- a Copenhagen Research Group for Inflammatory Skin (CORGIS), Department of Dermatology and Allergy, Herlev and Gentofte Hospital , University of Copenhagen , Hellerup , Denmark
| | - Claus Zachariae
- a Copenhagen Research Group for Inflammatory Skin (CORGIS), Department of Dermatology and Allergy, Herlev and Gentofte Hospital , University of Copenhagen , Hellerup , Denmark
| |
Collapse
|
20
|
Psoriasis and Depression: The Role of Inflammation. ACTAS DERMO-SIFILIOGRAFICAS 2018; 110:12-19. [PMID: 30509759 DOI: 10.1016/j.ad.2018.05.009] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2017] [Revised: 05/07/2018] [Accepted: 05/28/2018] [Indexed: 12/22/2022] Open
Abstract
Psoriasis is a chronic, systemic inflammatory disorder with multiple comorbidities. The most common comorbidities are mental disorders, especially depression, which can interact negatively with psoriasis to produce a dangerous vicious circle. Depression in psoriasis has traditionally been explained as a response to psychosocial factors and impaired quality of life. However, a new hypothesis linking depression and psoriasis through chronic inflammation offers insights that should help to understand and treat these diseases. In this approach, new drugs and lifestyle have an important role.
Collapse
|
21
|
Yosipovitch G, Reich A, Steinhoff M, Beselin A, Kent T, Dossenbach M, Berggren L, Henneges C, Luger T. Impact of Ixekizumab Treatment on Itch and Psoriasis Area and Severity Index in Patients with Moderate-to-Severe Plaque Psoriasis: An Integrated Analysis of Two Phase III Randomized Studies. Dermatol Ther (Heidelb) 2018; 8:621-637. [PMID: 30465321 PMCID: PMC6261114 DOI: 10.1007/s13555-018-0267-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2018] [Indexed: 12/16/2022] Open
Abstract
INTRODUCTION We evaluated baseline itch and its impact on the efficacy of ixekizumab (IXE) in clearing psoriasis and improving quality-of-life measures, and we explored the relationship between itch and psoriatic skin improvement. METHODS Data were analyzed from two double-blind, randomized, controlled phase III studies (UNCOVER-2/3) comparing etanercept (ETN), IXE, and placebo (PBO) in patients with moderate-to-severe plaque psoriasis. Long-term analysis included UNCOVER-3 data from week 0 to week 156. RESULTS At week 12, a clinically meaningful improvement in itch [Itch Numeric Rating Scale (NRS) reduction ≥ 4] was seen in 70.0%, 88.6%, and 90.8% of the IXE-treated patients in the baseline Itch NRS 4-6, 7-8, and 9-10 groups, respectively (all itch severity groups p < 0.001 versus ETN and PBO). Also, 68.9%, 67.1%, and 73.6% of the IXE-treated patients in the baseline Itch NRS 4-6, 7-8, and 9-10 groups, respectively, showed an improvement of ≥ 90.0% in the Psoriatic Area and Severity Index (PASI) at week 12 as compared to the baseline (PASI 90) (all itch severity groups p < 0.001 versus ETN and PBO). For most patients, itch reduction preceded psoriatic plaque improvement. Sustained effects of IXE on itch and PASI were observed during 3 years of treatment. CONCLUSIONS Regardless of baseline itch severity, IXE treatment provided a rapid improvement in itch followed by clinically meaningful improvements in psoriasis. FUNDING Eli Lilly and Company. TRIAL REGISTRATION ClinicalTrials.gov identifiers, NCT01597245 and NCT01646177.
Collapse
Affiliation(s)
- Gil Yosipovitch
- Department of Dermatology and Cutaneous Surgery, Itch Center, University of Miami, Miami, FL, USA
| | - Adam Reich
- Department of Dermatology, University of Rzeszow, Rzeszow, Poland
| | - Martin Steinhoff
- Department of Dermatology & Venereology & Translational Research Institute, Weill Cornell Medicine-Qatar, Hamad Medical Corporation, Qatar University, Doha, Qatar
- Department of Dermatology, Weill Cornell University, New York City, NY, USA
| | - Anke Beselin
- Lilly Deutschland GmbH, Bad Homburg vor der Höhe, Germany.
