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Eviatar T, Furer V, Polachek A, Zisman D, Peleg H, Elalouf O, Levartovsky D, Kaufman I, Broyde A, Haddad A, Feld J, Aassi M, Quebe-Fehling E, Alarcon I, Pel S, Paran D, Elkayam O. Effect of Secukinumab and Tumor Necrosis Factor Inhibitors on Humoral Response to BNT162b2 mRNA Vaccine in Patients With Spondyloarthritis Compared to Immunocompetent Controls. J Rheumatol 2024; 51:415-422. [PMID: 37914221 DOI: 10.3899/jrheum.2023-0357] [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] [Accepted: 10/06/2023] [Indexed: 11/03/2023]
Abstract
OBJECTIVE To assess the humoral response to the BNT162b2 mRNA vaccine among patients with spondyloarthritis (SpA) receiving secukinumab (SEC) compared to those receiving tumor necrosis factor inhibitors (TNFi) and immunocompetent controls. METHODS Consecutive patients with psoriatic arthritis or axial SpA receiving SEC (n = 37) or TNFi (monotherapy, n = 109; + methotrexate [MTX], n = 16), immunocompetent controls (n = 122), and patients with rheumatoid arthritis (RA) receiving TNFi therapy (controls, n = 50) were vaccinated with 2 or 3 doses of the BNT162b2 vaccine. We evaluated humoral response, adverse events, and disease activity, and monitored for breakthrough coronavirus disease 2019 (COVID-19) postvaccination. RESULTS The 2-dose vaccine regimen induced a comparable seropositive response in all study groups. S1/S2 antibody titers (in binding antibody units/mL; mean [SD]) were higher in the SEC group vs the TNFi + MTX-SpA and TNFi-RA groups (192.5 [68.4] vs 104.6 [46.9], P < 0.001, and 143.1 [81.9], P = 0.004). After 6 months, 96.3%, 96.6%, and 80.9% of the SEC, immunocompetent, and TNFi monotherapy-SpA groups (P = 0.10), respectively; 66.7% of the TNFi + MTX-SpA group (P = 0.03); and 63% of the TNFi-RA group (P = 0.004) remained seropositive. S1/S2 antibody titer decline was steeper in the TNFi groups than the SEC group. After the third dose, 100% of the SpA and immunocompetent and 88.9% of the TNFi-RA (P = 0.25) groups were seropositive. Rate of breakthrough COVID-19 infection was higher in the TNFi groups than in the SEC group (36-37.5% vs 10.8%). No significant between-group differences were observed for postvaccination disease activity and adverse events. CONCLUSION SEC did not interfere with the immunogenic response to BNT162b2 vaccine in patients with SpA; however, TNFi therapy was associated with lower S1/S2-antibody titers, faster decline, and higher rate of breakthrough infections.
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Affiliation(s)
- Tali Eviatar
- T. Eviatar, MD, V. Furer, MD, A. Polachek, MD, O. Elalouf, MD, D. Levartovsky, MD, I. Kaufman, MD, A. Broyde, MD, S. Pel, MPH, D. Paran, MD, O. Elkayam, MD, Rheumatology Department, Tel Aviv Sourasky Medical Center and Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel;
| | - Victoria Furer
- T. Eviatar, MD, V. Furer, MD, A. Polachek, MD, O. Elalouf, MD, D. Levartovsky, MD, I. Kaufman, MD, A. Broyde, MD, S. Pel, MPH, D. Paran, MD, O. Elkayam, MD, Rheumatology Department, Tel Aviv Sourasky Medical Center and Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ari Polachek
- T. Eviatar, MD, V. Furer, MD, A. Polachek, MD, O. Elalouf, MD, D. Levartovsky, MD, I. Kaufman, MD, A. Broyde, MD, S. Pel, MPH, D. Paran, MD, O. Elkayam, MD, Rheumatology Department, Tel Aviv Sourasky Medical Center and Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Devy Zisman
- D. Zisman, MD, A. Haddad, MD, J. Feld, MD, Rheumatology Unit, Carmel Hospital, and Faculty of Medicine, Technion Israel Institute of Technology, Haifa, Israel
| | - Hagit Peleg
- H. Peleg, MD, Rheumatology Unit, Hadassah University Hospital, and the Hebrew University of Jerusalem Faculty of Medicine, Jerusalem, Jerusalem, Israel
| | - Ofir Elalouf
- T. Eviatar, MD, V. Furer, MD, A. Polachek, MD, O. Elalouf, MD, D. Levartovsky, MD, I. Kaufman, MD, A. Broyde, MD, S. Pel, MPH, D. Paran, MD, O. Elkayam, MD, Rheumatology Department, Tel Aviv Sourasky Medical Center and Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - David Levartovsky
- T. Eviatar, MD, V. Furer, MD, A. Polachek, MD, O. Elalouf, MD, D. Levartovsky, MD, I. Kaufman, MD, A. Broyde, MD, S. Pel, MPH, D. Paran, MD, O. Elkayam, MD, Rheumatology Department, Tel Aviv Sourasky Medical Center and Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ilana Kaufman
- T. Eviatar, MD, V. Furer, MD, A. Polachek, MD, O. Elalouf, MD, D. Levartovsky, MD, I. Kaufman, MD, A. Broyde, MD, S. Pel, MPH, D. Paran, MD, O. Elkayam, MD, Rheumatology Department, Tel Aviv Sourasky Medical Center and Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Adi Broyde
- T. Eviatar, MD, V. Furer, MD, A. Polachek, MD, O. Elalouf, MD, D. Levartovsky, MD, I. Kaufman, MD, A. Broyde, MD, S. Pel, MPH, D. Paran, MD, O. Elkayam, MD, Rheumatology Department, Tel Aviv Sourasky Medical Center and Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Amir Haddad
- D. Zisman, MD, A. Haddad, MD, J. Feld, MD, Rheumatology Unit, Carmel Hospital, and Faculty of Medicine, Technion Israel Institute of Technology, Haifa, Israel
| | - Joy Feld
- D. Zisman, MD, A. Haddad, MD, J. Feld, MD, Rheumatology Unit, Carmel Hospital, and Faculty of Medicine, Technion Israel Institute of Technology, Haifa, Israel
| | - Maher Aassi
- M. Aassi, MD, E. Quebe-Fehling, PhD, I. Alarcon, MD, Novartis Pharma AG, Medical Affairs, Basel, Switzerland
| | - Erhard Quebe-Fehling
- M. Aassi, MD, E. Quebe-Fehling, PhD, I. Alarcon, MD, Novartis Pharma AG, Medical Affairs, Basel, Switzerland
| | - Ivette Alarcon
- M. Aassi, MD, E. Quebe-Fehling, PhD, I. Alarcon, MD, Novartis Pharma AG, Medical Affairs, Basel, Switzerland
| | - Sara Pel
- T. Eviatar, MD, V. Furer, MD, A. Polachek, MD, O. Elalouf, MD, D. Levartovsky, MD, I. Kaufman, MD, A. Broyde, MD, S. Pel, MPH, D. Paran, MD, O. Elkayam, MD, Rheumatology Department, Tel Aviv Sourasky Medical Center and Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Daphna Paran
- T. Eviatar, MD, V. Furer, MD, A. Polachek, MD, O. Elalouf, MD, D. Levartovsky, MD, I. Kaufman, MD, A. Broyde, MD, S. Pel, MPH, D. Paran, MD, O. Elkayam, MD, Rheumatology Department, Tel Aviv Sourasky Medical Center and Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ori Elkayam
- T. Eviatar, MD, V. Furer, MD, A. Polachek, MD, O. Elalouf, MD, D. Levartovsky, MD, I. Kaufman, MD, A. Broyde, MD, S. Pel, MPH, D. Paran, MD, O. Elkayam, MD, Rheumatology Department, Tel Aviv Sourasky Medical Center and Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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2
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Narbutt J, Żuber Z, Lesiak A, Bień N, Szepietowski JC. Vaccinations in Selected Immune-Related Diseases Treated with Biological Drugs and JAK Inhibitors-Literature Review and Statement of Experts from Polish Dermatological Society. Vaccines (Basel) 2024; 12:82. [PMID: 38250895 PMCID: PMC10820194 DOI: 10.3390/vaccines12010082] [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: 12/19/2023] [Revised: 01/08/2024] [Accepted: 01/09/2024] [Indexed: 01/23/2024] Open
Abstract
The growing use of biological drugs in immune-mediated chronic diseases has undoubtedly revolutionized their treatment. Yet, the topic of vaccinations in this group of patients still raises many concerns and implies many therapeutic problems that require discussion and standardization of management. The aim of this literature review is to present current knowledge regarding safety and efficacy of vaccinations in dermatological and rheumatological patients treated with biological drugs and JAK inhibitors. Additionally, this article provides recommendation from experts of the Polish Dermatological Society about proper use of vaccinations during therapy with biologics. Generally, all live attenuated vaccines are contraindicated during immunosuppressive/immunomodulatory therapy. If there is need, they should be administered long enough prior to the therapy or after cessation. Yet, inactivated vaccines mostly can be safely used, but the problem in this case is the effectiveness of the vaccination. Most studies report that the immune response in patients on biologics after administration of different inactivated vaccines is similar to or even better than in the control group. Thus, the importance of vaccination among patients on biologics must be emphasized to reduce omissions and the fear of possible side effects or insufficient post-vaccination response.
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Affiliation(s)
- Joanna Narbutt
- Department of Dermatology, Pediatric Dermatology and Oncology Clinic, Medical University of Lodz, 90-419 Lodz, Poland; (J.N.); (A.L.)
| | - Zbigniew Żuber
- Department of Pediatrics, Faculty of Medicine and Health Sciences, Andrzej Frycz Modrzewski Krakow University, 30-705 Krakow, Poland;
| | - Aleksandra Lesiak
- Department of Dermatology, Pediatric Dermatology and Oncology Clinic, Medical University of Lodz, 90-419 Lodz, Poland; (J.N.); (A.L.)
| | - Natalia Bień
- Department of Dermatology, Pediatric Dermatology and Oncology Clinic, Medical University of Lodz, 90-419 Lodz, Poland; (J.N.); (A.L.)
| | - Jacek C. Szepietowski
- Department of Dermatology, Venereology and Allergology, Wroclaw Medical University, 50-368 Wroclaw, Poland;
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3
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van Sleen Y, van der Geest KSM, Huckriede ALW, van Baarle D, Brouwer E. Effect of DMARDs on the immunogenicity of vaccines. Nat Rev Rheumatol 2023; 19:560-575. [PMID: 37438402 DOI: 10.1038/s41584-023-00992-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/08/2023] [Indexed: 07/14/2023]
Abstract
Vaccines are important for protecting individuals at increased risk of severe infections, including patients undergoing DMARD therapy. However, DMARD therapy can also compromise the immune system, leading to impaired responses to vaccination. This Review focuses on the impact of DMARDs on influenza and SARS-CoV-2 vaccinations, as such vaccines have been investigated most thoroughly. Various data suggest that B cell depletion therapy, mycophenolate mofetil, cyclophosphamide, azathioprine and abatacept substantially reduce the immunogenicity of these vaccines. However, the effects of glucocorticoids, methotrexate, TNF inhibitors and JAK inhibitors on vaccine responses remain unclear and could depend on the dosage and type of vaccination. Vaccination is aimed at initiating robust humoral and cellular vaccine responses, which requires efficient interactions between antigen-presenting cells, T cells and B cells. DMARDs impair these cells in different ways and to different degrees, such as the prevention of antigen-presenting cell maturation, alteration of T cell differentiation and selective inhibition of B cell subsets, thus inhibiting processes that are necessary for an effective vaccine response. Innovative modified vaccination strategies are needed to improve vaccination responses in patients undergoing DMARD therapy and to protect these patients from the severe outcomes of infectious diseases.
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Affiliation(s)
- Yannick van Sleen
- Department of Rheumatology and Clinical Immunology, University Medical Center Groningen, Groningen, the Netherlands.
| | - Kornelis S M van der Geest
- Department of Rheumatology and Clinical Immunology, University Medical Center Groningen, Groningen, the Netherlands
| | - Anke L W Huckriede
- Department of Medical Microbiology and Infection Prevention, University Medical Center Groningen, Groningen, the Netherlands
| | - Debbie van Baarle
- Department of Medical Microbiology and Infection Prevention, University Medical Center Groningen, Groningen, the Netherlands
| | - Elisabeth Brouwer
- Department of Rheumatology and Clinical Immunology, University Medical Center Groningen, Groningen, the Netherlands.
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4
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Messas T, Lim RK, Burns L, Yumeen S, Kroumpouzos G. A critical review of COVID-19 course and vaccination in dermatology patients on immunomodulatory/biologic therapy: recommendations should not differ between non-pregnant and pregnant individuals. Front Med (Lausanne) 2023; 10:1121025. [PMID: 37332768 PMCID: PMC10272467 DOI: 10.3389/fmed.2023.1121025] [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: 12/10/2022] [Accepted: 04/24/2023] [Indexed: 06/20/2023] Open
Abstract
COVID-19 can have detrimental effects on immunosuppressed patients. Here, we evaluate the evidence regarding continuing immunomodulatory/biologic (IMBI) therapy in pregnant dermatology patients during the COVID-19 pandemic. Also, we discuss the risks of COVID-19 vaccination in pregnant dermatology patients on IMBI therapy. As indicated in this review, regarding continuing IMBI therapy in pregnant dermatology patients during the pandemic, there is no compelling reason for treating them differently than non-pregnant. The body of evidence indicates that mRNA COVID-19 vaccines are safe during pregnancy. Studies on rheumatology patients, a group that overlaps significantly with the dermatology group, provided essential findings. IMBI in a non-pregnant rheumatology patient was not associated with COVID-19 mortality (except for rituximab), and vaccination of the rheumatology patient during pregnancy improved the obstetric outcomes compared to the unvaccinated patient. Based on this data, it can be stated that after weighing the benefit-risk profile of the available COVID-19 vaccines, the recommendation for the pregnant dermatology patient speaks in favor of the COVID-19 vaccination. COVID-19 vaccine recommendations in pregnant dermatology patients on IMBI should not differ from those for their non-pregnant counterparts.
