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Armstrong AW, Foley P, Liu Y, Miller M, Teneralli RE, Bewley A, Gordon KB, Papp KA, Han C. Direct and Indirect Effect of Guselkumab on Anxiety, Depression, and Quality of Life in Patients with Moderate-to-Severe Plaque Psoriasis: A Mediation Analysis. Dermatol Ther (Heidelb) 2024:10.1007/s13555-024-01250-9. [PMID: 39177870 DOI: 10.1007/s13555-024-01250-9] [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: 05/01/2024] [Accepted: 07/31/2024] [Indexed: 08/24/2024] Open
Abstract
INTRODUCTION Treating plaque psoriasis (PsO) with guselkumab (GUS) promotes skin clearance and is associated with improvements in health-related quality of life (HRQoL), anxiety, and depression. It is unclear whether improvements in patient-reported outcomes are due to resolution of skin symptoms or the direct result of GUS treatment. METHODS Two phase 3, placebo- and active-comparator-controlled studies randomized patients with moderate-to-severe PsO to GUS, placebo (crossing over to GUS at week 16), or adalimumab. Post hoc mediation analyses examined direct and indirect effects of GUS, versus adalimumab, on Dermatology Life Quality Index (DLQI) or Hospital Anxiety and Depression Scale (HADS) after adjusting for indirect effects mediated by skin clearance, evaluated via Psoriasis Area and Severity Index (PASI), to determine the direct effect of GUS on dermatology HRQoL, depression, and anxiety. RESULTS Compared with adalimumab, the natural direct effect (NDE) of GUS on change in DLQI from baseline was - 2.04 (P < 0.001), using PASI improvement as a mediator, indicating 89.2% of the total treatment effect was due to direct effects of GUS; using PASI 90 as a mediator, NDE of GUS was - 1.43 (P < 0.001), with 62.2% of the total treatment effect attributed to direct effects of GUS. Compared with adalimumab, 25.5% of change in HADS anxiety score was mediated through PASI improvement (NDE - 0.74; P = 0.002), indicating 74.5% of the total effect was independent of PASI improvement. Similarly, 24% of treatment effect was mediated through PASI 90 (NDE - 0.76; P = 0.002). Comparable proportions of the total improvement in HADS depression scores were due to direct and indirect effects of GUS mediated through PASI improvement (direct, 50.2%; indirect, 49.8%) or PASI 90 (direct, 59.5%; indirect, 40.5%). CONCLUSIONS GUS-mediated improvements in anxiety, depression, and overall HRQoL are not solely mediated by resolution of PsO signs, suggesting GUS use has a potential direct effect on anxiety and depression.
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Affiliation(s)
| | - Peter Foley
- The University of Melbourne, St. Vincent's Hospital Melbourne and Probity Medical Research, Skin Health Institute, Carlton, VIC, Australia
| | - Yan Liu
- Janssen Global Services, LLC, Horsham/Malvern, 200 Great Valley Pkwy, Malvern, PA, USA
| | - Megan Miller
- Janssen Research & Development, LLC, Spring House, PA, USA
| | - Rachel E Teneralli
- Janssen Global Services, LLC, Horsham/Malvern, 200 Great Valley Pkwy, Malvern, PA, USA
| | | | | | - Kim A Papp
- Alliance Clinical Trials and Probity Medical Research Inc, Waterloo, ON, Canada
| | - Chenglong Han
- Janssen Global Services, LLC, Horsham/Malvern, 200 Great Valley Pkwy, Malvern, PA, USA.
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Armstrong AW, Gooderham M, Lynde C, Maari C, Forman S, Green L, Laquer V, Zhang X, Franchimont N, Gangolli EA, Blau J, Zhao Y, Zhang W, Srivastava B, Heap G, Papp K. Tyrosine Kinase 2 Inhibition With Zasocitinib (TAK-279) in Psoriasis: A Randomized Clinical Trial. JAMA Dermatol 2024:2822710. [PMID: 39167366 PMCID: PMC11339701 DOI: 10.1001/jamadermatol.2024.2701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2024] [Accepted: 06/17/2024] [Indexed: 08/23/2024]
Abstract
Importance New, effective, and well-tolerated oral therapies are needed for treating psoriasis. Zasocitinib, a highly selective allosteric tyrosine kinase 2 (TYK2) inhibitor, is a potential new oral treatment for this disease. Objective To assess the efficacy, safety, and tolerability of zasocitinib in patients with moderate to severe plaque psoriasis. Design, Setting, and Participants This phase 2b, randomized, double-blind, placebo-controlled, multiple-dose randomized clinical trial was conducted from August 11, 2021, to September 12, 2022, at 47 centers in the US and 8 in Canada. The study included a 12-week treatment period and a 4-week follow-up period. Key eligibility criteria for participants included age 18 to 70 years; a Psoriasis Area and Severity Index (PASI) score of 12 or greater; a Physician's Global Assessment score of 3 or greater; and a body surface area covered by plaque psoriasis of 10% or greater. Of 287 patients randomized, 259 (90.2%) received at least 1 dose of study treatment. Intervention Patients were randomly assigned (1:1:1:1:1) to receive zasocitinib at 2, 5, 15, or 30 mg or placebo orally, once daily, for 12 weeks. Main Outcomes and Measures The primary efficacy end point was the proportion of patients achieving 75% or greater improvement in PASI score (PASI 75) at week 12. Secondary efficacy end points included PASI 90 and 100 responses. Safety was also assessed. Results In total, 259 patients were randomized and received treatment (mean [SD] age, 47 [13] years; 82 women [32%]). At week 12, PASI 75 was achieved for 9 (18%), 23 (44%), 36 (68%), and 35 (67%) patients receiving zasocitinib at 2, 5, 15, and 30 mg, respectively, and 3 patients (6%) receiving placebo. PASI 90 responses were consistent with PASI 75. PASI 100 demonstrated a dose response at all doses, with 17 patients (33%) achieving PASI 100 with zasocitinib, 30 mg. Treatment-emergent adverse events occurred for 23 patients (44%) receiving placebo and 28 (53%) to 31 (62%) patients receiving the 4 different doses of zasocitinib, with no dose dependency and no clinically meaningful longitudinal differences in laboratory parameters. Conclusions and Relevance This randomized clinical trial found that potent and selective inhibition of TYK2 with zasocitinib at oral doses of 5 mg or more once daily resulted in greater skin clearance than placebo over 12 weeks. Trial Registration ClinicalTrials.gov Identifier: NCT04999839.
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Affiliation(s)
| | - Melinda Gooderham
- SKiN Centre for Dermatology and Probity Medical Research, Peterborough, Ontario, Canada
| | - Charles Lynde
- Lynde Institute for Dermatology and Probity Medical Research, Markham, Ontario, Canada
| | | | | | - Lawrence Green
- George Washington University School of Medicine, Rockville, Maryland
| | - Vivian Laquer
- First OC Dermatology Research, Fountain Valley, California
| | | | | | | | - Jessamyn Blau
- Takeda Development Center Americas Inc, Cambridge, Massachusetts
| | - Yiwei Zhao
- Takeda Development Center Americas Inc, Cambridge, Massachusetts
| | - Wenwen Zhang
- Takeda Development Center Americas Inc, Cambridge, Massachusetts
| | | | - Graham Heap
- Takeda Development Center Americas Inc, Cambridge, Massachusetts
| | - Kim Papp
- Alliance Clinical Trials and Probity Medical Research, Waterloo, Ontario, Canada
- Department of Dermatology, University of Toronto School of Medicine, Toronto, Ontario, Canada
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Ghezzi G, Costanzo A, Borroni RG. Health-Related Quality of Life in Psoriasis: Literature Review. J Clin Med 2024; 13:4623. [PMID: 39200764 PMCID: PMC11354811 DOI: 10.3390/jcm13164623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2024] [Revised: 08/03/2024] [Accepted: 08/05/2024] [Indexed: 09/02/2024] Open
Abstract
The assessment of quality of life (QoL) in patients with psoriasis plays a crucial role in understanding the impact of the disease and evaluating treatment outcomes. We provide an overview of the key measures used to assess QoL in psoriasis patients, including both generic and psoriasis-specific instruments. The limitations and strengths of instruments such as the Dermatology Life Quality Index (DLQI), Skindex, and Psoriasis Disability Index (PDI) are discussed, highlighting their psychometric properties and areas for improvement. Furthermore, this review examines the potential of disease-specific QoL measures in providing greater sensitivity to disease-related burden and change compared to generic instruments. However, most of the available psoriasis-specific patient-reported outcome measures need further validation. We aim to provide valuable insights into the importance of using validated QoL measures in clinical practice and research, ultimately contributing to a more comprehensive assessment of the impact of psoriasis on patients' lives and enhancing the evaluation of treatment interventions.
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Affiliation(s)
- Gioele Ghezzi
- Humanitas University, 20072 Pieve Emanuele, MI, Italy;
- Dermatology Unit, Humanitas Research Hospital—IRCCS, 20089 Rozzano, MI, Italy;
| | - Antonio Costanzo
- Dermatology Unit, Humanitas Research Hospital—IRCCS, 20089 Rozzano, MI, Italy;
- Department of Biomedical Sciences, Humanitas University, 20072 Pieve Emanuele, MI, Italy
| | - Riccardo G. Borroni
- Dermatology Unit, Humanitas Research Hospital—IRCCS, 20089 Rozzano, MI, Italy;
- Department of Biomedical Sciences, Humanitas University, 20072 Pieve Emanuele, MI, Italy
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Ritchlin CT, Mease PJ, Boehncke WH, Tesser J, Chakravarty SD, Rampakakis E, Shawi M, Schiopu E, Merola JF, McInnes IB, Deodhar A. Durable control of psoriatic arthritis with guselkumab across domains and patient characteristics: post hoc analysis of a phase 3 study. Clin Rheumatol 2024; 43:2551-2563. [PMID: 38844682 PMCID: PMC11269379 DOI: 10.1007/s10067-024-06991-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Revised: 04/30/2024] [Accepted: 05/02/2024] [Indexed: 07/25/2024]
Abstract
OBJECTIVES Evaluate patterns of stringent disease control with 2 years of guselkumab across key disease-identified domains and patient-reported outcomes (PROs) in subgroups of patients with psoriatic arthritis (PsA) defined by baseline characteristics. METHOD This post hoc analysis of DISCOVER-2 (Clinicaltrials.gov NCT03158285) evaluated biologic-naïve PsA patients (≥ 5 swollen/ ≥ 5 tender joints, C-reactive protein [CRP] ≥ 0.6 mg/dL) randomized to guselkumab every 4 weeks (Q4W); guselkumab at Weeks 0 and 4, then Q8W; or placebo with crossover to guselkumab Q4W at Week 24. Achievement of American College of Rheumatology 50/70% improvement (ACR50/70), Investigator's Global Assessment (IGA) 0, dactylitis/enthesitis resolution, Functional Assessment of Chronic Illness Therapy (FACIT)-Fatigue response (≥ 4-point improvement), HAQ-Disability Index (HAQ-DI) response (≥ 0.35-point improvement), PsA Disease Activity Score (PASDAS) low disease activity (LDA), and minimal disease activity (MDA) was assessed at Weeks 24, 52, and 100 in subgroups defined by sex and baseline medication use, body mass index, PsA duration, swollen/tender joints, CRP, and psoriasis severity/extent. Patients with missing categorical response data were considered nonresponders. RESULTS 442/493 (90%) guselkumab-randomized patients completed treatment through Week 100. Significant multi-domain efficacy of guselkumab versus placebo was shown across adequately sized patient subgroups. A pattern of continuous improvement was observed across key PsA domains and PROs within patient subgroups: 65%-85% of guselkumab-randomized patients had enthesitis/dactylitis resolution, 50%-70% achieved complete skin clearance, 60%-80% reported meaningful improvements in function/fatigue, 40%-65% achieved PASDAS LDA, and 35%-50% achieved MDA at Week 100. CONCLUSION Patients with active PsA receiving guselkumab demonstrated durable achievement of stringent endpoints associated with disease control across key PsA domains and PROs, regardless of baseline characteristics. Key Points • Among biologic-naïve patients with highly active psoriatic arthritis (PsA), efficacy of guselkumab across stringent disease endpoints and patient-reported outcomes (PROs) at Week 24 was consistent regardless of baseline demographics and disease characteristics. • Within guselkumab-randomized PsA patient subgroups, major improvements in joint disease activity, complete skin clearance, dactylitis/enthesitis resolution, clinically meaningful improvements in PROs, and achievement of low overall disease activity were maintained through Week 100. • Durable stringent endpoint achievement indicating disease control was observed with guselkumab, regardless of baseline patient or disease characteristics.
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Affiliation(s)
| | - Philip J Mease
- Rheumatology Research, Providence Swedish Medical Center, Seattle, WA, USA
- University of Washington School of Medicine, Seattle, WA, USA
| | - Wolf-Henning Boehncke
- Division of Dermatology and Venereology, Geneva University Hospitals, University of Geneva, Geneva, Switzerland
| | - John Tesser
- Arizona Arthritis & Rheumatology Associates, P.C., Phoenix, AZ, USA
| | - Soumya D Chakravarty
- Janssen Scientific Affairs, LLC, a Johnson & Johnson Company, Horsham, PA, USA
- Drexel University College of Medicine, Philadelphia, PA, USA
| | - Emmanouil Rampakakis
- Department of Pediatrics, McGill University, Montreal, QC, Canada
- Scientific Affairs, JSS Medical Research, Inc, Montreal, QC, Canada
| | - May Shawi
- Janssen Research & Development, LLC, Titusville, NJ, USA
| | - Elena Schiopu
- Medical College of Georgia at Augusta University, Augusta, GA, USA
| | - Joseph F Merola
- Department of Dermatology and Department of Medicine, Division of Rheumatology, UT Southwestern Medical Center, Dallas, TX, USA
| | - Iain B McInnes
- College of Medical Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
| | - Atul Deodhar
- Division of Arthritis and Rheumatic Diseases, Oregon Health & Science University, Portland, OR, USA
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Pérez-Chada LM, Hopkins ZH, Balak DMW, Rashid S, Creadore A, Chu B, Villa C, Woodbury MJ, Armstrong AW, Strand V, Gottlieb AB, Merola JF, Barbieri JS. Patient-Reported Outcome Measures for Health-Related Quality of Life in Patients With Psoriasis: A Systematic Review. JAMA Dermatol 2024; 160:550-563. [PMID: 38265774 PMCID: PMC11096065 DOI: 10.1001/jamadermatol.2023.5439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2024]
Abstract
Importance Multiple patient-reported outcome measures (PROMs) for health-related quality of life (HRQL) exist for patients with psoriasis. Evidence for the content validity and other measurement properties of these PROMs is critical to determine which HRQL PROMs could be recommended for use. Objective To systematically review the validity of HRQL-focused PROMs used in patients with psoriasis. Evidence Review Using PubMed and Embase, full-text articles published in English or Spanish on development or validation studies for psoriasis-specific, dermatology-specific, or generic HRQL PROMs were included. Development studies included original development studies, even if not studied in psoriasis patients per Consensus-Based Standards for the Selection of Health Measurement Instruments (COSMIN) recommendations. If a study included multiple diagnoses, more than 50% of patients had to have psoriasis or psoriasis-specific subgroup analyses available. Data extraction and analysis followed the COSMIN guidelines. Two independent reviewers extracted and analyzed the data, including PROM characteristics, quality of measurement properties (structural validity, internal consistency, cross-cultural validity, reliability, measurement error, criterion validity, construct validity, and responsiveness), and level of evidence. PROMs were classified into 3 levels of recommendations: (1) PROM recommended for use; (2) PROM requires further validation; and (3) PROM not recommended for use. Findings Overall, 97 articles were identified for extraction. This included 19 psoriasis-specific, 8 skin-specific, and 6 generic PROMs. According to COSMIN standards, most measures identified received a B recommendation for use, indicating their potential but requiring further validation. Only the Rasch reduced version of the Impact of Psoriasis Questionnaire (IPSO-11 Rasch) received an A recommendation for use given that it had sufficient content validity, structural validity, and internal consistency. Conclusions and Relevance This study identified a significant lack of information concerning the quality of HRQL measures in psoriasis. This gap in knowledge can be attributed to the fact that traditional measures were developed using validation criteria that differ from the current standards in use. Consequently, additional validation studies in accordance with contemporary standards will be useful in aiding researchers and clinicians in determining the most suitable measure for assessing HRQL in patients with psoriasis.