| | - Toby Kent
- Eli Lilly and Company UK, Hampshire, United Kingdom
| | | | | | | | - Thomas Luger
- Department of Dermatology, University of Muenster, Muenster, Germany
| |
Collapse
|
22
|
Shelton SK, Bai SR, Jordan JK, Sheehan AH. Ixekizumab: A Review of Its Use for the Management of Moderate to Severe Plaque Psoriasis. Ann Pharmacother 2018; 53:276-284. [DOI: 10.1177/1060028018799982] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
Objective: To review the efficacy, safety, and place in therapy of ixekizumab for the treatment of moderate to severe plaque psoriasis. Data Sources: PubMed (1966 to July 2018) and clinicaltrials.gov were searched using the terms ixekizumab, LY2439821, interleukin-17, and psoriasis. Study Selection and Data Extraction: Human studies published in peer-reviewed medical journals in English were used. Data Synthesis: The efficacy and safety of ixekizumab has been primarily reported by 4 phase III trials (UNCOVER-1, UNCOVER-2, UNCOVER-3, and UNCOVER-J) and multiple post hoc analyses. The average proportions of patients achieving a 75%, 90%, and 100% reduction in their Psoriasis Area and Severity Index (PASI) were 89%, 70%, and 38%, respectively, after 12 weeks of therapy. PASI75 was maintained for up to 3 years in 80.5% of participants. Ixekizumab was statistically significantly more effective than ustekinumab, with 76.5%, compared with 59%, of patients achieving PASI90 in 52 weeks. The most common adverse events include nasopharyngitis (14.1%), upper respiratory tract infections (7.9%), and injection-site reactions (6.8%), which are similar to that for other biological agents. The risk of inflammatory bowel disease may be increased with ixekizumab. Relevance to Patient Care and Clinical Practice: This review summarizes and evaluates clinical data regarding the efficacy and safety of ixekizumab and discusses relevant differences compared with other biological agents used for the management of chronic plaque psoriasis. Conclusions: Ixekizumab is a highly efficacious and well-tolerated treatment option for patients with moderate to severe plaque psoriasis.
Collapse
Affiliation(s)
| | - Sandra R. Bai
- Purdue University College of Pharmacy, Indianapolis, IN, USA
| | - Joseph K. Jordan
- Butler University College of Pharmacy and Health Sciences, Indianapolis, IN, USA
| | | |
Collapse
|
23
|
Kaufman BP, Alexis AF. Biologics and Small Molecule Agents in Allergic and Immunologic Skin Diseases. Curr Allergy Asthma Rep 2018; 18:55. [PMID: 30171358 DOI: 10.1007/s11882-018-0804-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
PURPOSE OF REVIEW Biologics and small molecules are key therapeutic options in the treatment of chronic immunologic and allergic skin conditions. By directly targeting innate and inflammatory responses within the skin, including pro-inflammatory cytokines and cellular signaling pathways, these new agents have the potential to counteract the inflammatory cascade responsible for various conditions, including psoriasis and atopic dermatitis. Over the past decade, groundbreaking research identifying key cytokines and receptors involved in the pathogenesis of these diseases has allowed for the development of highly efficacious biologics and small molecules that are associated with unprecedented rates of skin clearance and favorable adverse event profiles. RECENT FINDINGS This narrative review evaluates new and upcoming biologic and small molecule agents for the treatment of two allergic/immunologic skin diseases-atopic dermatitis and psoriasis. Numerous small molecules and biologics targeting TNF-α, IL-12/23, IL-17 and IL-17R, and IL-23 are commercially available for the treatment of psoriasis, and newer agents are in various stages of development. Currently, dupilumab, a monoclonal antibody that blocks IL-4R∝, is the only approved biologic for atopic dermatitis. Antibodies targeting IL-13 and IL-31 and small molecules that inhibit Janus kinase and pruritus-mediating receptors are currently being studied in clinical trials. Further investigations into the pathophysiology of atopic dermatitis will likely yield additional therapeutic options in the future. This article reviews recent literature on small molecules and biologics for the treatment of atopic dermatitis and psoriasis.
Collapse
Affiliation(s)
- Bridget P Kaufman
- Mount Sinai St. Luke's and West, 1090 Amsterdam Avenue, Suite 11B, New York, NY, 10029, USA.