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Affiliation(s)
- Tassahil Messas
- Department of Dermatology, University Hospital Centre, University of Constantine III, Constantine, Algeria
| | - Rachel K. Lim
- Alpert Medical School, Brown University, Providence, RI, United States
| | - Laura Burns
- Department of Dermatology, Alpert Medical School, Brown University, Providence, RI, United States
| | - Sara Yumeen
- Department of Dermatology, Alpert Medical School, Brown University, Providence, RI, United States
| | - George Kroumpouzos
- Department of Dermatology, Alpert Medical School, Brown University, Providence, RI, United States
- GK Dermatology, PC, South Weymouth, MA, United States
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5
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Aryanian Z, Balighi K, Afshar ZM, Zamanian MH, Razavi Z, Hatami P. COVID vaccine recommendations in dermatologic patients on immunosuppressive agents: Lessons learned from pandemic. J Cosmet Dermatol 2022; 21:6568-6573. [PMID: 36214611 PMCID: PMC9874417 DOI: 10.1111/jocd.15448] [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: 06/06/2022] [Revised: 09/08/2022] [Accepted: 10/06/2022] [Indexed: 01/27/2023]
Abstract
BACKGROUND Since SARS-CoV2 vaccines were approved without enough long-term monitoring due to emergent situations, some issues have been raised about timing and protocol of receiving them by patients treated by different immunosuppressive agents. AIM AND METHOD Here, we present different aspects of SARS-CoV-2 vaccination in such patients in the field of dermatology. RESULT In brief, SARS-CoV-2 vaccination is recommended in all dermatologic patients, regardless of their disorders and therapeutic regimens. Nevertheless, special considerations should be given to the immunosuppressive therapy and its association with vaccination timing due to the decreased immunogenicity of vaccines in this setting. CONCLUSION Novel biologic immunotherapies are advantageous over conventional systemic therapies not only in their safety and selective functions but also in this aspect that many of them do not affect vaccines immunogenicity.
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Affiliation(s)
- Zeinab Aryanian
- Autoimmune Bullous Diseases Research CenterTehran University of Medical SciencesTehranIran,Department of DermatologyBabol University of Medical SciencesBabolIran
| | - Kamran Balighi
- Autoimmune Bullous Diseases Research CenterTehran University of Medical SciencesTehranIran,Department of Dermatology, School of Medicine Razi HospitalTehran University of Medical SciencesTehranIran
| | - Zeinab Mohseni Afshar
- Clinical Research Development Center, Imam Reza HospitalKermanshah University of Medical SciencesKermanshahIran,Department of Infectious Disease, School of Medicine, Imam Reza HospitalKermanshah University of Medical SciencesKermanshahIran
| | - Mohammad Hossein Zamanian
- Department of Infectious Disease, School of Medicine, Imam Reza HospitalKermanshah University of Medical SciencesKermanshahIran
| | - Zahra Razavi
- Autoimmune Bullous Diseases Research CenterTehran University of Medical SciencesTehranIran,Department of Dermatology, School of Medicine Razi HospitalTehran University of Medical SciencesTehranIran
| | - Parvaneh Hatami
- Autoimmune Bullous Diseases Research CenterTehran University of Medical SciencesTehranIran
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6
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Fan R, Cohen JM. Vaccination Recommendations for Psoriasis and Atopic Dermatitis Patients on Biologic Therapy: A Practical Guide. THE YALE JOURNAL OF BIOLOGY AND MEDICINE 2022; 95:249-255. [PMID: 35782480 PMCID: PMC9235258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Novel biologic therapies have revolutionized the treatment of psoriasis and atopic dermatitis. Although they are generally safe, they are immunomodulatory and therefore unique considerations apply in regards to infections and vaccine administration. This review aims to provide a clear and practical guide for dermatologists or other healthcare providers to reference when caring for psoriasis or atopic dermatitis patients being treated with biologic therapies using currently available guidelines and clinical data. Vaccinations for approved biologics including TNFα, IL-12/23, IL-23, IL-17, and IL-4/13 inhibitors will be discussed, with a special note on current COVID-19 vaccination recommendations.
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Affiliation(s)
- Ryan Fan
- Yale School of Medicine, New Haven, CT, USA
| | - Jeffrey M. Cohen
- Department of Dermatology, Yale School of Medicine, New
Haven, CT, US,To whom all correspondence should be addressed:
Jeffrey M. Cohen, MD, Department of Dermatology, 15 York St, New Haven, CT
06510;
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Martire B, Ottaviano G, Sangerardi M, Sgrulletti M, Chini L, Dellepiane RM, Montin D, Rizzo C, Pignata C, Marseglia GL, Moschese V. Vaccinations in Children and Adolescents Treated With Immune-Modifying Biologics: Update and Current Developments. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2022; 10:1485-1496. [PMID: 35085809 DOI: 10.1016/j.jaip.2022.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Revised: 01/13/2022] [Accepted: 01/13/2022] [Indexed: 06/14/2023]
Abstract
Treatment with immune-modifying biologics has positively impacted disease control and quality of life in many patients with immune-mediated disorders. However, the higher susceptibility to common and opportunistic pathogens is of concern. Thus, immunization strategies to control vaccine-preventable diseases represent a critical issue in this population. However, limited data exist on the safety, immunogenicity, and efficacy of available vaccines in patients on biologics, particularly in children. Here, according to published literature and real-life experience and practice, we report the interim indications of the Italian Society of Pediatric Allergology and Immunology (SIAIP) Vaccine Committee and of the Italian Primary Immunodeficiency Network (IPINet) Centers on immunization of children and adolescents receiving biologics. Our aim is to provide a practical guidance for the clinician to ensure optimal protection for patients and the community.
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Affiliation(s)
- Baldassarre Martire
- Pediatrics and Neonatology Unit, Maternal-Infant Department, Monsignor A. R. Dimiccoli Hospital, Barletta, Italy.
| | - Giorgio Ottaviano
- Molecular and Cellular Immunology Unit, Great Ormond Street Institute of Child Health, University College of London, London, UK
| | - Maria Sangerardi
- Department of Pediatrics and Emergency, Pediatric Hospital, Policlinico - University of Bari, Bari, Italy
| | - Mayla Sgrulletti
- Pediatric Immunopathology and Allergology Unit, University of Rome, Tor Vergata, Policlinico Tor Vergata, Rome, Italy
| | - Loredana Chini
- Pediatric Immunopathology and Allergology Unit, University of Rome, Tor Vergata, Policlinico Tor Vergata, Rome, Italy
| | - Rosa Maria Dellepiane
- Pediatric Intermediate Care Unit, Scientific Institute for Research, Hospitalization and Healthcare Foundation (IRCSS); Ca Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Davide Montin
- Department of Public Health and Pediatrics, Regina Margherita Children Hospital, University of Turin, Turin, Italy
| | - Caterina Rizzo
- Innovation and Clinical Pathways Unit, Bambino Gesù Children Hospital, IRCCS, Rome, Italy
| | - Claudio Pignata
- Department of Translational Medical Sciences-Section of Pediatrics, Federico II University of Naples, Naples, Italy
| | - Gian Luigi Marseglia
- Department of Pediatrics, IRCCS Foundation, Policlinico San Matteo, University of Pavia, Pavia, Italy
| | - Viviana Moschese
- Pediatric Immunopathology and Allergology Unit, University of Rome, Tor Vergata, Policlinico Tor Vergata, Rome, Italy
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8
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Deodhar A, Bhana S, Winthrop K, Gensler LS. COVID-19 Outcomes and Vaccination in Patients with Spondyloarthritis. Rheumatol Ther 2022; 9:993-1016. [PMID: 35598255 PMCID: PMC9124289 DOI: 10.1007/s40744-022-00462-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Accepted: 05/03/2022] [Indexed: 12/04/2022] Open
Abstract
The rapid transmission of the highly infectious severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which causes coronavirus disease 2019 (COVID-19), led to widespread infection throughout the world. Concerns and challenges regarding COVID-19 illness have emerged for patients with immune-mediated inflammatory diseases, such as spondyloarthritis (SpA), who receive treatment with biologic or targeted synthetic disease-modifying antirheumatic drugs (DMARDs), because this population is vulnerable to infections and has a high prevalence of risk factors associated with severe COVID-19 illness. Available data on COVID-19 indicate that patients with SpA who are treated with DMARDs have SARS-CoV-2 infection rates comparable with those in the general population, with similar increased risk associated with older age and comorbidities. Novel vaccines against SARS-CoV-2 are approved or authorized for emergency use by the US Food and Drug Administration, and others are in development to prevent infection and serious illness. This review provides an overview of SpA, the mechanism of action for the SARS-CoV-2 infection, the clinical course of COVID-19, and the vaccines approved for, or in development against, SARS-CoV-2. Detailed information on the use of established vaccines in patients with SpA receiving DMARDs is provided, along with recommendations for COVID-19 vaccination. Available evidence has shown COVID-19 vaccination in patients with SpA, among other rheumatic diseases, to be safe and effective with most DMARD use; however, there is evidence of potential interference with some therapies used in SpA. Healthcare providers should educate patients to provide the knowledge and confidence to receive a COVID-19 vaccine, since the potential benefit outweighs the low risk of vaccine-related adverse events.
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9
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Garcillán B, Salavert M, Regueiro JR, Díaz-Castroverde S. Response to Vaccines in Patients with Immune-Mediated Inflammatory Diseases: A Narrative Review. Vaccines (Basel) 2022; 10:297. [PMID: 35214755 PMCID: PMC8877652 DOI: 10.3390/vaccines10020297] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Revised: 01/26/2022] [Accepted: 02/13/2022] [Indexed: 12/28/2022] Open
Abstract
Patients with immune-mediated inflammatory diseases (IMIDs), such as rheumatoid arthritis and inflammatory bowel disease, are at increased risk of infection. International guidelines recommend vaccination to limit this risk of infection, although live attenuated vaccines are contraindicated once immunosuppressive therapy has begun. Biologic therapies used to treat IMIDs target the immune system to stop chronic pathogenic process but may also attenuate the protective immune response to vaccines. Here, we review the current knowledge regarding vaccine responses in IMID patients receiving treatment with biologic therapies, with a focus on the interleukin (IL)-12/23 inhibitors. B cell-depleting therapies, such as rituximab, strongly impair vaccines immunogenicity, and tumor necrosis factor (TNF) inhibitors and the cytotoxic T-lymphocyte-associated antigen-4 (CTLA-4) fusion protein abatacept are also associated with attenuated antibody responses, which are further diminished in patients taking concomitant immunosuppressants. On the other hand, integrin, IL-6, IL-12/23, IL-17, and B-cell activating factor (BAFF) inhibitors do not appear to affect the immune response to several vaccines evaluated. Importantly, treatment with biologic therapies in IMID patients is not associated with an increased risk of infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) or developing severe disease. However, the efficacy of SARS-CoV-2 vaccines on IMID patients may be reduced compared with healthy individuals. The impact of biologic therapies on the response to SARS-CoV-2 vaccines seems to replicate what has been described for other vaccines. SARS-CoV-2 vaccination appears to be safe and well tolerated in IMID patients. Attenuated but, in general, still protective responses to SARS-CoV-2 vaccination in the context of certain therapies warrant current recommendations for a third primary dose in IMID patients treated with immunosuppressive drugs.
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Affiliation(s)
| | - Miguel Salavert
- Infectious Disease Unit, Department of Clinical Medicine, La Fe Health Research Institute, Hospital Universitari i Politècnic La Fe, 46026 Valencia, Spain;
| | - José R. Regueiro
- Department of Immunology, Ophthalmology and ENT, School of Medicine, Complutense University, 12 de Octubre Health Research Institute (imas12), 28040 Madrid, Spain;
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10
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Körber A, Augustin M, Behrens F, Gerdes S, von Kiedrowski R, Schäkel K, Sticherling M, Wilsmann-Theis D, Wohlrab J, Simon JC. [Treatment of psoriasis with secukinumab : Practical guidance]. DER HAUTARZT 2021; 72:984-991. [PMID: 34417630 PMCID: PMC8378296 DOI: 10.1007/s00105-021-04871-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 07/07/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Moderate to severe plaque psoriasis can be treated effectively with immunomodulating biologicals such as the interleukin-17A inhibitor secukinumab. In practice, however, questions often arise as to how to proceed in special situations, such as infections, comorbidity, pregnancy, or surgery. OBJECTIVES To address frequent questions about the treatment of plaque psoriasis with secukinumab in a consensus document of German psoriasis experts that supplements current guidelines. METHODS In a virtual expert meeting in May 2020, practical aspects of the treatment of psoriasis were discussed based on the experience of the participants and on current literature. The results of this discussion were summarized in the present consensus document. RESULTS This article provides practical guidance on case history, documentation of previous therapies, severity of psoriasis, and comorbidities before starting therapy with secukinumab. For patients treated with secukinumab, the course of action in case of vaccinations, chronic or acute infections, surgical interventions, special manifestations of psoriasis, and comorbidities including history of cancer and autoimmune disorders is discussed. Questions regarding family planning and health policy regulations are also addressed. DISCUSSION The recommendations for the treatment of psoriasis with secukinumab summarized in this consensus document may contribute to achieve optimal therapy for patients and to improve their quality of life.