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Affiliation(s)
| | | | - Deepak M W Balak
- Department of Dermatology, Leiden University Medical Center, Leiden, the Netherlands
| | - Sarem Rashid
- Department of Dermatology, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts
| | - Andrew Creadore
- Department of Dermatology, Brigham and Women's Hospital, Boston, Massachusetts
| | - Brian Chu
- Department of Dermatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Camila Villa
- Department of Dermatology, Brigham and Women's Hospital, Boston, Massachusetts
| | - Michael J Woodbury
- Department of Dermatology, Brigham and Women's Hospital, Boston, Massachusetts
| | - April W Armstrong
- Department of Dermatology, University of California, Los Angeles, Los Angeles
| | - Vibeke Strand
- Division of Immunology and Rheumatology, Stanford University School of Medicine, Palo Alto, California
| | - Alice B Gottlieb
- Department of Dermatology, Icahn School of Medicine at Mt Sinai, New York, New York
| | - Joseph F Merola
- Division of Rheumatology, Department of Dermatology and Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| | - John S Barbieri
- Department of Dermatology, Brigham and Women's Hospital, Boston, Massachusetts
- Associate Editor and Evidence-Based Practice Editor, JAMA Dermatology
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Hong EJ, Yoon HJ, Kwon MJ, Kim JY, Kim JE, Park YL, Lee S, Bae Y, Lee SH. Factors Associated With Achieving Complete Skin Clearance Compared to Almost Complete Skin Clearance in Patients With Moderate to Severe Psoriasis Treated With Biologics: A Retrospective Chart Review. Ann Dermatol 2024; 36:91-98. [PMID: 38576247 PMCID: PMC10995612 DOI: 10.5021/ad.23.074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2023] [Revised: 11/24/2023] [Accepted: 12/13/2023] [Indexed: 04/06/2024] Open
Abstract
BACKGROUND Biologics have demonstrated high efficacy in achieving 'almost complete' skin clearance in patients with moderate to severe psoriasis. Nonetheless, achieving 'complete' skin clearance remains a treatment goal for some highly biologics-resistant patients, as residual lesions impact their quality of life. OBJECTIVE The risk factors for failure to achieve a Psoriasis Area and Severity Index (PASI) 100 response in patients with good response to biologics remain unknown. METHODS This retrospective study evaluated the risk factors by comparing patients who achieved complete skin clearance (PASI100) with those who achieved almost complete skin clearance (PASI90). A database of 131 psoriasis patients treated with biologics, who achieved a PASI90 or PASI100 response, was reviewed from a tertiary referral hospital in South Korea. The patients were classified into PASI90 and PASI100 groups according to their PASI response. RESULTS The PASI100 group had a lower prevalence of smoking history (adjusted odds ratio [OR], 0.34; 95% confidence interval [CI], 0.14-0.85; p=0.021) and psoriasis on the anterior lower legs at baseline (adjusted OR, 0.18; 95% CI, 0.03-0.99; p=0.049) than patients in the PASI90 group. CONCLUSION This study suggested that smoking history and psoriatic skin lesions on the anterior lower legs are considered as the risk factors for the failure to achieve a PASI100 response in psoriasis patients treated with biologics.
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Affiliation(s)
- Eun Ji Hong
- Department of Dermatology, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, Korea
| | - Hee Jung Yoon
- Department of Dermatology, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, Korea
| | - Min Jung Kwon
- Department of Dermatology, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, Korea
| | - Jae Yun Kim
- Department of Dermatology, Soonchunhyang University Cheonan Hospital, Soonchunhyang University College of Medicine, Cheonan, Korea
| | - Jung Eun Kim
- Department of Dermatology, Soonchunhyang University Cheonan Hospital, Soonchunhyang University College of Medicine, Cheonan, Korea
| | - Young Lip Park
- Department of Dermatology, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, Korea
| | - SangHoon Lee
- Department of Dermatology, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, Korea
| | - Youin Bae
- Department of Dermatology, Soonchunhyang University Seoul Hospital, Soonchunhyang University College of Medicine, Seoul, Korea.
| | - Sul Hee Lee
- Department of Dermatology, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, Korea.
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Won SH, Shin BS, Bae KN, Son JH, Shin K, Kim HS, Ko HC, Kim MB, Kim BS. Which Areas Are Still Left in Biologics Responsive Korean Patients with Moderate to Severe Plaque Psoriasis. Ann Dermatol 2023; 35:6-10. [PMID: 36750453 PMCID: PMC9905854 DOI: 10.5021/ad.21.274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Revised: 08/17/2022] [Accepted: 10/12/2022] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND Psoriasis localized to certain body areas, such as the scalp, nails, palms, soles, intertriginous regions, and genital regions, is reportedly difficult to treat. OBJECTIVE To investigate the biologics-resistant areas in South Korean patients with psoriasis treated with biologics. METHODS The study included 50 patients with chronic moderate to severe plaque psoriasis from the Pusan National University Hospital and Chosun University Hospital between October 2019 and September 2020. The patients had at least one psoriatic lesion, were treated with biologics for more than six months, and exhibited a partial or good response (reaching a Psoriasis Area and Severity Index [PASI] score of 1~5 after biologics treatment). RESULTS A total of 50 patients with psoriasis (32 male, mean±standard deviation 47.8±11 years), with a median PASI score of 1.8, were included. The most common biologics-resistant areas were the anterior lower leg (56.0%), followed by the knee (48.0%) and posterior lower leg (42.0%). The proportion of biologics-resistant areas were obtained for body regions traditionally considered as difficult-to-treat entities, including the fingernails (10.0%), toenails (14.0%), scalp (38.0%), palm (12.0%), sole (14.0%), and genital areas (10.0%). CONCLUSION This study determined the biologics-resistant areas in South Korean patients, successfully treated with biologics, in a real-world clinical setting.
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Affiliation(s)
- Sang-Hyeon Won
- Department of Dermatology, School of Medicine, Pusan National University, Busan, Korea
| | - Bong Seok Shin
- Department of Dermatology, Chosun University Hospital, Gwangju, Korea
| | - Kyung-Nam Bae
- Department of Dermatology, School of Medicine, Pusan National University, Busan, Korea
| | - Jin-Hwa Son
- Department of Dermatology, School of Medicine, Pusan National University, Busan, Korea
| | - Kihyuk Shin
- Department of Dermatology, School of Medicine, Pusan National University, Busan, Korea
| | - Hoon-Soo Kim
- Department of Dermatology, School of Medicine, Pusan National University, Busan, Korea.,Biomedical Research Institute, Pusan National University Hospital, Busan, Korea
| | - Hyun-Chang Ko
- Department of Dermatology, School of Medicine, Pusan National University, Busan, Korea
| | - Moon-Bum Kim
- Department of Dermatology, School of Medicine, Pusan National University, Busan, Korea.,Biomedical Research Institute, Pusan National University Hospital, Busan, Korea
| | - Byung-Soo Kim
- Department of Dermatology, School of Medicine, Pusan National University, Busan, Korea.,Biomedical Research Institute, Pusan National University Hospital, Busan, Korea.
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Thaçi D, Vender R, de Rie MA, Conrad C, Pariser DM, Strober B, Vanvoorden V, Wang M, Madden C, de Cuyper D, Kimball AB. Safety and efficacy of bimekizumab through 2 years in patients with moderate-to-severe plaque psoriasis: longer-term results from the BE SURE randomized controlled trial and the open-label extension from the BE BRIGHT trial. Br J Dermatol 2023; 188:22-31. [PMID: 36689515 DOI: 10.1093/bjd/ljac021] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 09/09/2022] [Accepted: 09/16/2022] [Indexed: 01/09/2023]
Abstract
BACKGROUND BE SURE 1-year results demonstrated the superior efficacy of bimekizumab compared with adalimumab with no unexpected safety findings. OBJECTIVES To provide efficacy and safety data over 2 years of bimekizumab treatment compared with adalimumab from BE SURE and the BE BRIGHT open-label extension (OLE) in patients with moderate-to-severe plaque psoriasis. METHODS The 56-week double-blinded BE SURE phase III randomized controlled trial randomized patients 1 : 1 : 1 to bimekizumab 320 mg every 4 weeks (Q4W), bimekizumab 320 mg Q4W to week 16 then every 8 weeks (Q8W), or adalimumab 40 mg every 2 weeks to week 24 then bimekizumab 320 mg Q4W. After completing BE SURE, patients could enter the ongoing BE BRIGHT OLE, with possible dosing adjustments based on Psoriasis Area and Severity Index (PASI). The primary outcome in BE BRIGHT was incidence of treatment-emergent adverse events (TEAEs); safety data are reported by study period through week 104. Efficacy data are reported for the intention-to-treat population through week 104 by initial randomization group, with ≥ 90% improvement from baseline PASI (PASI 90) and 100% improvement (PASI 100) as key outcomes. RESULTS Of the patients randomized to bimekizumab, 158 were assigned to Q4W, and 161 to Q4W/Q8W. At week 104, PASI 90 was achieved by 91.2% and 89.7%, and PASI 100 was achieved by 72.3% and 68.1%, for Q4W and Q4W/Q8W, respectively; comparable to week 16 results. Among the 159 patients randomized to adalimumab, responses rapidly and substantially increased after the week 24 bimekizumab switch; at week 104, 96.9% and 70.2% of patients achieved PASI 90 and PASI 100 respectively. Through weeks 24-104, the three most common TEAEs in any bimekizumab-treated group were nasopharyngitis, oral candidiasis and upper respiratory tract infection. Rates of serious TEAEs were low. CONCLUSIONS Clinical responses observed through week 16 of BE SURE in patients randomized to bimekizumab were sustained through 104 weeks of treatment, regardless of Q4W or Q8W maintenance dosing. Response rates were also sustained through week 104 in patients who switched from adalimumab to bimekizumab at week 24, and were similar to those observed in the bimekizumab groups. Bimekizumab was well tolerated with no new safety signals.
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Affiliation(s)
- Diamant Thaçi
- Institute and Comprehensive Center for Inflammation Medicine, University Hospital of Lübeck, Lübeck, Germany
| | - Ron Vender
- Dermatrials Research Inc., Hamilton, ON, Canada
| | - Menno A de Rie
- Department of Dermatology, Amsterdam University Medical Centres, Amsterdam, the Netherlands
| | - Curdin Conrad
- Department of Dermatology, Lausanne University Hospital, Switzerland
| | - David M Pariser
- Department of Dermatology, Eastern Virginia Medical School, Norfolk, VA, USA
- Virginia Clinical Research, Inc., Norfolk, VA, USA
| | - Bruce Strober
- Yale University, New Haven, CT, USA
- Central Connecticut Dermatology Research, Cromwell, CT, USA
| | | | | | | | | | - Alexa B Kimball
- Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, MA, USA
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Son SW, Lee JH, Ahn J, Chang SE, Choi EH, Han TY, Jang YH, Kim HO, Kim MB, Kim YC, Ko HC, Ko JY, Lee SE, Lee YW, Lew BL, Na CH, Park CO, Park CW, Park KY, Park K, Park YL, Roh JY, Seo YJ, Shin MK, Lee S, Cho SH. Assessment of Disease Severity and Quality of Life in Patients with Atopic Dermatitis from South Korea. Ann Dermatol 2022; 34:419-430. [PMID: 36478424 PMCID: PMC9763909 DOI: 10.5021/ad.21.239] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 07/22/2022] [Accepted: 08/01/2022] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Data illustrating the impact of atopic dermatitis (AD) on lives of adults with AD in South Korea are limited. OBJECTIVE To assess the AD disease severity and its impact on quality of life (QoL) in patients with AD from South Korea. METHODS Patients with AD utilizing the specialist dermatology services of major hospitals in South Korea were assessed for disease severity using Eczema Area and Severity Index (EASI) score, for QoL using Dermatology Life Quality Index (DLQI) (for QoL), and for comorbidities and treatment experience via retrospective review of 12-month medical records. Clinical and sociodemographic characteristics were also measured. RESULTS Of the 1,163 patients, 695 (59.8%) were men (mean age [years]±standard deviation: 31.6±12.1). Overall, 52.9% (n=615) patients had moderate-to-severe disease (EASI>7). The QoL of 72.3% (n=840) patients was affected moderately-to-severely (DLQI score: 6~30). Systemic immunosuppressants were used ≥1 over past 12 months in 51.9% (n=603) patients, and the most commonly used were cyclosporines (45.7%, n=531) and systemic corticosteroids (40.5%, n=471). Approximately, 10.8% (n=126) patients consulted or received treatment for AD-related eye problem. Of these, 40% (n=50) patients reported poor, very poor, or completely blind status; approximately, 16.7% patients (n=192) reported having depression or anxiety; and 35.5% (n=410) reported suicidal ideation or suicidal attempt. CONCLUSION A large proportion of patients had moderate-to-severe AD, a compromised QoL, and ocular or mental health comorbidities, indicating a high disease burden despite systemic treatment. These findings highlight the importance of a holistic approach for the evaluation and treatment of patients with AD.
