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Dattola A, Bernardini N, Caldarola G, Coppola R, De Simone C, Giordano D, Giunta A, Moretta G, Pagnanelli G, Panasiti V, Persechino S, Potenza C, Trovato F, Zangrilli A, Bianchi L, Pellacani G, Peris K, Richetta AG. Effectiveness of Ixekizumab in Elderly Patients for the Treatment of Moderate-to-Severe Psoriasis: Results From a Multicenter, Retrospective Real-Life Study in the Lazio Region. Dermatol Pract Concept 2024; 14:dpc.1403a166. [PMID: 39122514 PMCID: PMC11314344 DOI: 10.5826/dpc.1403a166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/14/2024] [Indexed: 08/12/2024] Open
Abstract
INTRODUCTION This was an observational, retrospective, multicenter study, enrolling elderly patients (>65 years old) treated with ixekizumab with a diagnosis of psoriasis (PsO) and/or psoriatic arthritis (PsA) during the period 2020 to 2023. OBJECTIVES Efficacy of ixekizumab in elderly patients in the treatment of moderate to severe psoriasis. METHODS We included 73 patients with psoriasis (32.9%), psoriatic arthritis (1.4%) and both of them (PsO-PsA 65.8%), attending the outpatient clinics of seven Italian referral center for psoriasis in Lazio region: Policlinico Umberto I Università Roma La Sapienza, Sant'Andrea Università di Roma La Sapienza, Polo Pontino Università Roma La Sapienza, Fondazione Policlinico Universitario A. Gemelli, Università Campus Biomedico Roma, Istituto Dermopatico dell'Immacolata - IDI and Policlinico Tor Vergata. We collected data related to the characteristics of the patients (age, sex, body mass index) and of the disease (age at onset, duration of psoriasis, previous treatments). The severity of psoriasis was measured with the Psoriasis Area and Severity Index (PASI) score at baseline and after 16, 24, 52, 104 and 156 weeks of treatment. RESULTS PASI90 was achieved by all the patients in week 16 and remained stable until the end of the study. PASI100 has been achieved by 55.1% of patients at weeks 16 and by 81.3% at week 104. A statistically significant difference has been showed between baseline and all the other time points (P < 0.0001) for PASI score. A similar trend was observed for Visual Analogue Scale score and Dermatology Life Quality Index score. CONCLUSIONS Ixekizumab was effective and with a good safety profile in psoriatic patients over 65 years. No significant adverse events were reported.
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Affiliation(s)
- Annunziata Dattola
- Dermatology Unit, Department of Clinical Internal, Anesthesiological and Cardiovascular Science, University of La Sapienza, Rome, Italy
| | - Nicoletta Bernardini
- Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome - Polo Pontino, ASL Latina, Latina, Italy
| | - Giacomo Caldarola
- Section of Dermatology, Department of Translational Medicine and Surgery, Catholic University of the S. Heart; Rome, Italy
- Dermatology Unit, Policlinico A. Gemelli, IRCCS, Rome, Italy
| | - Rosa Coppola
- Fondazione Policlinico Universitario Campus Bio Medico, Rome, Italy
| | - Clara De Simone
- Section of Dermatology, Department of Translational Medicine and Surgery, Catholic University of the S. Heart; Rome, Italy
- Dermatology Unit, Policlinico A. Gemelli, IRCCS, Rome, Italy
| | - Domenico Giordano
- Department of Neurosciences, Mental Health and Sensory Organs, “Sapienza” University of Rome, Rome, Italy
| | | | - Gaia Moretta
- Department of Dermatology, Istituto Dermopatico dell’Immacolata IDI IRCCS, Rome, Italy
| | - Gianluca Pagnanelli
- Department of Dermatology, Istituto Dermopatico dell’Immacolata IDI IRCCS, Rome, Italy
| | - Vincenzo Panasiti
- Dermatology Unit, Policlinico A. Gemelli, IRCCS, Rome, Italy
- Department of Dermatology, Istituto Dermopatico dell’Immacolata IDI IRCCS, Rome, Italy
| | - Severino Persechino
- Department of Neurosciences, Mental Health and Sensory Organs, “Sapienza” University of Rome, Rome, Italy
| | - Concetta Potenza
- Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome - Polo Pontino, ASL Latina, Latina, Italy
| | - Federica Trovato
- Dermatology Unit, Department of Clinical Internal, Anesthesiological and Cardiovascular Science, University of La Sapienza, Rome, Italy
| | | | - Luca Bianchi
- Dermatology Unit, University of Rome “Tor Vergata”, Rome, Italy
| | - Giovanni Pellacani
- Dermatology Unit, Department of Clinical Internal, Anesthesiological and Cardiovascular Science, University of La Sapienza, Rome, Italy
| | - Ketty Peris
- Section of Dermatology, Department of Translational Medicine and Surgery, Catholic University of the S. Heart; Rome, Italy
- Dermatology Unit, Policlinico A. Gemelli, IRCCS, Rome, Italy
| | - Antonio Giovanni Richetta
- Dermatology Unit, Department of Clinical Internal, Anesthesiological and Cardiovascular Science, University of La Sapienza, Rome, Italy
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Neema S, Kothari R, Rout A, Mani S, Bhatt S, Sandhu S. Systemic treatment of psoriasis in special population. Indian J Dermatol Venereol Leprol 2023; 0:1-8. [PMID: 37317756 DOI: 10.25259/ijdvl_7_2023] [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: 01/03/2023] [Accepted: 03/21/2023] [Indexed: 06/16/2023]
Abstract
Psoriasis is a common skin disorder affecting approximately 1% of the general population. The treatment of psoriasis depends on the body surface area involvement, quality of life impairment and associated co-morbidities. Special population comprising of pregnant women, lactating mothers, elderly individuals and children, is more vulnerable. They are not included in drug trials; rendering the data for use of systemic treatment scant and is mainly based on anecdotal evidence. In this narrative review, we discuss systemic treatment options in this special population. Though couples planning a family are not considered a special population, they form a subset that require special therapeutic consideration and have also been included in this review.
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Affiliation(s)
| | - Rohit Kothari
- Department of Dermatology, Command Hospital Air Force, Bengaluru, Karnataka, India
| | | | - Siddharth Mani
- Department of Dermatology, INHS Sanjivani Kochi, Kerala, India
| | - Siddharth Bhatt
- Department of Dermatology, INHS Asvini, Mumbai, Maharashtra, India
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Megna M, Camela E, Battista T, Genco L, Martora F, Noto M, Picone V, Ruggiero A, Monfrecola G, Fabbrocini G, Potestio L. Efficacy and safety of biologics and small molecules for psoriasis in pediatric and geriatric populations. Part II: focus on elderly patients. Expert Opin Drug Saf 2023; 22:43-58. [PMID: 36718748 DOI: 10.1080/14740338.2023.2173171] [Citation(s) in RCA: 39] [Impact Index Per Article: 39.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
INTRODUCTION The management of moderate-to-severe forms of psoriasis is becoming a frequent concern in geriatric age due to the higher risk to develop treatment adverse events, logistic issues, vulnerability to immune-related diseases and cancer, presence of comorbidities and the risk of drug interactions. In this context, traditional systemic treatments are often contraindicated, and biologic drugs and small molecules seem to be a valuable option. However, data on their effectiveness and safety in elderly patients are scant. AREAS COVERED The aim of this review is to analyze the current literature in order to point out data on the efficacy and safety of biologic drugs and small molecules for the management of psoriasis in elderly patients in order to put the basis for universally shared treatment algorithm following available evidence. Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines were used for the literature research. EXPERT OPINION/COMMENTARY Our review suggests biologics and small molecules as an effective and safe option for the management of moderate-to-severe forms of psoriasis in elderly patients.
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Affiliation(s)
- Matteo Megna
- Section of Dermatology - Department of Clinical Medicine and Surgery, University of Naples Federico II, Napoli, Italy
| | - Elisa Camela
- Section of Dermatology - Department of Clinical Medicine and Surgery, University of Naples Federico II, Napoli, Italy
| | - Teresa Battista
- Section of Dermatology - Department of Clinical Medicine and Surgery, University of Naples Federico II, Napoli, Italy
| | - Lucia Genco
- Section of Dermatology - Department of Clinical Medicine and Surgery, University of Naples Federico II, Napoli, Italy
| | - Fabrizio Martora
- Section of Dermatology - Department of Clinical Medicine and Surgery, University of Naples Federico II, Napoli, Italy
| | - Matteo Noto
- Section of Dermatology - Department of Clinical Medicine and Surgery, University of Naples Federico II, Napoli, Italy
| | - Vincenzo Picone
- Section of Dermatology - Department of Clinical Medicine and Surgery, University of Naples Federico II, Napoli, Italy
| | - Angelo Ruggiero
- Section of Dermatology - Department of Clinical Medicine and Surgery, University of Naples Federico II, Napoli, Italy
| | - Giuseppe Monfrecola
- Section of Dermatology - Department of Clinical Medicine and Surgery, University of Naples Federico II, Napoli, Italy
| | - Gabriella Fabbrocini
- Section of Dermatology - Department of Clinical Medicine and Surgery, University of Naples Federico II, Napoli, Italy
| | - Luca Potestio
- Section of Dermatology - Department of Clinical Medicine and Surgery, University of Naples Federico II, Napoli, Italy
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Musumeci ML, Trecarichi AC, Caruso G, Aleo A, Platania H, Micali G. Long lasting response to anti-tumor necrosis factor α agents in psoriasis: A real life experience. Dermatol Ther 2022; 35:e15956. [PMID: 36271708 DOI: 10.1111/dth.15956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Accepted: 10/05/2022] [Indexed: 12/30/2022]
Abstract
Psoriasis is a chronic, immune-mediated inflammatory disease for which no definitive cure exists and patients difficult to treat with moderate to severe psoriasis often require life-long therapy. In general, the use of any biologic agent as monotherapy allows a long-term efficacy, however survival response may progressively decrease over time. We report real-world long lasting response data in psoriatic patients on treatment with anti-TNFα evaluating those on the same anti-TNFα agent (infliximab, etanercept, adalimumab) from January 2011 and December 2013 to December 31, 2021 as monotherapy. On 210 treated patients, 69 were found to maintain the same anti-TNFα agent. The median survival rate for etanercept, infliximab and adalimumab was 10, 9.6, and 9.5 years respectively and the efficacy rate was similar (mean PASI96). Our results demonstrate that anti-TNFα agents are a long-term effective and safe therapeutic option for a satisfying proportion (33%) of patients with moderate-to-severe chronic plaque psoriasis. Further long-term real life studies are needed to better understand which are the causes of drug failure or persistent response and why these may occur at different time intervals in patients on the same drug.
