1
|
Paller AS, Guide SV, Ayala D, Gonzalez ME, Lucky AW, Bagci IS, Marinkovich MP. Practical considerations relevant to treatment with the gene therapy beremagene geperpavec-svdt for dystrophic epidermolysis bullosa. J DERMATOL TREAT 2024; 35:2350232. [PMID: 38724041 DOI: 10.1080/09546634.2024.2350232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2024] [Accepted: 04/24/2024] [Indexed: 05/15/2024]
Abstract
BACKGROUND/PURPOSE Dystrophic epidermolysis bullosa (DEB), a rare genetic skin disease caused by loss-of-function mutations in COL7A1, the gene encoding type VII collagen (COL7), is characterized by skin blistering, scarring, and extracutaneous manifestations that markedly reduce patient quality-of-life. Beremagene geperpavec-svdt ('B-VEC') is a gene therapy employing a non-integrating, replication-defective herpes simplex virus type 1 (HSV-1)-based vector encoding two copies of full-length human COL7A1 to restore COL7 protein after topical administration to DEB wounds. B-VEC was approved in the United States in 2023 as the first topical gene therapy and the first approved treatment for DEB. However, few providers have experience with use of this gene therapy. METHODS Data was obtained through literature review and the experience of providers who participated in the B-VEC clinical study or initiated treatment after B-VEC approval. RESULTS This review discusses the burden of disease, describes the clinical trial outcomes of B-VEC, and provides physician and patient/caregiver recommendations as a practical guide for the real-world use of B-VEC, which can be administered in-office or at the patient's home. CONCLUSIONS By continuing to optimize the practical aspects of B-VEC administration, the focus will continue to shift to patient-centric considerations and improved patient outcomes.
Collapse
Affiliation(s)
- Amy S Paller
- Departments of Dermatology and Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Shireen V Guide
- Mission Dermatology Center, Department of Dermatology, Children's Hospital of Orange County, University of California Irvine, Rancho Santa Margarita, California, USA
| | - Diego Ayala
- Mission Dermatology Center, Department of Dermatology, Children's Hospital of Orange County, University of California Irvine, Rancho Santa Margarita, California, USA
| | | | - Anne W Lucky
- Division of Dermatology, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Isin Sinem Bagci
- Department of Dermatology, Stanford University School of Medicine, Stanford, California, USA
| | - M Peter Marinkovich
- Department of Dermatology, Stanford University School of Medicine, Stanford, California, USA
| |
Collapse
|
2
|
Chateau AV, Aldous C, Dlova N, Blackbeard D. 'It breaks my heart': Healthcare practitioners' caring for families with epidermolysis bullosa. Health SA 2023; 28:2355. [PMID: 37927945 PMCID: PMC10623493 DOI: 10.4102/hsag.v28i0.2355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Accepted: 07/11/2023] [Indexed: 11/07/2023] Open
Abstract
Background Epidermolysis bullosa (EB) is a painful genodermatosis presenting with skin fragility and blisters. There is no cure; the prognosis is guarded and depends on the subtype of the disease. Managing these patients can be emotionally challenging for healthcare practitioners. Aim To determine the perceptions, impact, and needs of healthcare practitioners (HCP) caring for patients and their families with EB. Setting Nelson Mandela School of Medicine, Durban and Grey's Hospital, Pietermaritzburg, KwaZulu-Natal. Methods The study was guided by interpretative phenomenological analysis. Individual in-depth interviews were conducted with 10 healthcare practitioners. Guba's trustworthiness framework was used to ensure rigour. Results Six global themes were identified, each related primarily to the perceptions, impact, and needs of healthcare practitioners. The experiences and perceptions of healthcare practitioners were that caring for patients with an incurable disease such as EB could negatively impact healthcare practitioners. There were divergent views among the disciplines of HCPs regarding the extent of care in a resource-limited environment. This resulted in negative emotions, ethical concerns, and a need for continued medical education and the application of coping strategies. Healthcare practitioners observed that patients and their families were vulnerable, requiring comprehensive biopsychosocial care. Conclusion Healthcare practitioners should be aware of their emotional challenges, seek support where necessary, and use effective coping strategies and self-care. Contribution The concerns and needs of healthcare practitioners are highlighted and interventional strategies to assist healthcare practitioners are suggested which will ultimately improve patient care.
