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Wu S, Xu Y, Yang L, Guo L, Jiang X. Short-term risk and long-term incidence rate of infection and malignancy with IL-17 and IL-23 inhibitors in adult patients with psoriasis and psoriatic arthritis: a systematic review and meta-analysis. Front Immunol 2023; 14:1294416. [PMID: 38106423 PMCID: PMC10721978 DOI: 10.3389/fimmu.2023.1294416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Accepted: 11/10/2023] [Indexed: 12/19/2023] Open
Abstract
The risk of infection and malignancy may be a concern for patients with psoriasis receiving interleukin (IL)-17 and IL-23 inhibitors, particularly with long-term treatments. We aimed to estimate the short-term risks and long-term incidence rates of infection and malignancy with IL-17 or IL-23 antagonists in adult patients with psoriasis and psoriatic arthritis through this comprehensive meta-analysis (PROSPERO registration number: CRD42022363127). We searched PubMed, MEDLINE, Web of Science and ClinicalTrials.gov until May 17, 2023 for randomized placebo-controlled trials and long-term (≥ 52 weeks) open-label extension studies. The estimates of short-term risk ratios (RRs) and long-term exposure-adjusted incidence rates (EAIRs) were pooled using R software 4.1.1 and STATA 16.0. This review included 45 randomized placebo-controlled studies and 27 open-label extension studies. Short-term RRs of serious infection, overall infection and malignancy were 1.45 (95% confidence intervals, 95% CI: 0.81-2.59), 1.20 (95% CI: 1.06-1.35), 0.83 (95% CI: 0.41-1.71) with IL-17 inhibitors; and 0.68 (95% CI: 0.38-1.22), 1.13 (95% CI: 1.00-1.28), 0.87 (95% CI: 0.37-2.04) with IL-23 inhibitors. Increased short-term risks of nasopharyngitis and Candida infection with IL-17 inhibitors were found. Long-term EAIRs of serious infection, overall infection, nonmelanoma skin cancer (NMSC), malignancies excluding NMSC, nasopharyngitis and upper respiratory tract infection were 1.11/100 patient-years (PYs), 57.78/100PYs, 0.47/100PYs, 0.24/100PYs, 15.07/100PYs, 8.52/100PYs, 3.41/100PYs with IL-17 inhibitors; and 1.09/100PYs, 48.50/100PYs, 0.40/100PYs, 0.43/100PYs, 10.75/100PYs, 5.84/100PYs with IL-23 inhibitors. Long-term EAIR of Candida infection was 3.41/100PYs with IL-17 inhibitors. No active or reactivated tuberculosis was ever reported in all the trials, and only a few cases of latent tuberculosis, hepatitis, and herpes zoster were reported during the long-term extension periods. No evidence of increased EAIRs of infection and malignancy with longer durations was found. Our study suggested that short-term risk and long-term incidence of infections and malignancies in psoriasis patients receiving IL-17 inhibitors and IL-23 inhibitors are generally low. However, close monitoring is required for nasopharyngitis and Candida infection with IL-17 inhibitors. Systematic Review Registration https://www.crd.york.ac.uk/PROSPERO/, identifier CRD42022363127.
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Affiliation(s)
- Shuwei Wu
- Department of Dermatology, West China Hospital, Sichuan University, Chengdu, China
- Laboratory of Dermatology, Clinical Institute of Inflammation and Immunology, Frontiers Science Center for Disease-related Molecular Network, West China Hospital, Sichuan University, Chengdu, China
| | - Yuanyuan Xu
- Department of Dermatology, West China Hospital, Sichuan University, Chengdu, China
- Laboratory of Dermatology, Clinical Institute of Inflammation and Immunology, Frontiers Science Center for Disease-related Molecular Network, West China Hospital, Sichuan University, Chengdu, China
| | - Lihua Yang
- Department of Dermatology, West China Hospital, Sichuan University, Chengdu, China
- Laboratory of Dermatology, Clinical Institute of Inflammation and Immunology, Frontiers Science Center for Disease-related Molecular Network, West China Hospital, Sichuan University, Chengdu, China
| | - Linghong Guo
- Department of Dermatology, West China Hospital, Sichuan University, Chengdu, China
- Laboratory of Dermatology, Clinical Institute of Inflammation and Immunology, Frontiers Science Center for Disease-related Molecular Network, West China Hospital, Sichuan University, Chengdu, China
- Tianfu Jincheng Laboratory & Institute of Future Medical Innovation, City of Future Medicine, Chengdu, China
| | - Xian Jiang
- Department of Dermatology, West China Hospital, Sichuan University, Chengdu, China
- Laboratory of Dermatology, Clinical Institute of Inflammation and Immunology, Frontiers Science Center for Disease-related Molecular Network, West China Hospital, Sichuan University, Chengdu, China
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Salle R, Tubach F, Arlegui H, Curmin R, Viguier M, Beylot-Barry M, Dupuy A, Beneton N, Joly P, De Rycke Y, Jullien D, Mahé E, Paul C, Richard MA, Bachelez H, Zago M, Chosidow O, Sbidian É. Clinical features, therapeutic choice and response by phototype in psoriasis: analysis of the French PsoBioTeq cohort. Clin Exp Dermatol 2023; 48:1238-1246. [PMID: 37409606 DOI: 10.1093/ced/llad233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2023] [Revised: 06/22/2023] [Accepted: 07/03/2023] [Indexed: 07/07/2023]
Abstract
BACKGROUND Little is known about phototype and the response to systemic treatment in psoriasis. OBJECTIVES To assess the characteristics of psoriasis, the therapeutic choice and its efficacy according to phototype. METHODS We included patients from the PsoBioTeq cohort initiating a first biologic. Patients were classified according to their phototype. The evaluation included disease characteristics, choice of the initial biologic and therapeutic response at 12 months based on 90% improvement from baseline in Psoriasis Area and Severity Index (PASI 90) and Dermatology Life Quality Index (DLQI) 0/1. RESULTS Of the 1400 patients included, 423 (30.2%), 904 (64.6%) and 73 (5.2%) were in the phototype I-II, III-IV and V-VI groups, respectively. The V-VI group had a higher initial DLQI, and more frequently initiated ustekinumab. Patients in the V-VI group maintained the initial biologic prescribed as did the other phototype groups, even though the proportion of patients reaching PASI 90 and DLQI 0/1 at 12 months was lower in this group than the other groups. CONCLUSIONS Patient phototype seems associated with quality of life and choice of the initial biologic in psoriasis. The phototype V-VI group less frequently switched treatments than did the other groups when the response was not efficient.