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Affiliation(s)
| | | | | | - Alice Aleo
- Dermatology Clinic, University of Catania, Catania, Italy
| | - Helga Platania
- Dermatology Clinic, University of Catania, Catania, Italy
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Megna M, Potestio L, Fabbrocini G, Camela E. Treating psoriasis in the elderly: biologics and small molecules. Expert Opin Biol Ther 2022; 22:1503-1520. [PMID: 35695241 DOI: 10.1080/14712598.2022.2089020] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
INTRODUCTION Psoriasis prevalence in the elderly is growing. It is estimated that 15% of elderly psoriasis patients suffer from moderate-to-severe disease, thus requiring systemic treatments. However, conventional systemic agents' use is limited due to contraindications and drug-interactions. Conversely, biologics and small molecules seem to be a valuable option, although the geriatric psoriasis population is frequently excluded from trials and shared guidelines are lacking. AREAS COVERED Relevant English literature (trials, real-life studies, case series, and reviews) regarding biologics and/or small molecules in the elderly were searched for up to January 17, 2022. EXPERT OPINION Treatment of moderate-to-severe psoriasis in the elderly may be challenging due to multiple comorbidities, polypharmacy, and increased risk of infections and cancers. However, new targeted therapies offer the possibility to perform a tailored-tail management, considering comorbidities, drug-interactions, and frailties which characterize this class of patients. Several real-world data support biologics and small molecules' efficacy and safety in the elderly with mainly no significant difference as compared to young adults. Elderly psoriasis patients' expectations are as high as those of their younger counterparts. Hence, they deserve the best therapeutic options according to their peculiarities for a long-term psoriasis remission and an improved quality of life.
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Affiliation(s)
- Matteo Megna
- Section of Dermatology, Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Luca Potestio
- Section of Dermatology, Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Gabriella Fabbrocini
- Section of Dermatology, Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Elisa Camela
- Section of Dermatology, Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
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Di Cesare A, Ricceri F, Rosi E, Fastame MT, Prignano F. Therapy of PsO in Special Subsets of Patients. Biomedicines 2022; 10:2879. [PMID: 36359399 PMCID: PMC9687729 DOI: 10.3390/biomedicines10112879] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Revised: 10/17/2022] [Accepted: 10/27/2022] [Indexed: 01/02/2024] Open
Abstract
Psoriasis is a chronic, inflammatory skin disease that may occur at any age, with a bimodal peak of incidence around the age of 16-20 years of age (early onset) and 57-60 years (late-onset). It is estimated that roughly 70% of patients develop the disease before the age of 40, which coincides with the reproductive years. Moreover, psoriasis is a chronic disease, meaning that, with increased life-duration expectancy, the number of patients affected with psoriasis aged over 65 years is going to increase and represent a big therapeutic challenge. Actually, no specific drug recommendation is available, based only on the age of the patients, while therapeutic prescription should take into account that elderly patients have more comorbidities than younger patients, with polypharmacy and an increased risk of drug interactions. Women with psoriasis are more likely to report a worse influence of the disease on their quality of life, and they are more susceptible to the development of depression. Furthermore, pregnancy and lactation represent a major contraindication to several systemic agents, and only a few studies exist providing the safety of certain drugs during these periods of life of a woman, such as certolizumab pegol. In this paper, we discuss systemic therapeutic strategies, including conventional and biological therapies, in a special subset of patients affected with moderate-to-severe psoriasis focusing on elderly patients and on female patients in fertile age, pregnancy, and lactation.
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Affiliation(s)
| | | | | | | | - Francesca Prignano
- Department of Health Sciences, Section of Dermatology, University of Florence, 50125 Florence, Italy
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Drug Survival, Safety, and Effectiveness of Biologics in Older Patients with Psoriasis: A Comparison with Younger Patients-A BioCAPTURE Registry Study. Drugs Aging 2022; 39:715-727. [PMID: 35859228 PMCID: PMC9300332 DOI: 10.1007/s40266-022-00961-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/08/2022] [Indexed: 11/03/2022]
Abstract
BACKGROUND Psoriasis is a common inflammatory disease in any age group, but also in older patients (≥ 65 years of age). Since older patients are often excluded from clinical trials, limited data specifically on this growing population are available, e.g. regarding the safety and performance of biological treatment. AIMS We aimed to give insight into this specific population by comparing the drug survival and safety of biologics in older patients with that in younger patients. METHODS In this real-world observational study, data from 3 academic and 15 non-academic centers in The Netherlands were extracted from the prospective BioCAPTURE registry. Biologics included in this study were tumor necrosis factor (TNF)-α, interleukin (IL)-17, IL-12/23, and IL-23 inhibitors. Patients were divided into two age groups: ≥ 65 years and < 65 years. The Charlson Comorbidity Index (CCI) was used to measure comorbid disease status, and all adverse events (AEs) that led to treatment discontinuation were classified according to the Medical Dictionary for Regulatory Activities (MedDRA) classification. All AEs that led to treatment discontinuation were studied to check whether they could be classified as serious AEs (SAEs). Kaplan-Meier survival curves for overall 5-year drug survival and split according to reasons of discontinuation (ineffectiveness or AEs) were constructed. Cox regression models were used to correct for possible confounders and to investigate associations with drug survival in both age groups separately. Psoriasis Area and Severity Index (PASI) scores during the first 2 years of treatment and at the time of treatment discontinuation were assessed and compared between age groups. RESULTS A total of 890 patients were included, of whom 102 (11.4%) were aged ≥ 65 years. Body mass index, sex, and distribution of biologic classes (e.g. TNFα, IL12/23) were not significantly different between the two age groups. A significantly higher CCI score was found in older patients, indicative of more comorbidity (p < 0.001). The 5-year ineffectiveness-related drug survival was lower for older patients (44.5% vs. 60.5%; p = 0.006), and the 5-year overall (≥ 65 years: 32.4% vs. < 65 years: 42.1%; p = 0.144) and AE-related (≥ 65 years: 82.1% vs. < 65 years: 79.5%; p = 0.913) drug survival was comparable between age groups. Of all AEs (n = 155) that led to discontinuation, 16 (10.3%) were reported as SAEs but these only occurred in younger patients. After correcting for confounders, the same trends were observed in the drug survival outcomes. Linear regression analyses on PASI scores showed no statistical differences at 6, 12, 18, and 24 months of treatment between age groups. CONCLUSIONS This study in a substantial, well-defined, prospective cohort provides further support that the use of biologics in older patients seems well-tolerated and effective. Biologic discontinuation due to AEs did not occur more frequently in older patients. Older patients discontinued biologic treatment more often due to ineffectiveness, although no clear difference in PASI scores was observed. More real-world studies on physician- and patient-related factors in older patients are warranted.
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Actualización práctica de las recomendaciones del Grupo de Psoriasis de la Academia Española de Dermatología y Venereología (GPS) para el tratamiento de la psoriasis con terapia biológica. Parte 2 «Manejo de poblaciones especiales, pacientes con comorbilidad y gestión del riesgo». ACTAS DERMO-SIFILIOGRAFICAS 2022; 113:583-609. [DOI: 10.1016/j.ad.2022.01.024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Accepted: 01/26/2022] [Indexed: 12/19/2022] Open
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Carrascosa JM, Puig L, Romero IB, Salgado-Boquete L, Del Alcázar E, Lencina JJA, Moreno D, de la Cueva P. [Translated article] Practical Update of the Guidelines Published by the Psoriasis Group of the Spanish Academy of Dermatology and Venereology (GPs) on the Treatment of Psoriasis With Biologic Agents: Part 2-Management of Special Populations, Patients With Comorbid Conditions, and Risk. ACTAS DERMO-SIFILIOGRAFICAS 2022; 113:T583-T609. [PMID: 35748004 DOI: 10.1016/j.ad.2022.01.040] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Accepted: 01/26/2022] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Since its inception, the Psoriasis Group (GPs) of the Spanish Academy of Dermatology and Venereology (AEDV) has worked to continuously update recommendations for the treatment of psoriasis based on the best available evidence and incorporating proposals arising from and aimed at clinical practice. An updated GPs consensus document on the treatment of moderate to severe psoriasis was needed because of changes in the treatment paradigm and the approval in recent years of a large number of new biologic agents. METHODOLOGY The consensus document was developed using the nominal group technique complemented by a scoping review. First, a designated coordinator selected a group of GPs members for the panel based on their experience and knowledge of psoriasis. The coordinator defined the objectives and key points for the document and, with the help of a documentalist, conducted a scoping review of articles in Medline, Embase, and the Cochrane Library up to January 2021. The review included systematic reviews and meta-analyses as well as clinical trials not included in those studies and high-quality real-world studies. National and international clinical practice guidelines and consensus documents on the management of moderate to severe psoriasis were also reviewed. The coordinator then drew up a set of proposed recommendations, which were discussed and modified in a nominal group meeting. After several review processes, including external review by other GPs members, the final document was drafted. RESULTS The present guidelines include updated recommendations on assessing the severity of psoriasis and criteria for the indication of systemic treatment. They also include general principles for the treatment of patients with moderate to severe psoriasis and define treatment goals for these patients as well as criteria for the indication and selection of initial and subsequent therapies Practical issues, such as treatment failure and maintenance of response, are also addressed.