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Affiliation(s)
| | - Matthias Augustin
- Institut für Versorgungsforschung in der Dermatologie und bei Pflegeberufen (IVDP), Universitätsklinikum Hamburg-Eppendorf, Hamburg, Deutschland
| | - Frank Behrens
- Rheumatologie, Medizinische Klinik 2, Universitätsklinikum Goethe-Universität, Frankfurt am Main, Deutschland
| | - Sascha Gerdes
- Psoriasis-Zentrum, Klinik für Dermatologie, Venerologie und Allergologie, Universitätsklinikum Schleswig-Holstein Campus Kiel, Kiel, Deutschland
| | - Ralph von Kiedrowski
- Dermatologische Spezialpraxis für chronisch-entzündliche System-Dermatosen, Dermato-Onkologie und Allergologie, Selters (Westerwald), Deutschland
| | - Knut Schäkel
- Hautklinik, Universitätsklinikum Heidelberg, Heidelberg, Deutschland
| | - Michael Sticherling
- Hautklinik und Psoriasiszentrum, Universitätsklinikum Erlangen, Deutsches Zentrum Immuntherapie, Erlangen, Deutschland
| | - Dagmar Wilsmann-Theis
- Klinik und Poliklinik für Dermatologie und Allergologie, Universitätsklinikum Bonn, Bonn, Deutschland
| | - Johannes Wohlrab
- Universitätsklinik für Dermatologie und Venerologie, Martin-Luther-Universität Halle-Wittenberg, Halle, Deutschland
| | - Jan-Christoph Simon
- Klinik und Poliklinik für Dermatologie, Venerologie und Allergologie, Universitätsklinikum Leipzig AöR, Philipp-Rosenthal-Str. 23, 04103, Leipzig, Deutschland.
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11
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Hasseli R, Pfeil A, Krause A, Schulze-Koops H, Müller-Ladner U, Specker C. A survey to evaluate knowledge, perceptions and attitudes toward COVID-19 vaccinations among rheumatologists in Germany. Rheumatol Int 2021; 41:1949-1956. [PMID: 34498112 PMCID: PMC8425463 DOI: 10.1007/s00296-021-04986-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Accepted: 08/30/2021] [Indexed: 12/12/2022]
Abstract
The objective is to evaluate the attitude of rheumatologists regarding the use of COVID-19 vaccination in patients with inflammatory rheumatic diseases (IRDs). From February 2nd until March 15th, 2021, rheumatologists from Germany were asked to participate anonymously in a survey addressing their attitude with respect to COVID-19 vaccinations of IRD patients. The survey was completed by 214 participants (107 men, 103 women, 4 unspecified). More than half of the physicians (61%) were working in rheumatologic private practices and 62% had more than 20 years of experience in rheumatology. 90% reported to be at least confidential in handling issues of COVID-19 vaccination and 99% would recommend COVID-19 vaccination for IRD patients. The majority would not recommend to stop or reduce immunomodulatory drugs for vaccination except for rituximab. More than 70% would prefer vaccination with a mRNA vaccine for their IRD patients. This study shows that almost all rheumatologists in Germany support the COVID-19 vaccination for their IRD patients without reducing or terminating the actual immunomodulatory medication to potentially improve the response to the vaccine. This attitude is in accordance with the current recommendations of the German Society of Rheumatology regarding COVID-19 vaccination in IRD patients, and indicates that these have been well accepted and work in everyday clinical practice.
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Affiliation(s)
- Rebecca Hasseli
- Department of Rheumatology and Clinical Immunology, Campus Kerckhoff, Justus-Liebig-University Giessen, Bad Nauheim, Germany.
| | - Alexander Pfeil
- Department of Internal Medicine III, University Hospital Jena, Jena, Germany
| | - Andreas Krause
- Department of Rheumatology, Clinical Immunology and Osteology, Immanuel Hospital, Berlin, Germany
| | - Hendrik Schulze-Koops
- Division of Rheumatology and Clinical Immunology, Department of Internal Medicine IV, University of Munich, Munich, Germany
| | - Ulf Müller-Ladner
- Department of Rheumatology and Clinical Immunology, Campus Kerckhoff, Justus-Liebig-University Giessen, Bad Nauheim, Germany
| | - Christof Specker
- Department of Rheumatology and Clinical Immunology, Kliniken Essen-Mitte, Essen, Germany
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12
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Friedman MA, Curtis JR, Winthrop KL. Impact of disease-modifying antirheumatic drugs on vaccine immunogenicity in patients with inflammatory rheumatic and musculoskeletal diseases. Ann Rheum Dis 2021; 80:1255-1265. [PMID: 34493491 DOI: 10.1136/annrheumdis-2021-221244] [Citation(s) in RCA: 57] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Accepted: 08/25/2021] [Indexed: 12/14/2022]
Abstract
Patients with rheumatic diseases are at increased risk of infectious complications; vaccinations are a critical component of their care. Disease-modifying antirheumatic drugs may reduce the immunogenicity of common vaccines. We will review here available data regarding the effect of these medications on influenza, pneumococcal, herpes zoster, SARS-CoV-2, hepatitis B, human papilloma virus and yellow fever vaccines. Rituximab has the most substantial impact on vaccine immunogenicity, which is most profound when vaccinations are given at shorter intervals after rituximab dosing. Methotrexate has less substantial effect but appears to adversely impact most vaccine immunogenicity. Abatacept likely decrease vaccine immunogenicity, although these studies are limited by the lack of adequate control groups. Janus kinase and tumour necrosis factor inhibitors decrease absolute antibody titres for many vaccines, but do not seem to significantly impact the proportions of patients achieving seroprotection. Other biologics (interleukin-6R (IL-6R), IL-12/IL-23 and IL-17 inhibitors) have little observed impact on vaccine immunogenicity. Data regarding the effect of these medications on the SARS-CoV-2 vaccine immunogenicity are just now emerging, and early glimpses appear similar to our experience with other vaccines. In this review, we summarise the most recent data regarding vaccine response and efficacy in this setting, particularly in light of current vaccination recommendations for immunocompromised patients.
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Affiliation(s)
| | - Jeffrey R Curtis
- Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham Department of Medicine, Birmingham, Alabama, USA
| | - Kevin L Winthrop
- Medicine, Oregon Health & Science University, Portland, Oregon, USA.,School of Public Health, Oregon Health & Science University, Portland, Oregon, USA
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13
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Speeckaert R, Lambert J, Puig L, Speeckaert M, Lapeere H, De Schepper S, van Geel N. Vaccinations in Patients Receiving Systemic Drugs for Skin Disorders: What Can We Learn for SARS-Cov-2 Vaccination Strategies? Drugs R D 2021; 21:341-350. [PMID: 34106430 PMCID: PMC8188745 DOI: 10.1007/s40268-021-00349-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/14/2021] [Indexed: 01/20/2023] Open
Abstract
Large-scale vaccination strategies are currently being deployed against severe acute respiratory syndrome coronavirus-2 (SARS-Cov-2). Whether systemic medication for skin diseases affects the efficacy of vaccination and whether temporary interruption or extension of the dosing interval is necessary is under debate. Most immunomodulating/immunosuppressive drugs only affect vaccine-induced immune responses to a limited or moderate extent, preserving sufficient immunity in most patients. Mycophenolate mofetil, Janus kinase inhibitors, and rituximab require a more cautious approach, and judicious timing of vaccination might be appropriate in patients receiving these treatments. It should be noted that, for most drugs except methotrexate, data on the length of the interruption period to restore vaccine-induced immune responses to normal levels are either very limited or absent. In these cases, only the drug half-life can be used as a practical guideline. In most patients, systemic medication can be continued through the vaccination process, although case-by-case decisions can be considered.
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Affiliation(s)
- Reinhart Speeckaert
- Department of Dermatology, Ghent University Hospital, Corneel Heymanslaan 10, 9000, Ghent, Belgium.
| | - Jo Lambert
- Department of Dermatology, Ghent University Hospital, Corneel Heymanslaan 10, 9000, Ghent, Belgium
| | - Luis Puig
- Department of Dermatology, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
| | | | - Hilde Lapeere
- Department of Dermatology, Ghent University Hospital, Corneel Heymanslaan 10, 9000, Ghent, Belgium
| | - Sofie De Schepper
- Department of Dermatology, Ghent University Hospital, Corneel Heymanslaan 10, 9000, Ghent, Belgium
| | - Nanja van Geel
- Department of Dermatology, Ghent University Hospital, Corneel Heymanslaan 10, 9000, Ghent, Belgium
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14
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Tournadre A, Sellam J, Morel J, Jullien D, Bouhnik Y, Cornec D, Devauchelle-Pensec V, Goupille P, Kluger N, Lazaro E, Goff BL, Lédinghen VD, Lequerré T, Nocturne G, Seror R, Truchetet ME, Verhoeven F, Richez C, Pham T. Practical management of patients on anti-IL17 therapy: Practical guidelines drawn up by the Club Rhumatismes et Inflammation (CRI). Joint Bone Spine 2021; 88:105210. [PMID: 34074455 DOI: 10.1016/j.jbspin.2021.105210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Anne Tournadre
- Service de Rhumatologie, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Jérémie Sellam
- Service de Rhumatologie, CHU Saint-Antoine, Paris, France
| | - Jacques Morel
- Service de Rhumatologie, CHU Montpellier, Montpellier, France
| | | | - Yoram Bouhnik
- Service de Gastro-entérologie, CHU Hôpital Beaujon, Clichy, France
| | - Divi Cornec
- Service de Rhumatologie, CHRU La Cavale Blanche, Brest, France
| | | | | | - Nicolas Kluger
- Dpt Dermatology, Helsinki, Finland; Service de Dermatologie, CHU Bichat-Claude Bernard, Paris, France
| | - Estibaliz Lazaro
- Service de Médecine interne, Hôpital Haut-Lévêque, CHU Bordeaux, Pessac, France
| | | | - Victor de Lédinghen
- Unité d'Hépatologie et transplantation hépatique, Hôpital Haut-Lévêque, CHU Bordeaux, Pessac, France
| | | | | | - Raphaèle Seror
- Service de Rhumatologie, Bicêtre, Le Kremlin-Bicêtre, France
| | | | | | | | - Thao Pham
- Service de Rhumatologie, CHU Sainte-Marguerite, Marseille, France
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15
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Wang C, Rademaker M, Tate B, Baker C, Foley P. SARS-CoV-2 (COVID-19) vaccination in dermatology patients on immunomodulatory and biologic agents: Recommendations from the Australasian Medical Dermatology Group. Australas J Dermatol 2021; 62:151-156. [PMID: 33786833 PMCID: PMC8250550 DOI: 10.1111/ajd.13593] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2021] [Accepted: 02/21/2021] [Indexed: 12/18/2022]
Abstract
As the phase III COVID-19 vaccine trials excluded patients on immunosuppressive treatments, or patients with significant autoimmunity, the Australasian Medical Dermatology Group make the following preliminary recommendations around COVID-19 vaccination in dermatology patients on immunomodulatory and/or biologic agents. Vaccination against COVID-19 is strongly encouraged for all patients on immunomodulatory drugs and/or biologic agents. There are currently insufficient data to recommend one COVID-19 vaccine or vaccine type (mRNA, recombinant, inactivated virus) over another. No specific additional risk in patients on immunomodulatory or biologic therapies has so far been identified. Data on vaccine efficacy in patients on immunomodulatory or biologic therapies are missing, so standard vaccination protocols are recommended until otherwise advised.
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Affiliation(s)
| | - Marius Rademaker
- Waikato Clinical CampusFaculty of Medical and Health Sciences, University of AucklandHamiltonNew Zealand
| | - Bruce Tate
- Western HospitalMelbourneVictoriaAustralia
| | - Christopher Baker
- Skin Health InstituteCarltonVictoriaAustralia
- St Vincent’s Hospital MelbourneThe University of MelbourneFitzroyVictoriaAustralia
| | - Peter Foley
- Skin Health InstituteCarltonVictoriaAustralia
- St Vincent’s Hospital MelbourneThe University of MelbourneFitzroyVictoriaAustralia
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16
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Simonetti O, Rizzetto G, Molinelli E, Diotallevi F, Radi G, Cirioni O, D’Errico MM, Offidani A. Safety and Efficacy of Vaccines during COVID-19 Pandemic in Patients Treated with Biological Drugs in a Dermatological Setting. Healthcare (Basel) 2021; 9:healthcare9040401. [PMID: 33916122 PMCID: PMC8067116 DOI: 10.3390/healthcare9040401] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Revised: 03/24/2021] [Accepted: 03/24/2021] [Indexed: 12/20/2022] Open
Abstract
The BNT162b2 and mRNA-1273 vaccines, consisting of mRNA, have recently become available. The absolute novelty of these vaccines introduces questions about their safety and efficacy, especially in patients who are treated with biological drugs in dermatology. The aim of our review was to provide a broad overview of the current use of all available vaccinations in concomitance with biological therapy and to suggest indications for the new mRNA Covid-19 vaccines. We conducted a narrative review of the literature regarding the indications and safety of the various types of vaccines currently available in dermatological patients treated with biological therapy. The safety and efficacy of administering inactivated vaccines in patients undergoing biological therapy with inhibitors of TNF-α, IL-17, IL-12/23, and IL-4/13 was confirmed. Inactivated vaccines can be administered during therapy with inhibitors of IL-23 and IgE, taking into account that the level of evidence is lower due to the lack of specific studies. Live attenuated vaccines were contraindicated in concomitance with all biological therapies considered, except omalizumab. According to this evidence, we assume that there are currently no contraindications to the administration of the new Covid-19 BNT162b2 and mRNA-1273 vaccines during biological therapy with inhibitors of TNF-α, IL-17, IL-12/23, IL-23, and IL-4/13, since these vaccines are comparable to inactivated ones. For patients with chronic urticaria or allergic asthma treated with omalizumab, we currently recommend caution in using the mRNA Covid-19 vaccines (30 min observation). The only contraindications were a previous history of hypersensitivity to the Covid-19 vaccines themself or to their excipients. In conclusion, further randomized clinical trials are needed to evaluate the efficacy of the antibody response in these patients.