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Affiliation(s)
- Sang Wook Son
- Department of Dermatology, Korea University Ansan Hospital, Korea University College of Medicine, Ansan, Korea
| | - Ji Hyun Lee
- Department of Dermatology, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Jiyoung Ahn
- Department of Dermatology, National Medical Center, Seoul, Korea
| | - Sung Eun Chang
- Department of Dermatology and Research Institute of Dermatology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Eung Ho Choi
- Department of Dermatology, Wonju Severance Christian Hospital, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Tae Young Han
- Department of Dermatology, Nowon Eulji Medical Center, Eulji University, Seoul, Korea
| | - Yong Hyun Jang
- Department of Dermatology, Kyungpook National University Hospital, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Hye One Kim
- Department of Dermatology, Hallym University Kangnam Sacred Heart Hospital, Seoul, Korea
| | - Moon-Bum Kim
- Department of Dermatology, Pusan National University Hospital, Busan, Korea
| | - You Chan Kim
- Department of Dermatology, Ajou University Hospital, Ajou University School of Medicine, Suwon, Korea
| | - Hyun Chang Ko
- Department of Dermatology, Pusan National University Yangsan Hospital, School of Medicine, Pusan National University, Yangsan, Korea
| | - Joo Yeon Ko
- Department of Dermatology, Hanyang University Seoul Hospital, Hanyang University College of Medicine, Seoul, Korea
| | - Sang Eun Lee
- Department of Dermatology and Cutaneous Biology Research Institute, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Yang Won Lee
- Department of Dermatology, Konkuk University School of Medicine, Seoul, Korea
| | - Bark-Lynn Lew
- Department of Dermatology, Kyung Hee University Hospital at Gangdong, Kyung Hee University College of Medicine, Seoul, Korea
| | - Chan Ho Na
- Department of Dermatology, Chosun University Hospital, College of Medicine, Chosun University, Gwangju, Korea
| | - Chang Ook Park
- Department of Dermatology and Cutaneous Biology Research Institute, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Chun Wook Park
- Department of Dermatology, Hallym University Kangnam Sacred Heart Hospital, Seoul, Korea
| | - Kui Young Park
- Department of Dermatology, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Korea
| | - Kun Park
- Department of Dermatology, Wonkwang University Hospital, Iksan, Korea
| | - Young Lip Park
- Department of Dermatology, Soonchunhyang University Bucheon Hospital, Bucheon, Korea
| | - Joo Young Roh
- Department of Dermatology, Gachon University Gil Medical Center, Gachon University College of Medicine, Incheon, Korea
| | - Young-Joon Seo
- Department of Dermatology, Chungnam National University Hospital, Daejeon, Korea
| | - Min Kyung Shin
- Department of Dermatology, Kyung Hee University Hospital, College of Medicine, Kyung Hee University, Seoul, Korea
| | - Sujin Lee
- Medical Affairs, Sanofi-Aventis Korea Co., Ltd., Seoul, Korea
| | - Sang Hyun Cho
- Department of Dermatology, Incheon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
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10
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Al-Oudah GA, Sahib AS, Al-Hattab MK, Al-Ameedee AA. Effect of CoQ10 Administration to Psoriatic Iraqi Patients on Biological Therapy Upon Severity Index (PASI) and Quality of Life Index (DLQI) Before and After Therapy. JOURNAL OF POPULATION THERAPEUTICS AND CLINICAL PHARMACOLOGY = JOURNAL DE LA THERAPEUTIQUE DES POPULATIONS ET DE LA PHARMACOLOGIE CLINIQUE 2022; 29:e52-e60. [PMID: 35848197 DOI: 10.47750/jptcp.2022.931] [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: 02/15/2022] [Accepted: 03/01/2022] [Indexed: 06/15/2023]
Abstract
Psoriasis is a medical condition in which the skin of the body is affected at a multisytemic level. Patients with moderate to severe psoriasis have a considerably reduced quality of life as a result of their disease. For morphological indicators, the Psoriasis Area Severity Index (PASI) test is one of the methods for indicating the severity of the illness. An imbalance between pro-oxidants and antioxidants in our bodies causes oxidative stress and plays a crucial role in the pathophysiology of chronic inflammatory diseases like psoriasis(1). It has been considered that antioxidant treatment can be an effective therapeutic option. The goal of this clinical investigation was to see if there was a link between the percentage change in quality of life and the clinical severity of psoriasis during a 12-week period among Iraqi psoriatic patients. Over the course of 3 months, 24 psoriatic patients (9 females and 15 males) ranging in age from 17 to 72 years participated in a prospective double-blinded clinical experiment. Two groups of participants were formed. A biological medicine (adalimumab) and a placebo was given to group A (n = 11), whereas group B (n = 13) received 100 mg CoQ10 adjuvant therapy in addition to the biological medication already provided. The Psoriasis Area and Severity Index (PASI) and the Dermatology Life Quality Index (DLQI) were used to examine patients (DLQI). Treatment with both biological and adjuvant CoQ10 therapy showed a substantial association between the PASI and the DLQI (p = 0.000132). After 3 months of therapy, the mean (SD) of the PASI score for all patients was 20.88 7.15, with a 67.48% ± 22.25% improvement change. The mean SD of the DLQI score at baseline was 12.5 ± 4.71, with a change of 56.13% ± 20.15% following treatment. After therapy with a biological medication, there was a favorable association between the PASI and the DLQI (p > 0.05). This indicates that therapy with a biological medication with daily administration of 100 mg CoQ10 supplements to psoriatic patients for 12 weeks improved the correlation between PASI and DLQI.
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Affiliation(s)
- Ghadah Ali Al-Oudah
- Department of Pharmacology, College of Pharmacy University of Mustansiriyah, Iraq
- Department of Pharmacy, Al-Mustaqbal University College, Hilla, Iraq;
| | - Ahmed Salih Sahib
- Department of Pharmacology, College of Pharmacy, University of Kerbala, Kerbala, Iraq
| | - Mohammed K Al-Hattab
- Department of Dermatology, Hammurabi Medical College, University of Babylon, Iraq
| | - Ali Ameer Al-Ameedee
- MBChB Resident Doctor at Babil Health Directorate, Iraqi Ministry of Health, Iraq
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11
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Blauvelt A, Gooderham M, Griffiths CEM, Armstrong AW, Zhu B, Burge R, Gallo G, Guo J, Garrelts A, Lebwohl M. Cumulative Clinical Benefits of Biologics in the Treatment of Patients with Moderate-to-Severe Psoriasis over 1 Year: a Network Meta-Analysis. Dermatol Ther (Heidelb) 2022; 12:727-740. [PMID: 35195887 PMCID: PMC8941028 DOI: 10.1007/s13555-022-00690-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Accepted: 02/03/2022] [Indexed: 12/03/2022] Open
Abstract
Introduction Both early clinical improvement and long-term maintenance of clinical efficacy of treatments matter to patients with psoriasis. We compared cumulative clinical benefits of treatment with biologics over 1 year based on the area under the curve (AUC) for Psoriasis Area and Severity Index (PASI) 100 and PASI 90 responses in patients with moderate-to-severe psoriasis using a network meta-analysis (NMA). Methods Published phase 3 randomized, placebo- or active-controlled clinical trial data for biologics approved for the treatment of moderate-to-severe psoriasis were obtained from a systematic literature review up to 30 September 2020. Eighteen clinical trials that included data from baseline to 48 or 52 weeks where AUC could be calculated were included. Data were compared using a fixed-effect model with a separate random-effect baseline model to account for effects of the placebo arm. Cumulative clinical benefit was estimated using the AUC for PASI 100 and PASI 90 responses (complete and almost-complete skin clearance, respectively). Normalized AUC was compared using Bayesian NMA. Cumulative days of response were calculated using normalized AUC and study duration. Results Interleukin (IL)-17 and IL-23 inhibitors demonstrated greater cumulative clinical benefits for both PASI 100 and PASI 90 versus IL-12/23 and tumor necrosis factor inhibitors. Over 52 weeks, cumulative days with PASI 100 were greatest with ixekizumab [158.7 (95% credible interval, 147.4, 170.0) days] followed by risankizumab [154.0 (144.9, 163.4) days]; PASI 90 days were greatest with risankizumab [249.3 (239.5, 259.2) days] followed by ixekizumab [238.8 (227.1, 250.8) days]. Both ixekizumab and risankizumab showed greater cumulative days with PASI 100 or PASI 90 responses versus secukinumab [117.9 (110.7, 125.2) and 215.5 (208.2, 223.1) days, respectively] and greater cumulative days with PASI 100 versus guselkumab [130.7 (120.5, 140.9) days]. Conclusion For complete and almost-complete skin clearance, ixekizumab and risankizumab provided the greatest cumulative clinical benefits over 1 year. Supplementary Information The online version contains supplementary material available at 10.1007/s13555-022-00690-5.
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Affiliation(s)
- Andrew Blauvelt
- Oregon Medical Research Center, 9945 SW Locust St., Suite G, Portland, OR, 97223, USA.
| | | | - Christopher E M Griffiths
- Dermatology Centre, Salford Royal Hospital, NIHR Manchester Biomedical Research Centre, University of Manchester, Manchester, UK
| | - April W Armstrong
- Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Baojin Zhu
- Eli Lilly and Company, Indianapolis, IN, USA
| | - Russel Burge
- Eli Lilly and Company, Indianapolis, IN, USA.,University of Cincinnati, Cincinnati, OH, USA
| | - Gaia Gallo
- Eli Lilly and Company, Indianapolis, IN, USA
| | - Jiaying Guo
- Eli Lilly and Company, Indianapolis, IN, USA
| | | | - Mark Lebwohl
- Icahn School of Medicine at Mount Sinai, Mount Sinai Hospital, New York, NY, USA
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12
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Deucravacitinib in Moderate to Severe Psoriasis: Clinical and Quality-of-Life Outcomes in a Phase 2 Trial. Dermatol Ther (Heidelb) 2022; 12:495-510. [PMID: 35025062 PMCID: PMC8850503 DOI: 10.1007/s13555-021-00649-y] [Citation(s) in RCA: 27] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Accepted: 11/16/2021] [Indexed: 11/13/2022] Open
Abstract
Introduction Deucravacitinib is an oral, selective tyrosine kinase 2 inhibitor that demonstrated therapeutic benefit in a Phase 2 clinical trial of adults with moderate to severe plaque psoriasis. This analysis was designed to evaluate the effect of deucravacitinib on additional clinical and quality-of-life (QoL) outcomes and assess the relationship between these outcomes in adults with psoriasis. Methods Post-hoc analysis of a 12-week Phase 2 trial was conducted for the three most efficacious dosage groups (3 mg twice daily, 6 mg twice daily, 12 mg once daily) and placebo. Investigator assessments for efficacy included Psoriasis Area and Severity Index (PASI), body surface area (BSA) involvement, and static Physician's Global Assessment; QoL was assessed using the Dermatology Life Quality Index (DLQI). Treatment responses and their associations were evaluated over time. Results Deucravacitinib elicited improvement versus placebo as early as Week 4 for most efficacy measures (including changes in absolute PASI and BSA), with efficacy trends observed from Week 2 to Week 12. Improvements in QoL, assessed by achievement of a DLQI overall score of 0/1 (no effect at all on patient’s life), followed a pattern similar to deucravacitinib-related clinical outcomes over 12 weeks. Overall, patients with greater improvements in psoriasis-related clinical signs and symptoms also reported greater improvement in QoL. However, complete skin clearance was not required for achieving DLQI 0/1. Conclusion Deucravacitinib treatment produced early response and similar trends in improvements across multiple efficacy assessments and QoL in moderate to severe plaque psoriasis. Deucravacitinib has the potential to become a promising new oral therapy for this condition. Trial Registration ClinicalTrials.gov identifier; NCT02931838. Supplementary Information The online version contains supplementary material available at 10.1007/s13555-021-00649-y. Psoriasis is a skin disease that affects up to 2% of the population. In psoriasis, red, scaly lesions develop on the skin driven by an aberrant immune response. Psoriasis impacts not only physical and mental health but also quality of life (QoL). Deucravacitinib is being investigated as a treatment for psoriasis. We performed a Phase 2 dose-ranging, placebo-controlled, 12-week study of deucravacitinib in adults with moderate to severe psoriasis. Patients in the USA, Australia, Canada, Germany, Japan, Latvia, Mexico, and Poland participated. The study showed that oral treatment with deucravacitinib was effective using a disease severity score (percentage of patients with ≥ 75% reduction from baseline in Psoriasis Area and Severity Index score) at Week 12—placebo 7% and deucravacitinib 67%–75% for the three highest dosages—and was generally well tolerated. We further analyzed the association between efficacy and a QoL measure, the Dermatology Life Quality Index (DLQI), in patients who received placebo or the most effective dosages of deucravacitinib (≥ 3 mg twice daily). Deucravacitinib was effective at the three dosage levels tested. Skin improvement occurred early during treatment and was mirrored by improvements in DLQI score during the 12 weeks of treatment. Although some patients did not have complete clearance of their psoriasis, a large percentage of those patients still achieved considerable improvement in QoL as measured by achieving a DLQI score of 0/1 (i.e., no effect at all on the patient’s QoL).
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13
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Kokolakis G, Vadstrup K, Hansen JB, Carrascosa JM. Brodalumab Is Associated with High Rates of Complete Clearance and Quality of Life Improvement: A Subgroup Analysis of Patients with Psoriasis and Concomitant Psoriatic Arthritis. Dermatology 2021; 238:620-629. [PMID: 34823247 PMCID: PMC9393840 DOI: 10.1159/000520290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Accepted: 10/18/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Psoriatic arthritis (PsA) is a chronic inflammatory disease associated with psoriasis that significantly impairs physical function and quality of life (QoL). Prompt therapeutic intervention is crucial for limiting PsA progression and preventing disability. OBJECTIVES The aim of this study was to compare the efficacy of brodalumab versus ustekin-umab and the impact on QoL in patients with moderate-to-severe plaque psoriasis, by concomitant PsA status. METHODS This post hoc analysis of pooled data from the phase 3 AMAGINE-2 and -3 trials evaluated complete skin clearance (100% improvement of Psoriasis Area and Severity Index [PASI 100]), improvement in symptom severity (Psoriasis Symptom Inventory [PSI] response), and QoL (Dermatology Life Quality Index [DLQI] score of 0/1) by concomitant PsA status. A competing risk model assessed cumulative incidence over 52 weeks with outcomes of PASI 100 or inadequate response. RESULTS This analysis included 929 patients with moderate-to-severe psoriasis. Concomitant PsA was present in 79/339 (23%) and 110/590 (19%) patients receiving brodalumab 210 mg and ustekinumab, respectively. At Week 52, odds ratios (ORs) (95% confidence intervals [CIs]) for complete clearance with brodalumab versus ustekin-umab were 3.15 (1.52-6.55, p = 0.0015) in patients with concomitant PsA and 3.05 (2.19-4.26, p < 0.0001) in patients without concomitant PsA. Corresponding Week 52 ORs (95% CIs) for DLQI 0/1 with brodalumab versus ustekinumab were 2.05 (1.07-3.90, p = 0.0277) and 1.83 (1.32-2.53, p = 0.0002); Week 52 ORs (95% CIs) for PSI ≤8 with brodalumab versus ustekinumab were 3.42 (1.43-8.18, p = 0.0036) and 1.40 (1.01-1.95, p = 0.0434). The 52-week cumulative incidence of patients achieving PASI 100 was significantly higher for brodalumab versus ustekinumab in patients with concomitant PsA (p = 0.0001) and in those without concomitant PsA (p < 0.0001). CONCLUSIONS Treatment with brodalumab rapidly results in high levels of complete and sustained skin clearance and greater cumulative treatment benefit in patients with moderate-to-severe psoriasis versus ustekinumab, regardless of concomitant PsA status.