| | - Andrew F Alexis
- Mount Sinai St. Luke's and West, 1090 Amsterdam Avenue, Suite 11B, New York, NY, 10029, USA
| |
Collapse
|
24
|
Zink A, Schuster B, Rüth M, Pereira M, Philipp‐Dormston W, Biedermann T, Ständer S. Medical needs and major complaints related to pruritus in Germany: a 4‐year retrospective analysis using Google AdWords Keyword Planner. J Eur Acad Dermatol Venereol 2018; 33:151-156. [DOI: 10.1111/jdv.15200] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2018] [Accepted: 07/06/2018] [Indexed: 11/27/2022]
Affiliation(s)
- A. Zink
- Department of Dermatology and Allergy Technical University of Munich Munich Germany
| | - B. Schuster
- Department of Dermatology and Allergy Technical University of Munich Munich Germany
| | - M. Rüth
- Department of Dermatology and Allergy Technical University of Munich Munich Germany
| | - M.P. Pereira
- Center for Chronic Pruritus Department of Dermatology University Hospital Münster Münster Germany
| | | | - T. Biedermann
- Department of Dermatology and Allergy Technical University of Munich Munich Germany
| | - S. Ständer
- Center for Chronic Pruritus Department of Dermatology University Hospital Münster Münster Germany
| |
Collapse
|
25
|
Abstract
Chronic pruritus is a common condition that has a detrimental impact on quality of life. As the molecular pathogenesis of itch is elucidated, novel therapies that disrupt itch pathways are being investigated. Emerging treatments include drugs targeting the neural system, drugs targeting the immune system, antihistamines, bile acid transport inhibitors, and topical drugs that work through a variety of mechanisms such as phosphodiesterase-4 inhibition or targeting of nerve ion channels. Many of these therapies show promising results in the treatment of chronic itch of various etiologies, such as atopic dermatitis, psoriasis, uremic pruritus, and cholestatic pruritus.
Collapse
Affiliation(s)
- Matthew W McEwen
- Kaplan-Amonette Department of Dermatology, College of Medicine, University of Tennessee Health Science Center, 930 Madison Avenue, Suite 840, Memphis, TN 38163, USA
| | - Elizabeth M Fite
- Department of Dermatology, University of Tennessee Health Science Center, 930 Madison Avenue, Suite 840, Memphis, TN 38163, USA
| | - Gil Yosipovitch
- Department of Dermatology, Miami Itch Center, University of Miami, Miller School of Medicine, 1600 Northwest 10th Avenue, Rosenstiel Medical Science Building - Room 2023, Miami, FL 33136, USA
| | - Tejesh Patel
- Kaplan-Amonette Department of Dermatology, University of Tennessee Health Science Center, 930 Madison Avenue, Suite 840, Memphis, TN 38163, USA.
| |
Collapse
|
26
|
Stull DE, Griffiths CEM, Gilloteau I, Zhao Y, Guana A, Finlay AY, Sherif B, Houghton K, Puig L. Differential effects of secukinumab vs. ustekinumab for treatment of psoriasis on quality of life, work productivity and activity impairment: a structural equation modelling analysis. Br J Dermatol 2018; 178:1297-1307. [PMID: 29355896 DOI: 10.1111/bjd.16366] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/05/2018] [Indexed: 01/31/2023]
Abstract
BACKGROUND The appearance and lifelong, chronic nature of psoriasis result in considerable burden to patients, such as sleep impairment, depressive symptoms, negative self-esteem and reduced work productivity. OBJECTIVES To examine direct and indirect (mediated) effects of secukinumab vs. ustekinumab on quality of life, work productivity and activity impairment based on psoriasis severity and symptoms. METHODS Analyses were based on data from the CLEAR study. Structural equation modelling examined the effects of secukinumab vs. ustekinumab on the Dermatology Life Quality Index (DLQI) and on the Work Productivity and Activity Impairment (WPAI) questionnaire using Psoriasis Area and Severity Index (PASI) severity and symptoms (pain, itching and scaling) as potential mediators. Analyses were conducted primarily for patients achieving a PASI 90 response (90% or greater reduction in PASI from baseline) at week 16 (repeated at week 52) and for PASI 50, 75 and 100. RESULTS Results at weeks 16 and 52 showed that the effect of treatment on change in DLQI score was mediated by the PASI 90 response and by improvements in itching, pain, and scaling. Achieving any PASI response as early as week 16 directly resulted in significantly better WPAI scores. At week 52, both PASI response and improvement in scaling directly resulted in significantly better WPAI scores. Pain, itching and scaling were correlated (r = 0·51-0·68); improvement in any of these had a significant effect (directly or indirectly) on WPAI. All results favoured secukinumab over ustekinumab. CONCLUSIONS The results underscore the important role of both PASI response and reduction in symptoms on improvements in health-related quality of life and work and daily activity in favour of secukinumab vs. ustekinumab.