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Affiliation(s)
- Romain Salle
- Department of Dermatology, Hôpital Henri Mondor, Créteil, France
| | - Florence Tubach
- Sorbonne Université, INSERM, Institut Pierre Louis d'Épidémiologie et de Santé Publique, AP-HP, Hôpital Pitié Salpêtrière, Département de Santé Publique, Centre de Pharmacoépidémiologie (Cephepi), Paris, France
| | - Hugo Arlegui
- Sorbonne Université, INSERM, Institut Pierre Louis d'Épidémiologie et de Santé Publique, AP-HP, Hôpital Pitié Salpêtrière, Département de Santé Publique, Centre de Pharmacoépidémiologie (Cephepi), Paris, France
| | - Raphaëlle Curmin
- Sorbonne Université, INSERM, Institut Pierre Louis d'Épidémiologie et de Santé Publique, AP-HP, Hôpital Pitié Salpêtrière, Département de Santé Publique, Centre de Pharmacoépidémiologie (Cephepi), Paris, France
| | - Manuelle Viguier
- Department of Dermatology and Venereology, Hôpital Robert Debré, Centre Hospitalier Universitaire (CHU) de Reims, Reims, France
| | - Marie Beylot-Barry
- Department of Dermatology, Hôpital Saint-André CHU de Bordeaux; and Bordeaux Institute of Oncology, INSERM U1312, Team 05, Université de Bordeaux, Bordeaux, France
| | - Alain Dupuy
- Department of Dermatology, CHU de Rennes; Pharmacoepidemiology and Health Services Research, Université de Rennes; and EHESP French School of Public Health, Rennes, France
| | | | - Pascal Joly
- Department of Dermatology, Rouen University Hospital, INSERM U1234, CHU Rouen Normandie, Rouen, France
| | - Yann De Rycke
- Sorbonne Université, INSERM, Institut Pierre Louis d'Épidémiologie et de Santé Publique, AP-HP, Hôpital Pitié Salpêtrière, Département de Santé Publique, Centre de Pharmacoépidémiologie (Cephepi), Paris, France
| | - Denis Jullien
- Department of Dermatology, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France
| | - Emmanuel Mahé
- Department of Dermatology, Hôpital Victor Dupouy, Argenteuil, France
| | - Carle Paul
- Department of Dermatology, INSERM Infinity U1291, Paul Sabatier University, Toulouse, France
| | | | - Hervé Bachelez
- Department of Dermatology, Hôpital Saint-Louis, AP-HP; Université Paris Diderot/Université Paris Cité; and INSERM UMR1163, Institut Imagine, Paris, France
| | - Marilyn Zago
- Sorbonne Université, INSERM, Institut Pierre Louis d'Épidémiologie et de Santé Publique, AP-HP, Hôpital Pitié Salpêtrière, Département de Santé Publique, Centre de Pharmacoépidémiologie (Cephepi), Paris, France
| | - Olivier Chosidow
- Department of Dermatology, Hôpital Henri Mondor, Créteil, France
- Facial Dermatosis Clinic, Hôpital Universitaire Pitié-Salpêtrière, Paris, France; and Université Paris-Est Créteil (UPEC), Créteil, France
| | - Émilie Sbidian
- Department of Dermatology, Hôpital Henri Mondor, Créteil, France
- Clinical Investigation Centre, Hôpital Henri Mondor, Créteil, France
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3
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Arlegui H, Mahé E, Richard MA, De Rycke Y, Viguier M, Beylot-Barry M, Dupuy A, Beneton N, Joly P, Jullien D, Bachelez H, Sbidian É, Chosidow O, Paul C, Tubach F. Impact of the first wave of the COVID-19 pandemic on the treatment of psoriasis with systemic therapies in France: Results from the PSOBIOTEQ cohort. Ann Dermatol Venereol 2023:S0151-9638(23)00009-1. [PMID: 36914553 PMCID: PMC9928748 DOI: 10.1016/j.annder.2023.01.005] [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: 08/19/2022] [Revised: 11/18/2022] [Accepted: 01/31/2023] [Indexed: 02/17/2023]
Abstract
BACKGROUND The nature of the COVID-19 pandemic led to concerns among patients and physicians about the potential impact of immunosuppressive treatments for chronic diseases such as psoriasis on the risk of severe COVID-19. OBJECTIVES To describe treatment modifications and determine the incidence of COVID-19 infection among psoriasis patients during the first wave of the pandemic, and identify the factors associated with these events. METHODS Data from PSOBIOTEQ cohort relating to the first COVID-19 wave in France (March to June, 2020), as well as a patient-centred COVID-19 questionnaire, were used to evaluate the impact of lockdown on changes (discontinuations, delays or reductions) in systemic therapies, and to determine the incidence of COVID-19 cases among these patients. Logistic regression models were used to assess associated factors. RESULTS Among the 1751 respondents (89.3%), 282 patients (16.9%) changed their systemic treatment for psoriasis, with 46.0% of these changes being initiated by the patients themselves. Patients were more likely to experience psoriasis flare-ups during the first wave if they changed their treatment during this period (58.7% vs 14.4%; P < 0.0001). Changes to systemic therapies were less frequent among patients with cardiovascular diseases (P < 0.001), and those aged ≥ 65 years (P = 0.02). Overall, 45 patients (2.9%) reported having COVID-19, and eight (17.8%) required hospitalization. Risk factors for COVID-19 infection were close contact with a positive case (P < 0.001) and living in a region with a high incidence of COVID-19 (P < 0.001). Factors associated with a lower risk of COVID-19 were avoiding seeing a physician (P = 0.002), systematically wearing a mask during outings (P = 0.011) and being a current smoker (P = 0.046). CONCLUSIONS Discontinuation of systemic psoriasis treatments during the first COVID-19 wave (16.9%) - mainly decided by patients themselves (46.0%) - was associated with a higher incidence of disease flares (58.7% vs 14.4%). This observation and factors associated with a higher risk of COVID-19 highlight the need to maintain and adapt patient-physician communication during health crises according to patient profiles, with the aim of avoiding unnecessary treatment discontinuations and ensuring that patients are informed about the risk of infection and the importance of complying with hygiene rules.
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Affiliation(s)
- H Arlegui
- AP-HP, Hôpital Pitié-Salpêtrière, Centre de Pharmaco-épidémiologie (Cephépi), INSERM, CIC-1901, Paris, France
| | - E Mahé
- Service de Dermatologie, Hôpital Victor Dupouy, Argenteuil, France
| | - M-A Richard
- Service de Dermatologie, EA 3279: CEReSS - Health Service Research and Quality of Life Centre, Timone Hospital, Assistance Publique-Hôpitaux de Marseille, Aix-Marseille University, Marseille, France
| | - Y De Rycke
- Sorbonne Université, INSERM, Institut Pierre Louis d'Épidémiologie et de Santé Publique, AP-HP, Hôpital Pitié-Salpêtrière, Département de Santé Publique, Centre de Pharmaco-épidémiologie (Cephépi), CIC-1901, 75013 Paris, France
| | - M Viguier
- Service de Dermatologie-Vénéréologie, Hôpital Robert Debré, Université Reims Champagne Ardenne, 51100 Reims, France
| | - M Beylot-Barry
- Service de Dermatologie, CHU de Bordeaux, Translational Research on Oncodermatology and Rare skin diseases, Bordeaux Institute of Oncology, UMR 1312 INSERM, Université Bordeaux, Bordeaux, France
| | - A Dupuy
- France Univ Rennes, CHU Rennes, 35000 Rennes, France
| | - N Beneton
- REPERES Pharmaco-Epidemiology and Health Services Research, University Rennes and French School of Public Health, Rennes, France
| | - P Joly
- Service de Dermatologie, Hôpital du Mans, Le Mans, France
| | - D Jullien
- Service de Dermatologie, Hospices Civils de Lyon, Edouard Herriot Hospital, Lyon F-69003; Lyon-1 University; INSERM U1111 - CIRI, Lyon F-69007, France
| | - H Bachelez
- Service de Dermatologie, Assistance Publique- Hôpitaux de Paris, Hôpital Saint-Louis, Université Paris Cité, Paris, France; INSERM UMR1163, Institut Imagine, Paris, France
| | - É Sbidian
- Service de Dermatologie, Assistance Publique- Hôpitaux de Paris, Hôpital Saint-Louis, Université Paris Cité, Paris, France; Hôpital Henri Mondor, Clinical Investigation Centre, Université Paris-Est Créteil (UPEC), Epidemiology in Dermatology and Evaluation of Therapeutics (EpiDermE) - EA 7379, Créteil, France
| | - O Chosidow
- Service de Dermatologie, Assistance Publique- Hôpitaux de Paris, Hôpital Saint-Louis, Université Paris Cité, Paris, France; Groupe de recherche Dynamyc, EA7380, Faculté de Santé de Créteil, École nationale vétérinaire d'Alfort, USC ANSES, Université Paris-Est Créteil, Créteil, France
| | - C Paul
- Service de Dermatologie, Toulouse University Hospital (CHU), Paul Sabatier University, Toulouse, France
| | - F Tubach
- Sorbonne Université, INSERM, Institut Pierre Louis d'Épidémiologie et de Santé Publique, AP-HP, Hôpital Pitié-Salpêtrière, Département de Santé Publique, Centre de Pharmaco-épidémiologie (Cephépi), CIC-1901, 75013 Paris, France.
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Curmin R, Guillo S, De Rycke Y, Bachelez H, Beylot‐Barry M, Beneton N, Chosidow O, Dupuy A, Joly P, Jullien D, Richard M, Viguier M, Sbidian E, Paul C, Mahé E, Tubach F. Switches between biologics in patients with moderate-to-severe psoriasis: results from the French cohort PSOBIOTEQ. J Eur Acad Dermatol Venereol 2022; 36:2101-2112. [PMID: 35793473 PMCID: PMC9796114 DOI: 10.1111/jdv.18409] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Accepted: 05/18/2022] [Indexed: 01/01/2023]
Abstract
BACKGROUND Biologics are the cornerstone of treatment of patients with moderate-to-severe plaque psoriasis and switches between biologics are frequently needed to maintain clinical improvement over time. OBJECTIVES The main purpose of this study was to describe precisely switches between biologics and how their pattern changed over time with the recent availability of new biologic agents. METHODS We included patients receiving a first biologic agent in the Psobioteq multicenter cohort of adults with moderate-to-severe psoriasis receiving systemic treatment. We described switches between biologics with chronograms, Sankey and Sunburst diagrams, assessed cumulative incidence of first switch by competing risks survival analysis and reasons for switching. We assessed the factors associated with the type of switch (intra-class - i.e. within the same therapeutic class - vs. inter-class) in patients switching from a TNF-alpha inhibitor using multivariate logistic regression. RESULTS A total of 2153 patients was included. The cumulative incidence of switches from first biologic was 34% at 3 years. Adalimumab and ustekinumab were the most prescribed biologic agents as first and second lines of treatment. The main reason for switching was loss of efficacy (72%), followed by adverse events (11%). Patients receiving a TNF-alpha inhibitor before 2016 mostly switched to ustekinumab, whereas those switching in 2016 or after mostly switched to an IL-17 inhibitor. Patients switching from a first-line TNF-alpha inhibitor before 2016 were more likely to switch to another TNF-alpha inhibitor compared with patients switching since 2018. Patients switching from etanercept were more likely to receive another TNF-alpha inhibitor rather than another therapeutic class of bDMARD compared with patients switching from adalimumab. CONCLUSION This study described the switching patterns of biologic treatments and showed how they changed over time, due to the availability of the new biologic agents primarily IL-17 inhibitors.