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Affiliation(s)
- Oriana Simonetti
- Clinic of Dermatology, Department of Clinical and Molecular Sciences, Polytechnic University of Marche, 60121 Ancona, Italy; (G.R.); (E.M.); (F.D.); (G.R.); (A.O.)
- Correspondence:
| | - Giulio Rizzetto
- Clinic of Dermatology, Department of Clinical and Molecular Sciences, Polytechnic University of Marche, 60121 Ancona, Italy; (G.R.); (E.M.); (F.D.); (G.R.); (A.O.)
| | - Elisa Molinelli
- Clinic of Dermatology, Department of Clinical and Molecular Sciences, Polytechnic University of Marche, 60121 Ancona, Italy; (G.R.); (E.M.); (F.D.); (G.R.); (A.O.)
| | - Federico Diotallevi
- Clinic of Dermatology, Department of Clinical and Molecular Sciences, Polytechnic University of Marche, 60121 Ancona, Italy; (G.R.); (E.M.); (F.D.); (G.R.); (A.O.)
| | - Giulia Radi
- Clinic of Dermatology, Department of Clinical and Molecular Sciences, Polytechnic University of Marche, 60121 Ancona, Italy; (G.R.); (E.M.); (F.D.); (G.R.); (A.O.)
| | - Oscar Cirioni
- Clinic of Infectious Diseases, Department of Biomedical Sciences and Public Health, Polytechnic University of Marche, 60121 Ancona, Italy;
| | - Marcello Mario D’Errico
- Department of Biomedical Sciences and Public Health, Section of Hygiene, Preventive Medicine and Public Health, Polytechnic University of the Marche, 60121 Ancona, Italy;
| | - Annamaria Offidani
- Clinic of Dermatology, Department of Clinical and Molecular Sciences, Polytechnic University of Marche, 60121 Ancona, Italy; (G.R.); (E.M.); (F.D.); (G.R.); (A.O.)
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17
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A practical approach for vaccinations including COVID-19 in autoimmune/autoinflammatory rheumatic diseases: a non-systematic review. Clin Rheumatol 2021. [PMID: 33751280 DOI: 10.1007/s10067‐021‐05700‐z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
The COVID-19 pandemic has occupied the world agenda since December 2019. With no effective treatment yet, vaccination seems to be the most effective method of prevention. Recently developed vaccines have been approved for emergency use only and are currently applied to large populations. Considering both the underlying pathogenic mechanisms of autoimmune/autoinflammatory rheumatological diseases (AIIRDs) and the immunosuppressive drugs used in treatment, vaccination for COVID-19 deserves special attention in such patients. In this article, we aimed to give simple messages to the clinicians for COVID-19 vaccination in patients with AIIRDs based upon the current evidence regarding the use of other vaccines in this patient group. For this purpose, we conducted a "Pubmed search" using the following keywords: Influenza, Hepatitis B, Pneumococcal, and Shingles vaccines and the frequently used conventional and biologic disease-modifying antirheumatic drugs (DMARDs). Likewise, an additional search was performed for the COVID-19 immunization in patients with AIIRDs and considering such drugs. In summary, patients with AIIRDs should also be vaccinated against COVID-19, preferably when disease activity is under control and when there is no concurrent infection. Low-degree immunosuppression does not appear to decrease antibody responses to vaccines. Ideally, vaccinations should be done before the initiation of any biological DMARDs. Patients receiving rituximab should be vaccinated at least 4 weeks before or 6 months after treatment. Since tofacitinib may also reduce antibody responses, especially in combination with methotrexate, it may be appropriate to discontinue this drug before vaccination and to restart after 14 days of immunization. Key points • COVID-19 vaccinations should preferably be made during remission in patients with autoimmune/autoinflammatory rheumatological diseases. • Low-degree immunosuppression may not interfere with antibody response to vaccines. • Ideally, vaccinations should be made before the initiation of any biological DMARDs. • Timing of vaccination is especially important in the case of rituximab.
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18
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Soy M, Keser G, Atagunduz P, Mutlu MY, Gunduz A, Koybaşi G, Bes C. A practical approach for vaccinations including COVID-19 in autoimmune/autoinflammatory rheumatic diseases: a non-systematic review. Clin Rheumatol 2021; 40:3533-3545. [PMID: 33751280 PMCID: PMC7982510 DOI: 10.1007/s10067-021-05700-z] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 03/05/2021] [Accepted: 03/15/2021] [Indexed: 12/12/2022]
Abstract
The COVID-19 pandemic has occupied the world agenda since December 2019. With no effective treatment yet, vaccination seems to be the most effective method of prevention. Recently developed vaccines have been approved for emergency use only and are currently applied to large populations. Considering both the underlying pathogenic mechanisms of autoimmune/autoinflammatory rheumatological diseases (AIIRDs) and the immunosuppressive drugs used in treatment, vaccination for COVID-19 deserves special attention in such patients. In this article, we aimed to give simple messages to the clinicians for COVID-19 vaccination in patients with AIIRDs based upon the current evidence regarding the use of other vaccines in this patient group. For this purpose, we conducted a “Pubmed search” using the following keywords: Influenza, Hepatitis B, Pneumococcal, and Shingles vaccines and the frequently used conventional and biologic disease-modifying antirheumatic drugs (DMARDs). Likewise, an additional search was performed for the COVID-19 immunization in patients with AIIRDs and considering such drugs. In summary, patients with AIIRDs should also be vaccinated against COVID-19, preferably when disease activity is under control and when there is no concurrent infection. Low-degree immunosuppression does not appear to decrease antibody responses to vaccines. Ideally, vaccinations should be done before the initiation of any biological DMARDs. Patients receiving rituximab should be vaccinated at least 4 weeks before or 6 months after treatment. Since tofacitinib may also reduce antibody responses, especially in combination with methotrexate, it may be appropriate to discontinue this drug before vaccination and to restart after 14 days of immunization.
Key points • COVID-19 vaccinations should preferably be made during remission in patients with autoimmune/autoinflammatory rheumatological diseases. • Low-degree immunosuppression may not interfere with antibody response to vaccines. • Ideally, vaccinations should be made before the initiation of any biological DMARDs. • Timing of vaccination is especially important in the case of rituximab. |
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Affiliation(s)
- Mehmet Soy
- Altınbas University (previously Kemerbas University) Faculty of Medicine Department of Internal Medicine, Division of Rheumatology, Bahcelievler MedicalPark Hospital, Istanbul, Turkey. .,, Altunizade Mah. Atif Bey sk. Gokdeniz Sitesi, E-3; Usküdar, Istanbul, Turkey.
| | - Gökhan Keser
- Ege University Faculty of Medicine Department of Internal Medicine, Division of Rheumatology, Bornova, Izmir, Turkey
| | - Pamir Atagunduz
- Marmara University Faculty of Medicine Department of Internal Medicine, Division of Rheumatology, Istanbul, Turkey
| | - Melek Yalçin Mutlu
- University of Health Sciences, Basaksehir Cam and Sakura City Hospital, Basaksehir, Istanbul, Turkey.,Department of Rheumatology, University of Health Sciences, Bakırköy Dr. Sadi Konuk Training and Research Hospital, İstanbul, Turkey
| | - Alper Gunduz
- Şişli Hamidiye Etfal Training and Research Hospital, Department of Infectious Diseases, İstanbul, Turkey
| | - Gizem Koybaşi
- Yedikule Chest Diseases and Chest Surgery Training and Research Hospital, İstanbul, Turkey
| | - Cemal Bes
- University of Health Sciences, Başakşehir Çam and Sakura City Hospital, Istanbul, Turkey.,Department of Rheumatology, University of Health Sciences, Bakırköy Dr. Sadi Konuk Training and Research Hospital, İstanbul, Turkey
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19
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Merola JF, Bagel J, Almgren P, Røpke MA, Lophaven KW, Vest NS, Grewal P. Tralokinumab does not impact vaccine-induced immune responses: Results from a 30-week, randomized, placebo-controlled trial in adults with moderate-to-severe atopic dermatitis. J Am Acad Dermatol 2021; 85:71-78. [PMID: 33744356 DOI: 10.1016/j.jaad.2021.03.032] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Revised: 02/23/2021] [Accepted: 03/07/2021] [Indexed: 12/18/2022]
Abstract
BACKGROUND Atopic dermatitis (AD) is a chronic inflammatory skin disease. Interleukin (IL) 13 is a type 2 cytokine that is key to the inflammation underlying AD. Tralokinumab is a first-in-class, fully human, monoclonal antibody that specifically binds with high affinity to IL-13, neutralizing it in AD. Immunomodulatory treatments may impair vaccine-induced immune responses. OBJECTIVE Assess the immune responses to standard vaccines in adults with moderate-to-severe AD who are undergoing treatment with tralokinumab. METHODS ECZema TRAlokinumab Trial No. 5 (ECZTRA 5; NCT03562377) was a phase 2, double-blind, randomized, placebo-controlled trial taking place over 30 weeks. Eligible adults were randomized 1:1, with 107 patients receiving tralokinumab 300 mg and 108 patients receiving a placebo every 2 weeks for 16 weeks. All patients received Tdap (tetanus/diphtheria/pertussis) and meningococcal vaccines at week 12. The primary end points were positive antitetanus and antimeningococcal responses between weeks 12 and 16 (noninferiority margin, -25%; responder, >3-fold increase in IgG). RESULTS The noninferiority of tralokinumab versus placebo for immune response to Tdap (91.9% vs 96.1%) and meningococcal (86.0% vs 84.2%) vaccines was demonstrated at week 16. During treatment, the rates of adverse events were lower for tralokinumab than for the placebo, with most events being mild or moderate. LIMITATIONS Responses to other vaccines (including influenza) were not examined. CONCLUSIONS Treatment with tralokinumab 300 mg every 2 weeks did not affect immune responses to Tdap and meningococcal vaccines. Treatment was well tolerated when administered concomitantly with the vaccines and demonstrated a safety profile comparable to phase 3 trials.
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Affiliation(s)
- Joseph F Merola
- Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts.
| | - Jerry Bagel
- Eczema Treatment Center of New Jersey, East Windsor, New Jersey
| | | | | | | | | | - Parbeer Grewal
- Division of Dermatology, University of Alberta, Edmonton, Canada
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20
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Gresham LM, Marzario B, Dutz J, Kirchhof MG. An evidence-based guide to SARS-CoV-2 vaccination of patients on immunotherapies in dermatology. J Am Acad Dermatol 2021; 84:1652-1666. [PMID: 33482251 PMCID: PMC7816618 DOI: 10.1016/j.jaad.2021.01.047] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Revised: 01/08/2021] [Accepted: 01/15/2021] [Indexed: 12/15/2022]
Abstract
Immune-mediated diseases and immunotherapeutics can negatively affect normal immune functioning and, consequently, vaccine safety and response. The COVID-19 pandemic has incited research aimed at developing a novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccine. As SARS-CoV-2 vaccines are developed and made available, the assessment of anticipated safety and efficacy in patients with immune-mediated dermatologic diseases and requiring immunosuppressive and/or immunomodulatory therapy is particularly important. A review of the literature was conducted by a multidisciplinary committee to provide guidance on the safety and efficacy of SARS-CoV-2 vaccination for dermatologists and other clinicians when prescribing immunotherapeutics. The vaccine platforms being used to develop SARS-CoV-2 vaccines are expected to be safe and potentially effective for dermatology patients on immunotherapeutics. Current guidelines for the vaccination of an immunocompromised host remain appropriate when considering future administration of SARS-CoV-2 vaccines.
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Affiliation(s)
- Louise M Gresham
- Division of Dermatology, Department of Medicine, University of Ottawa and The Ottawa Hospital, Ottawa, Canada
| | - Barbara Marzario
- Division of Dermatology, Department of Medicine, University of Ottawa and The Ottawa Hospital, Ottawa, Canada
| | - Jan Dutz
- Department of Dermatology and Skin Sciences, University of British Columbia, Vancouver, Canada
| | - Mark G Kirchhof
- Division of Dermatology, Department of Medicine, University of Ottawa and The Ottawa Hospital, Ottawa, Canada.
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21
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Chiricozzi A, Gisondi P, Bellinato F, Girolomoni G. Immune Response to Vaccination in Patients with Psoriasis Treated with Systemic Therapies. Vaccines (Basel) 2020; 8:vaccines8040769. [PMID: 33339348 PMCID: PMC7767096 DOI: 10.3390/vaccines8040769] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Revised: 12/11/2020] [Accepted: 12/15/2020] [Indexed: 02/07/2023] Open
Abstract
Psoriasis is a chronic inflammatory skin disease usually treated with immunomodulatory/immunosuppressive agents. The use of these agents has been associated with an increased susceptibility to infections. Vaccination might represent a critical aspect in the management of patients with psoriasis treated with immunomodulatory/immunosuppressive therapies. This narrative review aimed to provide an overview on the immune response to vaccines in subjects treated with systemic agents used to treat patients with moderate to severe psoriasis. Publications appearing in PubMed, Scopus, and ISI–Web of Knowledge database were selected using Medical Subject Headings key terms. Overall, published data confirmed that vaccination with attenuated live vaccines during therapy with immunomodulatory/immunosuppressive therapies should be avoided. For nonlive vaccines, a more favorable safety profile of biologic agents compared to conventional systemic agents is described as the humoral response to vaccines is in general well-preserved. Treatment with cyclosporine and methotrexate is associated with lower antibody titers to vaccines, and thus these agents are better discontinued during vaccination. In contrast, treatment with biological agents is not associated with lower antibody response and can thus be continued safely.