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Affiliation(s)
- J M Carrascosa
- Departamento de Dermatología, Hospital Universitari Germans Trias I Pujol, Badalona, Universitat Autònoma de Barcelona, IGTP, Barcelona, Spain.
| | - L Puig
- Departamento de Dermatología, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - I B Romero
- Departamento de Dermatología, Hospital General Universitario de Alicante-ISABIAL - Universidad Miguel Hernández de Elche, Alicante, Spain
| | - L Salgado-Boquete
- Departamento de Dermatología, Complejo Hospitalario Universitario de Pontevedra, Pontevedra, Spain
| | - E Del Alcázar
- Departamento de Dermatología, Hospital Universitari Germans Trias I Pujol, Badalona, Universitat Autònoma de Barcelona, IGTP, Barcelona, Spain
| | - J J A Lencina
- Servicio de Dermatología, Hospital Universitario Vega Baja, Alicante, Spain
| | - D Moreno
- Departamento de Dermatología, Hospital Universitario Virgen Macarena, Universidad de Sevilla, Sevilla, Spain
| | - P de la Cueva
- Servicio de Dermatología, Hospital Universitario Infanta Leonor, Universidad Complutense de Madrid, Madrid, Spain
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Zheng Z, Guo Q, Ma D, Wang X, Zhang C, Wang H, Zhang L, Zhang G. Related Risk Factors and Treatment Management of Psoriatic Arthritis Complicated With Cardiovascular Disease. Front Cardiovasc Med 2022; 9:835439. [PMID: 35463753 PMCID: PMC9019598 DOI: 10.3389/fcvm.2022.835439] [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: 12/14/2021] [Accepted: 03/07/2022] [Indexed: 01/09/2023] Open
Abstract
Psoriatic arthritis (PsA) is a chronic autoimmune inflammatory joint disease related to psoriasis (PsO). The risk of PsA patients with cardiovascular disease (CVD) is significantly higher than that of the general population. At present, the relevant mechanism is not clear, chronic inflammation and traditional cardiovascular risk factors are the most important factors for the increased risk of CVD in PsA patients. Early assessment of the risk of PsA patients with CVD, and active control of the disease activity of PsA patients and intervention of traditional cardiovascular risk factors can delay the progression of CVD risk. This article reviews the epidemiology and pathogenesis between PsA and CVD, and reviews the latest developments in the risk assessment and management of CVD in PsA patients.
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Affiliation(s)
- Zhoulan Zheng
- Third Hospital of Shanxi Medical University, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Taiyuan, China
| | - Qianyu Guo
- Third Hospital of Shanxi Medical University, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Taiyuan, China
| | - Dan Ma
- Third Hospital of Shanxi Medical University, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Taiyuan, China
| | - Xuexue Wang
- Third Hospital of Shanxi Medical University, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Taiyuan, China
| | - Chengqiang Zhang
- The Fifth Clinical Medical College of Shanxi Medical University, Taiyuan, China
| | - Haiyao Wang
- Third Hospital of Shanxi Medical University, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Taiyuan, China
| | - Liyun Zhang
- Third Hospital of Shanxi Medical University, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Taiyuan, China
| | - Gailian Zhang
- The Fifth Clinical Medical College of Shanxi Medical University, Taiyuan, China
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Ruggiero A, Fabbrocini G, Cinelli E, Ocampo Garza SS, Camela E, Megna M. Anti-interleukin-23 for psoriasis in elderly patients: guselkumab, risankizumab and tildrakizumab in real-world practice. Clin Exp Dermatol 2021; 47:561-567. [PMID: 34642965 PMCID: PMC9299162 DOI: 10.1111/ced.14979] [Citation(s) in RCA: 52] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Accepted: 10/11/2021] [Indexed: 12/15/2022]
Abstract
Background Elderly patients (aged ≥ 65 years) represent an increasing proportion of patients with psoriasis and 15% of these have moderate to severe disease. Biologics are being used frequently in this group of patients even though safety and efficacy data are limited. In addition, owing to anti‐interleukin (IL)‐23 therapies being a relatively recent option, no data have been reported about their use in elderly patients with psoriasis. Aim To evaluate and compare the safety and efficacy of guselkumab, risankizumab and tildrakizumab in real‐world practice in elderly patients. Methods This was a single‐centre retrospective study that enrolled patients aged ≥ 65 years with moderate to severe plaque psoriasis, treated with guselkumab, risankizumab or tildrakizumab. The length of the study for each group depended on the drug (44 weeks for risankisumab, 40 weeks for guselkumab and 28 weeks for tildrakizumab, owing to its more recent availability in Italy). Results In total, 34 patients were enrolled (n = 20 on guselkumab; n = 8 on risankizumab; n = 6 on tildrakizumab). At Week 4, 29.4% reached 90% improvement in Psoriasis Area and Severity Index (PASI90) and 8.8% reached 100% improvement in PASI (PASI100); at Week 28, PASI90 and PASI100 was reached by 58.8% and 29.4%, respectively. At the final follow‐up (Week 40 or 44, depending on drug), data were available only for the risankizumab (Week 40) and guselkumab (Week 44) and groups, and showed that 71.4% of patients had reached PASI90 and 53.5% had reached PASI100. Four patients (11.7%) discontinued treatment. No significant differences were found between the three groups. The limitations of the study included its retrospective nature of the study, small sample size, and different numbers of patients and follow‐up duration for the different groups (highest for guselkumab, lowest for tildrakizumab). Conclusion The three anti‐IL‐23 therapies assessed are promising, safe and effective options in elderly patients, and there was no significant difference between them. However, more data are needed to confirm our results and to understand their role in the management of this group of patients.
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Affiliation(s)
- A Ruggiero
- Section of Dermatology, Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - G Fabbrocini
- Section of Dermatology, Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - E Cinelli
- Section of Dermatology, Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - S S Ocampo Garza
- Department of Dermatology, University Hospital Dr José Eleuterio González, Universidad Autónoma de Nuevo León, Monterrey, Mexico
| | - E Camela
- Section of Dermatology, Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - M Megna
- Section of Dermatology, Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
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Tang E, Maqbool T, Lam M, Adam GP, Tadrous M, Rochon PA, Drucker AM. Safety of Systemic Medications Among Older Adults With Psoriasis and Atopic Dermatitis: A Systematic Review of Observational Studies. J Cutan Med Surg 2021; 25:397-408. [PMID: 33566683 DOI: 10.1177/1203475421993770] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
BACKGROUND Psoriasis and atopic dermatitis are common among older adults (≥65 years old), but clinical trials often exclude that population. OBJECTIVE To synthesize evidence from observational studies on the safety of systemic therapies (conventional or biologic) for psoriasis and atopic dermatitis among older adults in a systematic review. METHODS We searched MEDLINE and EMBASE (inception to October 31, 2019) and included observational studies reporting adverse events among older people treated with systemic therapy for psoriasis or atopic dermatitis. Outcomes were death, hospitalization, emergency department visits, infections, major cardiovascular events, renal toxicity, hepatotoxicity, and cytopenias. We assessed study quality using the Newcastle-Ottawa Scale. RESULTS We included 22 studies on treatment for psoriasis and 2 for atopic dermatitis. Most studies were small and non-comparative and 20 of 24 were low quality. Studies comparing safety between medications or medication classes or between older and younger adults did not show apparent differences but had wide confidence intervals around relative effect estimates. Heterogeneity of study design and reporting precluded quantitative synthesis. CONCLUSIONS There is scant evidence on the safety of conventional systemic and biologic medications for older adults with psoriasis or atopic dermatitis; older adults and their clinicians should be aware of this evidence gap.
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Affiliation(s)
- Evan Tang
- 793812366 Faculty of Medicine, University of Toronto, Canada
| | - Talha Maqbool
- Department of Family and Community Medicine, University of Toronto, Canada
| | - Megan Lam
- 12362 Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Canada
| | - Gaelen P Adam
- 174610 Center for Evidence Synthesis in Health, Brown University School of Public Health, Providence, USA
| | - Mina Tadrous
- 70378 Leslie Dan Faculty of Pharmacy, University of Toronto, Canada.,7985 Women's College Research Institute, Women's College Hospital, Canada
| | - Paula A Rochon
- 7985 Women's College Research Institute, Women's College Hospital, Canada
| | - Aaron M Drucker
- 7985 Women's College Research Institute, Women's College Hospital, Canada.,Division of Dermatology, Department of Medicine, University of Toronto, Canada
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13
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Nast A, Smith C, Spuls P, Avila Valle G, Bata‐Csörgö Z, Boonen H, De Jong E, Garcia‐Doval I, Gisondi P, Kaur‐Knudsen D, Mahil S, Mälkönen T, Maul J, Mburu S, Mrowietz U, Reich K, Remenyik E, Rønholt K, Sator P, Schmitt‐Egenolf M, Sikora M, Strömer K, Sundnes O, Trigos D, Van Der Kraaij G, Yawalkar N, Dressler C. EuroGuiDerm Guideline on the systemic treatment of Psoriasis vulgaris – Part 1: treatment and monitoring recommendations. J Eur Acad Dermatol Venereol 2020; 34:2461-2498. [DOI: 10.1111/jdv.16915] [Citation(s) in RCA: 62] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Accepted: 08/13/2020] [Indexed: 12/14/2022]
Affiliation(s)
- A. Nast
- Department of Dermatology, Venereology and Allergology Charité – Universitätsmedizin BerlinCorporate Member of Freie Universität BerlinHumboldt‐Universität zu BerlinBerlin Institute of Health Berlin Germany
| | - C. Smith
- St John’s Institute of Dermatology London UK
| | - P.I. Spuls
- Academic Medical Centre Amsterdam Amsterdam Netherlands
| | - G. Avila Valle
- Department of Dermatology, Venereology and Allergology Charité – Universitätsmedizin BerlinCorporate Member of Freie Universität BerlinHumboldt‐Universität zu BerlinBerlin Institute of Health Berlin Germany
| | | | - H. Boonen
- Office‐Based Dermatology Practice Geel Belgium
| | - E. De Jong
- Radboud University medical centre Nijmegen Netherlands
| | - I. Garcia‐Doval
- Unidad de InvestigaciónFundación Piel Sana AEDV Madrid España
| | | | | | - S. Mahil
- Guy's and St Thomas' NHS Foundation Trust London UK
| | - T. Mälkönen
- Helsinki University Central Hospital Helsinki Finland
| | - J.T. Maul
- Department of Dermatology University Hospital of Zürich Zürich Switzerland
| | - S. Mburu
- International Federation of Psoriasis Associations (IFPA)
| | - U. Mrowietz
- Universitätsklinikum Schleswig‐Holstein Kiel Germany
| | - K. Reich
- Translational Research in Inflammatory Skin Diseases Institute for Health Services Research in Dermatology and Nursing University Medical Center Hamburg‐Eppendorf Hamburg Germany
| | | | | | - P.G. Sator
- Municipal Hospital Hietzing Vienna Austria
| | - M. Schmitt‐Egenolf
- Dermatology Department of Public Health & Clinical Medicine Umeå University Umeå Sweden
| | - M. Sikora
- Department of Dermatology Medical University of Warsaw Warszawa Poland
| | - K. Strömer
- Office‐Based Dermatology Practice Mönchengladbach Germany
| | | | - D. Trigos
- International Federation of Psoriasis Associations (IFPA)
| | | | - N. Yawalkar
- Department of Dermatology, Inselspital Bern University HospitalUniversity of Bern Bern Switzerland
| | - C. Dressler
- Department of Dermatology, Venereology and Allergology Charité – Universitätsmedizin BerlinCorporate Member of Freie Universität BerlinHumboldt‐Universität zu BerlinBerlin Institute of Health Berlin Germany
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14
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van Winden MEC, van der Schoot LS, van de L’Isle Arias M, van Vugt LJ, van den Reek JMPA, van de Kerkhof PCM, de Jong EMGJ, Lubeek SFK. Effectiveness and Safety of Systemic Therapy for Psoriasis in Older Adults. JAMA Dermatol 2020; 156:1229-1239. [DOI: 10.1001/jamadermatol.2020.2311] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Affiliation(s)
| | | | | | - Lieke J. van Vugt
- Department of Dermatology, Maastricht University Medical Center, Maastricht, the Netherlands
| | | | | | - Elke M. G. J. de Jong
- Department of Dermatology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Satish F. K. Lubeek
- Department of Dermatology, Radboud University Medical Center, Nijmegen, the Netherlands
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15
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Shary N, Kalb RE. Optimizing the Treatment of Moderate-to-Severe Psoriasis in Older Adults. Drugs Aging 2020; 37:715-723. [PMID: 32776216 DOI: 10.1007/s40266-020-00790-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Psoriasis is a lifelong disease and its prevalence in older adults continues to increase as the population ages. Therefore, it is important for physicians to understand the management of the disease in this population. While the management of psoriasis in older adults is similar to the management of patients below the age of 65 years, there are special considerations when treating older patients. Older patients may have more comorbidities, more immunosuppression, and are often taking additional medications that can interact with those being used to treat psoriasis. Safer and more effective treatment options for psoriasis have been introduced in recent years, particularly injectable biological agents. Unfortunately, older patients with psoriasis are oftentimes underrepresented in the clinical trials for these new medications. Subsequent studies have focused on the safety and efficacy of these medications in older adults. The results of these studies demonstrate that biologic agents are well tolerated in older patients and are more effective in treating psoriasis than conventional systemic therapies. In addition, new small-molecule agents such as apremilast also offer an effective and safe treatment option for older patients with psoriasis. The results of these studies can help guide physicians with incorporating these newer medications into the treatment regimen of older psoriasis patients. Despite the proven safety and efficacy of biologic agents, their frequency of use in elderly patients is still almost half of that in non-elderly patients.