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Affiliation(s)
- Georgios Kokolakis
- Psoriasis Research and Treatment Centre, Clinic of Dermatology, Venereology and Allergology, Charité − Universitätsmedizin Berlin, Berlin, Germany
| | | | | | - Jose Manuel Carrascosa
- Department of Dermatology, Hospital Universitari Germans Trias i Pujol, Universitat Autònoma of Barcelona, IGTP, Badalona, Spain
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14
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Reich K, Hansen JB, Puig L, Konstantinou MP, Warren RB. Complete clearance and Psoriasis Area and Severity Index response for brodalumab and ustekinumab by previous treatment history in AMAGINE-2 and AMAGINE-3. J Eur Acad Dermatol Venereol 2021; 35:2034-2044. [PMID: 34076919 DOI: 10.1111/jdv.17433] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Revised: 04/26/2021] [Accepted: 05/19/2021] [Indexed: 01/15/2023]
Abstract
BACKGROUND The pathway for treatment of psoriasis is partly dependent upon disease severity, and patients may experience inadequate response at any point along the treatment pathway. Patients who repeatedly fail therapy represent a population in whom effective and well-tolerated treatment options are limited. OBJECTIVES To investigate and describe patients achieving Psoriasis Area and Severity Index (PASI) 100 and cumulative treatment benefit over time in patients with moderate-to-severe psoriasis receiving brodalumab or ustekinumab by prior treatment. METHODS We conducted a post hoc analysis of data from two phase 3, randomized, controlled, 52-week AMAGINE trials of brodalumab to describe patients who achieved complete clearance as measured by PASI 100 by prior treatment subgroup (naïve to systemic and biologic treatment, systemic-treated but biologic-naïve, biologic-treated without failure, and biologic-treated with failure). A competing risk model was used to assess cumulative incidence over a 52-week period with outcomes of PASI 100 or inadequate response. Cumulative clinical benefit of treatment was determined with an area under the curve analysis. RESULTS The 52-week cumulative incidence of patients achieving PASI 100 was consistently higher for brodalumab vs. ustekinumab across treatment pathway subgroups (76% vs. 58% in systemic/biologic-naïve patients, 78% vs. 55% in systemic-treated/biologic-naïve patients, 75% vs. 41% in biologic-treated patients without failure, and 70% vs. 30% in biologic-treated patients with failure). Rates of inadequate response were lower with brodalumab compared with ustekinumab across all subgroups. Cumulative treatment benefit was also higher for all subgroups treated with brodalumab compared with those treated with ustekinumab. CONCLUSION Treatment with brodalumab was associated with higher levels of complete clearance and greater cumulative benefit over time compared with ustekinumab, in patients with moderate-to-severe psoriasis, regardless of prior treatment experience.
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Affiliation(s)
- K Reich
- Translational Research in Inflammatory Skin Diseases, Institute for Health Services Research in Dermatology and Nursing, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | | | - L Puig
- Department of Dermatology, Hospital de la Santa Creu i Sant Pau, Autonomous University of Barcelona, Barcelona, Spain
| | | | - R B Warren
- Dermatology Centre, Salford Royal NHS Foundation Trust, Manchester NIHR Biomedical Research Centre, University of Manchester, Manchester, UK
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15
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Lebwohl M, Soliman AM, Yang H, Wang J, Freimark J, Puig L. Impact of PASI response on work productivity and the effect of risankizumab on indirect costs using machine learning in patients with moderate-to-Severe psoriasis. J DERMATOL TREAT 2021; 33:2094-2101. [PMID: 33899655 DOI: 10.1080/09546634.2021.1919287] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVES To compare the impact of Psoriasis Area and Severity Index (PASI) response on total work productivity impairment (TWPI) in patients with moderate-to-severe psoriasis; to compare TWPI and associated indirect costs among patients treated with risankizumab, adalimumab, ustekinumab, and placebo. METHODS Data from REVEAL (adalimumab phase III trial) were used to assess differences in trial-observed TWPI across PASI response cohorts. A machine learning model used REVEAL data to predict TWPI for patients in the risankizumab trials. These values were used to estimate work loss hours and work impairment-related indirect costs for each treatment cohort. RESULTS Among REVEAL patients (N = 741), TWPI in the PASI 100, 90-99, 75-89 cohorts was lower than the PASI <75 cohort (p < 0.05); mean TWPI was lowest with PASI 100 (1.7%) vs. 90-99 (2.5%) vs. 75-89 (4.8%) vs. <75 (14.3%). There was a significant (p < 0.0001) monotonic relationship between higher PASI response and lower TWPI. In the risankizumab trials (N = 2,046), incremental TWPI relative to risankizumab was 3.4%/week for ustekinumab/adalimumab, and 17.1%/week for placebo; incremental indirect cost savings for risankizumab were $2,179/year vs. adalimumab, $2,321/year vs. ustekinumab, and $11,284/year vs. placebo. CONCLUSIONS Higher PASI responses were associated with reduced TWPI. Risankizumab was associated with less work impairment/indirect costs versus ustekinumab/adalimumab/placebo.
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Affiliation(s)
- Mark Lebwohl
- Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | | | - Hongbo Yang
- Analysis Group, Inc, Boston, Massachusetts, USA
| | - Jessie Wang
- Analysis Group, Inc, Boston, Massachusetts, USA
| | | | - Lluís Puig
- Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
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16
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Bruins FM, Bronckers IMGJ, Groenewoud HMM, van de Kerkhof PCM, de Jong EMGJ, Seyger MMB. Association Between Quality of Life and Improvement in Psoriasis Severity and Extent in Pediatric Patients. JAMA Dermatol 2020; 156:72-78. [PMID: 31774449 DOI: 10.1001/jamadermatol.2019.3717] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance Treatment of psoriasis is associated with improved quality of life (QOL) in those with the disease. However, in daily clinical practice, the association between the degree of psoriasis clearance and QOL has not been studied to date, especially in the pediatric population. Objectives To identify the association between the degree of psoriasis improvement (as measured by the Psoriasis Area Severity Index [PASI] and body surface area [BSA] response) and QOL (as measured by the Children's Dermatology Life Quality Index [CDLQI]) in pediatric psoriasis, and to assess the association of treatment type with QOL, independent of psoriasis improvement. Design, Setting, and Participants Data used in this single-center cohort study were extracted from the Child-CAPTURE (Continuous Assessment of Psoriasis Treatment Use Registry), a prospective, observational, daily clinical practice cohort of all children (aged <18 years) with a psoriasis diagnosis who attended the outpatient clinic of the Department of Dermatology at the Radboud University Medical Center in Nijmegen, the Netherlands, between September 3, 2008, and May 4, 2018. All records of treatment episodes with CDLQI, PASI, and BSA scores were included in the analysis. Exposures Patients were treated according to daily clinical care. Treatments were clustered into topical, dithranol, conventional systemic, and biological treatments. Because of low numbers of UV-B phototherapy, this treatment was not assessed. Main Outcomes and Measures Primary outcomes were mean change of CDLQI scores per PASI and BSA response categories (0 to <50, 50 to <75, 75 to <90, and ≥90) and mean CDLQI change per treatment categories. Results In total, 319 patients (median [interquartile range] age, 10.0 [7.0] years; 183 female [57.4%]) were analyzed for PASI score improvement (399 treatment episodes) and improvement in BSA involvement (366 treatment episodes). The greatest improvements in CDLQI scores were seen in the PASI ≥90 response category, with an estimated marginal mean change in CDLQI score of -6.6 (95% CI, -7.5 to -5.7). The greatest improvements in CDLQI scores were also observed in the BSA ≥90 response category, with an estimated marginal mean change in CDLQI score of -6.8 (95% CI, -7.5 to -6.1). Systemic treatment demonstrated a greater degree of improvement of CDLQI compared with topical treatment, independent of PASI response categories. Conclusions and Relevance This cohort study in a real-world setting found that the greatest improvements in QOL were associated with PASI 90 or greater, a decrease in BSA involvement of 90% or greater, and systemic treatments. These findings suggest that reaching PASI 90 or greater and decreasing BSA involvement by at least 90% may be clinically meaningful treatment goals that will help pediatric patients with psoriasis reach optimal QOL.
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Affiliation(s)
- Finola M Bruins
- Department of Dermatology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Inge M G J Bronckers
- Department of Dermatology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Hans M M Groenewoud
- Department for Health Evidence, Radboud University, Nijmegen, the Netherlands
| | | | - Elke M G J de Jong
- Department of Dermatology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Marieke M B Seyger
- Department of Dermatology, Radboud University Medical Center, Nijmegen, the Netherlands
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17
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Warren RB, Hansen JB, Reich K, Paul C, Puig L. Complete clearance and psoriasis area and severity index response for brodalumab and ustekinumab in AMAGINE-2 and -3. J Eur Acad Dermatol Venereol 2020; 35:450-457. [PMID: 32662540 DOI: 10.1111/jdv.16816] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Revised: 06/15/2020] [Accepted: 07/02/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND Modern biologics achieve complete skin clearance [100% improvement in psoriasis area and severity index (PASI 100)] in 30-45% of psoriasis patients. Cumulative benefit considering rapidity, frequency and sustainability of response has not been thoroughly investigated. OBJECTIVES Compare the frequency, rapidity and sustainability of PASI 90 and 100 response in patients with moderate-to-severe psoriasis treated with brodalumab or ustekinumab. METHODS Integrated analyses of the brodalumab Phase III AMAGINE-2 (NCT01708603) and -3 (NCT01708629) trials were performed to determine proportion of patients achieving PASI response per visit; corresponding odds ratios (OR) were calculated. Cumulative clinical benefit of treatment was determined with area-under-the-curve (AUC) analysis. Cumulative incidence of response was analysed using a competing risk model of PASI response or rescue. Sustained response was evaluated by time to inadequate response using Kaplan-Meier methods. Proportion of time spent in different response states was descriptively analysed. Association between PASI response and health-related quality of life [Dermatology Life Quality Index (DLQI)] was assessed using data from all treatment groups from AMAGINE-1, -2 and -3. RESULTS A significantly higher proportion of patients treated with brodalumab achieved PASI 100 vs. ustekinumab (Week 52: 51% vs. 28%; OR [95% CI] 2.8 [2.1, 3.7]; P < 0.0001), with significant differences observed from Week 4. Cumulative benefit through 52 weeks was 69% higher with brodalumab (AUC ratio: 1.69; P < 0.001). Brodalumab patients were also significantly more likely to achieve a PASI 100 at least once over 52 weeks vs. ustekinumab (76% vs. 52%; P < 0.0001). Once response was achieved, brodalumab patients had a low likelihood of failure or need for rescue. There was significant positive association between PASI response level and DLQI0/1 achievement (P < 0.0001). CONCLUSION Brodalumab treatment resulted in significantly higher levels of skin clearance, longer sustained response and greater cumulative treatment benefit vs. ustekinumab.
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Affiliation(s)
- R B Warren
- Dermatology Centre, The University of Manchester, Salford Royal NHS Foundation Trust, NIHR Manchester BRC Centre, Manchester, UK
| | | | - K Reich
- Institute for Health Services Research in Dermatology and Nursing, University Medical Center Hamburg-Eppendorf, Skinflammation® Center, Hamburg, Germany
| | - C Paul
- Toulouse University and Larrey Hospital, Toulouse, France
| | - L Puig
- Department of Dermatology, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona School of Medicine, Barcelona, Spain
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Association Between Patient- and Physician-Reported Outcomes in Patients with Moderate-To-Severe Plaque Psoriasis Treated with Biologics in Real Life (PSO-BIO-REAL). Dermatol Ther (Heidelb) 2020; 10:1099-1109. [PMID: 32761560 PMCID: PMC7477065 DOI: 10.1007/s13555-020-00428-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Indexed: 11/23/2022] Open
Abstract
Introduction Clinical trials have shown that psoriasis patients who achieve complete skin clearance are more likely to report no impairment in health-related quality of life (HRQoL) and no psoriasis symptoms versus patients who achieve almost complete skin clearance. However, real-world data are lacking. The objective of this study was to estimate the real-world proportion of moderate-to-severe psoriasis patients on biologic treatment who achieved a Psoriasis Symptom Inventory (PSI) total score of 0 (PSI 0; no symptoms) and a Dermatology Life Quality Index (DLQI) score of 0/1 (DLQI 0/1; no impact on HRQoL), and to study the relationship between patient-reported symptoms and HRQoL versus physician-reported psoriasis severity (Psoriasis Area and Severity Index [PASI]). Methods The PSO-BIO-REAL study was a multinational, prospective, real-world, non-interventional study that included patients aged ≥ 18 years with moderate-to-severe plaque psoriasis who had initiated biologic therapy (either biologic-naïve or had switched biologics [biologic-experienced]). Psoriasis symptoms were evaluated using the PSI, and HRQoL was assessed using the DLQI. Assessments were conducted at baseline and at 6 and 12 months after initiating biologic treatment. Associations between PSI and DLQI with PASI were evaluated using Spearman correlation coefficients. Post-hoc analyses evaluated individual PSI items and the association to PASI response, DLQI and PSI by index biologic. Results At 12 months, 25.5% of patients achieved PSI 0, and 51.2% achieved DLQI 0/1, with greater proportions achieving these scores among biologic-naïve than among biologic-experienced patients. There was a moderate-to-strong correlation between PSI and DLQI scores and PASI scores, with 64.8% of patients with absolute PASI 0 and 19.4% with absolute PASI > 0 ≤ 2 achieving PSI 0 (6 and 12 months pooled). Achievement of response varied by index biologic. Conclusion This study demonstrates that in a real-world setting patients’ QoL improves with skin clearance. The results also demonstrate that the correlation between skin clearance and improvements in HRQoL (DLQI) and psoriasis symptoms (PSI) is not complete, which highlights the importance of considering both patient- and physician-reported outcomes in the assessment of psoriasis treatment outcomes.
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Jang DH, Heo SJ, Jung HJ, Park MY, Seo SJ, Ahn J. Retrospective Study of Dupilumab Treatment for Moderate to Severe Atopic Dermatitis in Korea: Efficacy and Safety of Dupilumab in Real-World Practice. J Clin Med 2020; 9:jcm9061982. [PMID: 32599878 PMCID: PMC7355558 DOI: 10.3390/jcm9061982] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 06/18/2020] [Accepted: 06/23/2020] [Indexed: 12/23/2022] Open
Abstract
Among biological agents for the treatment of atopic dermatitis (AD), dupilumab is a front-runner. Although many studies have been conducted on the real-world use of dupilumab, the sample size is often small and data is primarily on Western people. Therefore, we investigated the efficacy and safety of dupilumab in patients with moderate-to-severe AD in Korea. All patients with moderate-to-severe AD treated with dupilumab from September 2018 to June 2019 in this institution were included and analyzed by medical records. They were evaluated using the Eczema Area and Severity Index (EASI), Numerical Rating Scale (NRS), Patient Oriented Eczema Measure (POEM), and Dermatology Quality of Life Index (DLQI), respectively on admission, after two weeks (only EASI and NRS) and after 16 weeks. Laboratory tests were measured before and 16 weeks after treatment. A total of 101 patients were included. All efficacy tools showed a significant decrease after 16 weeks; EASI 77.4%, NRS 70.0%, POEM 60.7%, and DLQI 65.0%. EASI was characterized by a marked improvement of 51.5% in just two weeks. The treatment response was not significantly different according to the interval of treatment. Elevated Lactate Dehydrogenase (LDH) at 16 weeks was associated with poor treatment response. Moreover, a high eosinophil count was related to a lower change in EASI and POEM. In the correlation analysis, EASI was not correlated to DLQI before treatment. For changes after 16 weeks, POEM showed the highest correlation with DLQI. (R = 0.66, p < 0.001) In the additional analysis for factors affecting treatment response, the female gender was associated with good treatment response. (odds ratio = 5.4, p = 0.04) Adverse events from treatment included facial erythema (9.9%) and conjunctivitis (5.0%). Overall, it was confirmed that the efficacy of dupilumab in the real-world is similar to that of the existing clinical trials. We suggest that POEM is a useful tool for identifying the quality of life. The female gender was associated with a good treatment response. Both an elevated LDH and a high eosinophil count could be a therapeutic biomarker. Further research will be needed for a long-term period.