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Affiliation(s)
- Andrea Chiricozzi
- Dermatologia, Dipartimento Scienze Mediche e Chirurgiche, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
- Dermatologia, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
- Correspondence: ; Tel.: +39-3395668320; Fax: +39-0761-571321
| | - Paolo Gisondi
- Section of Dermatology and Venereology, Department of Medicine, University of Verona, 37129 Verona, Italy; (P.G.); (F.B.); (G.G.)
| | - Francesco Bellinato
- Section of Dermatology and Venereology, Department of Medicine, University of Verona, 37129 Verona, Italy; (P.G.); (F.B.); (G.G.)
| | - Giampiero Girolomoni
- Section of Dermatology and Venereology, Department of Medicine, University of Verona, 37129 Verona, Italy; (P.G.); (F.B.); (G.G.)
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22
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Mohme S, Schmalzing M, Müller CSL, Vogt T, Goebeler M, Stoevesandt J. Immunizations in immunocompromised patients: a guide for dermatologists. J Dtsch Dermatol Ges 2020; 18:699-723. [PMID: 32713146 DOI: 10.1111/ddg.14156] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Accepted: 06/05/2020] [Indexed: 12/11/2022]
Abstract
The increasingly frequent use of immunomodulatory agents in dermatology requires the observance of specific recommendations for immunization. These recommendations are developed and regularly updated by the German Standing Committee on Vaccination (STIKO), an independent advisory group at the Robert Koch Institute. Dermatological patients on immunosuppressive treatment should ideally receive all vaccinations included in the standard immunization schedule. Additionally, it is recommended that they also undergo vaccination against the seasonal flu, pneumococci, and herpes zoster (inactivated herpes zoster subunit vaccine for patients ≥ 50 years). Additional immunizations against Haemophilus influenzae type B, hepatitis B and meningococci may be indicated depending on individual comorbidities and exposure risk. Limitations of use, specific contraindications and intervals to be observed between vaccination and immunosuppression depend on the immunosuppressive agent used and its dosing. Only under certain conditions may live-attenuated vaccines be administered in patients on immunosuppressive therapy. Given its strong suppressive effect on the humoral immune response, no vaccines - except for flu shots - should be given within six months after rituximab therapy. This CME article presents current recommendations on immunization in immunocompromised individuals, with a special focus on dermatological patients. Its goal is to enable readers to provide competent counseling and to initiate necessary immunizations in this vulnerable patient group.
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Affiliation(s)
- Sophia Mohme
- Department of Dermatology, Venereology and Allergology, University Hospital, Würzburg, Germany
| | - Marc Schmalzing
- Department of Medicine II, Rheumatology/Clinical Immunology, University Hospital, Würzburg, Germany
| | - Cornelia S L Müller
- Department of Dermatology, Venereology and Allergology, Saarland University, Homburg/Saar, Germany
| | - Thomas Vogt
- Department of Dermatology, Venereology and Allergology, Saarland University, Homburg/Saar, Germany
| | - Matthias Goebeler
- Department of Dermatology, Venereology and Allergology, University Hospital, Würzburg, Germany
| | - Johanna Stoevesandt
- Department of Dermatology, Venereology and Allergology, University Hospital, Würzburg, Germany
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23
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Patrikiou E, Liaskos C, Mavropoulos A, Ntavari N, Gkoutzourelas A, Simopoulou T, Fechner K, Scheper T, Meyer W, Katsiari CG, Roussaki-Schulze A, Zafiriou E, Sakkas LI, Bogdanos DP. Autoantibodies against specific nuclear antigens are present in psoriatic disease and are diminished by secukinumab. Clin Chim Acta 2020; 510:400-407. [PMID: 32710943 DOI: 10.1016/j.cca.2020.07.037] [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: 12/10/2019] [Revised: 07/18/2020] [Accepted: 07/19/2020] [Indexed: 02/07/2023]
Abstract
Anti-nuclear antibodies (ANA) are frequently detected in patients with psoriasis (Ps) and psoriatic arthritis (PsA), but their target autoantigens remain unknown. We assessed antibody (ab) reactivity against 23 known nuclear antigens in patients with Ps and PsA and assess the effects of secukinumab (anti-IL17A) treatment on ANA levels. A total of 201 patients, 101 with Ps and 100 with PsA, and 50 ANA-negative healthy controls (HCs) were tested for ANAs by a line immunoassay testing reactivity to 23 nuclear antigens. Ab reactivity to at least 1 antigen was found in 20.4% psoriatic disease patients (25.7% Ps and 15% PsA) compared to 8% HCs (p = ns), the most frequent being against dense fine speckled 70 (DFS70) (6.5%). In Ps and PsA patients with secukinumab-induced remission, anti-DFS70 and other antigen-specific autoantibodies were diminished over time. No decline was noted for IgG abs against antigens from pathogens such as cytomegalovirus, Epstein-Barr virus and Helicobacter pylori. Autoantibody decrease was associated with significant reduction of plasmablasts, follicular B and follicular T cells. In conclusion, one third of antigen-specific ANA patients with psoriatic disease recognize DFS70. Secukinumab decreases nuclear antigen autoreactivity, plasmablasts, follicular B and follicular T cells, highlighting a new mechanism of its action.
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Affiliation(s)
- Eleni Patrikiou
- Department of Rheumatology and Clinical Immunology, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larisa, Greece
| | - Christos Liaskos
- Department of Rheumatology and Clinical Immunology, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larisa, Greece
| | - Athanasios Mavropoulos
- Department of Rheumatology and Clinical Immunology, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larisa, Greece
| | - Niki Ntavari
- Department of Dermatology, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larisa, Greece
| | - Athanasios Gkoutzourelas
- Department of Rheumatology and Clinical Immunology, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larisa, Greece
| | - Theodora Simopoulou
- Department of Rheumatology and Clinical Immunology, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larisa, Greece
| | - Kai Fechner
- Institute of Immunology Affiliated to Euroimmun AG, Lübeck, Germany
| | - Thomas Scheper
- Institute of Immunology Affiliated to Euroimmun AG, Lübeck, Germany
| | - Wolfgang Meyer
- Institute of Immunology Affiliated to Euroimmun AG, Lübeck, Germany
| | - Christina G Katsiari
- Department of Rheumatology and Clinical Immunology, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larisa, Greece
| | - Aggeliki Roussaki-Schulze
- Department of Dermatology, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larisa, Greece
| | - Efterpi Zafiriou
- Department of Dermatology, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larisa, Greece
| | - Lazaros I Sakkas
- Department of Rheumatology and Clinical Immunology, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larisa, Greece
| | - Dimitrios P Bogdanos
- Department of Rheumatology and Clinical Immunology, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larisa, Greece. http://www.autorheumatology.com
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24
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Mohme S, Schmalzing M, Müller CSL, Vogt T, Goebeler M, Stoevesandt J. Impfen bei Immunsuppression: ein Leitfaden für die dermatologische Praxis. J Dtsch Dermatol Ges 2020; 18:699-725. [PMID: 32713144 DOI: 10.1111/ddg.14156_g] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Accepted: 06/05/2020] [Indexed: 12/15/2022]
Affiliation(s)
- Sophia Mohme
- Klinik und Poliklinik für Dermatologie, Venerologie und Allergologie, Universitätsklinikum Würzburg
| | - Marc Schmalzing
- Medizinische Klinik und Poliklinik II, Rheumatologie/Klinische Immunologie, Universitätsklinikum Würzburg
| | - Cornelia S L Müller
- Klinik und Poliklinik für Dermatologie, Venerologie und Allergologie, Universität des Saarlandes, Homburg/Saar
| | - Thomas Vogt
- Klinik und Poliklinik für Dermatologie, Venerologie und Allergologie, Universität des Saarlandes, Homburg/Saar
| | - Matthias Goebeler
- Klinik und Poliklinik für Dermatologie, Venerologie und Allergologie, Universitätsklinikum Würzburg
| | - Johanna Stoevesandt
- Klinik und Poliklinik für Dermatologie, Venerologie und Allergologie, Universitätsklinikum Würzburg
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25
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Bashyam AM, Feldman SR. Should patients stop their biologic treatment during the COVID-19 pandemic. J DERMATOL TREAT 2020; 31:317-318. [PMID: 32191143 DOI: 10.1080/09546634.2020.1742438] [Citation(s) in RCA: 86] [Impact Index Per Article: 21.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Affiliation(s)
- Arjun M Bashyam
- Center for Dermatology Research, Department of Dermatology, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Steven R Feldman
- Center for Dermatology Research, Department of Dermatology, Wake Forest School of Medicine, Winston-Salem, North Carolina.,Department of Pathology, Wake Forest School of Medicine, Winston-Salem, North Carolina.,Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Winston-Salem, North Carolina.,Department of Dermatology, University of Southern Denmark, Odense, Denmark
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26
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Kordzadeh-Kermani E, Khalili H, Karimzadeh I, Salehi M. Prevention Strategies to Minimize the Infection Risk Associated with Biologic and Targeted Immunomodulators. Infect Drug Resist 2020; 13:513-532. [PMID: 32110062 PMCID: PMC7035951 DOI: 10.2147/idr.s233137] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Accepted: 01/29/2020] [Indexed: 12/18/2022] Open
Abstract
The introduction of biologic and targeted immunomodulators is a significant breakthrough in the therapeutic area of various fields of medicine. The occurrence of serious infections, a complication of secondary immunosuppression associated with these agents, leads to increased morbidity and mortality. Implementing preventive strategies could minimize infection-related complications and improve therapeutic outcomes. The purpose of this review is to focus on current evident approaches regarding screening, monitoring, preventing (immunization and chemoprophylaxis), and management of infections in patients who are candidates for about 70 biologic and targeted immunomodulators. Recommendations are based on relevant guidelines, especially the ESCMID Study Group for Infections in Compromised Hosts (ESGICH) Consensus Document series published in 2018.
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Affiliation(s)
- Elaheh Kordzadeh-Kermani
- Department of Clinical Pharmacy, School of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran
| | - Hossein Khalili
- Department of Clinical Pharmacy, School of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran
| | - Iman Karimzadeh
- Department of Clinical Pharmacy, School of Pharmacy, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mohammadreza Salehi
- Department of Infectious Diseases, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
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27
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Lu RM, Hwang YC, Liu IJ, Lee CC, Tsai HZ, Li HJ, Wu HC. Development of therapeutic antibodies for the treatment of diseases. J Biomed Sci 2020; 27:1. [PMID: 31894001 PMCID: PMC6939334 DOI: 10.1186/s12929-019-0592-z] [Citation(s) in RCA: 1028] [Impact Index Per Article: 257.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Accepted: 11/18/2019] [Indexed: 12/13/2022] Open
Abstract
It has been more than three decades since the first monoclonal antibody was approved by the United States Food and Drug Administration (US FDA) in 1986, and during this time, antibody engineering has dramatically evolved. Current antibody drugs have increasingly fewer adverse effects due to their high specificity. As a result, therapeutic antibodies have become the predominant class of new drugs developed in recent years. Over the past five years, antibodies have become the best-selling drugs in the pharmaceutical market, and in 2018, eight of the top ten bestselling drugs worldwide were biologics. The global therapeutic monoclonal antibody market was valued at approximately US$115.2 billion in 2018 and is expected to generate revenue of $150 billion by the end of 2019 and $300 billion by 2025. Thus, the market for therapeutic antibody drugs has experienced explosive growth as new drugs have been approved for treating various human diseases, including many cancers, autoimmune, metabolic and infectious diseases. As of December 2019, 79 therapeutic mAbs have been approved by the US FDA, but there is still significant growth potential. This review summarizes the latest market trends and outlines the preeminent antibody engineering technologies used in the development of therapeutic antibody drugs, such as humanization of monoclonal antibodies, phage display, the human antibody mouse, single B cell antibody technology, and affinity maturation. Finally, future applications and perspectives are also discussed.
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Affiliation(s)
- Ruei-Min Lu
- Institute of Cellular and Organismic Biology, Academia Sinica, Taipei, 115, Taiwan
| | - Yu-Chyi Hwang
- Institute of Cellular and Organismic Biology, Academia Sinica, Taipei, 115, Taiwan
| | - I-Ju Liu
- Institute of Cellular and Organismic Biology, Academia Sinica, Taipei, 115, Taiwan
| | - Chi-Chiu Lee
- Institute of Cellular and Organismic Biology, Academia Sinica, Taipei, 115, Taiwan
| | - Han-Zen Tsai
- Institute of Cellular and Organismic Biology, Academia Sinica, Taipei, 115, Taiwan
| | - Hsin-Jung Li
- Institute of Cellular and Organismic Biology, Academia Sinica, Taipei, 115, Taiwan
| | - Han-Chung Wu
- Institute of Cellular and Organismic Biology, Academia Sinica, Taipei, 115, Taiwan. .,, 128 Academia Rd., Section 2, Nankang, Taipei, 11529, Taiwan.