Collapse
Affiliation(s)
- Antoinette V Chateau
- Department of Dermatology, Grey's Hospital, Pietermaritzburg, South Africa
- Department of Dermatology, Faculty of Health Science, University of KwaZulu-Natal, Durban, South Africa
| | - Colleen Aldous
- School of Clinical Medicine, Faculty of Health Science, University of KwaZulu-Natal, Durban, South Africa
| | - Ncoza Dlova
- Department of Dermatology, Faculty of Health Science, University of KwaZulu-Natal, Durban, South Africa
| | - David Blackbeard
- Department of Psychology, Grey's Hospital, Pietermaritzburg, South Africa
- Department of Psychiatry, Faculty of Health Science, University of KwaZulu-Natal, Durban, South Africa
| |
Collapse
|
3
|
Walsh C, Leavey G, Mc Laughlin M, Paller AS, Irvine AD, Browne F, Mellerio JE, Bewley A. Novel mixed-method, inclusive protocol involving global key stakeholders, including carers as experts, to co-develop relevant Caregiver-Reported Outcome Domains (CRODs) in skin disease. BMJ Open 2023; 13:e068893. [PMID: 36657764 PMCID: PMC9853252 DOI: 10.1136/bmjopen-2022-068893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
INTRODUCTION Ichthyoses comprise a heterogenous group of rare genetic skin disorders that involves the entire skin surface, often with additional syndromic features, and pose many clinical challenges. Without curative intervention, the mainstay of life-long symptom management is supportive in nature and can remain the responsibility of the caregiver. Although impact on the wider family is considered an important outcome of policies and services, there is a lack of caregiver consensus on what outcome domains to measure to fully assess the impact of ichthyosis on the patient and the caregiver. This project aims to identify a set of core outcome domains towards a core outcome set for ichthyosis that can measure all relevant concepts of ichthyosis in clinical practice, service delivery and research. METHODS AND ANALYSIS Following the COMET (Core Outcome Measures in Effectiveness Trials) initiative, this project will employ a mixed-method study design which was developed using public and patient involvement and an international multidisciplinary expert group (clinical experts, patients and their representatives, policymakers, researchers and service providers). Experts by experience, or caregivers, will be recruited through online ichthyosis support groups. Phase one will focus on item generation and involve: (1) a systematic literature review, (2) a multimethods international qualitative study with ichthyosis caregivers and (3) co-development of items for an e-survey. Phase two, item refinement, will employ a novel four-pronged consensus approach: (1) an e-Delphi survey, (2) statistical analysis of e-Delphi survey results, (3) online qualitative feedback and (4) an online consensus discussion. All methodological considerations will be clearly linked with each Core Outcome Set-STAndards for Developing recommendation. ETHICS AND DISSEMINATION Research Ethics Committee approval obtained from the School of Psychology, Ulster University (UK)(Ref:REC/20/0004). Results will be presented in published international peer-reviewed journals, at scientific meetings and support groups. REGISTRATION COMET database (January 2019).