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Affiliation(s)
- Dong Hyek Jang
- Department of Dermatology, National Medical Center, Seoul 04564, Korea; (D.H.J.); (H.J.J.); (M.Y.P.)
| | - Seok Jae Heo
- Department of Biostatistics and Computing, Yonsei University Graduate School, Seoul 03722, Korea;
| | - Hye Jung Jung
- Department of Dermatology, National Medical Center, Seoul 04564, Korea; (D.H.J.); (H.J.J.); (M.Y.P.)
| | - Mi Yeon Park
- Department of Dermatology, National Medical Center, Seoul 04564, Korea; (D.H.J.); (H.J.J.); (M.Y.P.)
| | - Seong Jun Seo
- Department of Dermatology, Chung-Ang University Hospital, Seoul 06973, Korea;
| | - Jiyoung Ahn
- Department of Dermatology, National Medical Center, Seoul 04564, Korea; (D.H.J.); (H.J.J.); (M.Y.P.)
- Correspondence: ; Tel.: +82-2-2260-7315
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20
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Teeple A, Fitzgerald T. Cost per responder for guselkumab versus secukinumab in the United States based on a head-to-head trial of moderate to severe plaque psoriasis . J DERMATOL TREAT 2020; 33:518-524. [PMID: 32479140 DOI: 10.1080/09546634.2020.1770172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Aims: To estimate cost per response (CPR) in the United States and number-needed-to-treat (NNT) among subjects receiving guselkumab or secukinumab for moderate to severe plaque psoriasis.Materials and methods: Results from ECLIPSE, a double-blind, head-to-head, 48-week study of guselkumab compared with secukinumab were used to estimate 48-week, annual induction, and maintenance year CPRs for Psoriasis Area and Severity Index (PASI) 75, 90, and 100 responses for all patients and for PASI 90 response in patients according to previous systemic treatment.Results: Week 48 PASI 90 response rates were 84.5% for guselkumab and 70.0% for secukinumab. The CPR for PASI 90 response at 48 weeks was $89,960 for guselkumab versus $110,977 for secukinumab, and for the maintenance year it was $77,109 for guselkumab versus $88,781 for secukinumab. The NNT for a PASI 90 response was 1.18 for guselkumab and 1.43 for secukinumab. CPR and NNT values were also lower for guselkumab than for secukinumab, for PASI 75 and PASI 100 for the three time periods, and for PASI 90 at 48-weeks, regardless of previous systemic treatment.Conclusions: Results from a head-to-head study showed that, compared with secukinumab, guselkumab had lower NNTs and CPRs for PASI 75, PASI 90, and PASI 100 responses.
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Affiliation(s)
- Amanda Teeple
- Real World Value & Evidence, Janssen Scientific Affairs LLC, Horsham, PA, USA
| | - Timothy Fitzgerald
- Real World Value & Evidence, Janssen Scientific Affairs LLC, Horsham, PA, USA
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21
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Lanna C, Galluzzi C, Zangrilli A, Bavetta M, Bianchi L, Campione E. Psoriasis in difficult to treat areas: treatment role in improving health-related quality of life and perception of the disease stigma. J DERMATOL TREAT 2020; 33:531-534. [PMID: 32419527 DOI: 10.1080/09546634.2020.1770175] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Background: When psoriasis affects scalp, nails, palms and soles, it is considered difficult to treat and causes severe impairment of life quality.Objective: We evaluated which difficult site most impacts on the patient's quality of life and how quality of life changes during treatment.Methods: We conducted a prospective observational study in patients receiving adalimumab over a 24 weeks period, through assessment at weeks 0, 4 and 24 using PASI, PAIN VAS, ITCH VAS, DLQI, NAPSI, PSSI. Pearson correlation was used to evaluate the relationship between the various measurements on the basis of three different deltas (between T0 and T24, between T0 and T4, between T0 and average between T4 and T24)Results: The correlation matrix between T0 and T24 shows a significant correlation between delta PASI and delta ITCH and delta ITCH and delta DLQI and a significant correlation between ITCH delta and DLQI delta and a correlation close to significance between DLQI and NAPSI.Conclusion: We identified itching as a mediator between the cutaneous extension of psoriasis and the impact on quality of life. We also documented the predominant role of nail psoriasis in defining the impact on the quality of life of the psoriatic patient.
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Affiliation(s)
- Caterina Lanna
- Dermatology Unit, System Medicine Department, University of Tor Vergata, Rome, Italy
| | | | - Arianna Zangrilli
- Dermatology Unit, System Medicine Department, University of Tor Vergata, Rome, Italy
| | - Mauro Bavetta
- Dermatology Unit, System Medicine Department, University of Tor Vergata, Rome, Italy
| | - Luca Bianchi
- Dermatology Unit, System Medicine Department, University of Tor Vergata, Rome, Italy
| | - Elena Campione
- Dermatology Unit, System Medicine Department, University of Tor Vergata, Rome, Italy
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22
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Marsili F, Travaglini M, Stinco G, Manzoni R, Tiberio R, Prignano F, Mazzotta A, Cannavò SP, Cuccia A, Germino M, Bongiorno MR, Persechino S, Florio T, Pettinato M, Tabanelli M, Sarkar R, Aloisi E, Bartezaghi M, Orsenigo R. Effectiveness of cyclosporine A in patients with moderate to severe plaque psoriasis in a real-life clinical setting in Italy: the TRANSITION study. J DERMATOL TREAT 2020; 33:401-407. [PMID: 32349568 DOI: 10.1080/09546634.2020.1757017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Background: Cyclosporine A (CsA) is one of the systemic therapeutic options for moderate-to-severe psoriasis, based on its efficacy and rapidity of action. The current study investigated the response to CsA in patients with moderate-to-severe plaque psoriasis.Materials and Methods: TRANSITION was an observational, cross-sectional, multicentre study which evaluated the proportion of partial- and suboptimal-responders among patients with moderate-to-severe plaque psoriasis treated with continuous CsA for ≥12 weeks. Patients demonstrating a Psoriasis Area and Severity Index (PASI) response of ≥90, ≥75 and <90, ≥50 and <75 and <50 were defined as responders, suboptimal-responders, partial-responders, and non-responders, respectively.Results: A total of 196 patients (mean age, 46.6 years; 62.8% males) from 14 sites in Italy were evaluated. At the study visit, the mean (SD) PASI score was 4.2(5.5) compared with 15.3(7.1) prior to the last CsA cycle. For response categories, 39.8%, 22.4%, 16.8%, and 20.9% of patients were responders, suboptimal-responders, partial-responders, and non-responders to CsA treatment. Overall, 28.6% of patients permanently discontinued treatment with CsA (lack of efficacy [10.2%], poor tolerability and voluntary discontinuation [3.6% each], and other [11.7%]).Conclusion: Patients were only partially satisfied with CsA treatment, reporting measurable impact on quality of life. Only 40% patients showed a satisfactory response to CsA.
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Affiliation(s)
- F Marsili
- Unit of Dermatology, Versilia Hospital, Lido di Camaiore, Lucca, Italy
| | - M Travaglini
- Centro per la cura della Psoriasi, Hospital "Di Summa-Perrino", Brindisi, Italy
| | - G Stinco
- Institute of Dermatology, Department of Medicine, University Hospital, Udine, Italy
| | - R Manzoni
- Division of Dermatology, Azienda Sanitaria Locale of Biella, Ponderano, Italy
| | - R Tiberio
- SCDU Dermatology, AOU Maggiore della Carità, Novara, Italy
| | - F Prignano
- Department of Health Science Dermatology Unit, University of Florence, Firenze, Italy
| | - A Mazzotta
- Dermatology Unit, San Camillo-Forlanini Hospital, Rome, Italy
| | - S P Cannavò
- Dermatology Unit, University Hospital Policlinico "G. Martino", Messina, Italy
| | - A Cuccia
- Unit of Dermatology, San Donato Hospital, Arezzo, Italy
| | - M Germino
- Department of Dermatology, Hospital Policlinico Città di Udine, Udine, Italy
| | - M R Bongiorno
- Dermatology Unit, University Hospital Policlinico "P. Giaccone", Palermo, Italy
| | - S Persechino
- Dermatology Unit, NESMOS Department, S. Andrea Hospital, University of Rome "Sapienza", Rome, Italy
| | - T Florio
- Dermatology Unit, Hospital Di Venere-Carbonara di Bari, Bari, Italy
| | - M Pettinato
- Dermatology Unit, University Hospital "Policlinico-Vittorio Emanuele", Catania, Italy
| | - M Tabanelli
- U.O.C. Dermatologia Ravenna AUSL Romagna, Ospedale Santa Maria delle Croci, Ravenna, Italy
| | - R Sarkar
- Novartis Pharma AG, Basel, Switzerland
| | - E Aloisi
- Novartis Farma SpA, Origgio, Italy
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23
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Barbieri M, Loconsole F, Migliore A, Capri S. A cost-effectiveness and budget impact analysis of apremilast in patients with psoriasis in the Italian setting. J Med Econ 2020; 23:362-370. [PMID: 31856619 DOI: 10.1080/13696998.2019.1707209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Aims: The aim of this study was to conduct a cost-effectiveness analysis, as well as a budget impact analysis, on the use of apremilast for the treatment of adult patients with moderate-to-severe plaque psoriasis (defined as a psoriasis area severity index [PASI] ≥ 10), who failed to respond to, had a contraindication to, or were intolerant to other systemic therapies, within the Italian National Health Service (NHS).Materials and methods: A Markov state-transition cohort model adapted to the Italian context was used to compare the costs of the currently available treatments and of the patients' quality of life with two alternative treatment sequences, with or without apremilast as pre-biologic therapy. Moreover, a budget impact model was developed based on the population of patients treated for psoriasis in Italy, who would be eligible for treatment with apremilast.Results: Over 5 years, the cost-effectiveness analysis showed that the strategy of using apremilast before biologic therapy was dominant compared with the sequence of biologic treatments without apremilast. In addition, it is important to underline that the use of apremilast slightly increases the quality-adjusted life years gained over 5 years. Furthermore, within the budget impact analysis, the strategy including apremilast would lead to a saving of €16 million within 3 years. Savings would mainly be related to a reduction in pharmaceutical spending, hospital admissions and other drug administration-related costs.Conclusion: These models proved to be robust to variation in parameters and it suggested that the use of apremilast would lead to savings to the Italian healthcare system with potential benefits in terms of patients' quality of life.
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Affiliation(s)
- Marco Barbieri
- Centre for Health Economics, University of York, York, UK
| | - F Loconsole
- Department of Dermatology, University of Bari, Bari, Italy
| | - A Migliore
- Rheumatology Unit, S. Pietro Fatebenefratelli Hospital, Rome, Italy
| | - S Capri
- School of Economics and Management, Università Cattaneo-LIUC, Castellanza, Italy
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24
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Leonardi C, Reich K, Foley P, Torii H, Gerdes S, Guenther L, Gooderham M, Ferris LK, Griffiths CEM, ElMaraghy H, Crane H, Patel H, Burge R, Gallo G, Shrom D, Leung A, Lin CY, Papp K. Efficacy and Safety of Ixekizumab Through 5 Years in Moderate-to-Severe Psoriasis: Long-Term Results from the UNCOVER-1 and UNCOVER-2 Phase-3 Randomized Controlled Trials. Dermatol Ther (Heidelb) 2020; 10:431-447. [PMID: 32200512 PMCID: PMC7211779 DOI: 10.1007/s13555-020-00367-x] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Indexed: 01/09/2023] Open
Abstract
Introduction Ixekizumab, a high-affinity monoclonal antibody that selectively targets interleukin-17A, is approved for treatment of moderate-to-severe plaque psoriasis. Our objective was to evaluate the long-term efficacy and safety of ixekizumab in moderate-to-severe plaque psoriasis through 5 years. Methods Data were integrated from the UNCOVER-1 and UNCOVER-2, randomized, double-blinded, phase-3 trials. Patients who continuously received the labeled ixekizumab dose, were static Physician’s Global Assessment (sPGA) (0,1) responders at Week 12 and completed 60 weeks of treatment could enter the long-term extension (LTE) period. Patients could escalate to every-2-week dosing per investigator opinion. Efficacy and health outcomes included proportion of patients achieving Psoriasis Area and Severity Index (PASI) 75/90/100, sPGA (0,1) and (0), absolute PASI ≤ 5/ ≤ 3/ ≤ 2/ ≤ 1 and Dermatology Life Quality Index (DLQI) (0,1). Results exclude patients who escalated to every-2-week dosing. A modified non-responder imputation method was used to account for missing data. Supplemental analyses include patients who escalated to every-2-week dosing and observed and multiple imputation results. Exposure-adjusted safety outcomes are also reported. Results Of 206 patients who entered the LTE periods, 172 completed treatment. At Week 60, PASI 75/90/100 responses were 94.7%, 85.0% and 62.1%, respectively, and at year 5 were 90.3%, 71.3% and 46.3%, respectively. Similarly, meaningful responses were achieved for the other efficacy and health measures. Among patients with PASI 100 through 5 years, 92% achieved DLQI (0,1), indicating no impact of skin disease on quality of life. During the LTE period, exposure-adjusted incidence rates were 31.4 per 100 patient-years for treatment-emergent adverse events and 6.8 per 100 patient-years for serious adverse events. No deaths were reported. No new or unexpected safety findings were noted. Conclusions The results demonstrate 80 mg ixekizumab maintains long-term efficacy and a safety profile consistent with previous data in patients with moderate-to-severe plaque psoriasis through 5 years of treatment. Trial Registration ClinicalTrials.gov identifier, UNCOVER-1: NCT01474512, UNCOVER-2: NCT01597245. Electronic Supplementary Material The online version of this article (10.1007/s13555-020-00367-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
| | - Kristian Reich
- Center for Translational Research in Inflammatory Skin Diseases, Institute for Health Services Research in Dermatology and Nursing, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,Skinflammation® Center, Hamburg, Germany
| | - Peter Foley
- St. Vincent's Hospital Melbourne and Probity Medical Research, Skin Health Institute, The University of Melbourne, Melbourne, VIC, Australia
| | - Hideshi Torii
- Division of Dermatology, Tokyo Yamate Medical Center, Tokyo, Japan
| | - Sascha Gerdes
- Psoriasis-Center at the Department of Dermatology, University Medical Center Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Lyn Guenther
- Guenther Dermatology Research Centre, London, ON, Canada
| | - Melinda Gooderham
- SkiN Centre for Dermatology and Probity Medical Research, Peterborough, ON, Canada
| | - Laura K Ferris
- University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | | | - Hany ElMaraghy
- Eli Lilly and Company, Lilly Corporate Center, Indianapolis, IN, USA
| | - Heidi Crane
- Eli Lilly and Company, Lilly Corporate Center, Indianapolis, IN, USA
| | - Himanshu Patel
- Eli Lilly and Company, Lilly Corporate Center, Indianapolis, IN, USA
| | - Russel Burge
- Eli Lilly and Company, Lilly Corporate Center, Indianapolis, IN, USA
| | - Gaia Gallo
- Eli Lilly and Company, Lilly Corporate Center, Indianapolis, IN, USA
| | - David Shrom
- Eli Lilly and Company, Lilly Corporate Center, Indianapolis, IN, USA.
| | | | - Chen-Yen Lin
- Eli Lilly and Company, Lilly Corporate Center, Indianapolis, IN, USA
| | - Kim Papp
- K. Papp Clinical Research and Probity Medical Research Inc., Waterloo, ON, Canada
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25
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Porumb-Andrese E, Vâță D, Postolică R, Stătescu L, Stătescu C, Grăjdeanu AI, Pătrașcu AI, Popescu IA, Solovastru LG. Association between personality type, affective distress profile and quality of life in patients with psoriasis vs. patients with cardiovascular disease. Exp Ther Med 2019; 18:4967-4973. [PMID: 31798718 PMCID: PMC6880473 DOI: 10.3892/etm.2019.7933] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2019] [Accepted: 07/23/2019] [Indexed: 12/22/2022] Open
Abstract
Common chronic conditions, such as cardiovascular diseases and psoriasis, are associated with increased psychological distress. Health-related quality of life and personality type in patients with these two diseases were evaluated, including the patient's ability to respond truthfully or his/her tendency to be introverted or extroverted. The subjects (n=63) responded to questionnaires including: SF-36 questionnaire, Eysenck test and the questionnaire of the affective distress profile designed to assess the subjective dimension of functional negative emotions, dysfunctional negative emotions and positive emotions. Psoriasis patients had significantly higher average scores of physical functions and limitations brought on by emotional problems. Emotional instability was common for both types of patients and anxiety was associated with a low level of education. Overall, we believe that it is necessary to include items evaluating the patients' affective profile and personality in the assessment protocols of these diseases. These items could help the clinician in identifying possible factors that signal worsening of the disease or of non-response to treatment.