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Affiliation(s)
- Nico Shary
- Department of Dermatology, State University of New York at Buffalo School of Medicine and Biomedical Sciences, Buffalo, NY, USA
| | - Robert E Kalb
- Department of Dermatology, State University of New York at Buffalo School of Medicine and Biomedical Sciences, Buffalo, NY, USA.
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16
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Chimenti MS, D’Antonio A, Conigliaro P, Ferrigno S, Vendola A, Ferraioli M, Triggianese P, Costa L, Caso F, Perricone R. An Update for the Clinician on Biologics for the Treatment of Psoriatic Arthritis. Biologics 2020; 14:53-75. [PMID: 32903867 PMCID: PMC7445514 DOI: 10.2147/btt.s260754] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Accepted: 08/05/2020] [Indexed: 12/16/2022]
Abstract
Psoriatic arthritis (PsA) is a chronic inflammatory arthropathy typically associated with psoriasis (PsO). The pathogenesis is strictly related to the association among the presence of genetic risk alleles and innate and acquired immune response with dramatic consequences on bone remodeling. Clinically, PsA patients may present heterogenicity of articular and periarticular manifestations that may be associated with the presence of comorbidities making treatment decision challenging in patients management. The identification of patient-targeted therapies is still a critical issue. Actually, several biological and synthetic drugs are promising in terms of efficacy and safety profile. National and international treatment recommendations support clinicians in the decision of the best treatment, although they may have limits basically related to updates and different outcomes included in the clinical studies evaluated. The aim of this narrative review is therefore to give guidance for clinicians for PsA patients treatment. For this purpose, we evaluated evidence on biological therapies efficacy used for PsA treatment. Specifically, we reviewed data on biological therapies, Janus kinases (JAK) inhibitors, and drugs with a new mechanism of action that are part of the treatment pipeline. The concept of "switching" and "swapping" is also described, as well as data concerning special populations such as pregnant women and elderly patients.
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Affiliation(s)
- Maria Sole Chimenti
- Rheumatology, Allergology and Clinical Immunology, Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Arianna D’Antonio
- Rheumatology, Allergology and Clinical Immunology, Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Paola Conigliaro
- Rheumatology, Allergology and Clinical Immunology, Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Sara Ferrigno
- Rheumatology, Allergology and Clinical Immunology, Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Andrea Vendola
- Rheumatology, Allergology and Clinical Immunology, Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Mario Ferraioli
- Rheumatology, Allergology and Clinical Immunology, Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Paola Triggianese
- Rheumatology, Allergology and Clinical Immunology, Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Luisa Costa
- Rheumatology Unit, Department of Clinical Medicine and Surgery, School of Medicine and Surgery, University Federico II, Naples, Italy
| | - Francesco Caso
- Rheumatology Unit, Department of Clinical Medicine and Surgery, School of Medicine and Surgery, University Federico II, Naples, Italy
| | - Roberto Perricone
- Rheumatology, Allergology and Clinical Immunology, Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
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17
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Megna M, Camela E, Cinelli E, Fabbrocini G. Real‐life efficacy and safety of secukinumab in elderly patients with psoriasis over a 2‐year period. Clin Exp Dermatol 2020; 45:848-852. [DOI: 10.1111/ced.14258] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2020] [Revised: 04/15/2020] [Accepted: 04/21/2020] [Indexed: 01/06/2023]
Affiliation(s)
- M. Megna
- Section of Dermatology Department of Clinical Medicine and Surgery University of Naples Federico II Naples Italy
| | - E. Camela
- Section of Dermatology Department of Clinical Medicine and Surgery University of Naples Federico II Naples Italy
| | - E. Cinelli
- Section of Dermatology Department of Clinical Medicine and Surgery University of Naples Federico II Naples Italy
| | - G. Fabbrocini
- Section of Dermatology Department of Clinical Medicine and Surgery University of Naples Federico II Naples Italy
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18
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Tzanetakou V, Stergianou D, Giamarellos-Bourboulis EJ. Long-term safety of adalimumab for patients with moderate-to-severe hidradenitis suppurativa. Expert Opin Drug Saf 2020; 19:381-393. [PMID: 32098513 DOI: 10.1080/14740338.2020.1734560] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Introduction: Hidradenitis suppurativa (HS) is a chronic debilitating inflammatory skin disorder that affects regions rich in apocrine glands. Although the etiology of HS is not clear, inflammatory cytokines, like tumor necrosis factor (TNF)-α, participate in pathogenesis. Adalimumab (ADA), a human IgG1 monoclonal antibody that selectively targets TNFα, is the only EMA/FDA-approved biologic agent available for the therapy of moderate-to-severe HS.Areas covered: A comprehensive literature search was conducted to present existing studies with an emphasis on the safety profile of ADA for the treatment of moderate-to-severe HS. ADA is prescribed for more than 15 years for varied indications and has improved the therapeutic outcomes of many diseases. Clinical trials and real-life safety data from ADA administration in HS were presented, with particular attention to special populations, such as children, elderly, and pregnant women.Expert opinion: Existing data advise for limited safety concerns with long-term ADA treatment provided that patients are thoroughly screened for infections, latent tuberculosis, and history of malignancy before the start of treatment.
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Affiliation(s)
- Vassiliki Tzanetakou
- 4th Department of Internal Medicine, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Dimitra Stergianou
- 4th Department of Internal Medicine, Medical School, National and Kapodistrian University of Athens, Athens, Greece
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19
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Di Caprio R, Caiazzo G, Cacciapuoti S, Fabbrocini G, Scala E, Balato A. Safety concerns with current treatments for psoriasis in the elderly. Expert Opin Drug Saf 2020; 19:523-531. [PMID: 32056449 DOI: 10.1080/14740338.2020.1728253] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Introduction: The approach to manage psoriasis in the elderly (ages ≥65 years) patients can be challenging. They often suffer from multiple comorbidities and polypharmacy with possible adverse effects and undergo a progressive functional impairment of the immune system that increases susceptibility to infections as well as to auto-reactivity. Despite the increasing aging of the general population and although several therapies are currently available for psoriasis treatment, data regarding their use and tolerability in the elderly are quite limited.Areas covered: This review focuses on topical and systemic therapies that have been investigated in elderly patients in order to provide their safety profile in this population.Expert opinion: Conventional systemic therapies in elderly patients should be carefully dispensed and the correct dosage individually determined, taking into account the metabolism changes, organ impairment, comorbidities, concomitant medications, and contraindications. Apremilast, due to its satisfactory safety profile and low risk of drug interactions, results as an appropriate treatment option for elderly patients. Biologics (TNF-α, IL-12/23, IL-17, and IL-23 inhibitors) come out as safe and long-term options for the management of these patients resulting not associated with a higher risk of adverse events.