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Affiliation(s)
- R. Curmin
- Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé PubliqueParisFrance
| | - S. Guillo
- INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, AP‐HP, Hôpital Pitié Salpêtrière, Département de Santé Publique, Centre de Pharmacoépidémiologie (Cephepi)Sorbonne UniversitéParisFrance
| | - Y. De Rycke
- INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, AP‐HP, Hôpital Pitié Salpêtrière, Département de Santé Publique, Centre de Pharmacoépidémiologie (Cephepi)Sorbonne UniversitéParisFrance
| | - H. Bachelez
- Dermatologie, AP‐HP Hôpital Saint LouisParisFrance,Sorbonne Paris Cité Universitaire Paris DiderotParisFrance,UMR INSERM 1163, Institut ImagineParisFrance
| | - M. Beylot‐Barry
- Dermatologie CHU Bordeaux & INSERM U 1053Bordeaux UniversityBordeauxFrance
| | | | - O. Chosidow
- Dermatologie, AP‐HP, Hôpitaux universitaires Henri Mondor, Département de Dermatologie, UPEC, INSERM, Centre d'Investigation Clinique 1430, EA 7379 EpidermEUniversité Paris‐Est Créteil, UPECCréteilFrance
| | - A. Dupuy
- DermatologieCHU PontchaillouRennesFrance
| | - P. Joly
- DermatologieCHU RouenRouenFrance
| | - D. Jullien
- Dermatologie, Hospices Civils de Lyon, Hôpital E. HerriotUniversité Lyon‐1LyonFrance
| | - M.A. Richard
- Dermatologie, EA 3279: CEReSS ‐ Health Service Research and Quality of Life Center, Timone Hospital, Assistance Publique Hôpitaux de MarseilleAix‐Marseille UniversityMarseilleFrance
| | - M. Viguier
- Dermatologie‐VénéréologieHôpital Robert DebréReimsFrance
| | - E. Sbidian
- Dermatologie, AP‐HP, Hôpitaux universitaires Henri Mondor, Département de Dermatologie, UPEC, INSERM, Centre d'Investigation Clinique 1430, EA 7379 EpidermEUniversité Paris‐Est Créteil, UPECCréteilFrance
| | - C. Paul
- DermatologieCHU and Toulouse UniversityToulouseFrance
| | - E. Mahé
- DermatologieHôpital Victor DupouyArgenteuilFrance
| | - F. Tubach
- INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, AP‐HP, Hôpital Pitié Salpêtrière, Département de Santé Publique, Centre de Pharmacoépidémiologie (Cephepi)Sorbonne UniversitéParisFrance
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5
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Mahé E, Tubach F, Jullien D, Tran D, Paul C, Beylot-Barry M, Dupuy A, Viguier M, Richard MA, Sbidian E, Beneton N, Joly P, Chosidow O, Bachelez H. Impact of Childhood Onset Psoriasis on Addictive Behaviours, Socioeconomic and Educational Data in Adulthood. Acta Derm Venereol 2022; 102:adv00733. [DOI: 10.2340/actadv.v102.2484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Paediatric psoriasis has been associated with school absenteeism, limitation of physical activities, psychiatric disorders and, in the longer term, with sexual dysfunction and addictions. This raises the hypothesis that childhood onset psoriasis may affect patients’ educational development, and further social and professional outcomes. This study evaluated the relationship between childhood onset psoriasis and patients’ educational and socioeconomic characteristics, and the development of addictions in adulthood. This cross-sectional ancillary study captured patients’ characteristics at baseline in the French PSOBIOTEQ registry. Data in adulthood included: educational (baccalaureate) and socioeconomic (working activity) groups, smoking status (self-reporting of being a current smoker vs past smoker or non-smoker), alcohol consumption (defined as at least 1 glass of alcoholic beverage per day), and living conditions (alone/family/social institutions; child at home). A total of 1,960 patients were included, of whom 26.2% had childhood onset psoriasis. In multivariate analyses, childhood onset psoriasis was associated with smoker status (p = 0.02). No association was observed with educational level, working activity, living conditions, or alcohol consumption. This study provides reassuring data overall with regard to the impact of childhood onset psoriasis on major social outcomes. Evidence for some association with addictive behaviours paves the way for larger prospective studies assessing in depth the social and educational impact of this disease.
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Amici JM, Bergqvist C, Ly S, Corgibet F, Seï JF, Seneschal J, Sbidian E, Beylot-Barry M. CITY-PSO: Prescribing behaviour of French private-practice dermatologists in psoriasis management: An observational, multicentre, cross-sectional study. Ann Dermatol Venereol 2022; 149:169-175. [PMID: 35181154 DOI: 10.1016/j.annder.2022.01.001] [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: 07/24/2021] [Revised: 10/24/2021] [Accepted: 01/04/2022] [Indexed: 12/01/2022]
Abstract
BACKGROUND Information regarding the prescribing behaviour of French private-practice dermatologists (PPDs) is scarce. OBJECTIVES First, to describe the population of PPDs involved in psoriasis management. Second, to describe the population of adult patients treated for psoriasis and their management. METHODS We published a call for participation targeting PPDs; we first asked respondents to complete a form regarding their prescribing behaviour, and then to include consecutive patients consulting for psoriasis during a one-month study period and to collect patient data. RESULTS The 94 participating PPDs included 1022 patients of mean age 52.9±17.9 years. The average body mass index was 28, and 25% had vascular comorbidities. Two thirds of patients had chronic psoriasis, for which 45% had consulted at least 5 times. Psoriasis was mostly with plaques (70.8%) and 11.4% of patients had psoriatic arthritis. The average body surface area (BSA) affected was 10.1%. Among the 679 patients without initial systemic treatment, 159 were started on systemic treatment. The main agents initiated were phototherapy (n=63), methotrexate (n=40), acitretin (n=30) and apremilast (n=20). In multivariate analysis, a higher BSA [Odds Ratio (OR) 1.10, 95% Confidence Interval (CI): 1.07-1.13; P<10-4] and Dermatology Life Quality Index (DLQI) [OR 1.09, 95% CI: 1.03-1.15; P=0.04] were associated with prescription of systemic therapy at the end of the consultation. CONCLUSION The main limitation of our study was that participating PPDs were strongly involved in psoriasis management, which accounts for the high proportion of moderate-to-severe psoriasis and prescription of systemic treatments. Such committed PPDs and the development of psoriasis networks are key factors for improving the quality of care provided to psoriasis patients.
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Affiliation(s)
- J-M Amici
- Association des Dermato-Vénéréologues du Sud-Ouest (ADVSO, Association of Dermatologists and Venerologists of the French South-West), Maison de la Dermatologie, 8, rue Jules Ferry, 33290 Blanquefort, France; Dermatology department, Bordeaux university hospital, 33000 Bordeaux, France
| | - C Bergqvist
- CIC 1430 Inserm, Dermatology department, Henri-Mondor hospital, Assistance publique-Hôpitaux de Paris (AP-HP), 94000 Créteil, France
| | - S Ly
- Association des Dermato-Vénéréologues du Sud-Ouest (ADVSO, Association of Dermatologists and Venerologists of the French South-West), Maison de la Dermatologie, 8, rue Jules Ferry, 33290 Blanquefort, France; Dermatology department, Bordeaux university hospital, 33000 Bordeaux, France
| | - F Corgibet
- Fédération française de formation continue et d'évaluation en dermatologie et vénéréologie (FFFCEDV, French Federation of Continuing Education and Assessment in Dermatology), Maison de la Dermatologie, 10, cité Malesherbes, 75009 Paris, France
| | - J-F Seï
- Fédération française de formation continue et d'évaluation en dermatologie et vénéréologie (FFFCEDV, French Federation of Continuing Education and Assessment in Dermatology), Maison de la Dermatologie, 10, cité Malesherbes, 75009 Paris, France
| | - J Seneschal
- Dermatology department, Bordeaux university hospital, 33000 Bordeaux, France
| | - E Sbidian
- CIC 1430 Inserm, Dermatology department, Henri-Mondor hospital, Assistance publique-Hôpitaux de Paris (AP-HP), 94000 Créteil, France; EpiDermE, Paris-Est Créteil university, Val-de-Marne, 94000 Créteil, France
| | - M Beylot-Barry
- Dermatology department, Bordeaux university hospital, 33000 Bordeaux, France.