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Affiliation(s)
- Elena Porumb-Andrese
- Department of Dermatology, University of Medicine and Pharmacy 'Gr. T. Popa', 700115 Iași, Romania.,Dermatology Clinic of The Clinical Emergency County Hospital 'Sf. Spiridon', 700111 Iași, Romania
| | - Dan Vâță
- Department of Dermatology, University of Medicine and Pharmacy 'Gr. T. Popa', 700115 Iași, Romania.,Dermatology Clinic of The Clinical Emergency County Hospital 'Sf. Spiridon', 700111 Iași, Romania
| | | | - Laura Stătescu
- Department of Dermatology, University of Medicine and Pharmacy 'Gr. T. Popa', 700115 Iași, Romania.,Dermatology Clinic of The Clinical Emergency County Hospital 'Sf. Spiridon', 700111 Iași, Romania
| | - Cristian Stătescu
- Cardiology Clinic of The Institute of Cardiovascular Diseases, 700503 Iași, Romania
| | - Alina-Ioana Grăjdeanu
- Department of Dermatology, University of Medicine and Pharmacy 'Gr. T. Popa', 700115 Iași, Romania
| | - Adriana Ionela Pătrașcu
- Dermatology Clinic of The Clinical Emergency County Hospital 'Sf. Spiridon', 700111 Iași, Romania
| | - Ioana Adriana Popescu
- Department of Dermatology, University of Medicine and Pharmacy 'Gr. T. Popa', 700115 Iași, Romania
| | - Laura Gheucă Solovastru
- Department of Dermatology, University of Medicine and Pharmacy 'Gr. T. Popa', 700115 Iași, Romania.,Dermatology Clinic of The Clinical Emergency County Hospital 'Sf. Spiridon', 700111 Iași, Romania
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Teeple A, Muser E. Cost per response for guselkumab versus adalimumab in the United States using data from a head-to-head trial in moderate-to-severe plaque psoriasis. J Med Econ 2019; 22:1268-1273. [PMID: 31199173 DOI: 10.1080/13696998.2019.1632204] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Aims: To estimate annual cost per response (CPR) in the US and number needed to treat (NNT) among patients receiving guselkumab or adalimumab treatment for moderate-to-severe plaque psoriasis (PsO).Materials and methods: Results from VOYAGE 1, a double-blind, placebo-controlled, head-to-head, 48-week study of guselkumab compared with adalimumab in patients with moderate-to-severe PsO were used to estimate annual CPR for Psoriasis Area and Severity Index (PASI) 75, 90, and 100 responses. Drug dosing followed US label recommendations and drug costs were based on US annual wholesale acquisition costs. Number needed to treat (NNT) and annual CPR analyses were estimated, and week 48 response rates were assumed to be maintained for both the induction and maintenance years.Results: Week-48 PASI 90 response rates were 76.3% for guselkumab and 47.9% for adalimumab. The CPR for PASI 90 in the induction year for guselkumab was $113,861 vs $151,226 for adalimumab. Both drugs had lower CPRs for PASI 90 in the maintenance year: $85,395 for guselkumab and $140,424 for adalimumab for adalimumab. The NNT for a PASI 90 response was 1.3 for guselkumab and 2.1 for adalimumab; CPRs and NNT were also lower for guselkumab than for adalimumab for PASI 75 and PASI 100 for both induction and maintenance years.Limitations and conclusions: In this analysis, extrapolating 48-week results from a single head-to-head study, guselkumab was more cost-effective with lower NNT than adalimumab in both the induction and maintenance years for PASI 75, PASI 90, and PASI 100 responses.
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Affiliation(s)
- Amanda Teeple
- Real World Value and Evidence, Janssen Scientific Affairs, LLC, Horsham, PA, USA
| | - Erik Muser
- Real World Value and Evidence, Janssen Scientific Affairs, LLC, Horsham, PA, USA
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van de Kerkhof PCM, Loewe R, Mrowietz U, Falques M, Pau-Charles I, Szepietowski JC. Quality of life outcomes in adults with moderate-to-severe plaque psoriasis treated with dimethylfumarate (DMF): a post hoc analysis of the BRIDGE study. J Eur Acad Dermatol Venereol 2019; 34:119-126. [PMID: 31465585 PMCID: PMC7003897 DOI: 10.1111/jdv.15922] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Accepted: 08/08/2019] [Indexed: 01/07/2023]
Abstract
BACKGROUND Psoriasis is a chronic inflammatory skin disease associated with quality of life (QoL) impairment. BRIDGE was a randomized, double-blind, phase III study comparing the efficacy and safety of dimethylfumarate (DMF) with a fixed combination of fumaric acid esters (FAE) or placebo for the treatment of moderate-to-severe psoriasis. OBJECTIVES This post hoc analysis investigated treatment effect on QoL overall and by patient subgroups categorized by disease severity. Week 8 efficacy responses were also investigated as possible predictors of Week 16 Dermatology Life Quality Index (DLQI) outcomes. METHODS Patients were randomized to receive a maximum daily dose of 720 mg of DMF, FAE (gradual up-titration) or placebo for 16 weeks. Psoriasis Area Severity Index, Body Surface Area, Physician's Global Assessment and DLQI were assessed at baseline, Weeks 8 and 16. DLQI 0-1 indicated 'no effect on patient life'. Associations between baseline severity, Week 16 DLQI and Week 8 efficacy (as observed cases) were also examined. RESULTS At baseline, 671 patients were included in the full analysis set (267 randomized to DMF, 273 to FAE and 131 to placebo). DMF was superior to placebo (P < 0.001) and not significantly different to FAE regarding Week 16 DLQI outcomes (P > 0.05). Baseline disease severity did not impact DLQI outcomes at Week 16. In DMF- and FAE-treated patients, Week 8 PASI 50/75 responders reported better DLQI responses at Week 16 vs non-responders (P < 0.05). Week 8 PASI ≤ 3 and/or PGA 0-1 responders were also more likely to report DLQI 0-1 at Week 16 vs non-responders (P < 0.05). CONCLUSION Dimethylfumarate significantly improved DLQI outcomes vs. placebo and was not affected by baseline disease severity. Efficacy responses (PASI 50/75, PASI ≤3 and PGA 0-1) as early as Week 8 were predictive of QoL outcomes at Week 16 in DMF- and FAE-treated patients.
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Affiliation(s)
- P C M van de Kerkhof
- Department of Dermatology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - R Loewe
- Department of Dermatology, Medical University of Vienna, Vienna, Austria
| | - U Mrowietz
- Psoriasis-Centre, Department of Dermatology, University Medical Centre Schleswig-Holstein, Campus Kiel, Germany
| | | | | | - J C Szepietowski
- Department of Dermatology, Venereology and Allergology, Wroclaw Medical University, Wrocław, Poland
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Norlin J, Nilsson K, Persson U, Schmitt‐Egenolf M. Complete skin clearance and Psoriasis Area and Severity Index response rates in clinical practice: predictors, health‐related quality of life improvements and implications for treatment goals. Br J Dermatol 2019; 182:965-973. [DOI: 10.1111/bjd.18361] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/12/2019] [Indexed: 12/21/2022]
Affiliation(s)
- J.M. Norlin
- The Swedish Institute for Health Economics (IHE) Lund Sweden
| | - K. Nilsson
- The Swedish Institute for Health Economics (IHE) Lund Sweden
| | - U. Persson
- The Swedish Institute for Health Economics (IHE) Lund Sweden
| | - M. Schmitt‐Egenolf
- Department of Public Health and Clinical Medicine, Dermatology Umeå University 901 87 Umeå Sweden
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A Cost-per-Number Needed to Treat Analysis Assessing the Efficiency of Biologic Drugs in Moderate to Severe Plaque Psoriasis. ACTAS DERMO-SIFILIOGRAFICAS 2019. [DOI: 10.1016/j.adengl.2019.07.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Kouwenhoven TA, van der Ploeg JA, van de Kerkhof PC. Treatment goals in psoriasis from a patient perspective: a qualitative study. J DERMATOL TREAT 2019; 31:13-17. [DOI: 10.1080/09546634.2018.1544408] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Affiliation(s)
- Tessa A. Kouwenhoven
- Department of Dermatology, Radboud University Medical Center, Nijmegen, the Netherlands
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Leman J, Walton S, Layton AM, Ward KA, McBride S, Cliff S, Downs A, Landeira M, Bewley A. The real world impact of adalimumab on quality of life and the physical and psychological effects of moderate-to-severe psoriasis: a UK prospective, multicenter, observational study. J DERMATOL TREAT 2019; 31:213-221. [PMID: 30897016 DOI: 10.1080/09546634.2019.1592096] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Psoriasis can adversely affect quality of life (QoL) and emotional well-being. In this UK prospective observational study we evaluated the 'real-world' impact of adalimumab on QoL and the physical/psychological effects of moderate-to-severe psoriasis. Hundred and forty-three biologic-naïve patients with moderate-to-severe psoriasis, receiving adalimumab in clinical practice, were included. Patients completed a series of questionnaires at baseline (adalimumab initiation), 4 and 16-weeks and 6-months post-adalimumab initiation during routine visits. The main outcome measure was the proportion of Dermatology Life Quality Index (DLQI) 'responders' at 16 weeks, defined as ≥5 point reduction from baseline or DLQI = 0.90% (95% CI = 80.8%-94.6%) of evaluable patients were DLQI responders at 16-weeks. There were significant improvements at 16 weeks in patient-reported measures of QoL, mental and physical well-being, cutaneous body image, anxiety, depression and psoriasis severity, which were maintained at 6-months. Adalimumab treatment was associated with improvements in patients' QoL and psychological functioning, which occurred contemporaneously with improvements in cutaneous disease.
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Affiliation(s)
- Joyce Leman
- Department of Dermatology, Western Infirmary, Glasgow, United Kingdom
| | - Shernaz Walton
- Department of Dermatology, Castle Hill Hospital, East Yorkshire, United Kingdom
| | - Alison M Layton
- Department of Dermatology, Harrogate and District NHS Foundation Trust, Harrogate, United Kingdom
| | - Kathleen A Ward
- Department of Dermatology, Cannock Chase Hospital, Cannock, United Kingdom
| | - Sandy McBride
- Department of Dermatology, The Royal Free Hospital, London, United Kingdom
| | - Sandeep Cliff
- Department of Dermatology, East Surrey Hospital, Redhill, United Kingdom
| | - Anthony Downs
- Department of Dermatology, Royal Devon & Exeter Hospital, Exeter, United Kingdom
| | | | - Anthony Bewley
- Department of Dermatology, Barts Health NHS Trust (Whipps Cross and Royal London Hospitals), London, United Kingdom
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Núñez M, Huete T, de la Cueva P, Sacristán JA, Hartz S, Dilla T. A Cost-per-Number Needed to Treat Analysis Assessing the Efficiency of Biologic Drugs in Moderate to Severe Plaque Psoriasis. ACTAS DERMO-SIFILIOGRAFICAS 2019; 110:546-553. [PMID: 30851873 DOI: 10.1016/j.ad.2018.10.017] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2018] [Revised: 10/01/2018] [Accepted: 10/01/2018] [Indexed: 10/27/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Psoriasis is a chronic inflammatory skin disease with an estimated prevalence in Spain of 2.3% of the population. Approximately 30% of patients have moderate-to-severe forms. Treatment with biologic agents is proving to be a step forward in the management of the disease, although these treatments are very expensive. The objective of this study was to determine the efficiency, in terms of cost per number needed to treat (NNT), of the biologic drugs available in Spain for the treatment of moderate to severe plaque psoriasis. METHODS NNT data were obtained from a network meta-analysis that included all randomized clinical trials of biologic drugs sold in Spain. The cost of each treatment was calculated based on the approved dosage for the first year of treatment, as indicated in the Summary of Product Characteristics. These data were used to calculate the cost per NNT of the drugs for various PASI scores (75, 90, and 100). A sensitivity analysis was performed taking into consideration only the PASI-response measurement time (after 10, 12, or 16 weeks, depending on the drug). RESULTS The order of efficiency, from most to least efficient, in the case of a PASI 75 response was ixekizumab > ustekinumab 45mg > ustekinumab 90mg > secukinumab > infliximab > etanercept > adalimumab. The order for PASI 90 was ixekizumab >secukinumab >ustekinumab 45mg > ustekinumab 90mg > infliximab > adalimumab > etanercept. The order for PASI 100 was ixekizumab > secukinumab > infliximab > ustekinumab 90mg > ustekinumab 45mg > adalimumab > etanercept. The sensitivity analysis showed some changes in the order, depending on the response-assessment period. CONCLUSIONS The findings show a link between the efficacy of the biologic therapies available in Spain for the treatment of moderate-to-severe plaque psoriasis and their efficiency. Ixekizumab had the lowest cost per NNT for all PASI-response scores (75, 90, and 100) during the first year of treatment.
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Affiliation(s)
- M Núñez
- Eli Lilly and Company, Madrid, España.
| | - T Huete
- Eli Lilly and Company, Madrid, España
| | - P de la Cueva
- Servicio de Dermatología, Hospital Universitario Infanta Leonor, Madrid, España
| | | | - S Hartz
- Eli Lilly and Company, Surrey, Reino Unido
| | - T Dilla
- Eli Lilly and Company, Madrid, España
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Carrascosa JM, Rebollo F, Gómez S, De-la-Cueva P. Effects of etanercept on the patient-perceived results (PROs) in patients with moderate-to-severe plaque psoriasis: systematic review of the literature and meta-analysis. J DERMATOL TREAT 2018; 29:806-811. [DOI: 10.1080/09546634.2018.1467536] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
| | | | - Susana Gómez
- Pfizer Medical Department, Alcobendas Madrid, Spain
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Gottlieb AB, Blauvelt A, Thaçi D, Leonardi CL, Poulin Y, Drew J, Peterson L, Arendt C, Burge D, Reich K. Certolizumab pegol for the treatment of chronic plaque psoriasis: Results through 48 weeks from 2 phase 3, multicenter, randomized, double-blinded, placebo-controlled studies (CIMPASI-1 and CIMPASI-2). J Am Acad Dermatol 2018; 79:302-314.e6. [PMID: 29660421 DOI: 10.1016/j.jaad.2018.04.012] [Citation(s) in RCA: 109] [Impact Index Per Article: 18.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2017] [Revised: 03/29/2018] [Accepted: 04/05/2018] [Indexed: 11/30/2022]
Abstract
BACKGROUND Certolizumab pegol, the only Fc-free, PEGylated anti-tumor necrosis factor biologic, demonstrated clinically meaningful improvements suggestive of a positive risk-benefit balance in phase 2 studies in adults with moderate-to-severe chronic plaque psoriasis. OBJECTIVE Assess certolizumab efficacy and safety versus placebo in phase 3 studies. METHODS Patients with moderate-to-severe chronic plaque psoriasis were randomized 2:2:1 to certolizumab 400 mg, certolizumab 200 mg, or placebo every 2 weeks. At week 16, certolizumab-treated patients achieving a 50% reduction in Psoriasis Area and Severity Index continued treatment through week 48. Coprimary endpoints were week 16 responder rates, defined as a 75% reduction in Psoriasis Area and Severity Index and Physician's Global Assessment 0/1 (clear/almost clear) and ≥2-point improvement. Safety was assessed by treatment-emergent adverse events. RESULTS Week-16 endpoints were significantly greater for both doses of certolizumab versus placebo, and the responses were maintained through week 48. For most measures, improvement was numerically greater for certolizumab 400 mg. No unexpected safety signals were identified. LIMITATION There was no active comparator. CONCLUSION Treatment with either certolizumab 400 mg or 200 mg every 2 weeks was associated with significant and clinically meaningful improvements in moderate-to-severe psoriasis. The 400-mg dose could provide additional clinical benefit. The safety profile was consistent with the therapeutic class.