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28
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Furer V, Zisman D, Kaufman I, Arad U, Berman M, Sarbagil-Maman H, Elias M, Hadad A, Paran D, Drori Y, Friedman N, Mandelboim M, Elkayam O. Immunogenicity and safety of vaccination against seasonal influenza vaccine in patients with psoriatic arthritis treated with secukinumab. Vaccine 2020; 38:847-851. [DOI: 10.1016/j.vaccine.2019.10.081] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2019] [Revised: 10/21/2019] [Accepted: 10/27/2019] [Indexed: 01/03/2023]
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29
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Richi P, Martín MD, de Ory F, Gutiérrez-Larraya R, Casas I, Jiménez-Díaz AM, Cava F, Muñoz-Fernandez S. Secukinumab does not impair the immunogenic response to the influenza vaccine in patients. RMD Open 2019; 5:e001018. [PMID: 31565246 PMCID: PMC6744077 DOI: 10.1136/rmdopen-2019-001018] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Revised: 07/21/2019] [Accepted: 08/17/2019] [Indexed: 01/01/2023] Open
Abstract
Objective To evaluate whether immunological response to influenza vaccination is impaired in patients who are receiving secukinumab. Patients and methods Subjects suffering from psoriatic arthritis or ankylosing spondylitis who were receiving treatment with secukinumab and healthy volunteers were included. All participants received seasonal inactivated trivalent influenza vaccine recommended by the WHO in the 2017–2018 northern hemisphere influenza season, which contained an A/Michigan/45/2015 (H1N1)pdm09-like virus, an A/Hong Kong/4801/2014 (H3N2)-like virus and a B/Brisbane/60/2008-like virus. Haemagglutination inhibition was used to evaluate basal antibody (Ab) titres against the three influenza vaccine virus strains just before vaccination and at least 4 weeks after the vaccine administration. Response to vaccine was considered as >4-fold increases in Ab titre. Results Thirty subjects, 17 patients and 13 healthy controls, with a follow-up duration of 33±8 days, were analysed. There were no demographic differences between groups. Patients and controls achieved a median of 4.6-fold and 4.0-fold increases, respectively, for anti H1N1 and almost 4.0 (3.7) for patients and 5.3 for controls for anti-B Ab. Both groups presented a poor response against H3N2, with <1.5-fold increase. Seroconversion rates were similar in both groups. Secukinumab did not influence the response to the influenza vaccine (relative risk: 1.09 (95% CI 0.58 to 2.07) for H1N1, RR: 1.53 (95% CI 0.15 to 15.0) for H3N2 and RR: 0.72 (95% CI 0.32 to 1.83) for B strain). Conclusion In our study, secukinumab has no effect on the immunogenic response to the influenza vaccine.
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Affiliation(s)
- Patricia Richi
- Rheumatology Department, Infanta Sofía University Hospital, San Sebastian de los Reyes, Spain.,School of Medicine, European University of Madrid, Madrid, Spain
| | - María Dolores Martín
- Bactereology Department, BR Salud Laboratories, San Sebastian de los Reyes, Spain
| | - Fernando de Ory
- National Microbiology Centre, CIBER-ESP, Instituto de Salud Carlos III, Majadahonda, Spain
| | | | - Inmaculada Casas
- National Microbiology Centre, Instituto de Salud Carlos III Campus de Majadahonda, Majadahonda, Spain
| | - Ana María Jiménez-Díaz
- Rheumatology Department, Infanta Sofía University Hospital, San Sebastian de los Reyes, Spain
| | - Fernando Cava
- BR Salud Laboratories, San Sebastian de los Reyes, Spain
| | - Santiago Muñoz-Fernandez
- Rheumatology Department, Infanta Sofía University Hospital, San Sebastian de los Reyes, Spain.,School of Medicine, European University of Madrid, Madrid, Spain
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30
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Kolli SS, Kepley AL, Cline A, Feldman SR. A safety review of recent advancements in the treatment of psoriasis: analysis of clinical trial safety data. Expert Opin Drug Saf 2019; 18:523-536. [PMID: 31046481 DOI: 10.1080/14740338.2019.1614561] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
INTRODUCTION The management of psoriasis can include oral medications and injectable biologics. Safety data of these various treatment options are important to consider when choosing the right treatment for the patient. AREAS COVERED This review evaluates the safety of newer treatments approved for psoriasis, including interleukin-(IL)-17 inhibitors, IL-23/p19 inhibitors, ustekinumab, certolizumab pegol and apremilast, using phases III and IV clinical trial data. EXPERT OPINION Even as treatment of psoriasis becomes safer, it is important to recognize both common and uncommon adverse effects of treatment. Common adverse effects are similar across treatment options, including upper respiratory infection and injection-site reaction. Serious adverse effects occur less frequently and specific to the psoriasis treatment option, such as inflammatory bowel disease and candida infections with IL-17 inhibitors, tuberculosis with certolizumab pegol, and psychiatric events with apremilast. While IL-23/p19 inhibitors may have a slightly better safety profile than other biologics, long-term data are limited. The conclusions that can be drawn from clinical trial safety data are limited given that many clinical trials are not large enough to detect rare safety events. Data from registries provide important complementary information on long-term safety but there are limitations including a lack of randomized assignment between drug treatments.
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Affiliation(s)
- Sree S Kolli
- a Center for Dermatology Research, Department of Dermatology , Wake Forest School of Medicine , Winston-Salem , NC , USA
| | - Anna L Kepley
- a Center for Dermatology Research, Department of Dermatology , Wake Forest School of Medicine , Winston-Salem , NC , USA
| | - Abigail Cline
- a Center for Dermatology Research, Department of Dermatology , Wake Forest School of Medicine , Winston-Salem , NC , USA
| | - Steven R Feldman
- a Center for Dermatology Research, Department of Dermatology , Wake Forest School of Medicine , Winston-Salem , NC , USA.,b Department of Pathology , Wake Forest School of Medicine , Winston-Salem , NC , USA.,c Department of Public Health Sciences , Wake Forest School of Medicine , Winston-Salem , NC , USA
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31
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32
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Plachouri KM, Georgiou S. Challenges in the treatment of psoriasis with biologics: vaccination, history of malignancy, human immunodeficiency virus (HIV) infection, and pediatric psoriasis. Int J Dermatol 2019; 58:1008-1013. [PMID: 30891751 DOI: 10.1111/ijd.14436] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Revised: 01/23/2019] [Accepted: 02/28/2019] [Indexed: 12/25/2022]
Abstract
Biologics are potent immunomodulatory drugs, whose application in the treatment of psoriasis has shown extremely good therapeutic results and a satisfactory safety profile. The administration of these agents in special cases, such as in patients with HIV infection, previous malignancy, unclear vaccination status as well as children, can be challenging. This report is an updated systematic review of the use of biologics in the above-mentioned groups. Articles derived from the databases PubMed, EMBASE, and SCOPUS, and published between 1989 and 2018, were analyzed for this study. The existing evidence is not in all cases sufficient in order to provide adequate insight on the management of these complex situations. The aim of this report is to present a summarized update on the knowledge of this special topic so far and to draw into attention the need to conduct more systematic studies so as to clarify the best therapeutic strategies for these special patient groups when it comes to the use of biologics.
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Affiliation(s)
| | - Sophia Georgiou
- Dermatology Department, University of Patras, Patras, Greece
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33
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Papp KA, Haraoui B, Kumar D, Marshall JK, Bissonnette R, Bitton A, Bressler B, Gooderham M, Ho V, Jamal S, Pope JE, Steinhart AH, Vinh DC, Wade J. Vaccination Guidelines for Patients With Immune-Mediated Disorders on Immunosuppressive Therapies. J Cutan Med Surg 2018; 23:50-74. [PMID: 30463418 PMCID: PMC6330697 DOI: 10.1177/1203475418811335] [Citation(s) in RCA: 74] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND: Patients with immune-mediated diseases on immunosuppressive therapies have more infectious episodes than healthy individuals, yet vaccination practices by physicians for this patient population remain suboptimal. OBJECTIVES: To evaluate the safety and efficacy of vaccines in individuals exposed to immunosuppressive therapies and provide evidence-based clinical practice recommendations. METHODS: A literature search for vaccination safety and efficacy in patients on immunosuppressive therapies (2009-2017) was conducted. Results were assessed using the Grading of Recommendation, Assessment, Development, and Evaluation system. RESULTS: Several immunosuppressive therapies attenuate vaccine response. Thus, vaccines should be administered before treatment whenever feasible. Inactivated vaccines can be administered without treatment discontinuation. Similarly, evidence suggests that the live zoster vaccine is safe and effective while on select immunosuppressive therapy, although use of the subunit vaccine is preferred. Caution regarding other live vaccines is warranted. Drug pharmacokinetics, duration of vaccine-induced viremia, and immune response kinetics should be considered to determine appropriate timing of vaccination and treatment (re)initiation. Infants exposed to immunosuppressive therapies through breastmilk can usually be immunized according to local guidelines. Intrauterine exposure to immunosuppressive agents is not a contraindication for inactivated vaccines. Live attenuated vaccines scheduled for infants and children ⩾12 months of age, including measles, mumps, rubella, and varicella, can be safely administered as sufficient time has elapsed for drug clearance. CONCLUSIONS: Immunosuppressive agents may attenuate vaccine responses, but protective benefit is generally maintained. While these recommendations are evidence based, they do not replace clinical judgment, and decisions regarding vaccination must carefully assess the risks, benefits, and circumstances of individual patients.
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Affiliation(s)
- Kim A Papp
- 1 K Papp Clinical Research, Waterloo, ON, Canada.,2 Probity Medical Research, Waterloo, ON, Canada
| | - Boulos Haraoui
- 3 Centre Hospitalier de l'Université de Montréal, Montreal, QC, Canada
| | - Deepali Kumar
- 4 University Health Network, Toronto, ON, Canada.,5 Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - John K Marshall
- 6 Department of Medicine and Farncombe Family Digestive Health Research Institute, McMaster University, Hamilton, ON, Canada
| | | | - Alain Bitton
- 8 McGill University Health Centre, Montreal, QC, Canada
| | - Brian Bressler
- 9 Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada.,10 St Paul's Hospital, Vancouver, BC, Canada
| | - Melinda Gooderham
- 2 Probity Medical Research, Waterloo, ON, Canada.,11 Faculty of Medicine, Queen's University, Kingston, ON, Canada
| | - Vincent Ho
- 9 Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Shahin Jamal
- 12 Vancouver Coastal Health, Vancouver, BC, Canada
| | - Janet E Pope
- 13 Faculty of Medicine, University of Western Ontario, London, ON, Canada.,14 St Joseph's Health Care, London, ON, Canada
| | - A Hillary Steinhart
- 5 Faculty of Medicine, University of Toronto, Toronto, ON, Canada.,15 Mount Sinai Hospital, Toronto, ON, Canada
| | - Donald C Vinh
- 8 McGill University Health Centre, Montreal, QC, Canada.,16 Research Institute, McGill University Health Centre, Montreal, QC, Canada
| | - John Wade
- 9 Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada.,17 Vancouver General Hospital, Vancouver, BC, Canada
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34
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Gomez EV, Bishop JL, Jackson K, Muram TM, Phillips D. Response to Tetanus and Pneumococcal Vaccination Following Administration of Ixekizumab in Healthy Participants. BioDrugs 2018; 31:545-554. [PMID: 29116597 PMCID: PMC5696443 DOI: 10.1007/s40259-017-0249-y] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Background Ixekizumab (IXE) is an interleukin (IL)-17A antagonist approved for the treatment of adults with moderate-to-severe psoriasis. Objective The objective of this study was to determine if the immune response to tetanus and pneumococcal vaccines in healthy subjects administered IXE was noninferior to control. Methods In a randomized, open-label, parallel-group study, adult subjects received vaccinations alone (N = 42, control) or in combination with 160 mg IXE subcutaneously 2 weeks prior to vaccination and 80 mg IXE on the day of vaccination (N = 41, IXE). Response to tetanus vaccination was defined as anti-tetanus antibodies ≥ 1.0 IU and a ≥ 1.5-fold increase if baseline was ≤ 1.0 IU or a ≥ 2.5-fold increase if baseline was > 1.0 IU. Response to pneumococcal vaccination was defined as a ≥ 2-fold increase from baseline in anti-pneumococcal antibodies against > 50% of the 23 serotypes. The primary outcomes were the percentages of patients with a response to the tetanus and pneumococcal vaccines 4 weeks after vaccination. A noninferiority analysis of IXE to control using a 40% margin was evaluated for the primary outcomes. Safety and pharmacokinetics were also assessed. Results IXE (38 completers) was noninferior to control (41 completers) based on the difference in the proportion of responders to tetanus [1.4%; 90% confidence interval (CI) − 16.6 to 19.2] and pneumococcal (− 0.8%; 90% CI − 12.9 to 11.0) vaccines. Twenty subjects (14 IXE, six control) reported 43 mild treatment-emergent adverse events. Conclusion IXE does not suppress the humoral immune response to non-live vaccines and was well tolerated in healthy subjects. ClinicalTrial.gov identifier: NCT02543918. Electronic supplementary material The online version of this article (doi:10.1007/s40259-017-0249-y) contains supplementary material, which is available to authorized users.
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35
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Carrascosa JM, Del-Alcazar E. New therapies versus first-generation biologic drugs in psoriasis: a review of adverse events and their management. Expert Rev Clin Immunol 2018; 14:259-273. [DOI: 10.1080/1744666x.2018.1454835] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- J. M. Carrascosa
- Department of Dermatology, Hospital Universitari Germans Trias I Pujol, Badalona, Spain
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Ufer M, Shakeri-Nejad K, Gardin A, Su Z, Paule I, Marbury TC, Legangneux E. Impact of siponimod on vaccination response in a randomized, placebo-controlled study. NEUROLOGY(R) NEUROIMMUNOLOGY & NEUROINFLAMMATION 2017; 4:e398. [PMID: 28955715 PMCID: PMC5608565 DOI: 10.1212/nxi.0000000000000398] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/11/2017] [Accepted: 06/23/2017] [Indexed: 01/19/2023]
Abstract
OBJECTIVE To evaluate effects of siponimod on response to T-cell-dependent (influenza) and T-cell-independent (pneumococcal polysaccharide vaccine [PPV-23]) vaccinations in healthy participants. METHODS In this double-blind, placebo-controlled, parallel-group study, each participant underwent a 7-week treatment period and received intramuscular injections of influenza and PPV-23 vaccines (day 21). Participants were randomized to 4 treatment groups (N = 30 each) and received placebo or siponimod 2 mg once daily in concomitant, interrupted, or preceding fashion. Individual response to vaccination was defined by a ≥4-fold (influenza) antibody titer increase and by a ≥2-fold increase in serotype-specific immunoglobulin (Ig) G concentrations (PPV-23) on day 28 vs baseline. Responder rates were compared using noninferiority analysis. RESULTS Mean influenza titers were similar to placebo in the preceding and interrupted groups but lower in the concomitant group. The proportion of participants with influenza titers ≥40 four weeks after vaccination (seroprotection) was similar to placebo across all groups and antigens. In each treatment group, response criteria were met for 3 of 4 antigens including H1N1 and H3N2. A noninferior response was determined in the context of preceding treatment but not interrupted or concomitant treatment. Regarding PPV-23, approximately 90%-100% of participants exhibited a ≥2-fold increase in IgG concentrations vs baseline. Noninferior responder rates were determined for each siponimod treatment group. CONCLUSIONS Siponimod treatment had no relevant effect on antibody response to PPV-23. European Medicines Agency response criteria were essentially met for influenza, but titers were lower on concomitant treatment. Overall, these data suggest that siponimod has limited effect on the efficacy of vaccinations with neoantigens. CLASSIFICATION OF EVIDENCE This study provides Class II evidence that in healthy persons, siponimod had limited effect on the immune response following influenza or pneumococcal vaccinations.