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Affiliation(s)
- Roberta Di Caprio
- Department of Clinical Medicine and Surgery - Section of Dermatology, University of Naples Federico II, Italy
| | - Giuseppina Caiazzo
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - Sara Cacciapuoti
- Department of Clinical Medicine and Surgery - Section of Dermatology, University of Naples Federico II, Italy
| | - Gabriella Fabbrocini
- Department of Clinical Medicine and Surgery - Section of Dermatology, University of Naples Federico II, Italy
| | - Emanuele Scala
- Department of Clinical Medicine and Surgery - Section of Dermatology, University of Naples Federico II, Italy
| | - Anna Balato
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
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20
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Lahaye C, Tatar Z, Dubost JJ, Tournadre A, Soubrier M. Management of inflammatory rheumatic conditions in the elderly. Rheumatology (Oxford) 2020; 58:748-764. [PMID: 29982766 PMCID: PMC6477520 DOI: 10.1093/rheumatology/key165] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2017] [Revised: 05/08/2018] [Indexed: 12/21/2022] Open
Abstract
The number of elderly people with chronic inflammatory rheumatic diseases is increasing. This heterogeneous and comorbid population is at particular risk of cardiovascular, neoplastic, infectious and iatrogenic complications. The development of biotherapies has paved the way for innovative therapeutic strategies, which are associated with toxicities. In this review, we have focused on the scientific and therapeutic changes impacting the management of elderly patients affected by RA, SpA or PsA. A multidimensional health assessment resulting in an integrated therapeutic strategy was identified as a major research direction for improving the management of elderly patients.
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Affiliation(s)
- Clément Lahaye
- CHU Clermont-Ferrand, Department of Rheumatology, Hôpital Gabriel Montpied, Clermont-Ferrand, France
| | - Zuzana Tatar
- CHU Clermont-Ferrand, Department of Rheumatology, Hôpital Gabriel Montpied, Clermont-Ferrand, France
| | - Jean-Jacques Dubost
- CHU Clermont-Ferrand, Department of Rheumatology, Hôpital Gabriel Montpied, Clermont-Ferrand, France
| | - Anne Tournadre
- CHU Clermont-Ferrand, Department of Rheumatology, Hôpital Gabriel Montpied, Clermont-Ferrand, France
| | - Martin Soubrier
- CHU Clermont-Ferrand, Department of Rheumatology, Hôpital Gabriel Montpied, Clermont-Ferrand, France
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21
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Sandhu VK, Ighani A, Fleming P, Lynde CW. Biologic Treatment in Elderly Patients With Psoriasis: A Systematic Review. J Cutan Med Surg 2020; 24:174-186. [DOI: 10.1177/1203475419897578] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
With our aging population, an increasing number of psoriasis patients are classified as elderly. However, psoriasis treatment in older adults can be challenging, given an increased number of comorbid conditions and immunosenescence. Biologic agents present a solution to this treatment dilemma because of their high efficacy and favorable tolerability. The objective of this systematic review was to summarize the findings of clinical trial and real-world studies exploring the safety and efficacy of biologic agents in elderly patients with moderate-to-severe psoriasis. We searched MEDLINE, Embase, the Cochrane Library, and clinical trial databases. Studies analyzing biologics for psoriasis were included if elderly patients were the main population of interest or were a separate subgroup in their analysis. Eighteen articles met inclusion criteria after screening. Across all biologic classes, efficacy for biologics between nonelderly adult patient and elderly patients was similar. Adverse events (AEs) and infections occured at a similar frequency between both groups. However, serious AEs were more common in the elderly. The available literature on the safety and efficacy of biologic agents in elderly patients supports the use of these agents in this population. However, serious AEs and discontinuation due to AEs were more common in older patients. As elderly patients have a higher burden of comorbid conditions and an increased baseline vulnerability for AE, physicians should continue to be prudent in screening before initiating biologics and monitor patients more closely as AEs tend to be more severe.
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Affiliation(s)
| | - Arvin Ighani
- Division of Dermatology, University of Toronto, Toronto, ON, Canada
| | | | - Charles W. Lynde
- Division of Dermatology, University of Toronto, Toronto, ON, Canada
- Lynde Institute of Dermatology, Markham, ON, Canada
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22
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Ralph SJ, Weissenberger A, Bonev V, King LD, Bonham MD, Ferguson S, Smith AD, Goodman-Jones AA, Espinet AJ. Phase I/II parallel double-blind randomized controlled clinical trial of perispinal etanercept for chronic stroke: improved mobility and pain alleviation. Expert Opin Investig Drugs 2020; 29:311-326. [PMID: 31899977 DOI: 10.1080/13543784.2020.1709822] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Background: Previous open-label studies showed that chronic post-stroke pain could be abated by treatment with perispinal etanercept, although these benefits were questioned. A randomized double-blind placebo controlled clinical trial was conducted to test perispinal etanercept for chronic post-stroke pain.Research design and methods: Participants received two treatments, either perispinal etanercept (active) or saline (control). Primary outcomes were the differences in daily pain levels between groups analyzed by SPSS.Results: On the 0-100 points visual analog scale, perispinal etanercept reduced mean levels for worst and average daily pain from baseline after two treatments by 19.5 - 24 points (p < 0.05), and pain alleviation was maintained in the etanercept group, with no significant change in the control group. Thirty percent of etanercept participants had near complete pain abatement after first treatment. Goniometry of the paretic arm showed improved mean shoulder rotation by 55 degrees in active forward flexion for the etanercept group (p = 0.003) only.Conclusions: Perispinal etanercept can provide significant and ongoing benefits for the chronic post-stroke management of pain and greater shoulder flexion by the paretic arm. Effects are rapid and highly significant, supporting direct action on brain function.Trial registration: ACTRN12615001377527 and Universal Trial Number U1111-1174-3242.
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Affiliation(s)
- Stephen J Ralph
- School of Medical Science, Griffith University, Southport, Australia
| | | | | | - Liam D King
- School of Pharmacy, Griffith University, Southport, Australia
| | - Mikaela D Bonham
- School of Applied Psychology, Griffith University, Southport, Australia
| | - Samantha Ferguson
- School of Allied Health Sciences, Menzies Health Institute, Griffith University, Southport, Australia
| | - Ashley D Smith
- School of Allied Health Sciences, Menzies Health Institute, Griffith University, Southport, Australia.,Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, Canada
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23
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Borren NZ, Ananthakrishnan AN. Safety of Biologic Therapy in Older Patients With Immune-Mediated Diseases: A Systematic Review and Meta-analysis. Clin Gastroenterol Hepatol 2019; 17:1736-1743.e4. [PMID: 30616024 PMCID: PMC6609492 DOI: 10.1016/j.cgh.2018.12.032] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2018] [Revised: 12/06/2018] [Accepted: 12/23/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS Management of immune-mediated inflammatory diseases often requires lifelong immunosuppression. Increasing numbers of older patients have inflammatory diseases and are particularly vulnerable to risks of immune suppressive therapies-particularly infections and malignancies. METHODS We systematically searched PubMed/Medline and Embase to identify eligible studies that examined the safety of biologic therapies in older patients with immune-mediated inflammatory diseases (inflammatory bowel disease, rheumatoid arthritis, psoriasis). Included studies provided information on patients who began receiving therapy with a biologic agent when they were older than 60 years and a control population (either younger users of biologics or older patients who did not use biologics). Information of on overall pooled rates of infections, malignancy, and mortality were extracted. A DerSimonian and Laird random effects model was used to calculate pooled odds ratios (ORs) and 95% CIs. RESULTS Our meta-analysis included 14 unique studies that comprised 4719 older users of biologics, 13,305 younger users of biologics, and 3961 older patients who did not use biologics. The pooled prevalence of infections in older and younger users of biologics was 13% and 6% respectively, yielding a pooled random effects odds ratio of 2.28 (95% CI, 1.57-3.31). Older age was associated with a significant increase in risk of malignancy (OR, 3.07; 95% CI, 1.98-4.62) compared to younger age. Older users of biologics had a 3-fold increase in risk of infection compared to patients who did not use biologics (OR, 3.60; 95% CI, 1.62-8.01), but there were no significant differences in odds of malignancy (0.54, 95% CI, 0.28-1.05) or death (OR, 1.52; 95% CI, 0.44-5.28) compared to older patients who did not use biologics. CONCLUSION In a systematic review and meta-analysis of studies on the safety of biologic therapies in older patients with inflammatory diseases, we found that older users of biologic agents have an increased risk of infections compared with younger users or older patients who do not use biologics. Large, prospective cohort studies are needed to examine safety of biologic therapy in older patients with immune-mediated diseases.
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Affiliation(s)
| | - Ashwin N Ananthakrishnan
- Division of Gastroenterology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.
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25
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Hanssen SCA, van der Vleuten CJM, van Erp PEJ, Seyger MMB, van de Kerkhof PCM. The effect of adalimumab on the vasculature in psoriatic skin lesions. J DERMATOL TREAT 2018; 30:221-226. [DOI: 10.1080/09546634.2018.1506082] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Affiliation(s)
- S. C. A. Hanssen
- Department of dermatology, Radboud University Medical Centre, Nijmegen, GA, the Netherlands
| | | | - P. E. J. van Erp
- Department of dermatology, Radboud University Medical Centre, Nijmegen, GA, the Netherlands
| | - M. M. B. Seyger
- Department of dermatology, Radboud University Medical Centre, Nijmegen, GA, the Netherlands
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26
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López-Estebaranz J, de la Cueva-Dobao P, de la Torre Fraga C, Galán Gutiérrez M, González Guerra E, Mollet Sánchez J, Belinchón Romero I. Manejo de la psoriasis moderada-grave en condiciones de práctica habitual en el ámbito hospitalario español. ACTAS DERMO-SIFILIOGRAFICAS 2018; 109:631-642. [DOI: 10.1016/j.ad.2018.02.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2016] [Revised: 02/12/2018] [Accepted: 02/26/2018] [Indexed: 10/14/2022] Open
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27
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López-Estebaranz J, de la Cueva-Dobao P, de la Torre Fraga C, Galán Gutiérrez M, González Guerra E, Mollet Sánchez J, Belinchón Romero I. Management of Moderate to Severe Psoriasis in Routine Clinical Practice in Spanish Hospitals. ACTAS DERMO-SIFILIOGRAFICAS 2018. [DOI: 10.1016/j.adengl.2018.06.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
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28
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Körber A, Papavassilis C, Bhosekar V, Reinhardt M. Efficacy and Safety of Secukinumab in Elderly Subjects with Moderate to Severe Plaque Psoriasis: A Pooled Analysis of Phase III Studies. Drugs Aging 2018; 35:135-144. [PMID: 29404966 PMCID: PMC5847154 DOI: 10.1007/s40266-018-0520-z] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Background Psoriasis is a chronic inflammatory skin disease, affecting patients of a wide age range, including elderly patients. Elderly patients can respond differently to drug treatments and can be more vulnerable to adverse reactions. There are limited data on biologic therapies for psoriasis in elderly subjects. Secukinumab, a fully human monoclonal antibody that selectively neutralizes IL-17A, has proven significant efficacy in the treatment of moderate to severe psoriasis. Aims A post-hoc analysis of three phase III trials (ERASURE, FIXTURE and CLEAR) was performed to evaluate the efficacy and safety of secukinumab in elderly subjects. Methods Studies were multicentre, randomized, parallel-group, double-blind, 52-week phase III trials in subjects with moderate to severe plaque psoriasis. For efficacy analyses, 67 elderly subjects (≥ 65 years) treated with secukinumab 300 mg were compared with 841 younger subjects (18–64 years). Psoriasis Area and Severity Index (PASI), Dermatological Life Quality Index (DLQI) and safety were analysed. Results Elderly subjects had higher baseline frequencies of cardiovascular and metabolic disorders. Secukinumab efficacy in elderly subjects was comparable to that in younger subjects throughout 52 weeks of treatment. PASI 75 response was reached by 81.8% of elderly subjects and 79.4% of younger subjects at Week 52. Similar rates of DLQI 0/1 response were observed. The total rate of adverse events was similar between elderly and younger subjects. Conclusions Secukinumab at the recommended dose (300 mg) is effective and acceptably safe in subjects aged ≥ 65 years with moderate to severe psoriasis, with quality-of-life benefits, despite an increased prevalence of cardiovascular and metabolic comorbidities in this population. Electronic supplementary material The online version of this article (10.1007/s40266-018-0520-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Andreas Körber
- Department of Dermatology, University Hospital Essen (AöR), Hufelandstraße 55, 45147, Essen, Germany.