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Affiliation(s)
- Alice B Gottlieb
- New York Medical College at Metropolitan Hospital, New York, New York.
| | | | - Diamant Thaçi
- Comprehensive Centre Inflammation Medicine, University Hospital of Schleswig-Holstein Campus Lübeck, Lübeck, Germany
| | - Craig L Leonardi
- Central Dermatology, St. Louis, Missouri; Saint Louis University School of Medicine, St. Louis, Missouri
| | - Yves Poulin
- Centre de Recherche Dermatologique du Québec Métropolitain, Québec, Canada
| | | | | | | | | | - Kristian Reich
- Dermatologikum Hamburg, Hamburg, Germany; SCIderm Research Institute, Hamburg, Germany
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Youn SW, Lee JH, Yu DY, Kim Y, Kim BS, Seo SJ, Choe YB, Yun SK, Park J, Kim NI, Choi CW, Youn JI, Lee SJ, Lee MG, Kim KJ, Park CJ, Ro YS, Song HJ, Shin BS, Ahn SK, Lee JY, Won YH, Jang MS, Kim KH, Kim MH, Kim TY, Choi JH. The relationship between clinical characteristics including presence of exposed lesions and health-related quality of life (HRQoL) in patients with psoriasis: analysis from the nationwide epidemiologic study for psoriasis in Korea (EPI-PSODE study). J Eur Acad Dermatol Venereol 2018; 32:1499-1506. [PMID: 29430733 DOI: 10.1111/jdv.14865] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2017] [Accepted: 01/25/2018] [Indexed: 01/23/2023]
Abstract
BACKGROUND Psychological aspect and quality of life should be considered in treating patients with psoriasis. OBJECTIVE We sought to ascertain which clinical characteristics including presence of exposed lesions are associated with impairment of health-related quality of life (HRQoL) in patients with psoriasis. METHODS The EPI-PSODE study was a nationwide, multicenter, cross-sectional study conducted in Korea that included 1260 adult patients with psoriasis. In addition to clinical characteristics including presence of exposed lesions, data were collected using the Psoriatic Arthritis (PsA) Screening and Evaluation (PASE), Dermatology Life Quality Index (DLQI), MOS 36-Item Short-Form Health Survey (SF-36), Work Productivity and Activity Impairment Questionnaire Psoriasis (WPAI: PSO) and Medication Satisfaction Questionnaire (MSQ). RESULTS Patients with a DLQI score > 5 (n = 990) were younger, had an earlier onset of psoriasis, scored higher on the Psoriasis Area and Severity Index (PASI), had higher body surface area (BSA) and had higher PASE scores than patients with DLQI ≤ 5 (n = 266). The group of patients with exposed lesions (n = 871) were younger and male predominance, earlier onset of psoriasis, longer disease duration, higher PASI/BSA score and a higher proportion with drinking and smoking history each than the group of patients without exposed lesions (n = 389). Presence of exposed lesions negatively influenced DLQI, 36-Item Short-Form Health Survey (SF-36) (mental component), presenteeism, total work productivity impairment and total activity impairment in the WPAI: PSO. In multiple regression model, PASI score was the only variable which was significantly associated with all HRQoL measures. Presence of exposed lesions was a significant factor affecting DLQI and SF-36 (mental). CONCLUSION The presence of exposed lesions has a negative impact on quality of life, mental health and work productivity. Therefore, effective treatments are particularly needed for psoriasis patients with exposed lesions.
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Affiliation(s)
- S W Youn
- Department of Dermatology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - J-H Lee
- Department of Dermatology, Sungkyunkwan University School of Medicine, Samsung Medical Center, Seoul, Korea
| | - D Y Yu
- Medical Affairs, Janssen Korea, Seoul, Korea
| | - Y Kim
- Medical Affairs, Janssen Korea, Seoul, Korea
| | - B S Kim
- Department of Dermatology, Pusan National University School of Medicine, Busan, Korea
| | - S J Seo
- Department of Dermatology, Chung-Ang University Hospital, Seoul, Korea
| | - Y B Choe
- Department of Dermatology, Konkuk University School of Medicine, Seoul, Korea
| | - S-K Yun
- Department of Dermatology, Chonbuk National University Medical School, Jeonju, Korea
| | - J Park
- Department of Dermatology, Catholic University of Daegu School of Medicine, Daegu, Korea
| | - N I Kim
- Department of Dermatology, KyungHee University Medical center, Seoul, Korea
| | - C W Choi
- Department of Dermatology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - J I Youn
- Department of Dermatology, National Medical Center, Seoul, Korea
| | - S-J Lee
- Department of Dermatology, Kyungpook National University Hospital, Daegu, Korea
| | - M-G Lee
- Department of Dermatology, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - K J Kim
- Department of Dermatology, Hallym University Sacred Heart Hospital, Anyang, Korea
| | - C J Park
- Department of Dermatology, The Catholic University of Korea, Bucheon St. Mary's Hospital, Bucheon, Korea
| | - Y S Ro
- Department of Dermatology, Hanyang University Medical Center, Seoul, Korea
| | - H J Song
- Department of Dermatology, Korea University Guro Hospital, Seoul, Korea
| | - B S Shin
- Department of Dermatology, Chosun University Hospital, Gwangju, Korea
| | - S K Ahn
- Department of Dermatology, Wonju Severance Christian Hospital, Wonju, Korea
| | - J Y Lee
- Department of Dermatology, Chungbuk National University College of Medicine, Cheongju, Korea
| | - Y H Won
- Department of Dermatology, Chonnam National University Hospital, Gwangju, Korea
| | - M S Jang
- Department of Dermatology, Kosin University College of Medicine, Busan, Korea
| | - K H Kim
- Department of Dermatology, Dong-A University Hospital, Busan, Korea
| | - M H Kim
- Department of Dermatology, Dankook University Hospital, Cheonan, Korea
| | - T Y Kim
- Department of Dermatology, Catholic University of Korea Seoul St. Mary's Hospital, Seoul, Korea
| | - J-H Choi
- Department of Dermatology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
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Abstract
INTRODUCTION Interleukin (IL)-23 inhibitors are a new class of biologics currently undergoing clinical trials for the treatment of moderate-to-severe psoriasis. Phase III studies of guselkumab, an IL-23 receptor monoclonal antibody, are currently underway. METHODS We summarize the available phase III results to date, establishing the efficacy and safety of guselkumab in patients with moderate-to-severe plaque psoriasis. RESULTS Currently, there are available data of up to 48 weeks from two Phase III, multicenter, randomized, double-blind, placebo- and comparator-controlled clinical trials, VOYAGE 1 and VOYAGE 2. At week 16, the proportion of patients attaining at least a 90% improvement from baseline in the Psoriasis Area and Severity Index (PASI 90) was 73.3% in VOYAGE 1 and 70.0% in VOYAGE 2. Guselkumab remained efficacious through 48 weeks of treatment. Guselkumab maintained a satisfactory safety profile with the most frequently reported adverse events being nasopharyngitis, headache, and upper respiratory tract infection. CONCLUSION Phase III trials of Guselkumab suggest a favorable efficacy and safety profile of this novel drug. Although further studies are needed to assess long-term safety and efficacy, based on the results to date, guselkumab appears to be a promising therapeutic option for moderate-to-severe plaque-type psoriasis.
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Update on IL-17 Inhibitors for Psoriasis. CURRENT DERMATOLOGY REPORTS 2017. [DOI: 10.1007/s13671-017-0181-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Galluzzo M, Talamonti M, D’adamio S, Bianchi L. Pharmacokinetic drug evaluation of brodalumab for the treatment of psoriasis. Expert Opin Drug Metab Toxicol 2017; 13:679-691. [DOI: 10.1080/17425255.2017.1325874] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Affiliation(s)
- M. Galluzzo
- Department of Dermatology, University of Rome ‘Tor Vergata’, Rome, Italy
| | - M. Talamonti
- Department of Dermatology, University of Rome ‘Tor Vergata’, Rome, Italy
| | - S. D’adamio
- Department of Dermatology, University of Rome ‘Tor Vergata’, Rome, Italy
| | - L. Bianchi
- Department of Dermatology, University of Rome ‘Tor Vergata’, Rome, Italy
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Elewski BE, Puig L, Mordin M, Gilloteau I, Sherif B, Fox T, Gnanasakthy A, Papavassilis C, Strober BE. Psoriasis patients with psoriasis Area and Severity Index (PASI) 90 response achieve greater health-related quality-of-life improvements than those with PASI 75–89 response: results from two phase 3 studies of secukinumab. J DERMATOL TREAT 2017; 28:492-499. [DOI: 10.1080/09546634.2017.1294727] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Affiliation(s)
| | - Lluís Puig
- Department of Dermatology, Hospital de la Sanat Creu i Sant Pau, Barcelona, Spain
| | | | | | - Bintu Sherif
- RTI Health Solutions, Research Triangle Park, NC, USA
| | - Todd Fox
- Novartis Pharma AG, Basel, Switzerland
| | | | | | - Bruce E. Strober
- University of Connecticut Health Center, Farmington, CT, USA
- Probity Medical Research, Waterloo, Canada
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Wu D, Hou SY, Zhao S, Hou LX, Jiao T, Xu NN, Zhang N. Efficacy and safety of interleukin-17 antagonists in patients with plaque psoriasis: a meta-analysis from phase 3 randomized controlled trials. J Eur Acad Dermatol Venereol 2017; 31:992-1003. [PMID: 28107570 DOI: 10.1111/jdv.14125] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2016] [Accepted: 01/03/2017] [Indexed: 12/14/2022]
Abstract
BACKGROUND The interleukin-17 (IL-17) cytokine pathway plays a key role in the development of psoriasis. Antibodies targeting IL-17 or blocking its receptor may be a new therapeutic approach for psoriasis. To assist treatment selection in daily practice, it is essential to understand the benefit and risk profile of IL-17 antagonists. OBJECTIVE We performed a meta-analysis to evaluate the efficacy and safety of IL-17 antagonists in patients with psoriasis. METHODS We searched a number of databases for relevant randomized controlled trials (RCTs) published before May 2016. The following outcomes were evaluated: Psoriasis Area and Severity Index (PASI) 75, 90, 100 response, Investigator's Global Assessment (IGA) score of 0 or 1 response, adverse events (AEs) and withdrawals. The meta-analysis was performed using Review Manager 5.2 software. RESULTS Nine RCTs with 5951 patients were included. IL-17 antagonists achieved higher PASI 75, 90, 100 response rates and Dermatology Life Quality Index 0 or 1 response rates than placebo and a lower incidence of discontinuations due to lack of efficacy. In the safety analysis, no significant differences were found between the IL-17 antagonists and placebo in the proportion of patients with serious AEs, cardiovascular disease and discontinuations due to AEs. However, IL-17 antagonists were associated with a higher proportion of patients with any AEs and infections than placebo. CONCLUSION IL-17 antagonists were effective, with an acceptable safety profile, for patients with plaque psoriasis. Vigilance because of the potential for infection will be necessary for IL-17 antagonists.
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Affiliation(s)
- D Wu
- Second Departments of Rheumatology, Shengjing Hospital of China Medical University, Shenyang, Liaoning, China
| | - S-Y Hou
- Intensive Care Unit, The People's Hospital of Liaoning Province, Shenyang, Liaoning, China
| | - S Zhao
- Second Departments of Rheumatology, Shengjing Hospital of China Medical University, Shenyang, Liaoning, China
| | - L-X Hou
- Second Departments of Rheumatology, Shengjing Hospital of China Medical University, Shenyang, Liaoning, China
| | - T Jiao
- Second Departments of Rheumatology, Shengjing Hospital of China Medical University, Shenyang, Liaoning, China
| | - N-N Xu
- Second Departments of Rheumatology, Shengjing Hospital of China Medical University, Shenyang, Liaoning, China
| | - N Zhang
- Second Departments of Rheumatology, Shengjing Hospital of China Medical University, Shenyang, Liaoning, China
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Lacour JP, Paul C, Jazayeri S, Papanastasiou P, Xu C, Nyirady J, Fox T, Papavassilis C. Secukinumab administration by autoinjector maintains reduction of plaque psoriasis severity over 52 weeks: results of the randomized controlled JUNCTURE trial. J Eur Acad Dermatol Venereol 2017; 31:847-856. [PMID: 28111801 DOI: 10.1111/jdv.14073] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2016] [Accepted: 11/04/2016] [Indexed: 12/01/2022]
Abstract
BACKGROUND User satisfaction is an important factor associated with treatment adherence in chronic diseases including moderate-to-severe psoriasis. OBJECTIVE To evaluate the efficacy, safety and patient acceptability of 300 and 150 mg secukinumab - a fully human anti-interleukin-17A monoclonal antibody that has demonstrated efficacy in the treatment of patients with moderate-to-severe plaque psoriasis - self-administered by autoinjection. METHODS Patients with moderate-to-severe plaque psoriasis were randomized to secukinumab 300 mg, secukinumab 150 mg or placebo self-administered by autoinjection at baseline, Weeks 1, 2 and 3 and then every 4 weeks from Week 4 to Week 48. Efficacy responses [≥75/90/100% improvement in Psoriasis Area and Severity Index (PASI 75/90/100) and clear/almost clear skin by Investigator's Global Assessment 2011 modified version (IGA mod 2011 0/1)] were measured at Week 52. Patient-reported usability of the autoinjector was evaluated by the self-injection assessment questionnaire to Week 48. RESULTS At Week 52 with secukinumab 300 mg, PASI 75/90/100 and IGA mod 2011 0/1 responses were achieved by 81.4/64.1/38.8% and 69.6% of patients, respectively, by multiple imputation. At Week 52 with secukinumab 150 mg, PASI 75/90/100 and IGA mod 2011 0/1 responses were achieved by 75.2/57.4/33.1% and 60.2% of patients, respectively, by multiple imputation. Patient-assessed acceptability of the autoinjector remained high to Week 48. The proportion of patients experiencing adverse events was greater with secukinumab 300 mg (88.6%) than with secukinumab 150 mg (78.7%). CONCLUSION Self-administration of secukinumab using an autoinjector was associated with robust and sustained efficacy, a good safety profile and high acceptability.