Collapse
Affiliation(s)
- D E Stull
- RTI Health Solutions, Research Triangle Park, NC, U.S.A
| | - C E M Griffiths
- Dermatology Centre, Salford Royal Hospital, University of Manchester, Manchester Academic Health Science Centre, The Dermatology Centre, Salford Royal NHS Foundation Trust, Barnes Building, Manchester, M6 8HD, U.K
| | | | - Y Zhao
- Sun Pharma, Cranbury, NJ, U.S.A
| | - A Guana
- Novartis Pharmaceuticals Corporation, East Hanover, NJ, U.S.A
| | - A Y Finlay
- Department of Dermatology, Cardiff University School of Medicine, Cardiff, U.K
| | - B Sherif
- RTI Health Solutions, Research Triangle Park, NC, U.S.A
| | - K Houghton
- RTI Health Solutions, Research Triangle Park, NC, U.S.A
| | - L Puig
- Department of Dermatology, Hospital de la Santa Creu i Sant Pau, Mas Casanovas 90, Block A, 5th floor, Module 3, 08041, Barcelona, Spain
| |
Collapse
|
27
|
Frieder J, Kivelevitch D, Fiore CT, Saad S, Menter A. The impact of biologic agents on health-related quality of life outcomes in patients with psoriasis. Expert Rev Clin Immunol 2017; 14:1-19. [PMID: 29110556 DOI: 10.1080/1744666x.2018.1401468] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
INTRODUCTION Psoriasis is a common, immune-mediated skin disease often associated with significant physical and psychosocial impairment. Antipsoriatic biologic agents offer patients unparalleled treatment potential in regard to greater skin clearance and overall improved quality of life. Evaluation of the therapeutic efficacy of biologic agents on the full psoriasis disease burden must account for their impact on both physical symptoms, as well as patient-reported, health-related quality of life (HRQoL) measurements. Areas covered: Results from numerous clinical trials demonstrate the significant clinical efficacy of biological agents targeting tumor necrosis factor-α (TNF-α) and the interleukin (IL)-12/23 and IL-17 immune pathways. However, relatively limited data is available evaluating their full effect on quality of life outcomes. This review will discuss the most relevant and up-to-date clinical data on HRQoL measurements related to treatment with these aforementioned biologic agents. Expert commentary: Patient-reported outcomes (i.e. Dermatology Life Quality Index) are being used with increasing frequency in clinical trials, and provide valuable information on the impact of psoriasis on numerous aspects of day-to-day living. These outcomes must also be incorporated in clinical practice, in addition to physical assessment of disease severity, treatment decisions, and therapeutic response in the psoriasis patient population.
Collapse
Affiliation(s)
- Jillian Frieder
- a Division of Dermatology , Baylor University Medical Center , Dallas , TX , USA
| | - Dario Kivelevitch
- a Division of Dermatology , Baylor University Medical Center , Dallas , TX , USA
| | - Connie Tran Fiore
- a Division of Dermatology , Baylor University Medical Center , Dallas , TX , USA
| | - Saadeddine Saad
- b Texas A&M Health Science Center College of Medicine , Bryan , TX , USA
| | - Alan Menter
- a Division of Dermatology , Baylor University Medical Center , Dallas , TX , USA
| |
Collapse
|
28
|
Sekhon S, Jeon C, Nakamura M, Yan D, Afifi L, Bhutani T, Levin E. Clinical utility of ixekizumab in the treatment of moderate-to-severe plaque psoriasis. PSORIASIS-TARGETS AND THERAPY 2017; 7:65-72. [PMID: 29387609 PMCID: PMC5774608 DOI: 10.2147/ptt.s129792] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Psoriasis vulgaris is a chronic, immune-mediated systemic disease that affectŝ7.5 million people in the US. It can be treated with many therapies, often in combination, which include topicals, phototherapy, oral systemics, and biologics. Biologic agents target specific components of the immune system involved in the pathogenesis of psoriasis including TNF-alpha, IL-12, IL-17, and IL-23. The biologic ixekizumab, approved for the treatment of moderate–severe plaque psoriasis in the US, targets IL-17. This review describes the role of IL-17 in psoriasis, the mechanism by which ixekizumab targets this cytokine, and the clinical utility of ixekizumab.
Collapse
Affiliation(s)
- Sahil Sekhon
- Department of Dermatology, University of California, San Francisco, San Francisco, CA, USA
| | - Caleb Jeon
- Department of Dermatology, University of California, San Francisco, San Francisco, CA, USA
| | - Mio Nakamura
- Department of Dermatology, University of California, San Francisco, San Francisco, CA, USA
| | - Di Yan
- Department of Dermatology, University of California, San Francisco, San Francisco, CA, USA
| | - Ladan Afifi
- Department of Dermatology, University of California, San Francisco, San Francisco, CA, USA
| | - Tina Bhutani
- Department of Dermatology, University of California, San Francisco, San Francisco, CA, USA
| | - Ethan Levin
- Department of Dermatology, University of California, San Francisco, San Francisco, CA, USA
| |
Collapse
|