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Di Lernia V, Goldust M. An overview of the efficacy and safety of systemic treatments for psoriasis in the elderly. Expert Opin Biol Ther 2018; 18:897-903. [DOI: 10.1080/14712598.2018.1504016] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Vito Di Lernia
- Dermatology Unit, Arcispedale Santa Maria Nuova-IRCCS, Reggio Emilia, Italy
| | - Mohamad Goldust
- Department of Dermatology, Mazandaran University of Medical Sciences, Sari, Iran
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Ricceri F, Bardazzi F, Chiricozzi A, Dapavo P, Ferrara F, Mugheddu C, Romanelli M, Rongioletti F, Prignano F. Elderly psoriatic patients under biological therapies: an Italian experience. J Eur Acad Dermatol Venereol 2018; 33:143-146. [PMID: 29906311 DOI: 10.1111/jdv.15139] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2018] [Accepted: 06/04/2018] [Indexed: 12/21/2022]
Abstract
BACKGROUND The number of elderly patients with psoriasis is steadily increasing in the Western world; nevertheless, they are frequently excluded from biological clinical trials and described as a high-risk group for adverse events. Thus, there is lack of information concerning safety and effectiveness of available treatments for psoriasis in the elderly, particularly about new biological systemic drugs. OBJECTIVE Our aim was to describe our experience with all biological therapies currently used in the elderly (>65 years) psoriatic patients. METHODS A retrospective multicentric review of clinical records of all psoriatic patient aged 65 years or older actually receiving biological drugs (etanercept, adalimumab, infliximab, golimumab, certolizumab pegol, ustekinumab or secukinumab) was undertaken. RESULTS Our study population included 266 elderly psoriatic patients actually receiving any biological therapy (adalimumab 31.2%, ustekinumab 28.9%, etanercept 20.3%, secukinumab 15%, infliximab 3%, golimumab 1% and certolizumab pegol 0.6%). The PASI score at the baseline (week 0) ranged from 4 to 54; mean ± SD, 16.5 ± 7.1, which changed after biological administration to 3.7 ± 8 at week 16, 1.6 ± 2.1 at week 28 and 1.2 ± 2.1 at week 52. Among 266 elderly psoriatic patients, 25 adverse events were reported during the observation period. The most frequent events were infections with 12 (48%) reports, followed by malignancies with four (16%) reports. CONCLUSIONS To date, our study represents the widest experience on the use of biological drugs in elderly psoriatic patients. We found that all biologics for psoriasis showed a great efficacy also in elderly people, and the rate and the type of adverse effects were similar to the younger patients. In conclusion, the age alone should not limit our therapeutic options. Further observational study using multiple data sources is needed to evaluate long-term effectiveness and safety for elderly psoriatic patients.
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Affiliation(s)
- F Ricceri
- Department of Surgery and Translational Medicine, Dermatology Unit, University of Florence, Florence, Italy
| | - F Bardazzi
- Department of Specialized, Clinical and Experimental Medicine, Division of Dermatology, University of Bologna, Bologna, Italy
| | - A Chiricozzi
- Dermatology Department, University of Pisa, Pisa, Italy
| | - P Dapavo
- Department of Medical Sciences, Section of Dermatology, University of Turin, Turin, Italy
| | - F Ferrara
- Department of Specialized, Clinical and Experimental Medicine, Division of Dermatology, University of Bologna, Bologna, Italy
| | - C Mugheddu
- Department of Medical Sciences and Public Health, Unit of Dermatology, University of Cagliari, Cagliari, Italy
| | - M Romanelli
- Dermatology Department, University of Pisa, Pisa, Italy
| | - F Rongioletti
- Department of Medical Sciences and Public Health, Unit of Dermatology, University of Cagliari, Cagliari, Italy
| | - F Prignano
- Department of Surgery and Translational Medicine, Dermatology Unit, University of Florence, Florence, Italy
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Sator P. Safety and tolerability of adalimumab for the treatment of psoriasis: a review summarizing 15 years of real-life experience. Ther Adv Chronic Dis 2018; 9:147-158. [PMID: 30065812 DOI: 10.1177/2040622318772705] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2017] [Accepted: 03/23/2018] [Indexed: 12/15/2022] Open
Abstract
Biologic therapies like adalimumab are the gold standard for psoriasis treatment with efficacy and safety profiles allowing for long-term treatment. However, adalimumab cannot be used in all patients and may cause adverse drug reactions. This study reviews conditions that might limit the use of adalimumab under real-life conditions. Local injection site reactions affect 12-37% of patients but rarely require specific therapy. Dermatological adverse events (AEs) include the paradoxical psoriasis and tend to respond to adequate therapy without adalimumab discontinuation. Adalimumab increases the risk for infections; latent chronic infections like tuberculosis or hepatitis B/C impose the highest risk for serious AEs. However, administration of adalimumab may still be possible under appropriate monitoring or prophylactic therapy. Some studies indicate an increased risk of malignancies in patients with psoriasis exposed to adalimumab. Here, the causal relationship is unclear since both psoriasis and some first-line therapies increase the risk of malignancies. Depression frequently coincides with psoriasis and may respond to adalimumab as well. Cardiovascular diseases are contraindications for adalimumab, but evidence suggests that adalimumab may still be a treatment option. Overall AE rates range from 245 to 399 per 100 patient years (serious AEs: 6-23; death: 1-2). Thus, adalimumab is slightly less safe than ustekinumab and infliximab but exhibits superior effectiveness and drug survival. Adalimumab is safe for pregnant women during the first trimester, for children up to 4 years and for the elderly. Thus, in spite of several conditions that require specific attention, the favourable safety and tolerability of adalimumab for the treatment of psoriasis is confirmed.
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Affiliation(s)
- Paul Sator
- Department for Dermatology, Krankenhaus Hietzing, Austria
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Kostović K, Žužul K, Čeović R, Bukvić Mokos Z. Psoriasis in the mature patient: Therapeutic approach in the era of biologics. Clin Dermatol 2018; 36:222-230. [DOI: 10.1016/j.clindermatol.2017.10.013] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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Potenza MC, Peris K, Berardesca E, Bianchi L, Richetta A, Bernardini N, De Simone C, Teoli M, Zangrilli A, D'epiro S, Orsini D, Narcisi A, Chimenti S, Costanzo A. Use of biological drugs in patients with psoriasis and psoriatic arthritis in Italy: Results from the PSONG survey. Dermatol Ther 2017; 31. [DOI: 10.1111/dth.12565] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2017] [Revised: 05/31/2017] [Accepted: 09/26/2017] [Indexed: 11/27/2022]
Affiliation(s)
- Maria C. Potenza
- UOC di Dermatologia “Daniele Innocenzi”, Università degli Studi “Sapienza” Roma I facoltà di Medicina e Chirurgia, Polo Pontino; Terracina LT Italy
| | - Ketty Peris
- Istituto di Dermatologia Policlinico Gemelli; Rome Italy
| | | | - Luca Bianchi
- Clinica Dermatologica, Dipartimento di Medicina dei Sistemi, Universita Tor Vergata; Rome Italy
| | - Antonio Richetta
- Clinica Dermatologica, Dipartimento di Medicina dei Sistemi, Universita Tor Vergata; Rome Italy
- Centro psoriasi, Dipartimento di Medicina Interna e Specialità Mediche, Università “La Sapienza” Policlinico Umberto I; Rome Italy
| | - Nicoletta Bernardini
- UOC di Dermatologia “Daniele Innocenzi”, Università degli Studi “Sapienza” Roma I facoltà di Medicina e Chirurgia, Polo Pontino; Terracina LT Italy
| | | | - Miriam Teoli
- Clinica Dermatologica, Dipartimento di Medicina dei Sistemi, Universita Tor Vergata; Rome Italy
| | - Arianna Zangrilli
- Clinica Dermatologica, Dipartimento di Medicina dei Sistemi, Universita Tor Vergata; Rome Italy
| | - Sara D'epiro
- Centro psoriasi, Dipartimento di Medicina Interna e Specialità Mediche, Università “La Sapienza” Policlinico Umberto I; Rome Italy
| | - Diego Orsini
- Clinica Dermatologica, Dipartimento di Neuroscienze Salute Mentale e Organi di Senso (NESMOS); Università Sapienza- Azienda Ospedaliera Sant'Andrea; Rome Italy
| | - Alessandra Narcisi
- Clinica Dermatologica, Dipartimento di Neuroscienze Salute Mentale e Organi di Senso (NESMOS); Università Sapienza- Azienda Ospedaliera Sant'Andrea; Rome Italy
- Humanitas Clinical and Research Center; Skin Pathology Lab; Rozzano-Milan Italy
| | - Sergio Chimenti
- Clinica Dermatologica, Dipartimento di Medicina dei Sistemi, Universita Tor Vergata; Rome Italy
| | - Antonio Costanzo
- Humanitas Clinical and Research Center; Skin Pathology Lab; Rozzano-Milan Italy
- Dermatology Unit, Department of Biomedical Sciences; Humanitas University; Rozzano-Milan Italy
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Carrera CG, Dapavo P, Malagoli P, Naldi L, Arancio L, Gaiani F, Egan CG, Di Mercurio M, Cattaneo A. PACE study: real-life Psoriasis Area and Severity Index (PASI) 100 response with biological agents in moderate-severe psoriasis. J DERMATOL TREAT 2017; 29:481-486. [DOI: 10.1080/09546634.2017.1395805] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Affiliation(s)