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Affiliation(s)
- J-P Lacour
- Department of Dermatology, University Hospital of Nice, Nice, France
| | - C Paul
- Department of Dermatology, Paul Sabatier University, Toulouse, France
| | - S Jazayeri
- Alliance Dermatology and MOHS Center, Phoenix, AZ, USA
| | | | - C Xu
- Stanford University, Stanford, CA, USA
| | - J Nyirady
- Novartis Pharmaceuticals Corporation, East Hanover, NJ, USA
| | - T Fox
- Novartis Pharma AG, Basel, Switzerland
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Blauvelt A, Papp KA, Griffiths CEM, Randazzo B, Wasfi Y, Shen YK, Li S, Kimball AB. Efficacy and safety of guselkumab, an anti-interleukin-23 monoclonal antibody, compared with adalimumab for the continuous treatment of patients with moderate to severe psoriasis: Results from the phase III, double-blinded, placebo- and active comparator-controlled VOYAGE 1 trial. J Am Acad Dermatol 2017; 76:405-417. [PMID: 28057360 DOI: 10.1016/j.jaad.2016.11.041] [Citation(s) in RCA: 571] [Impact Index Per Article: 81.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2016] [Revised: 11/17/2016] [Accepted: 11/19/2016] [Indexed: 12/16/2022]
Abstract
BACKGROUND Guselkumab, an interleukin-23 blocker, was superior to adalimumab in treating moderate to severe psoriasis in a phase II trial. OBJECTIVES We sought to compare efficacy and safety of guselkumab with adalimumab and placebo in patients with psoriasis treated for 1 year. METHODS Patients were randomized to guselkumab 100 mg (weeks 0 and 4, then every 8 weeks; n = 329); placebo→guselkumab (weeks 0, 4, and 12 then guselkumab at weeks 16 and 20, then every 8 weeks; n = 174); or adalimumab (80 mg week 0, 40 mg week 1, then 40 mg every 2 weeks through week 47; n = 334). Physician-reported outcomes (Investigator Global Assessment, Psoriasis Area and Severity Index [PASI]), patient-reported outcomes (Dermatology Life Quality Index, Psoriasis Symptoms and Signs Diary), and safety were evaluated through week 48. RESULTS Guselkumab was superior (P < .001) to placebo at week 16 (85.1% vs 6.9% [Investigator Global Assessment score of 0/1 (cleared/minimal)] and 73.3% vs 2.9% [90% or greater improvement in PASI score from baseline (PASI 90)]). Guselkumab was also superior (P < .001) to adalimumab for Investigator Global Assessment 0/1 and PASI 90 at week 16 (85.1% vs 65.9% and 73.3% vs 49.7%), week 24 (84.2% vs 61.7% and 80.2% vs 53.0%), and week 48 (80.5% vs 55.4% and 76.3% vs 47.9%). Furthermore, guselkumab significantly improved patient-reported outcomes through week 48. Adverse event rates were comparable between treatments. LIMITATIONS Analyses were limited to 48 weeks. CONCLUSIONS Guselkumab demonstrated superior efficacy compared with adalimumab and was well tolerated in patients with psoriasis through 1 year.
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Affiliation(s)
| | - Kim A Papp
- K. Papp Clinical Research and Probity Research Inc, Waterloo, Ontario, Canada
| | - Christopher E M Griffiths
- Dermatology Center, Salford Royal Hospital, University of Manchester, Manchester Academic Health Science Center, Manchester, United Kingdom
| | - Bruce Randazzo
- Janssen Research & Development LLC, Spring House, Pennsylvania; Department of Dermatology, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania
| | - Yasmine Wasfi
- Janssen Research & Development LLC, Spring House, Pennsylvania
| | | | - Shu Li
- Janssen Research & Development LLC, Spring House, Pennsylvania
| | - Alexa B Kimball
- Department of Dermatology, Harvard Medical School and Beth Israel Deaconess Medical Center, Boston, Massachusetts
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Godse K. Secukinumab - First in Class Interleukin-17A Inhibitor for the Treatment of Psoriasis. Indian J Dermatol 2017; 62:195-199. [PMID: 28400641 PMCID: PMC5363145 DOI: 10.4103/ijd.ijd_233_16] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Psoriasis is a complex inflammatory disease that occurs in genetically susceptible individuals and presents with the development of erythematous scaly plaques on the skin. Interleukins (ILs) in the Th17 pathway play a pivotal role in the pathogenesis of psoriasis and have thus become targets for recent biologic drug development. Secukinumab is a human monoclonal IgG1k antibody that has been developed to target and block the actions of IL-17A. Secukinumab recently approved for use as first-line systemic therapy in a patient with moderate to severe psoriasis has been studied first in psoriasis before other diseases. Both Phase II and III clinical trials have demonstrated the effectiveness of secukinumab in the treatment of moderate-to-severe plaque psoriasis, and it has demonstrated superiority to other comparable biologics on the market, including the tumor necrosis factor inhibitor etanercept. Secukinumab has also shown superiority to ustekinumab, a relatively recent biologic introduced for the treatment of psoriasis. Besides demonstrating better efficacy compared to etanercept and ustekinumab, secukinumab has also demonstrated a greater impact of the quality of life of patients with a comparable safety profile. Secukinumab shows great promise in having a tremendous impact on the treatment of plaque psoriasis based on its ability to produce similar, if not better, clinical outcomes than other biologic antipsoriasis medications.
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Affiliation(s)
- Kiran Godse
- Department of Dermatology, D Y Patil University School of Medicine, Navi Mumbai, Maharashtra, India
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Body Region Involvement and Quality of Life in Psoriasis: Analysis of a Randomized Controlled Trial of Adalimumab. Am J Clin Dermatol 2016; 17:691-699. [PMID: 27815915 PMCID: PMC5110581 DOI: 10.1007/s40257-016-0229-x] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Background Psoriasis severity and treatment responsiveness vary by body region, which differentially impacts quality of life (QoL). Objective The objective of the study was to examine adalimumab efficacy by body region and regional response and QoL relationship. Methods Patients (n = 1212) with moderate-to-severe psoriasis were randomized 2:1 to 80 mg at week 0, followed by adalimumab 40 mg or placebo every other week for 16 weeks in the double-blind REVEAL study. Psoriasis Area and Severity Index (PASI) responses and Dermatology Life Quality Index outcomes were analyzed. Results Week 16 regional mean PASI improvements were significantly greater with adalimumab (83.1 ± 1.57, 81.3 ± 1.58, 75.7 ± 1.34, and 73.9 ± 1.26% in the trunk, head, upper extremities, and lower extremities, respectively; all p < 0.001 vs. placebo). Likewise, percentages of patients with regional PASI ≥75/≥90/100% reduction from baseline were significantly higher with adalimumab (all p < 0.001); adalimumab responses were greater for the trunk (77.9/65.0/59.1%) and head (74.6/66.1/62.8%; all p ≤ 0.0001 vs. lower) than upper (67.7/45.1/39.6%; p = 0.4, p = 0.04, p = 0.0005, respectively, vs. lower) and lower extremities (65.7/40.0/31.3%). Adalimumab significantly improved Dermatology Life Quality Index scores vs. placebo (8.2- vs 1.7-point decrease from baseline; p < 0.001). Limitations The study was a post hoc analysis. Conclusions Adalimumab treatment resulted in statistically significant and clinically meaningful improvements in disease severity and QoL. QoL improvements were associated with PASI responses in all body regions. Trial Registration ClinicalTrials.gov identifier NCT00237887. Electronic supplementary material The online version of this article (doi:10.1007/s40257-016-0229-x) contains supplementary material, which is available to authorized users.
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Feldman SR, Thaçi D, Gooderham M, Augustin M, de la Cruz C, Mallbris L, Buonanno M, Tatulych S, Kaur M, Lan S, Valdez H, Mamolo C. Tofacitinib improves pruritus and health-related quality of life up to 52 weeks: Results from 2 randomized phase III trials in patients with moderate to severe plaque psoriasis. J Am Acad Dermatol 2016; 75:1162-1170.e3. [DOI: 10.1016/j.jaad.2016.07.040] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2016] [Revised: 06/16/2016] [Accepted: 07/22/2016] [Indexed: 11/25/2022]
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Puig L, Thom H, Mollon P, Tian H, Ramakrishna G. Clear or almost clear skin improves the quality of life in patients with moderate-to-severe psoriasis: a systematic review and meta-analysis. J Eur Acad Dermatol Venereol 2016; 31:213-220. [DOI: 10.1111/jdv.14007] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2016] [Accepted: 07/22/2016] [Indexed: 01/19/2023]
Affiliation(s)
- L. Puig
- Department of Dermatology; Hospital de la Santa Creu i Sant Pau; Universitat Autonoma de Barcelona Medical School; Barcelona Spain
| | - H. Thom
- School of Social and Community Medicine; University of Bristol; Bristol UK
| | - P. Mollon
- Global Patient Access; Novartis Pharma AG; Basel Switzerland
| | - H. Tian
- Global Medical Affairs; Novartis Pharmaceuticals Corporation; One Health Plaza East Hanover NJ USA
| | - G.S. Ramakrishna
- Patient Access Services; Novartis Healthcare Private Limited; Hyderabad India
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Galluzzo M, D’adamio S, Bianchi L, Talamonti M. Brodalumab for the treatment of psoriasis. Expert Rev Clin Immunol 2016; 12:1255-1271. [DOI: 10.1080/1744666x.2016.1246957] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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48
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Strober B, Papp KA, Lebwohl M, Reich K, Paul C, Blauvelt A, Gordon KB, Milmont CE, Viswanathan HN, Li J, Pinto L, Harrison DJ, Kricorian G, Nirula A, Klekotka P. Clinical meaningfulness of complete skin clearance in psoriasis. J Am Acad Dermatol 2016; 75:77-82.e7. [DOI: 10.1016/j.jaad.2016.03.026] [Citation(s) in RCA: 73] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2015] [Revised: 03/15/2016] [Accepted: 03/21/2016] [Indexed: 11/28/2022]
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Farahnik B, Beroukhim K, Abrouk M, Nakamura M, Zhu TH, Singh R, Lee K, Bhutani T, Koo J. Brodalumab for the Treatment of Psoriasis: A Review of Phase III Trials. Dermatol Ther (Heidelb) 2016; 6:111-24. [PMID: 27221323 PMCID: PMC4906115 DOI: 10.1007/s13555-016-0121-x] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2016] [Indexed: 12/11/2022] Open
Abstract
INTRODUCTION Interleukin (IL)-17 inhibitors are the most recent class of monoclonal antibodies approved by the FDA for psoriasis treatment. Preclinical and phase II studies of brodalumab, a high-affinity IL-17 receptor monoclonal antibody, have been encouraging. METHODS We conducted a literature search using the PubMed database in order to assess the efficacy and safety profile of brodalumab. The search included the following key words: "psoriasis" and "IL-17" or "brodalumab." We also reviewed citations within articles to identify relevant sources. RESULTS At week 12, the proportion of patients attaining a 75% improvement from the baseline Psoriasis Area and Severity Index (PASI 75) was similar among the three phase III trials (AMAGINE-1, 83%; AMAGINE-2, 86%; AMAGINE-3, 85%). Brodalumab remained efficacious through 52 weeks of treatment. It maintained a satisfactory safety profile; the most frequently reported adverse events consisted of nasopharyngitis, headache, upper respiratory tract infection, and arthralgia. CONCLUSION Use of brodalumab revealed prompt clinical improvement and a favorable short-term safety profile in phase III trials, although further extension studies are needed to assess long-term safety. Based on the results, brodalumab appears to be a potent therapeutic option for patients with moderate-to-severe plaque-type psoriasis.
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Affiliation(s)
| | - Kourosh Beroukhim
- David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA
| | - Michael Abrouk
- School of Medicine, University of California, Irvine, Irvine, CA, USA
| | - Mio Nakamura
- Department of Dermatology, Psoriasis and Skin Treatment Center, University of California, San Francisco, San Francisco, CA, USA
| | - Tian Hao Zhu
- University of Southern California Keck School of Medicine, Los Angeles, CA, USA
| | - Rasnik Singh
- David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA
| | - Kristina Lee
- Department of Dermatology, Psoriasis and Skin Treatment Center, University of California, San Francisco, San Francisco, CA, USA
| | - Tina Bhutani
- Department of Dermatology, Psoriasis and Skin Treatment Center, University of California, San Francisco, San Francisco, CA, USA
| | - John Koo
- Department of Dermatology, Psoriasis and Skin Treatment Center, University of California, San Francisco, San Francisco, CA, USA
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Farahnik B, Beroukhim K, Zhu TH, Abrouk M, Nakamura M, Singh R, Lee K, Bhutani T, Koo J. Ixekizumab for the Treatment of Psoriasis: A Review of Phase III Trials. Dermatol Ther (Heidelb) 2016; 6:25-37. [PMID: 26910853 PMCID: PMC4799032 DOI: 10.1007/s13555-016-0102-0] [Citation(s) in RCA: 57] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2016] [Indexed: 01/01/2023] Open
Abstract
INTRODUCTION Interleukin-17 inhibitors are the newest class of monoclonal antibodies approved by the US Food and Drug Administration for the treatment of psoriasis. Preclinical and Phase II studies of ixekizumab, a high-affinity anti-IL-17A monoclonal antibody, have proved promising. METHODS We conducted an extensive literature search using the PubMed database to assess the efficacy and safety profile of ixekizumab. The search included the following key words: "psoriasis" and "IL-17" or "ixekizumab." We also reviewed citations within articles to identify relevant sources. RESULTS By week 12, the percentage of patients achieving a 75% improvement from baseline Psoriasis Area and Severity Index (PASI 75) was comparable among the three Phase III trials (UNCOVER-1, 89%; UNCOVER-2, 90%; UNCOVER-3, 87%). Ixekizumab continued to be efficacious through 60 weeks of treatment. The safety profile of ixekizumab was favorable; the most frequently reported adverse events consisted of nasopharyngitis, upper respiratory tract infection, injection-site reaction, and headache. CONCLUSION Overall, ixekizumab demonstrated rapid clinical improvement and favorable short-term safety profile in Phase III trials. The results support ixekizumab as an effective therapeutic option for patients with moderate-to-severe plaque-type psoriasis.
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Affiliation(s)
| | - Kourosh Beroukhim
- University of California-Los Angeles, David Geffen School of Medicine, Los Angeles, CA, USA
| | - Tian Hao Zhu
- University of Southern California Keck School of Medicine, Los Angeles, CA, USA
| | - Michael Abrouk
- University of California-Irvine, School of Medicine, Irvine, CA, USA
| | - Mio Nakamura
- Department of Dermatology, Psoriasis and Skin Treatment Center, University of California-San Francisco, San Francisco, CA, USA
| | - Rasnik Singh
- University of California-Los Angeles, David Geffen School of Medicine, Los Angeles, CA, USA
| | - Kristina Lee
- Department of Dermatology, Psoriasis and Skin Treatment Center, University of California-San Francisco, San Francisco, CA, USA
| | - Tina Bhutani
- Department of Dermatology, Psoriasis and Skin Treatment Center, University of California-San Francisco, San Francisco, CA, USA
| | - John Koo
- Department of Dermatology, Psoriasis and Skin Treatment Center, University of California-San Francisco, San Francisco, CA, USA
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