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7
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Bettuzzi T, Bachelez H, Beylot-Barry M, Arlégui H, Paul C, Viguier M, Mahé E, Beneton N, Jullien D, Richard MA, Joly P, Tubach F, Dupuy A, Sbidian E, Chosidow O. Evolution of Drug Survival with Biological Agents and Apremilast Between 2012 and 2018 in Psoriasis Patients from the PsoBioTeq Cohort. Acta Derm Venereol 2021; 102:adv00665. [PMID: 34806759 PMCID: PMC9631244 DOI: 10.2340/actadv.v101.566] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Drug survival reflects treatment effectiveness and safety in real life. There is limited data on the variation of drug survival with the availability of systemic treatments with additional biological disease-modifying antirheumatic drugs (bDMARDs) or synthetic disease-modifying antirheumatic drugs (sDMARDs). The aim of this study was to determine whether the increasing number of available systemic treatments for psoriasis affects drug survival over time. Patients were selected from the PsoBioTeq cohort, a French prospective observational cohort enrolling patients with moderate to severe psoriasis. All patients initiating a first bDMARD or sDMARD were included. The primary outcome was comparison of drug survival over time. A multivariate Cox proportional hazard ratio model was computed. A total of 1,866 patients were included; 739 females (39%), median age 47 years. In the multivariate Cox model, no association was found between the calendar year of initiation and drug survival (hazard ratio) overlapping from 0.80 (0.42–1.52) to 1.17 (0.64–2.17), p = 0.633). In conclusion, drug survival in psoriasis is not affected by the year of initiation.
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Affiliation(s)
- Thomas Bettuzzi
- Service de Dermatologie, Assistance Publique-Hôpitaux de Paris, Hôpital Henri-Mondor, Université Paris-Est, Créteil, France.
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Penso L, Dray-Spira R, Weill A, Pina Vegas L, Zureik M, Sbidian E. Association Between Biologics Use and Risk of Serious Infection in Patients With Psoriasis. JAMA Dermatol 2021; 157:1056-1065. [PMID: 34287624 DOI: 10.1001/jamadermatol.2021.2599] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Importance Biologics and targeted therapies, such as apremilast, are efficient treatments to manage moderate to severe psoriasis. More information about the risk of serious infection is needed for the newest treatment options in a real-world setting. Objective To assess the risk of serious infection among biologics and apremilast used to treat psoriasis, with etanercept as the comparator. Design, Setting, and Participants This nationwide cohort study from France involved data from the National Health Data System covering approximately 99% of the French population. All adults with psoriasis, defined as receiving at least 2 prescriptions of a topical vitamin D derivative within a 2-year period, registered in the database between January 1, 2008, and May 31, 2019, were eligible. The study population included those who were new users of biologic agents or apremilast (ie, without any prescriptions of a biologic or apremilast during the previous year). Patients with HIV infection or a history of cancer, transplant, or serious infection were excluded. End of follow-up was January 31, 2020. Main Outcome Measures The primary end point was a serious infection in a time-to-event analysis using propensity score-weighted Cox proportional hazards regression models, estimating weighted hazard ratios (wHRs) and 95% CIs. Results A total of 44 239 new users of biologic treatment were identified (mean [SD] age, 48.4 [13.8] years; 22 866 [51.7%] men; median follow-up, 12 months [interquartile range, 7-24 months]). A total of 29 618 (66.9%) were prescribed a tumor necrosis factor inhibitor first, 6658 (15.0%) an interleukin (IL) 12/23 inhibitor, 4093 (9.3%) an IL-17 inhibitor, 526 (1.2%) an IL-23 inhibitor, and 3344 (7.6%) apremilast. The total number of serious infections was 1656, and the overall crude incidence rate was 25.0 (95% CI, 23.8-26.2) per 1000 person-years. The most frequent serious infections were gastrointestinal infections (645 patients [38.9%]). After adjusting for time-dependent covariables, risk of serious infections was higher for new users of adalimumab (wHR, 1.22; 95% CI, 1.07-1.38) or infliximab (wHR, 1.79; 95% CI 1.49-2.16) vs etanercept, whereas ustekinumab was associated with a lower risk of having a serious infection (wHR, 0.79; 95% CI, 0.67-0.94). Risk of serious infections was not increased for new users of IL-17 and the IL-23 inhibitor guselkumab or apremilast vs etanercept. Risk of serious infections was increased with concomitant nonsteroidal anti-inflammatory drugs or systemic corticosteroids. Conclusions and Relevance In this cohort study of individuals with moderate to severe psoriasis, risk of serious infections was increased in new users of infliximab and adalimumab vs etanercept, whereas ustekinumab users had lower risk of having a serious infection but not new users of IL-17 and IL-23 inhibitors or apremilast. Other observational studies are needed to confirm results for the most recent drugs.
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Affiliation(s)
- Laetitia Penso
- Groupement d'intérêt scientifique Epidémiologie des produits de santé, L'Agence Nationale de Sécurité du Médicament et des Produits de Santé -Caisse Nationale de l'Assurance Maladie, Paris, France.,Epidémiologie en Dermatologie et Evaluation des Thérapeutiques, Université Paris-Est Creteil, Créteil, France
| | - Rosemary Dray-Spira
- Groupement d'intérêt scientifique Epidémiologie des produits de santé, L'Agence Nationale de Sécurité du Médicament et des Produits de Santé -Caisse Nationale de l'Assurance Maladie, Paris, France
| | - Alain Weill
- Groupement d'intérêt scientifique Epidémiologie des produits de santé, L'Agence Nationale de Sécurité du Médicament et des Produits de Santé -Caisse Nationale de l'Assurance Maladie, Paris, France.,Caisse Nationale d'Assurance Maladie des Travailleurs Salariés, Paris, France
| | - Laura Pina Vegas
- Epidémiologie en Dermatologie et Evaluation des Thérapeutiques, Université Paris-Est Creteil, Créteil, France.,Département de Rhumatologie, Assistance Publique-Hôpitaux de Paris, Hôpitaux universitaires Henri Mondor, Créteil, France
| | - Mahmoud Zureik
- Groupement d'intérêt scientifique Epidémiologie des produits de santé, L'Agence Nationale de Sécurité du Médicament et des Produits de Santé -Caisse Nationale de l'Assurance Maladie, Paris, France.,INSERM, Echappement aux anti-infectieux et Pharmacoépidémiologie, Centre de recherche en épidémiologie et santé des populations, Université de Versailles Saint-Quentin-en-Yvelines, Montigny le Bretonneux, France
| | - Emilie Sbidian
- Groupement d'intérêt scientifique Epidémiologie des produits de santé, L'Agence Nationale de Sécurité du Médicament et des Produits de Santé -Caisse Nationale de l'Assurance Maladie, Paris, France.,Epidémiologie en Dermatologie et Evaluation des Thérapeutiques, Université Paris-Est Creteil, Créteil, France.,Département de Dermatologie, Assistance Publique-Hôpitaux de Paris, Hôpitaux universitaires Henri Mondor, Université Paris-Est Creteil, Créteil, France.,INSERM, Centre d'Investigation Clinique 1430, Créteil, France
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9
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Penso L, Bergqvist C, Meyer A, Herlemont P, Weill A, Zureik M, Dray-Spira R, Sbidian E. Risk of inflammatory bowel disease in patients with psoriasis, psoriatic arthritis and ankylosing spondylitis initiating interleukin 17 inhibitors: a nationwide population-based study using the French national health data system. Arthritis Rheumatol 2021; 74:244-252. [PMID: 34279061 DOI: 10.1002/art.41923] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Revised: 05/14/2021] [Accepted: 07/08/2021] [Indexed: 11/07/2022]
Abstract
OBJECTIVES To investigate whether IL17-inhibitors (IL17i) initiation in real life is associated with a higher risk of inflammatory bowel disease (IBD) in patients with psoriasis (PsO), psoriatic arthritis and ankylosing spondylitis (PsA/AS). METHODS This nationwide cohort study involved the French national health data system database. All adults with PsO and PsA/AS who were new-users of IL17i during 2016-2019 were included. Two non-exposed PsO and PsA/AS population were included: new-users of (1) apremilast and (2) etanercept. End of follow-up was September 30, 2019. The primary end-point was an occurrence of IBD in a time-to-event analysis with propensity score-weighted Cox and Fine-Gray models. RESULTS A total of 16,793 IL17i new-users (mean age 48.4±13 years; 46% men); 20,556 apremilast new-users (mean age 52.5±14.6 years; 53% men); and 10,245 etanercept new-users (mean age 46.3±15 years; 44% men) were included. Previous systemic treatements were closer between IL17i and etanercept compared with apremilast. IBD occurred in 132 cases: 72 (0.43%) in IL17i new-users, 11 (0.05%) in apremilast new-users and 49 (0.48%) in etanercept new-users. Most IBD cases occurred after 6 months of exposure (82%, 55% and 76% respectively). After propensity score weighting, the risk of IBD was significantly greater with IL17i than apremilast (HRw 3.8, 95%CI 2.1-6.8). No difference was observed between IL17i and etanercept new-users (HRw 0.8, 95%CI 0.5-1.2). CONCLUSION Compared with patients initiating etanercept that displayed the same severity of the underlying disease, IL17i new-users did not present a higher risk of IBD. These results need to be confirmed in other large databases.