- Carlo Giovanni Carrera
- U.O. Dermatologia, Fondazione IRCCS Cà Granda – Ospedale Maggiore Policlinico, Milan, Italy
| | - Paolo Dapavo
- Department of Medical Sciences, Section of Dermatology, University of Turin, Turin, Italy
| | | | - Luigi Naldi
- U.O.C. Dermatologia, Ospedale San Bortolo – Azienda ULSS8, Berica (VI), Italy
| | - Luisa Arancio
- U.O. Dermatologia, Fondazione IRCCS Cà Granda – Ospedale Maggiore Policlinico, Milan, Italy
| | - Francesca Gaiani
- Dermatology Unit, Azienda Ospedaliera San Donato Milanese, Milan, Italy
| | | | | | - Angelo Cattaneo
- U.O. Dermatologia, Fondazione IRCCS Cà Granda – Ospedale Maggiore Policlinico, Milan, Italy
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Chimenti MS, Triggianese P, Conigliaro P, Tonelli M, Gigliucci G, Novelli L, Teoli M, Perricone R. A 2-year observational study on treatment targets in psoriatic arthritis patients treated with TNF inhibitors. Clin Rheumatol 2017; 36:2253-2260. [DOI: 10.1007/s10067-017-3769-4] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2017] [Revised: 06/20/2017] [Accepted: 07/18/2017] [Indexed: 01/22/2023]
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Elderly psoriatic arthritis patients on TNF-α blockers: results of an Italian multicenter study on minimal disease activity and drug discontinuation rate. Clin Rheumatol 2017; 36:1797-1802. [PMID: 28589323 DOI: 10.1007/s10067-017-3697-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2017] [Accepted: 05/22/2017] [Indexed: 12/31/2022]
Abstract
Psoriatic arthritis (PsA) is an inflammatory arthropathy, associated with skin and/or nail psoriasis. Real world data on efficacy and safety of TNF-α blockers in the elderly with PsA are lacking. The aim of this study was to evaluate the effectiveness, through the achievement of minimal disease activity (MDA), drug discontinuation rate, and safety in elderly patients with PsA on TNF-α blockers. A multicenter, observational study was carried out in four Italian centers. The assessment of disease activity and safety were performed at the start of anti-TNF-α (T0), at 6 months (T6) and at 12 months (T12). A total of 145 PsA patients were included in the study. At baseline 68 (46.9%) patients were on etanercept, 60 (41.3%) on adalimumab, 11 (7.6%) on golimumab, and 6 (4.1%) on infliximab. All the variables concerning PsA activity showed a statistically significant improvement when comparing T6 and T12 with T0. After 6 and 12 months of therapy, respectively, 31 (22.6%) and 71 (51.8%) patients achieved MDA (p < 0.001). The drug discontinuation rate was 5.5% with a mean of 6.8 months (range 2-10 months), and it was due to lack of efficacy, adverse events, and lost to follow-up. Nine patients (6.2%) reported the onset of mild infections resolved with antimicrobial specific oral regimen without therapy interruption. TNF-α blockers are effective in the achievement of a low disease status and safe in elderly patients with PsA. Therefore, age should not be considered a limitation to their use.
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Gisondi P, Altomare G, Ayala F, Bardazzi F, Bianchi L, Chiricozzi A, Costanzo A, Conti A, Dapavo P, De Simone C, Foti C, Naldi L, Offidani A, Parodi A, Piaserico S, Prignano F, Rongioletti F, Stingeni L, Talamonti M, Girolomoni G. Italian guidelines on the systemic treatments of moderate-to-severe plaque psoriasis. J Eur Acad Dermatol Venereol 2017; 31:774-790. [PMID: 28244153 DOI: 10.1111/jdv.14114] [Citation(s) in RCA: 117] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2016] [Accepted: 12/21/2016] [Indexed: 02/06/2023]
Abstract
Psoriasis is a common disease, which has a considerable impact on the healthcare system. Therefore, appropriate use of therapeutic resources is very important. Management of psoriasis in daily clinical practice is highly variable because many issues are still debated and not definitely addressed by the evidence-based medicine. Moreover, the different availability and reimbursability of drugs in each country justifies national guidelines. Expert consensus can provide helpful guidelines for optimizing patient care. A total of 20 dermatologists from different areas of Italy and with large experience in the treatment of psoriasis agreed to participate in the guidelines expert panel who aimed to reach consensus on the factors influencing psoriasis severity, the indications for systemic treatments, the parameters to be considered in the choice of treatment, and the factors to be considered in the choice of biological treatment. The recommendations for the use, screening and monitoring of systemic therapies were based on the 2015 S3 European Dermatology Forum/European Academy of Dermatology and Venereology psoriasis guidelines. Recommendations on the treatment of psoriasis in special patient populations were also agreed. The final document was discussed in a meeting moderated by a facilitator with participation of the entire group and adopting a nominal group technique to reach consensus. A statement was regarded as consented when agreement was achieved by at least 75% of the voting experts according to the Delphi procedure.
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Affiliation(s)
- P Gisondi
- Department of Medicine, Section of Dermatology and Venereology, University of Verona, Verona, Italy
| | - G Altomare
- Department of Dermatology and Venereology, I.R.C.C.S. Istituto Ortopedico Galeazzi, University of Milan, Milano, Italy
| | - F Ayala
- Department of Dermatology, University of Naples Federico II, Napoli, Italy
| | - F Bardazzi
- Division of Dermatology, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy
| | - L Bianchi
- Department of Dermatology, University of Rome Tor Vergata, Rome, Italy
| | - A Chiricozzi
- Department of Dermatology, University of Pisa, Pisa, Italy
| | - A Costanzo
- Department of Dermatology, Humanitas Research Hospital, Rozzano, Italy
| | - A Conti
- Department of Dermatology, University of Modena and Reggio Emilia, Modena, Italy
| | - P Dapavo
- Department of Biomedical Science and Human Oncology, Second Dermatologic Clinic, University of Turin, Turin, Italy
| | - C De Simone
- Department of Dermatology, Catholic University of the Sacred Heart, Rome, Italy
| | - C Foti
- Department of Biomedical Science and Human Oncology, Section of Dermatology, University of Bari, Bari, Italy
| | - L Naldi
- Department of Dermatology, Azienda Ospedaliera Papa Giovanni XXIII, Bergamo, Italy
| | - A Offidani
- Department of Clinical and Molecular Sciences, Dermatology Unit, Polytechnic Marche University, Ancona, Italy
| | - A Parodi
- Department of Dermatology, University of Genoa, Genova, Italy
| | - S Piaserico
- Department of Dermatology, University of Padua, Padova, Italy
| | - F Prignano
- Department of Dermatology, University of Florence, Firenze, Italy
| | - F Rongioletti
- Department of Medical Sciences and Public Health, Section of Dermatology, University of Cagliari, Cagliari, Italy
| | - L Stingeni
- Department of Medicine, Section of Clinical, Allergological and Venereological Dermatology, University of Perugia, Perugia, Italy
| | - M Talamonti
- Department of Dermatology, University of Rome Tor Vergata, Rome, Italy
| | - G Girolomoni
- Department of Medicine, Section of Dermatology and Venereology, University of Verona, Verona, Italy
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Carrascosa JM, Galán M, de Lucas R, Pérez-Ferriols A, Ribera M, Yanguas I. Expert Recommendations on Treating Psoriasis in Special Circumstances (Part II). ACTAS DERMO-SIFILIOGRAFICAS 2016; 107:712-729. [PMID: 27344068 DOI: 10.1016/j.ad.2016.04.017] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2016] [Revised: 04/15/2016] [Accepted: 04/19/2016] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND There is insufficient information on how best to treat moderate to severe psoriasis in difficult clinical circumstances. MATERIAL AND METHODS We considered 5 areas where there is conflicting or insufficient evidence: pediatric psoriasis, risk of infection in patients being treated with biologics, psoriasis in difficult locations, biologic drug survival, and impact of disease on quality of life. Following discussion of the issues by an expert panel of dermatologists specialized in the management of psoriasis, participants answered a questionnaire survey according to the Delphi method. RESULTS Consensus was reached on 66 (70.9%) of the 93 items analyzed; the experts agreed with 49 statements and disagreed with 17. It was agreed that body mass index, metabolic comorbidities, and quality of life should be monitored in children with psoriasis. The experts also agreed that the most appropriate systemic treatment for this age group was methotrexate, while the most appropriate biologic treatment was etanercept. Although it was recognized that the available evidence was inconsistent and difficult to extrapolate, the panel agreed that biologic drug survival could be increased by flexible, individualized dosing regimens, continuous treatment, and combination therapies. Finally, consensus was reached on using the Dermatology Quality of Life Index to assess treatment effectiveness and aid decision-making in clinical practice. CONCLUSIONS The structured opinion of experts guides decision-making regarding aspects of clinical practice for which there is incomplete or conflicting information.