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Affiliation(s)
- Mike Ufer
- Novartis Pharma AG (M.U., K.S.-N., A.G., Z.S., I.P., E.L.), Basel, Switzerland; and Orlando Clinical Research Center (T.C.M.), Orlando, FL
| | - Kasra Shakeri-Nejad
- Novartis Pharma AG (M.U., K.S.-N., A.G., Z.S., I.P., E.L.), Basel, Switzerland; and Orlando Clinical Research Center (T.C.M.), Orlando, FL
| | - Anne Gardin
- Novartis Pharma AG (M.U., K.S.-N., A.G., Z.S., I.P., E.L.), Basel, Switzerland; and Orlando Clinical Research Center (T.C.M.), Orlando, FL
| | - Zhenzhong Su
- Novartis Pharma AG (M.U., K.S.-N., A.G., Z.S., I.P., E.L.), Basel, Switzerland; and Orlando Clinical Research Center (T.C.M.), Orlando, FL
| | - Ines Paule
- Novartis Pharma AG (M.U., K.S.-N., A.G., Z.S., I.P., E.L.), Basel, Switzerland; and Orlando Clinical Research Center (T.C.M.), Orlando, FL
| | - Thomas C Marbury
- Novartis Pharma AG (M.U., K.S.-N., A.G., Z.S., I.P., E.L.), Basel, Switzerland; and Orlando Clinical Research Center (T.C.M.), Orlando, FL
| | - Eric Legangneux
- Novartis Pharma AG (M.U., K.S.-N., A.G., Z.S., I.P., E.L.), Basel, Switzerland; and Orlando Clinical Research Center (T.C.M.), Orlando, FL
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Nast A, Spuls P, van der Kraaij G, Gisondi P, Paul C, Ormerod A, Saiag P, Smith C, Dauden E, de Jong E, Feist E, Jobling R, Maccarone M, Mrowietz U, Papp K, Reich K, Rosumeck S, Talme T, Thio H, van de Kerkhof P, Werner R, Dressler C. European S3-Guideline on the systemic treatment of psoriasis vulgaris - Update Apremilast and Secukinumab - EDF in cooperation with EADV and IPC. J Eur Acad Dermatol Venereol 2017; 31:1951-1963. [DOI: 10.1111/jdv.14454] [Citation(s) in RCA: 92] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2017] [Accepted: 06/27/2017] [Indexed: 01/18/2023]
Affiliation(s)
- A. Nast
- Division of Evidence-Based Medicine; Department of Dermatology; Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin; Humboldt-Universität zu Berlin, and Berlin Institute of Health; Berlin Germany
| | - P.I. Spuls
- Department of Dermatology; Academic Medical Center; Amsterdam The Netherlands
| | - G. van der Kraaij
- Department of Dermatology; Academic Medical Center; Amsterdam The Netherlands
| | - P. Gisondi
- Section of Dermatology and Venereology; Department of Medicine; University of Verona; Verona Italy
| | - C. Paul
- Department of Dermatology; Paul Sabatier University; Toulouse France
| | - A.D. Ormerod
- Department of Dermatology; Aberdeen Royal Infirmary; Aberdeen UK
| | - P. Saiag
- Service de Dermatologie; Hôpital Ambroise Paré Université Paris V; Boulogne France
| | - C.H. Smith
- St Johns Institute of Dermatology; Guys and St Thomas’ Hospital Foundation Trust; London UK
| | - E. Dauden
- Hospital Universitario de la Princesa; Madrid Spain
| | - E.M. de Jong
- Radboud University medical center and Radboud University; Nijmegen The Netherlands
| | - E. Feist
- Department of Rheumatology and Clinical Immunology; Charité - Universitätsmedizin Berlin; Berlin Germany
| | | | | | - U. Mrowietz
- Department of Dermatology; Psoriasis-Center University Medical Center Schleswig Holstein; Kiel Germany
| | | | - K. Reich
- Dermatologikum Hamburg; Hamburg Germany
| | - S. Rosumeck
- Division of Evidence-Based Medicine; Department of Dermatology; Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin; Humboldt-Universität zu Berlin, and Berlin Institute of Health; Berlin Germany
| | - T. Talme
- Section of Dermatology and Venereology; Department of Medicine; Karolinska Institutet; Karolinska University Hospital; Huddinge Stockholm Sweden
| | - H.B. Thio
- Radboud University medical center and Radboud University; Nijmegen The Netherlands
| | - P. van de Kerkhof
- Radboud University medical center and Radboud University; Nijmegen The Netherlands
| | - R.N. Werner
- Division of Evidence-Based Medicine; Department of Dermatology; Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin; Humboldt-Universität zu Berlin, and Berlin Institute of Health; Berlin Germany
| | - C. Dressler
- Division of Evidence-Based Medicine; Department of Dermatology; Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin; Humboldt-Universität zu Berlin, and Berlin Institute of Health; Berlin Germany
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Reszke R, Szepietowski JC. Secukinumab in the treatment of psoriasis: an update. Immunotherapy 2017; 9:229-238. [DOI: 10.2217/imt-2016-0128] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Biological drugs are pharmaceuticals manufactured using biotechnology methods that may target specific cytokines, cytokine receptors or surface molecules, and modulate the immunological response of the organism. Psoriasis is a common cutaneous disease in which biological drugs have been evaluated and widely accepted in clinical practice. Secukinumab is a monoclonal antibody targeting IL-17A which has been extensively researched in clinical trials and registered in treating moderate to severe plaque psoriasis. We performed a literature search in Pubmed database on the pharmacology of secukinumab and randomized clinical trials investigating its efficacy and safety in treating plaque psoriasis in comparison to placebo or biological drugs (etanercept, ustekinumab). The administration of secukinumab in psoriatic subjects resulted in subjective and objective disease parameters reduction while exhibiting high safety profile. Secukinumab is an effective drug with a favorable safety profile. It has already taken an important position in managing plaque psoriasis in clinical practice.
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Affiliation(s)
- Radomir Reszke
- Department of Dermatology, Venereology & Allergology, Wroclaw Medical University, Chalubinskiego 1, 50–368 Wroclaw, Poland
| | - Jacek C Szepietowski
- Department of Dermatology, Venereology & Allergology, Wroclaw Medical University, Chalubinskiego 1, 50–368 Wroclaw, Poland
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Thomas K, Vassilopoulos D. Immunization in patients with inflammatory rheumatic diseases. Best Pract Res Clin Rheumatol 2016; 30:946-963. [PMID: 27964798 DOI: 10.1016/j.berh.2016.10.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2016] [Revised: 10/16/2016] [Accepted: 10/17/2016] [Indexed: 12/25/2022]
Abstract
Immunization represents the most efficient and simplest intervention to prevent certain viral and bacterial infections in the general population as well as in the vulnerable population of patients with inflammatory rheumatic diseases treated with immunosuppressives. Here, we present an updated review of literature data regarding the safety and efficacy of immunizations against different pathogens in rheumatic patients treated with conventional immunosuppressives or the newer biologic agents while at the same time we provide practical guidance for the appropriate vaccine administration in this patient population.
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Affiliation(s)
- Konstantinos Thomas
- Joint Rheumatology Program, Clinical Immunology-Rheumatology Unit, 2nd Department of Medicine and Laboratory, National and Kapodistrian University of Athens School of Medicine, Hippokration General Hospital, 114 Vass. Sophias Ave., 115 27, Athens, Greece
| | - Dimitrios Vassilopoulos
- Joint Rheumatology Program, Clinical Immunology-Rheumatology Unit, 2nd Department of Medicine and Laboratory, National and Kapodistrian University of Athens School of Medicine, Hippokration General Hospital, 114 Vass. Sophias Ave., 115 27, Athens, Greece.
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Malakouti M, Jacob SE, Anderson NJ. Treatment challenges in the management of moderate-to-severe plaque psoriasis - role of secukinumab. Clin Cosmet Investig Dermatol 2016; 9:347-355. [PMID: 27785085 PMCID: PMC5066687 DOI: 10.2147/ccid.s81160] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Psoriasis is a chronic inflammatory skin disease that has a negative impact on psychosocial well-being and cardiometabolic health. Treatment options for moderate-to-severe psoriasis have expanded with the development of interleukin-17 (IL-17) inhibitors, the first of which is now available - secukinumab. Secukinumab is a fully human monoclonal immunoglobulin G1 κ antibody that selectively inhibits the ligand IL-17A. In head-to-head studies, it is more effective than etanercept and ustekinumab, particularly in achieving Psoriasis Area and Severity Index (PASI) 90/100 and achieving PASI 50/75 as early as week 4. No head-to-head trials are available for comparison of adalimumab to secukinumab. Significant improvement in health care-related quality of life was also observed using the dermatology quality index in clinical studies. Safety data for secukinumab is comparable to available biologics. Specific safety concerns for the use of secukinumab include its use in patients with inflammatory bowel disease, reversible transient neutropenia, in those with a latex allergy, and the occurrence of mild to moderate oral or genital candidiasis. Secukinumab is an effective and safe treatment option that achieves high clearance rates up to PASI 90 and 100 as monotherapy in cases of moderate-to-severe psoriasis. It may be particularly helpful in patients with psoriasis who have formed antidrug antibodies or failed other biologic agents and in patients with psoriatic arthritis or ankylosing spondylitis.
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Affiliation(s)
- Mona Malakouti
- Department of Dermatology, Loma Linda University, Loma Linda, CA, USA
| | - Sharon E Jacob
- Department of Dermatology, Loma Linda University, Loma Linda, CA, USA
| | - Nancy J Anderson
- Department of Dermatology, Loma Linda University, Loma Linda, CA, USA
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Jaleel T, Elmets C, Weinkle A, Kassira S, Elewski B. Secukinumab (AIN-457) for the treatment of Psoriasis. Expert Rev Clin Pharmacol 2016; 9:187-202. [PMID: 26647300 DOI: 10.1586/17512433.2016.1129894] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Secukinumab (also known as AIN-457) is a human monoclonal antibody targeting IL-17A, which has been recently FDA-approved for the treatment of moderate to severe psoriasis and psoriatic arthritis with coexistent moderate to severe plaque psoriasis based on clinical trials demonstrating excellent efficacy. This review will address the rationale for targeting the IL-23/Th17/IL-17 axis, the role of IL-17 and Th17 cells in psoriasis and other chronic inflammatory diseases, and will examine pre-clinical studies, pharmacologic properties, clinical efficacy, and the safety profile of secukinumab.
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Affiliation(s)
- Tarannum Jaleel
- a Department of Dermatology , University of Alabama at Birmingham , Birmingham , AL , USA
| | - Craig Elmets
- a Department of Dermatology , University of Alabama at Birmingham , Birmingham , AL , USA
| | - Allison Weinkle
- c University of California San Diego School of Medicine , La Jolla , CA , USA
| | - Sama Kassira
- b University of Alabama School of Medicine , Birmingham , AL , USA
| | - Boni Elewski
- a Department of Dermatology , University of Alabama at Birmingham , Birmingham , AL , USA
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Wiedermann U, Sitte HH, Burgmann H, Eser A, Falb P, Holzmann H, Kitchen M, Köller M, Kollaritsch H, Kundi M, Lassmann H, Mutz I, Pickl WF, Riedl E, Sibilia M, Thalhammer F, Tucek B, Zenz W, Zwiauer K. [Guidelines for vaccination of immunocompromised individuals]. Wien Klin Wochenschr 2016; 128 Suppl 4:337-76. [PMID: 27457874 DOI: 10.1007/s00508-016-1033-6] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2016] [Accepted: 06/04/2016] [Indexed: 12/14/2022]
Abstract
Immunosuppression of various origins is associated with an increased risk of infection; therefore the prevention of infectious diseases by vaccination is especially important in immunocompromised patients. However, the response to vaccinations is often reduced in these risk groups and the application of live vaccines is contraindicated during immunosuppression.In the following expert statement, recommendations for vaccination were created on the basis of current evidence and theoretical/immunological considerations. A first, general part elaborates on efficacy and safety of vaccinations during immunosuppression, modes of action of immunosuppressive medications and recommended time intervals between immunosuppressive treatments and vaccinations. A core piece of this part is a graduation of immunosuppression into three stages, i. e. no relevant immunosuppression, mild to moderate and severe immunosuppression and the assignment of various medications (including biologicals) to one of those stages; this is followed by an overview of possible and necessary vaccinations in each of those stages.The second part gives detailed vaccination guidelines for common diseases and therapies associated with immunosuppression. Primary immune deficiencies, chronic kidney disease, diabetes mellitus, solid and hematological tumors, hematopoetic stem cell transplantation, transplantation of solid organs, aspenia, rheumatological-, gastroenterologic-, dermatologic-, neurologic diseases, biologicals during pregnancy and HIV infection are dealt with.These vaccination guidelines, compiled for the first time in Austria, aim to be of practical help for physicians to facilitate and improve vaccination coverage in immunocompromised patients and their household members and contact persons.