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Affiliation(s)
- Laëtitia Penso
- EPI-PHARE Scientific Interest Group in Epidemiology of Health Products, French National Agency for the Safety of Medicines and Health Products, French National Health Insurance.,EpiDermE, Université Paris Est Créteil, F-94010, Créteil, France
| | - Christina Bergqvist
- EPI-PHARE Scientific Interest Group in Epidemiology of Health Products, French National Agency for the Safety of Medicines and Health Products, French National Health Insurance.,Department of Dermatology, Assistance Publique-Hôpitaux de Paris, Henri Mondor Hospital, F-94010, Créteil, France
| | - Antoine Meyer
- EPI-PHARE Scientific Interest Group in Epidemiology of Health Products, French National Agency for the Safety of Medicines and Health Products, French National Health Insurance.,Department of Gastroenterology and Hepatology, Assistance Publique-Hôpitaux de Paris, Hôpital Bicêtre, Université Paris Sud, France
| | - Philippe Herlemont
- EPI-PHARE Scientific Interest Group in Epidemiology of Health Products, French National Agency for the Safety of Medicines and Health Products, French National Health Insurance
| | - Alain Weill
- EPI-PHARE Scientific Interest Group in Epidemiology of Health Products, French National Agency for the Safety of Medicines and Health Products, French National Health Insurance
| | - Mahmoud Zureik
- EPI-PHARE Scientific Interest Group in Epidemiology of Health Products, French National Agency for the Safety of Medicines and Health Products, French National Health Insurance.,University Paris-Saclay, UVSQ, Univ. Paris-Sud, Anti-infective evasion and pharmacoepidemiology, CESP, 78180, Montigny le Bretonneux, France
| | - Rosemary Dray-Spira
- EPI-PHARE Scientific Interest Group in Epidemiology of Health Products, French National Agency for the Safety of Medicines and Health Products, French National Health Insurance
| | - Emilie Sbidian
- EPI-PHARE Scientific Interest Group in Epidemiology of Health Products, French National Agency for the Safety of Medicines and Health Products, French National Health Insurance.,EpiDermE, Université Paris Est Créteil, F-94010, Créteil, France.,Department of Dermatology, Assistance Publique-Hôpitaux de Paris, Henri Mondor Hospital, F-94010, Créteil, France.,INSERM, Centre d'Investigation Clinique 1430, F-94010, Créteil, France
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10
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Beylot-Barry M, Seneschal J, Tran D, Bachelez H, Beneton N, Dupuy A, Joly P, Jullien D, Mahé E, Paul C, Richard MA, Sbidian E, Viguier M, Chosidow O, Tubach F. Characteristics of patients with psoriasis with Psoriasis Area and Severity Index < 10 treated with biological agents: results from the French PsoBioTeq cohort. Br J Dermatol 2021; 185:1052-1054. [PMID: 34128543 DOI: 10.1111/bjd.20585] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 06/13/2021] [Accepted: 06/13/2021] [Indexed: 01/20/2023]
Affiliation(s)
- M Beylot-Barry
- Dermatology Department, Bordeaux University Hospital, Bordeaux, France
| | - J Seneschal
- Dermatology Department, Bordeaux University Hospital, Bordeaux, France
| | - D Tran
- INSERM, Pierre Louis Institute for Epidemiology and Public Health, AP-HP, Paris, France.,Sorbonne University, Pitié Salpêtrière Hospitals, Public Health Department, Pharmacoepidemiology Centre, CIC-1422, Paris, France
| | - H Bachelez
- Dermatology Department, Saint-Louis Hospital, AP-HP, Université de Paris, Paris, France
| | - N Beneton
- Dermatology Department, Le Mans Hospital, Le Mans, France
| | - A Dupuy
- Dermatology Department, Rennes University Hospital, Rennes, France
| | - P Joly
- Dermatology Department, Rouen University Hospital, Rouen, France
| | - D Jullien
- Dermatology Department, Edouard Herriot Hospital, Lyon, France
| | - E Mahé
- Dermatology Department, Victor Dupouy Hospital, Argenteuil, France
| | - C Paul
- Dermatology Department, Toulouse University and University Hospital, Toulouse, France
| | - M-A Richard
- Dermatology Department, Marseille University Hospital, Marseille, France
| | - E Sbidian
- Dermatology Department, AP-HP, Henri Mondor University Hospitals, Paris-Est Créteil University, INSERM CIC1430, Créteil, France.,EpiDermE EA7379, Créteil, France
| | - M Viguier
- Dermatology-Venereology Department, Reims University Hospital, Reims, France
| | - O Chosidow
- Dermatology Department, AP-HP, Henri Mondor University Hospitals, Paris-Est Créteil University, INSERM CIC1430, Créteil, France.,Research Group Dynamic, EA7380, Créteil Health Faculty, Alfort National Veterinary School, USC ANSES, Paris-Est Créteil University, Créteil, France
| | - F Tubach
- INSERM, Pierre Louis Institute for Epidemiology and Public Health, AP-HP, Paris, France.,Sorbonne University, Pitié Salpêtrière Hospitals, Public Health Department, Pharmacoepidemiology Centre, CIC-1422, Paris, France
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11
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Bergqvist C, Stern R, Chosidow O. Psoriasis: an example of the complexity of decision making. Br J Dermatol 2021; 185:195-197. [DOI: 10.1111/bjd.19715] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Revised: 12/06/2020] [Accepted: 12/07/2020] [Indexed: 02/04/2023]
Affiliation(s)
- C. Bergqvist
- Département de Dermatologie AP‐HPHôpitaux universitaires Henri MondorUPEC CréteilF‐94010France
| | - R.S. Stern
- Beth Israel Deaconess Medical CenterHarvard Medical School Boston MA USA
| | - O. Chosidow
- Département de Dermatologie AP‐HPHôpitaux universitaires Henri MondorUPEC CréteilF‐94010France
- Research Group Dynamic EA7380 Faculté de Santé de Créteil Ecole nationale vétérinaire d’AlfortUSC ANSESUniversité Paris‐Est Créteil Créteil France
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12
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Mahe E, Moumane SH, Foist M. Topical medications for chronic plaque psoriasis: A 3-year longitudinal study in France. Dermatol Ther 2021; 34:e14781. [PMID: 33455063 DOI: 10.1111/dth.14781] [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: 09/28/2020] [Revised: 11/24/2020] [Accepted: 12/21/2020] [Indexed: 11/28/2022]
Abstract
Topical treatments are first-line therapies, prescribed to most patients with chronic plaque psoriasis. This non-interventional, longitudinal study examined data regarding the treatment pathways of French patients with psoriasis vulgaris using a pharmacy database. From this database, patients with an initial prescription of a topical treatment of interest (ie, calcipotriol alone and/or calcipotriol/betamethasone) between March and October 2013 were included in the study. The primary objective was to capture the switch from a topical treatment, from treatment initiation to receipt of a systemic therapy over a period of 3 years. A total of 26 605 patients were included in the study. The mean age was 58.5 years. The majority of patients (94.7%) maintained topical treatment during the 3 years, receiving a mean of 1.1 different therapies. Of 1400 patients who switched to a systemic therapy, 93.1% switched to a non-biological (mean time to switching >400 days), maintaining this for the remainder of the follow-up period. The most commonly prescribed first non-biological systemic therapy was methotrexate (37%). Less than 1% of patients switched to a biological therapy during follow up. Cohort analyses suggest that patients progressing to use of a systemic therapy within 12 months were those with more severe disease. There was a low rate of transition from topical to systemic therapies in patients with chronic plaque psoriasis during the first 3 years of treatment, suggesting stability of disease severity over time with topical therapy alone, potentially due to good patient adherence.