Collapse
Affiliation(s)
- Carleen Walsh
- Bamford Centre for Mental Health and Wellbeing, Ulster University, Coleraine, UK
| | - Gerard Leavey
- Bamford Centre for Mental Health and Wellbeing, Ulster University, Coleraine, UK
| | | | - Amy S Paller
- Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Alan D Irvine
- Department of Clinical Medicine, University of Dublin Trinity College, Dublin, Ireland
| | - Fiona Browne
- Department of Dermatology, Children's Health Ireland (CHI), Dublin, Ireland
| | - Jemima E Mellerio
- Department of Dermatology, St. John's Institute of Dermatology, St. Thomas' Hospital, London, UK
| | - Anthony Bewley
- Department of Clinical Medicine, Queen Mary University of London Barts and The London School of Medicine and Dentistry, London, UK
| |
Collapse
|
4
|
Lucky AW, Whalen J, Rowe S, Marathe KS, Gorell E. Diagnosis and Care of the Newborn with Epidermolysis Bullosa. Neoreviews 2021; 22:e438-e451. [PMID: 34210808 DOI: 10.1542/neo.22-7-e438] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Epidermolysis bullosa (EB) is a group of rare genetic disorders that are characterized by fragile skin. Because of its rarity, many neonatologists may not be familiar with the current diagnosis and treatment recommendations for EB. The classification of EB was updated in 2020. The diagnosis of EB is now more heavily based on genetic rather than clinical or histologic features. In this review, we summarize the basic classification of EB, the preferred methods of diagnosis including a panel of next-generation sequencing for all types of EB, as well as specific immunofluorescence and electron microscopy of skin biopsies in special circumstances. We also review the principles of skin care for the newborn with EB and discuss the possible associated comorbidities including infectious, gastrointestinal, respiratory, and genitourinary complications. Lastly, we discuss the approach to educating the family about the diagnosis, prognosis, and care of an infant with EB and describe resources for the successful transition of the infant from the hospital to the home.
Collapse
Affiliation(s)
- Anne W Lucky
- Cincinnati Children's Epidermolysis Bullosa (EB) Center, Division of Dermatology, Cincinnati Children's Hospital, Cincinnati, OH.,Department of Dermatology, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Jean Whalen
- Cincinnati Children's Epidermolysis Bullosa (EB) Center, Division of Dermatology, Cincinnati Children's Hospital, Cincinnati, OH
| | - Susan Rowe
- Cincinnati Children's Epidermolysis Bullosa (EB) Center, Division of Dermatology, Cincinnati Children's Hospital, Cincinnati, OH
| | - Kalyani S Marathe
- Cincinnati Children's Epidermolysis Bullosa (EB) Center, Division of Dermatology, Cincinnati Children's Hospital, Cincinnati, OH.,Department of Dermatology, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Emily Gorell
- Department of Dermatology, University of Cincinnati College of Medicine, Cincinnati, OH
| |
Collapse
|
5
|
Pinkova B, Buckova H, Borska R, Fajkusova L. Types of congenital nonsyndromic ichthyoses. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub 2020; 164:357-365. [PMID: 33087941 DOI: 10.5507/bp.2020.050] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Accepted: 10/12/2020] [Indexed: 11/23/2022] Open
Abstract
Congenital ichthyoses are a very heterogeneous group of diseases manifested by dry, rough and scaling skin. In all forms of ichthyoses, the skin barrier is damaged to a certain degree. Congenital ichthyoses are caused by various gene mutations. Clinical manifestations of the individual types vary as the patient ages. Currently, the diagnosis of congenital ichthyoses is based on molecular analysis, which also allows a complete genetic counseling and genetic prevention. It is appropriate to refer the patients to specialized medical centers, where the cooperation of a neonatologist, a pediatric dermatologist, a geneticist and other specialists is ensured.
Collapse
Affiliation(s)
- Blanka Pinkova
- Children's Dermatological Department of the Paediatric Clinic, Faculty of Medicine, Masaryk University and University Hospital Brno, Czech Republic
| | - Hana Buckova
- Children's Dermatological Department of the Paediatric Clinic, Faculty of Medicine, Masaryk University and University Hospital Brno, Czech Republic
| | - Romana Borska
- Center of Molecular Biology and Gene Therapy IHOK University Hospital Brno and Faculty of Medicine, Masaryk University, Brno, Czech Republic Corresponding author: Blanka Pinkova, e-mail
| | - Lenka Fajkusova
- Center of Molecular Biology and Gene Therapy IHOK University Hospital Brno and Faculty of Medicine, Masaryk University, Brno, Czech Republic Corresponding author: Blanka Pinkova, e-mail
| |
Collapse
|