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Affiliation(s)
- Ursula Wiedermann
- Institut für Spezifische Prophylaxe und Tropenmedizin, Medizinische Universität Wien, Kinderspitalgasse 15, 1090, Wien, Österreich.
| | - Harald H Sitte
- Institut für Pharmakologie, Medizinische Universität Wien, Wien, Österreich
| | - Heinz Burgmann
- Klinische Abteilung für Infektionen und Tropenmedizin, Medizinische Universität Wien, Wien, Österreich
| | - Alexander Eser
- Klinische Abteilung für Gastroenterologie und Hepatologie, Medizinische Universität Wien, Wien, Österreich
| | - Petra Falb
- Medizinmarktaufsicht, Agentur für Gesundheit und Ernährungssicherheit, Wien, Österreich
| | | | - Maria Kitchen
- Universitätsklinik für Dermatologie und Venerologie, Medizinische Universität Innsbruck, Innsbruck, Österreich
| | - Marcus Köller
- Sozialmedizinisches Zentrum Sophienspital, Wien, Österreich
| | - Herwig Kollaritsch
- Institut für Spezifische Prophylaxe und Tropenmedizin, Medizinische Universität Wien, Kinderspitalgasse 15, 1090, Wien, Österreich
| | - Michael Kundi
- Institut für Umwelthygiene, Medizinische Universität Wien, Wien, Österreich
| | - Hans Lassmann
- Abteilung für Neuroimmunologie, Medizinische Universität Wien, Wien, Österreich
| | | | - Winfried F Pickl
- Institut für Immunologie, Medizinische Universität Wien, Wien, Österreich
| | - Elisabeth Riedl
- Universitätsklinik für Dermatologie, Medizinische Universität Wien, Wien, Österreich
| | - Maria Sibilia
- Institut für Krebsforschung, Medizinische Universität Wien, Wien, Österreich
| | - Florian Thalhammer
- Klinische Abteilung für Infektionen und Tropenmedizin, Medizinische Universität Wien, Wien, Österreich
| | - Barbara Tucek
- Medizinmarktaufsicht, Agentur für Gesundheit und Ernährungssicherheit, Wien, Österreich
| | - Werner Zenz
- Klinische Abteilung für allgemeine Pädiatrie, Medizinische Universität Graz, Graz, Österreich
| | - Karl Zwiauer
- Klinische Abteilung für Kinder- und Jugendheilkunde, Universitätsklinikum St. Pölten, St. Pölten, Österreich
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Maldonado-Ficco H, Perez-Alamino R, Maldonado-Cocco JA. Secukinumab: a promising therapeutic option in spondyloarthritis. Clin Rheumatol 2016; 35:2151-61. [PMID: 27437696 DOI: 10.1007/s10067-016-3350-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2016] [Revised: 07/02/2016] [Accepted: 07/04/2016] [Indexed: 12/14/2022]
Abstract
Psoriatic arthritis (PsA) is the second most common chronic inflammatory joint disease. Ankylosing spondylitis (AS) is another less common but equally chronic and disabling spondyloarthritis (SpA). Therapeutic agents for the treatment of these diseases have been somewhat lacking as compared with those available for rheumatoid arthritis, which represents a significant challenge for both the treating physician and the pharmaceutical industry. A promising development for our understanding of the physiopathology of PsA and AS involves new targets to interrupt IL-17 and IL-12/IL-23 pathways. Up to 30-40 % of SpA patients have inadequate or poor response, or are intolerant to anti-TNF therapies. Therefore, there has been a clear unmet medical need in an important group of these patients. As a result, new therapeutic targets have emerged for the treatment of both axial and peripheral SpA. Interleukin 17 (IL-17) is a pro-inflammatory cytokine that is increased in psoriatic lesions as well as in the synovial fluid of patients with PsA and in sites of enthesitis in SpA. IL-23 has been shown to play an important role in the polarization of CD4+ T-cells to become IL-17 producers. Based on these evidences, blockade of the cytokine IL-17 or its receptors was considered to have therapeutic implications for the treatment of psoriasis, as well as PsA and AS.This article presents a thorough review of an IL-17 A blocking agent, its mechanism of action, its clinical efficacy and its therapeutic safety.
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Affiliation(s)
- Hernan Maldonado-Ficco
- Rheumatology Section, Department of Internal Medicine, Hospital San Antonio de Padua, Cordoba, Río Cuarto, Argentina.
| | - Rodolfo Perez-Alamino
- Rheumatology Section, Department of Internal Medicine, Hospital Avellaneda, Tucumán, Argentina
| | - José A Maldonado-Cocco
- University of Buenos Aires, Buenos Aires, Argentina.,Rheumatology Training Program, Buenos Aires University School of Medicine, Buenos Aires, Argentina
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Roman M, Madkan VK, Chiu MW. Profile of secukinumab in the treatment of psoriasis: current perspectives. Ther Clin Risk Manag 2015; 11:1767-77. [PMID: 26664127 PMCID: PMC4671779 DOI: 10.2147/tcrm.s79053] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Secukinumab (Cosentyx™) is a human monoclonal IgG1k antibody that has been developed to target and block the actions of IL-17A. It is known that this cytokine is elevated in lesions of psoriasis. Interleukins in the Th17 pathway play a pivotal role in the pathogenesis of psoriasis and have thus become targets for recent biologic drug development. As a monoclonal antibody immune modulator, secukinumab exhibits the expected pharmacokinetic properties of slow subcutaneous absorption, low clearance, and long half-life, although formal studies examining the impact of impaired hepatic or renal function on the overall pharmacokinetic profile have not been conducted. Both Phase II and III clinical trials have demonstrated the effectiveness of secukinumab in the treatment of moderate-to-severe plaque psoriasis, psoriatic arthritis, rheumatoid arthritis, ankylosing spondylitis, and noninfectious uveitis. In June 2015, secukinumab was approved by the US Food and Drug Administration for the treatment of adults with moderate-to-severe plaque psoriasis, with a wealth of clinical trials showcasing its efficacy in improving psoriasis area and severity index scores, and it is superior to other comparable biologics on the market, including the TNF inhibitor etanercept. As such, this review focuses on the marquee clinical trials involving secukinumab treatment of plaque psoriasis, while also exploring this drug's efficacy in treating patients with psoriatic arthritis, a disease that has a well-documented comorbidity in patients diagnosed with moderate-to-severe plaque psoriasis. Finally, the safety and tolerability of this drug in a variety of clinical trials to date have also been reviewed, and will undoubtedly have a large impact on this drug's postmarketing surveillance and future studies regarding its long-term safety.
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Affiliation(s)
- Michael Roman
- Division of Dermatology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Vandana K Madkan
- Division of Dermatology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Melvin W Chiu
- Division of Dermatology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
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Tabarkiewicz J, Pogoda K, Karczmarczyk A, Pozarowski P, Giannopoulos K. The Role of IL-17 and Th17 Lymphocytes in Autoimmune Diseases. Arch Immunol Ther Exp (Warsz) 2015; 63:435-49. [PMID: 26062902 PMCID: PMC4633446 DOI: 10.1007/s00005-015-0344-z] [Citation(s) in RCA: 158] [Impact Index Per Article: 17.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2014] [Accepted: 05/26/2015] [Indexed: 02/07/2023]
Abstract
The end of twentieth century has introduced some changes into T helper (Th) cells division. The identification of the new subpopulation of T helper cells producing IL-17 modified model of Th1-Th2 paradigm and it was named Th17. High abilities to stimulate acute and chronic inflammation made these cells ideal candidate for crucial player in development of autoimmune disorders. Numerous publications based on animal and human models confirmed their pivotal role in pathogenesis of human systemic and organ-specific autoimmune diseases. These findings made Th17 cells and pathways regulating their development and function a good target for therapy. Therapies based on inhibition of Th17-dependent pathways are associated with clinical benefits, but on the other hand are frequently inducing adverse effects. In this review, we attempt to summarize researches focused on the importance of Th17 cells in development of human autoimmune diseases as well as effectiveness of targeting IL-17 and its pathways in pre-clinical and clinical studies.
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Affiliation(s)
- Jacek Tabarkiewicz
- Centre for Innovative Research in Medical and Natural Sciences, Medical Faculty, University of Rzeszów, Rzeszow, Poland.
| | - Katarzyna Pogoda
- Centre for Innovative Research in Medical and Natural Sciences, Medical Faculty, University of Rzeszów, Rzeszow, Poland
| | | | - Piotr Pozarowski
- Department of Clinical Immunology, Medical University of Lublin, Lublin, Poland
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Abstract
Secukinumab (Cosentyx™) is a fully human monoclonal antibody against interleukin-17A, formulated for intravenous and subcutaneous administration. It received its first global approval in Japan on 26 December 2014 for the treatment of psoriasis and psoriatic arthritis in adults who are not adequately responding to systemic therapies (except for biologic agents). In the USA and the EU, secukinumab was approved in early 2015 for the treatment of patients with moderate-to-severe plaque psoriasis. Secukinumab is also being investigated in patients with ankylosing spondylitis and rheumatoid arthritis. This article summarizes the milestones in the development of secukinumab leading to its first approval for the treatment of adult patients with psoriasis and psoriatic arthritis.
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Abstract
Each month, subscribers to The Formulary Monograph Service receive 5 to 6 well-documented monographs on drugs that are newly released or are in late phase 3 trials. The monographs are targeted to Pharmacy & Therapeutics Committees. Subscribers also receive monthly 1-page summary monographs on agents that are useful for agendas and pharmacy/nursing in-services. A comprehensive target drug utilization evaluation/medication use evaluation (DUE/MUE) is also provided each month. With a subscription, the monographs are sent in print and are also available on-line. Monographs can be customized to meet the needs of a facility. A drug class review is now published monthly with The Formulary Monograph Service. Through the cooperation of The Formulary, Hospital Pharmacy publishes selected reviews in this column. For more information about The Formulary Monograph Service, call The Formulary at 800-322-4349. The September 2015 monograph topics are cangrelor, lumacaftor/ivacaftor, brexpiprazole, talimogene laherparepvec, and lesinurad. The Safety MUE is on cangrelor.
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Affiliation(s)
| | - Danial E Baker
- Director, Drug Information Center, and Professor of Pharmacy Practice, College of Pharmacy, Washington State University Spokane
| | - Shannon G Panther
- Clinical Assistant Professor, College of Pharmacy, Washington State University , Spokane
| | - Kyle Ingram PharmD
- Drug Information Resident, College of Pharmacy, Washington State University Spokane . The authors indicate no relationships that could be perceived as a conflict of interest
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Abstract
Secukinumab (Cosentyx™) is a fully human monoclonal immunoglobulin G1κ antibody targeting human interleukin-17A, an important cytokine in the pathogenesis of psoriasis. Secukinumab, as well as being first in its drug class, is the first biologic treatment to be approved in the EU for the first-line systemic treatment of moderate to severe plaque psoriasis. This article reviews the pharmacologic properties of secukinumab and its clinical efficacy and tolerability in adult patients with moderate to severe plaque psoriasis. In clinical trials, subcutaneous secukinumab was more effective than placebo, etanercept and ustekinumab at improving both psoriasis symptoms (with high skin clearance) and health-related quality of life. Moreover, secukinumab was more effective than placebo in the difficult-to-treat palmoplantar and nail psoriasis populations. Secukinumab was generally well tolerated, with low immunogenicity. Longer-term, efficacy was sustained and secukinumab remained well tolerated. Subcutaneous secukinumab is an effective and generally well tolerated first-line treatment for moderate to severe plaque psoriasis, and is a useful addition to the treatment options for this disease.
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50
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Meyer M, Garron T, Lubaki NM, Mire CE, Fenton KA, Klages C, Olinger GG, Geisbert TW, Collins PL, Bukreyev A. Aerosolized Ebola vaccine protects primates and elicits lung-resident T cell responses. J Clin Invest 2015; 125:3241-55. [PMID: 26168222 DOI: 10.1172/jci81532] [Citation(s) in RCA: 58] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2015] [Accepted: 05/28/2015] [Indexed: 01/05/2023] Open
Abstract
Direct delivery of aerosolized vaccines to the respiratory mucosa elicits both systemic and mucosal responses. This vaccine strategy has not been tested for Ebola virus (EBOV) or other hemorrhagic fever viruses. Here, we examined the immunogenicity and protective efficacy of an aerosolized human parainfluenza virus type 3-vectored vaccine that expresses the glycoprotein (GP) of EBOV (HPIV3/EboGP) delivered to the respiratory tract. Rhesus macaques were vaccinated with aerosolized HPIV3/EboGP, liquid HPIV3/EboGP, or an unrelated, intramuscular, Venezuelan equine encephalitis replicon vaccine expressing EBOV GP. Serum and mucosal samples from aerosolized HPIV3/EboGP recipients exhibited high EBOV-specific IgG, IgA, and neutralizing antibody titers, which exceeded or equaled titers observed in liquid recipients. The HPIV3/EboGP vaccine induced an EBOV-specific cellular response that was greatest in the lungs and yielded polyfunctional CD8+ T cells, including a subset that expressed CD103 (αE integrin), and CD4+ T helper cells that were predominately type 1. The magnitude of the CD4+ T cell response was greater in aerosol vaccinees. The HPIV3/EboGP vaccine produced a more robust cell-mediated and humoral immune response than the systemic replicon vaccine. Moreover, 1 aerosol HPIV3/EboGP dose conferred 100% protection to macaques exposed to EBOV. Aerosol vaccination represents a useful and feasible vaccination mode that can be implemented with ease in a filovirus disease outbreak situation.
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