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Affiliation(s)
- Emmanuel Mahe
- Department of Dermatology, Victor Dupouy Hospital, Paris, France
| | | | - Murielle Foist
- Medical Department, LEO Pharma, Voisins-Le-Bretonneux, France
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13
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Abstract
INTRODUCTION Hispanic/Latino populations are more likely to have extensive psoriasis than the non-Hispanic/Latino population. Biologics are indicated for moderate/severe psoriasis or psoriasis with comorbidities. No studies have assessed ethnicity as a predictor of biologic utilization. We aimed to determine if biologic utilization differs between Latinos and non-Latinos with psoriasis. METHODS This study utilizes data from the National Ambulatory Medical Care Survey (NAMCS) from 2003 to 2016. Psoriasis visits were selected by International Classification of Diseases, Ninth or Tenth Revision (ICD-9/ICD-10) classification. The primary outcome is biologic use at the time of visit. RESULTS Of 1202 psoriasis visits, Latinos consisted of 9.7% (95% Confidence Interval 7.3-12) of the study population and 65% (95%CI 61-69) used private insurance. Multivariate analysis reveals the increased likelihood of biologic utilization in Latinos compared to non-Latinos (Odds Ratio (OR) 2.4, 95% CI 1.1-5.4, p = .03). Independently, private insurance status is associated with increased biologic use compared to public insurance (OR 2.4, 95% CI 1.2-5.0, p = .02). Private insurance status did not differ between Latinos and non-Latinos with psoriasis (OR 1.0, 95% CI 0.5-1.9, p = .98). CONCLUSIONS Hispanic/Latino ethnicity and private insurance status are independent predictors of biologic utilization, suggesting that biologic mechanisms may influence the increased use of biologics in Latinos with psoriasis.
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Affiliation(s)
- Tammy Gonzalez
- Department of Dermatology, University of Cincinnati School of Medicine, Cincinnati, OH, USA
| | - Alan B Fleischer
- Department of Dermatology, University of Cincinnati School of Medicine, Cincinnati, OH, USA
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14
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Grodner C, Sbidian E, Weill A, Mezzarobba M. Epidemiologic study in a real‐world analysis of patients with treatment for psoriasis in the French national health insurance database. J Eur Acad Dermatol Venereol 2020; 35:411-416. [DOI: 10.1111/jdv.16566] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Accepted: 04/03/2020] [Indexed: 12/22/2022]
Affiliation(s)
- C. Grodner
- Département de Dermatologie AP‐HP Hôpitaux Universitaires Henri Mondor UPEC Créteil France
| | - E. Sbidian
- GIS‐EPIPHARE, Groupement d’intérêt scientifique Epidémiologie des produits de santé ANSM‐CNAM Paris France
- Centre d’Investigation Clinique 1430 INSERM Créteil France
- EA 7379 EpidermE Université Paris‐Est Créteil UPEC Créteil France
| | - A. Weill
- GIS‐EPIPHARE, Groupement d’intérêt scientifique Epidémiologie des produits de santé ANSM‐CNAM Paris France
- Caisse Nationale d’Assurance Maladie des Travailleurs Salariés (CNAM) Paris France
| | - M. Mezzarobba
- Caisse Nationale d’Assurance Maladie des Travailleurs Salariés (CNAM) Paris France
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15
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A Six-Year Analysis of Biological Therapy for Severe Psoriasis in a Lithuanian Reference Centre of Dermatovenereology. ACTA ACUST UNITED AC 2020; 56:medicina56060275. [PMID: 32512854 PMCID: PMC7353857 DOI: 10.3390/medicina56060275] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 05/29/2020] [Accepted: 06/02/2020] [Indexed: 12/23/2022]
Abstract
Background and Objectives: Biological therapy is widely used for the treatment of severe psoriasis. The objective of this study was to evaluate the efficacy and safety of biological therapy for patients with severe psoriasis. Materials and Methods: A retrospective study of 79 patients with severe psoriasis, who have been treated with biological therapy between 2012 and 2018, was conducted. During this study, the following data were collected and evaluated: sex, age, body mass index (BMI), duration of illness, the results of treatment with biological therapy, concomitant therapy, Psoriasis Area and Severity Index (PASI) and adverse events. Results: In total, 74.7% (n = 59) of subjects were male. Their overall average age was 47.4 ± 11.4 (range: 18–73) years. Their baseline BMI was 27.6 ± 5.9, which increased to 29.6 ± 4.5 after 6 years of treatment. The mean duration of psoriasis was 25.7 ± 12.5 years. In total, 39.2% (n = 31) of subjects received infliximab, 36.7% (n = 29)—etanercept, 24.1% (n = 19)—ustekinumab. The treatment duration for infliximab, etanercept and ustekinumab was 201.6 ± 86.8, 156.2 ± 137.4 and 219.1 ± 95.7 weeks (p < 0.01), respectively. Overall, 65.8% (n = 52) of subjects were also on methotrexate; 30.8% (n = 16) of them discontinued it due to clinical improvement (31.3% (n = 5)), impaired liver function (31.3% (n = 5)), and intolerance (25% (n = 4)). Baseline PASI was 20.8 ± 8.8. PASI 50 was achieved by 96.2% (n = 76) of patients at week 11, PASI 75 by 86.1% (n = 68) at week 16, PASI 90 by 54.4% (n = 43) at week 35, and PASI 100 by 13.9% (n = 11) at week 33. The overall incidence rate of adverse events was 0.362 per patient year of follow-up. Conclusion: Biological therapy is an effective and safe treatment for patients with severe psoriasis.
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16
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Zangrilli A, Bavetta M, Bianchi L. Adalimumab in children and adolescents with severe plaque psoriasis: a safety evaluation. Expert Opin Drug Saf 2020; 19:433-438. [PMID: 32250180 DOI: 10.1080/14740338.2020.1752659] [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] [Indexed: 02/08/2023]
Abstract
Introduction: Psoriasis is a chronic inflammatory systemic disease that affects 2% of the population and is associated with an important physical and physiological burden. About 0.5-2% of psoriatic cases onset during the pediatric age range, and often it's not diagnosed until adulthood. Adalimumab is an antitumor necrosis factor monoclonal antibody approved for use in children in 2008 and now it was used in several diseases in rheumatology, gastroenterology, and in dermatology.Areas covered: The purpose of this article was to summarize what has been described in the literature so far, about safety in the use of adalimumab in pediatric psoriasis. The presented data was extrapolated from a literature review from PubMed searches (using words 'pediatric psoriasis,' 'adalimumab children,' 'adalimumab safety,' 'pediatric psoriasis treatment,' 'adalimumab clinical trial'), treatment guidelines, and reports from European and United States regulatory agencies.Expert opinion: Actually there are some biologic agents for the treatment of pediatric psoriasis, but the lack of safety data from controlled trials is evident. The safety data on the use of adalimumab in pediatric psoriasis was taken from long-term studies in the adult population. These studies confirm the data on the safety of the drug as it is also supported by several works on real-life.
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Affiliation(s)
- A Zangrilli
- Dermatology Unit, University of Rome "Tor Vergata", Rome, Italy
| | - M Bavetta
- Dermatology Unit, University of Rome "Tor Vergata", Rome, Italy
| | - L Bianchi
- Dermatology Unit, University of Rome "Tor Vergata", Rome, Italy
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17
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Reddy V, Myers B, Brownstone N, Thibodeaux Q, Chan S, Liao W, Bhutani T. Update on Sleep and Pulmonary Comorbidities in Psoriasis. CURRENT DERMATOLOGY REPORTS 2020. [DOI: 10.1007/s13671-020-00293-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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18
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Peralta C, Hamid P, Batool H, Al Achkar Z, Maximus P. Psoriasis and Metabolic Syndrome: Comorbidities and Environmental and Therapeutic Implications. Cureus 2019; 11:e6369. [PMID: 31938651 PMCID: PMC6957052 DOI: 10.7759/cureus.6369] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Psoriasis (PS) is an incessant, fiery skin sickness characterized by erythematous plaques with thick silvery scales, white or red patches of the skin, which encompasses several immunological, biomolecular, genetic, and environmental factors that may lead to further development of metabolic syndrome (MS) and vice versa. Metabolic syndrome is composed of multiple components (high blood pressure, abdominal obesity, glucose intolerance, and dyslipidemia) of risk factors that arise primarily from insulin resistance, mostly mediated by inflammatory cytokines, such as tumor necrosis factor alpha (TNF-α), interleukin-6 (IL-6) together with leptin and adiponectin, which are molecules also found in PS. The incidence, severity, and poor prognosis of the psoriatic diseases could be influenced by cardiometabolic diseases, which are controllable or preventable with intense lifestyle modification such as diet, exercise, and weight control. We performed a far-reaching writing search of different databases as part of this review; 47 investigations were regarded as important based on our search. Fasting, proper weight management, and special diet modifications seemed to have a positive impact on the management of PS. This review agrees with previous literature that nutritionists and specialists of preventive medicine should play a central role in the evaluation and management of psoriatic patients. We recommended that the management of this disease should focus on the environmental factors first instead of the genetic and immunologic pathways.
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Affiliation(s)
- Cesar Peralta
- Internal Medicine, California Institute of Behavioral Neuroscience and Psychology, Fairfield, USA
| | - Pousette Hamid
- Neurology, California Institute of Behavioral Neurosciences and Psychology, Fairfield, USA
| | - Humera Batool
- Internal Medicine, California Institute of Behavorial Neurosciences and Psychology, Fairfield, USA
| | - Zeina Al Achkar
- Internal Medicine, California Institute of Behavioral Neuroscience and Pshycology, Fairfield, USA
| | - Pierre Maximus
- Internal Medicine, California Institute of Behavioral Neuroscience and Psychology, Fairfield, USA
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Th1, Th17, and Treg Responses are Differently Modulated by TNF-α Inhibitors and Methotrexate in Psoriasis Patients. Sci Rep 2019; 9:7526. [PMID: 31101850 PMCID: PMC6525159 DOI: 10.1038/s41598-019-43899-9] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Accepted: 04/18/2019] [Indexed: 11/23/2022] Open
Abstract
Psoriasis is a chronic, recurrent, immune-mediated, hyperproliferative inflammatory skin disease. The role of the adaptive immune system, particularly of Th1 and Th17 lymphocytes, has been regarded as prominent in the immunopathogenesis of psoriasis, as well as decreased Tregs function. Immunobiological drugs were administered in therapeutic pulses and a few studies evaluate their effects on the immune repertoire. The aim of this study was to evaluate the adaptive immune profile of patients with severe psoriasis under immunobiological treatment in two time points. Thirty-two psoriasis patients and 10 control patients were evaluated. In the group of psoriasis patients, 10 patients were on anti-TNF and 14 patients on methotrexate treatment, while 8 individuals were not treated. IL-17, IFN-γ, TNF-α, IL-6, IL-2, and IL-10 were analyzed. CD4 T cell intracellular cytokines were analyzed. It was observed that stimulation could significantly increase the production of IL-17, IFN-γ, TNF-α, and IL-10 only before anti-TNF pulse therapy. The activation of Th1 and Treg cells after stimulation was significantly higher before anti-TNF pulse. Patients on methotrexate or anti-TNF therapy produced significantly lower levels of TNF-α, IL-10, and IL-6. Furthermore, these patients showed a significant decrease in the activated CD4+ T cells. The treatment with immunomodulator or methotrexate modulates the activation of CD4+ T cells, and anti-TNF treatment appears to have a modulating effect on the activation and production of Th1, Th17, and Treg cells.
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20
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Phan C, Beauchet A, Burztejn A, Severino‐Freire M, Barbarot S, Girard C, Lasek A, Reguiai Z, Hadj‐Rabia S, Abasq C, Brenaut E, Droitcourt C, Perrussel M, Mallet S, Phan A, Lacour J, Khemis A, Bourrat E, Chaby G, Deborde R, Plantin P, Maruani A, Piram M, Maccari F, Fougerousse A, Kupfer‐Bessaguet I, Balguérie X, Barthelemy H, Martin L, Quiles‐Tsimaratos N, Mery‐Brossard L, Pallure V, Lons‐Danic D, Bouilly‐Auvray D, Beylot‐Barry M, Puzenat E, Aubin F, Mahé E. Biological treatments for paediatric psoriasis : a retrospective observational study on biological drug survival in daily practice in childhood psoriasis. J Eur Acad Dermatol Venereol 2019; 33:1984-1992. [DOI: 10.1111/jdv.15579] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Accepted: 02/27/2019] [Indexed: 02/06/2023]
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Guignant M, Mahé E, Duval-Modeste AB, Vermersch-Langlin A. [Psoriasis and HIV infection, what do French dermatologists do?]. Ann Dermatol Venereol 2019; 146:265-272. [PMID: 30833038 DOI: 10.1016/j.annder.2019.01.008] [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: 06/13/2018] [Revised: 11/14/2018] [Accepted: 01/07/2019] [Indexed: 10/27/2022]
Abstract
BACKGROUND The prevalence of psoriasis among patients presenting human immunodeficiency virus (HIV)infection is the same as in the general population, but the disease is more severe and refractory, and management is more complex. The aim of this survey was to assess the practices of French dermatologists concerning both screening for HIV in psoriasis patients and therapeutic management and follow-up of psoriasis patients with HIV. PATIENTS AND METHODS An anonymous national survey of practices was conducted by means of a questionnaire emailed to dermatologists in hospital in private practice in France between March and June 2017. RESULTS The questionnaire was completed by 262 dermatologists. They indicated that they carried out screening for HIV in psoriasis patients presenting risk factors (79.4%), prior to biotherapy (63.4%) or different systemic treatments other than retinoids (53.1%), if the psoriasis was severe (45.8%), or in the event of worsening (37.8%). 28.7% of practitioners surveyed were in fact treating patients with psoriasis and HIV, with a mean 3.1 patients being followed up. All practitioners prescribe systemic treatment, other than cyclosporine, but they frequently consult an infectious disease specialist before prescribing these therapies. The most widely used biotherapy was etanercept (65.5% of practitioners). More intensive laboratory follow-up was conducted for these patients in 72.1% of cases. CONCLUSION French dermatologists do not perform routine screening for HIV in psoriasis patients. However, where infection has been identified, their practices are modified accordingly. Therapeutic choices are consistent with the French recommendations. Nevertheless, recommendations appear necessary concerning HIV screening in this population.
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Affiliation(s)
- M Guignant
- Service de dermatologie, centre hospitalier universitaire Charles-Nicolle, 1, rue de Germont, 76031 Rouen cedex, France.
| | - E Mahé
- Service de dermatologie, hôpital Victor-Dupouy, 69, rue du Lieutenant-ColonelPrud'hon, 95100 Argenteuil, France
| | - A-B Duval-Modeste
- Service de dermatologie, centre hospitalier universitaire Charles-Nicolle, 1, rue de Germont, 76031 Rouen cedex, France
| | - A Vermersch-Langlin
- Service de dermatologie/IST, hôpital-Jean Bernard, avenue Desandrouin, 59322 Valenciennes cedex, France
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- Service de dermatologie, centre hospitalier universitaire Charles-Nicolle, 1, rue de Germont, 76031 Rouen cedex, France; Service de dermatologie, hôpital Victor-Dupouy, 69, rue du Lieutenant-ColonelPrud'hon, 95100 Argenteuil, France; Service de dermatologie/IST, hôpital-Jean Bernard, avenue Desandrouin, 59322 Valenciennes cedex, France
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22
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Tournier A, Khemis A, Maccari F, Reguiai Z, Bégon E, Fougerousse AC, Amy de la Breteque M, Beneton N, Parier J, Boyé T, Avenel-Audran M, Girard C, Pallure V, Perrot JL, Bastien M, Mahé E, Beauchet A. Methotrexate efficacy and tolerance in plaque psoriasis. A prospective real-life multicentre study in France. Ann Dermatol Venereol 2019; 146:106-114. [DOI: 10.1016/j.annder.2018.11.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2018] [Revised: 08/28/2018] [Accepted: 11/21/2018] [Indexed: 12/28/2022]
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Affiliation(s)
- Mina Amin
- Department of Medicine, Kaiser Permanente Los Angeles Medical Center, Los Angeles, CA, USA
| | - Erica B. Lee
- John A. Burns School of Medicine, University of Hawaii, Honolulu, HI, USA
| | - Tina Bhutani
- Department of Dermatology, University of California, San Francisco, CA, USA
| | - Jashin J. Wu
- Department of Dermatology, Kaiser Permanente Los Angeles Medical Center, Los Angeles, CA, USA
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24
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Gordon KB, Strober B, Lebwohl M, Augustin M, Blauvelt A, Poulin Y, Papp KA, Sofen H, Puig L, Foley P, Ohtsuki M, Flack M, Geng Z, Gu Y, Valdes JM, Thompson EHZ, Bachelez H. Efficacy and safety of risankizumab in moderate-to-severe plaque psoriasis (UltIMMa-1 and UltIMMa-2): results from two double-blind, randomised, placebo-controlled and ustekinumab-controlled phase 3 trials. Lancet 2018; 392:650-661. [PMID: 30097359 DOI: 10.1016/s0140-6736(18)31713-6] [Citation(s) in RCA: 405] [Impact Index Per Article: 67.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2018] [Revised: 07/18/2018] [Accepted: 07/19/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND Risankizumab is a humanised IgG1 monoclonal antibody that binds to the p19 subunit of interleukin-23, inhibiting this key cytokine and its role in psoriatic inflammation. We aimed to assess the efficacy and safety of risankizumab compared with placebo or ustekinumab in patients with moderate-to-severe chronic plaque psoriasis. METHODS UltIMMa-1 and UltIMMa-2 were replicate phase 3, randomised, double-blind, placebo-controlled and active comparator-controlled trials done at 139 sites in Australia, Austria, Belgium, Canada, Czech Republic, France, Germany, Japan, Mexico, Poland, Portugal, South Korea, Spain, and the USA. Eligible patients were 18 years or older, with moderate-to-severe chronic plaque psoriasis. In each study, patients were stratified by weight and previous exposure to tumour necrosis factor inhibitor and randomly assigned (3:1:1) by use of interactive response technology to receive 150 mg risankizumab, 45 mg or 90 mg ustekinumab (weight-based per label), or placebo. Following the 16-week double-blind treatment period (part A), patients initially assigned to placebo switched to 150 mg risankizumab at week 16; other patients continued their originally randomised treatment (part B, double-blind, weeks 16-52). Study drug was administered subcutaneously at weeks 0 and 4 during part A and at weeks 16, 28, and 40 during part B. Co-primary endpoints were proportions of patients achieving a 90% improvement in the Psoriasis Area Severity Index (PASI 90) and a static Physician's Global Assessment (sPGA) score of 0 or 1 at week 16 (non-responder imputation). All efficacy analyses were done in the intention-to-treat population. These trials are registered with ClinicalTrials.gov, numbers NCT02684370 (UltIMMa-1) and NCT02684357 (UltIMMa-2), and have been completed. FINDINGS Between Feb 24, 2016, and Aug 31, 2016, 506 patients in UltIMMa-1 were randomly assigned to receive 150 mg risankizumab (n=304), 45 mg or 90 mg ustekinumab (n=100), or placebo (n=102). Between March 1, 2016, and Aug 30, 2016, 491 patients in UltIMMa-2 were randomly assigned to receive 150 mg risankizumab (n=294), 45 mg or 90 mg ustekinumab (n=99), or placebo (n=98). Co-primary endpoints were met for both studies. At week 16 of UltIMMa-1, PASI 90 was achieved by 229 (75·3%) patients receiving risankizumab versus five (4·9%) receiving placebo (placebo-adjusted difference 70·3% [95% CI 64·0-76·7]) and 42 (42·0%) receiving ustekinumab (ustekinumab-adjusted difference 33·5% [22·7-44·3]; p<0·0001 vs placebo and ustekinumab). At week 16 of UltIMMa-2, PASI 90 was achieved by 220 (74·8%) patients receiving risankizumab versus two (2·0%) receiving placebo (placebo-adjusted difference 72·5% [95% CI 66·8-78·2]) and 47 (47·5%) receiving ustekinumab (ustekinumab-adjusted difference 27·6% [16·7-38·5]; p<0·0001 vs placebo and ustekinumab). In UltIMMa-1, sPGA 0 or 1 at week 16 was achieved by 267 (87·8%) patients receiving risankizumab versus eight (7·8%) receiving placebo (placebo-adjusted difference 79·9% [95% CI 73·5-86·3]) and 63 (63·0%) receiving ustekinumab (ustekinumab-adjusted difference 25·1% [15·2-35·0]; p<0·0001 vs placebo and ustekinumab). In UltIMMa-2, 246 (83·7%) patients receiving risankizumab versus five (5·1%) receiving placebo (placebo-adjusted difference 78·5% [95% CI 72·4-84·5]) and 61 (61·6%) receiving ustekinumab achieved sPGA 0 or 1 at week 16 (ustekinumab-adjusted difference 22·3% [12·0-32·5]; p<0·0001 vs placebo and ustekinumab). The frequency of treatment-emergent adverse events in UltIMMa-1 and UltIMMa-2 was similar across risankizumab (part A: 151 [49·7%] of 304 and 134 [45·6%] of 294; part B: 182 [61·3%] of 297 and 162 [55·7%] of 291), placebo (part A: 52 [51·0%] of 102 and 45 [45·9%] of 98), ustekinumab (part A: 50 [50·0%] of 100 and 53 [53·5%] of 99; part B: 66 [66·7%] of 99 and 70 [74·5%] of 94), and placebo to risankizumab (part B: 65 [67·0%] of 97 and 61 [64·9%] of 94) treatment groups throughout the study duration. INTERPRETATION Risankizumab showed superior efficacy to both placebo and ustekinumab in the treatment of moderate-to-severe plaque psoriasis. Treatment-emergent adverse event profiles were similar across treatment groups and there were no unexpected safety findings. FUNDING AbbVie and Boehringer Ingelheim.
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Affiliation(s)
| | - Bruce Strober
- University of Connecticut Health Center and Probity Medical Research, Farmington, CT, USA
| | - Mark Lebwohl
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | | | | | - Yves Poulin
- Centre Dermatologique du Québec Métropolitain, Québec, QC, Canada
| | - Kim A Papp
- K Papp Clinical Research and Probity Medical Research, Waterloo, ON, Canada
| | - Howard Sofen
- University of California, Los Angeles, CA, USA; School of Medicine, Los Angeles, CA, USA
| | - Lluís Puig
- Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Peter Foley
- University of Melbourne, Parkville, Skin & Cancer Foundation Inc, Carlton, Probity Medical Research, Carlton, and St Vincent's Hospital Melbourne, Fitzroy VIC, Australia
| | | | - Mary Flack
- Boehringer Ingelheim Pharmaceuticals, Ridgefield, CT, USA
| | | | | | | | | | - Hervé Bachelez
- Saint-Louis Hospital, AP-HP, Sorbonne Paris Cité Université Paris Diderot, INSERUM UMR 1163, Institut Imagine, Paris, France.
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Talamonti M, Galluzzo M, Bernardini N, Caldarola G, Persechino S, Cantoresi F, Egan C, Potenza C, Peris K, Bianchi L. Psoriasis Area and Severity Index response in moderate-severe psoriatic patients switched to adalimumab: results from the OPPSA study. J Eur Acad Dermatol Venereol 2018; 32:1737-1744. [DOI: 10.1111/jdv.15077] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Accepted: 05/04/2018] [Indexed: 01/13/2023]
Affiliation(s)
- M. Talamonti
- Department of Dermatology; University of Rome ‘Tor Vergata’; Rome Italy
| | - M. Galluzzo
- Department of Dermatology; University of Rome ‘Tor Vergata’; Rome Italy
| | - N. Bernardini
- Department of Medical and Surgical Sciences and Biotechnologies; Division of Dermatology ‘Daniele Innocenzi’; University of Rome ‘La Sapienza’; Polo Pontino Italy
| | - G. Caldarola
- Institute of Dermatology; Catholic University of the Sacred Heart; Rome Italy
| | - S. Persechino
- Department of Dermatology; NESMOS Unit; Sant'Andrea Hospital; Sapienza University of Rome; Rome Italy
| | - F. Cantoresi
- Department of Dermatology; Policlinico Umberto I; ‘Sapienza’ University of Rome; Rome Italy
| | | | - C. Potenza
- Department of Medical and Surgical Sciences and Biotechnologies; Division of Dermatology ‘Daniele Innocenzi’; University of Rome ‘La Sapienza’; Polo Pontino Italy
| | - K. Peris
- Institute of Dermatology; Catholic University of the Sacred Heart; Rome Italy
| | - L. Bianchi
- Department of Dermatology; University of Rome ‘Tor Vergata’; Rome Italy
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Carrera CG, Dapavo P, Malagoli P, Naldi L, Arancio L, Gaiani F, Egan CG, Di Mercurio M, Cattaneo A. PACE study: real-life Psoriasis Area and Severity Index (PASI) 100 response with biological agents in moderate-severe psoriasis. J DERMATOL TREAT 2017; 29:481-486. [DOI: 10.1080/09546634.2017.1395805] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Affiliation(s)
- Carlo Giovanni Carrera
- U.O. Dermatologia, Fondazione IRCCS Cà Granda – Ospedale Maggiore Policlinico, Milan, Italy
| | - Paolo Dapavo
- Department of Medical Sciences, Section of Dermatology, University of Turin, Turin, Italy
| | | | - Luigi Naldi
- U.O.C. Dermatologia, Ospedale San Bortolo – Azienda ULSS8, Berica (VI), Italy
| | - Luisa Arancio
- U.O. Dermatologia, Fondazione IRCCS Cà Granda – Ospedale Maggiore Policlinico, Milan, Italy
| | - Francesca Gaiani
- Dermatology Unit, Azienda Ospedaliera San Donato Milanese, Milan, Italy
| | | | | | - Angelo Cattaneo
- U.O. Dermatologia, Fondazione IRCCS Cà Granda – Ospedale Maggiore Policlinico, Milan, Italy
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