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Affiliation(s)
- J M Carrascosa
- Servei de Dermatologia, Hospital Universitari GermansTrias i Pujol, Universitat Autònoma de Barcelona, Badalona, Barcelona, España.
| | - M Galán
- Servicio de Dermatología, Hospital de Jaén, Jaén, España
| | - R de Lucas
- Servicio de Dermatología, Hospital Universitario La Paz, Madrid, España
| | - A Pérez-Ferriols
- Servicio de Dermatología, Hospital General de Valencia, Valencia, España
| | - M Ribera
- Servicio de Dermatología, Hospital Universitari Parc Taulí, Universitat Autònoma de Barcelona, Sabadell, Barcelona, España
| | - I Yanguas
- Servicio de Dermatología, Hospital Universitario de Navarra, Pamplona, España
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Expert Recommendations on Treating Psoriasis in Special Circumstances (Part II). ACTAS DERMO-SIFILIOGRAFICAS 2016. [DOI: 10.1016/j.adengl.2016.08.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Chimenti MS, Triggianese P, Narcisi A, Marinari B, Teoli M, Faleri S, Arcese A, Perricone R, Costanzo A. Long-term treatment with adalimumab in psoriatic arthritis: serum adalimumab concentration, immunogenicity and the link with clinical response. J Int Med Res 2016; 44:48-52. [PMID: 27683139 PMCID: PMC5536527 DOI: 10.1177/0300060515593235] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES An observational study to evaluate the relationship between serum concentrations of adalimumab and disease activity in patients receiving long-term adalimumab treatment for psoriatic arthritis. METHODS Serum adalimumab and adalimumab antidrug antibodies were quantified by enzyme linked immunosorbent assay. Disease activity was assessed using Disease Activity Score (44 joint measures). Serum C-reactive protein was quantified using standard methods. RESULTS A total of 30 patients were recruited. There were significant inverse correlations between serum adalimumab concentration and serum C-reactive protein (CRP) concentration [r = -0.43], the number of tender joints (r = -0.4), and Disease Activity Score (DAS44)-CRP (r = -0.36). Mean serum adalimumab levels were significantly higher in patients with DAS44-CRP <1.6 than in patients with DAS44-CRP ≥1.6. CONCLUSIONS Serum adalimumab could be an important tool that may improve the management of psoriatic arthritis in patients responding to long-term treatment.
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Affiliation(s)
- Maria Sole Chimenti
- Rheumatology, Allergology and Clinical Immunology, Department of Systemic Medicine, University of Rome "Tor Vergata", Rome, Italy
| | - Paola Triggianese
- Rheumatology, Allergology and Clinical Immunology, Department of Systemic Medicine, University of Rome "Tor Vergata", Rome, Italy
| | - Alessandra Narcisi
- Dermatology, Department of Neurosciences, Mental Health, and Sensory (NESMOS), Sapienza - University of Rome, Rome, Italy
| | - Barbara Marinari
- Dermatology, Department of Systemic Medicine, University of Rome "Tor Vergata", Rome, Italy
| | - Miriam Teoli
- Dermatology, Department of Systemic Medicine, University of Rome "Tor Vergata", Rome, Italy
| | - Sara Faleri
- Dermatology, Department of Systemic Medicine, University of Rome "Tor Vergata", Rome, Italy
| | - Annalisa Arcese
- Dermatology, Department of Neurosciences, Mental Health, and Sensory (NESMOS), Sapienza - University of Rome, Rome, Italy
| | - Roberto Perricone
- Rheumatology, Allergology and Clinical Immunology, Department of Systemic Medicine, University of Rome "Tor Vergata", Rome, Italy
| | - Antonio Costanzo
- Dermatology, Department of Neurosciences, Mental Health, and Sensory (NESMOS), Sapienza - University of Rome, Rome, Italy
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Chiricozzi A, Pavlidis A, Dattola A, Bianchi L, Chimenti MS, Fida M, Saraceno R. Efficacy and safety of infliximab in psoriatic patients over the age of 65. Expert Opin Drug Saf 2016; 15:1459-1462. [PMID: 27534970 DOI: 10.1080/14740338.2016.1226279] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND Clinical data on the long-term safety and efficacy of infliximab on psoriatic patients who are older than 65 years are limited. OBJECTIVES The aim is to report the long-term efficacy, safety and tolerance of infliximab in geriatric patients. METHODS This was a retrospective study conducted at the Department of Dermatology of the University of Rome Tor Vergata. Clinical data were reported at week 12, 52, 104, 208. RESULTS 151 charts were evaluated. A total of 27 patients were included. Range of the age was between 65 and 85 years; mean age was 73 years ±5.4; female to male ratio was 1:2; mean age of onset of psoriasis was 43 years±17. The average of treatment duration was 39 months ±27 (range 1-100). Fourteen patients suffered from plaque type psoriasis and 13 from psoriatic arthritis. At the baseline the mean PASI score was 15.6 ± 10.2. At week 12, 52, 104, and 208 the mean PASI was 2, 2.3, 1.9 and 1.8 respectively. A reduction in the mean PASI was maintained in the long-term treatment in 12 patients (p < 0.001). CONCLUSION Our data suggest that long-term treatment with infliximab is effective and safe in patients over 65 years old and that IV therapy is also associated with a high compliance.
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Affiliation(s)
| | | | - Annunziata Dattola
- b Department of Dermatology , University of Rome Tor Vergata , Rome , Italy
| | - Luca Bianchi
- b Department of Dermatology , University of Rome Tor Vergata , Rome , Italy
| | - Maria Sole Chimenti
- c Department of Rheumatology, Allergology and Clinical Immunology , University of Rome 'Tor Vergata' , Rome , Italy
| | - Monika Fida
- d Faculty of Medicine , University of Tirana , Tirana , Albania
| | - Rosita Saraceno
- b Department of Dermatology , University of Rome Tor Vergata , Rome , Italy
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Conigliaro P, Chimenti M, Triggianese P, Sunzini F, Novelli L, Perricone C, Perricone R. Autoantibodies in inflammatory arthritis. Autoimmun Rev 2016; 15:673-83. [DOI: 10.1016/j.autrev.2016.03.003] [Citation(s) in RCA: 64] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2016] [Accepted: 02/28/2016] [Indexed: 02/07/2023]
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Chiricozzi A, Zangrilli A, Bavetta M, Bianchi L, Chimenti S, Saraceno R. Real-life 9-year experience with adalimumab in psoriasis and psoriatic arthritis: results of a single-centre, retrospective study. J Eur Acad Dermatol Venereol 2016; 31:304-311. [DOI: 10.1111/jdv.13771] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2015] [Accepted: 04/19/2016] [Indexed: 12/24/2022]
Affiliation(s)
- A. Chiricozzi
- Dermatology Department; University of Pisa; Pisa Italy
| | - A. Zangrilli
- Department of Dermatology; University of Rome Tor Vergata; Rome Italy
| | - M. Bavetta
- Department of Dermatology; University of Rome Tor Vergata; Rome Italy
| | - L. Bianchi
- Department of Dermatology; University of Rome Tor Vergata; Rome Italy
| | - S. Chimenti
- Department of Dermatology; University of Rome Tor Vergata; Rome Italy
| | - R. Saraceno
- Department of Dermatology; University of Rome Tor Vergata; Rome Italy
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Hayashi M, Umezawa Y, Fukuchi O, Ito T, Saeki H, Nakagawa H. Efficacy and safety of ustekinumab treatment in elderly patients with psoriasis. J Dermatol 2016; 41:974-80. [PMID: 25346301 DOI: 10.1111/1346-8138.12653] [Citation(s) in RCA: 57] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2014] [Accepted: 08/27/2014] [Indexed: 12/17/2022]
Abstract
The ratio of the elderly among psoriasis patients has been increasing. However, satisfactory long-term management of psoriasis for the elderly is challenging because of the more frequent presence of comorbidities, and the higher risk of adverse events from systemic therapeutic agents than younger patients. The use of ustekinumab (UST) appears to be an appropriate systemic treatment because it is considered less likely to cause adverse events than other systemic treatments, as well as necessitating fewer hospital visits. Our retrospective study aimed to evaluate the efficacy and safety profile of UST in elderly patients with psoriasis. The study included 24 patients aged over 65 years (range, 65-88 years; mean, 73.1 years) with moderate to severe plaque psoriasis with impaired quality of life. Efficacy and safety were assessed over a 1-year period using the Psoriasis Area and Severity Index (PASI) and the Dermatology Live Quality Index (DLQI). The efficacy was evaluated by the proportion of subjects who achieved ≥75% reduction in PASI score (PASI 75). PASI 75 responses were 56.5% at week 16, 59.1% at week 28, and 60.0% at week 52. None of the patients developed any serious infection during the 1-year treatment. The mean DLQI score at weeks 0, 16, 28, and 52 was 7.8 ± 6.0, 2.5 ± 3.4, 1.4 ± 1.7, and 1.2 ± 1.7, respectively. UST showed sufficient efficacy for elderly patients with psoriasis without any serious infection over the 1-year treatment. Our results suggest that UST is the preferable agent for the treatment of elderly patients with psoriasis.
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Affiliation(s)
- Mitsuha Hayashi
- Department of Dermatology, The Jikei University School of Medicine, Tokyo, Japan
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de la Brassinne M, Ghislain PD, Lambert JLW, Lambert J, Segaert S, Willaert F. Recommendations for managing a suboptimal response to biologics for moderate-to-severe psoriasis: A Belgian perspective. J DERMATOL TREAT 2015; 27:128-33. [PMID: 26415615 DOI: 10.3109/09546634.2015.1086476] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Over the past decade, biologics have become the gold standard in the treatment of moderate-to-severe psoriasis for patients who have failed or who have contraindications to traditional systemic treatments. However, although practical recommendations on how to treat a suboptimal response to biologics exist in other chronic inflammatory diseases, they are only just beginning to emerge for psoriasis. This article aims to formulate recommendations in the case of a suboptimal response of psoriasis to biologics in the Belgian setting. A Belgian taskforce of psoriasis experts was convened to review the results of a literature search and formulate recommendations based on the available evidence and provide expert opinion to address gaps in the evidence. The taskforce has proposed a treatment algorithm for patients with a primary non-response or a secondary loss of response to help address an unmet need. Expert recommendations have been developed to address treatment strategies in case of a primary or secondary suboptimal response to biologics in the treatment of moderate-to-severe psoriasis in Belgium.
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Affiliation(s)
- Michel de la Brassinne
- a Department of Dermatology , Centre Hospitalier Universitaire de Liège , Liège , Belgium
| | - Pierre-Dominique Ghislain
- b Department of Dermatology , Clinical Research, Cliniques Saint-Luc, Université Catholique de Louvain , Brussels , Belgium
| | - Jo L W Lambert
- c Department of Dermatology , University of Ghent , Ghent , Belgium
| | - Julien Lambert
- d Department of Dermatology , University Hospital of Antwerp, University of Antwerp , Antwerp , Belgium
| | - Siegfried Segaert
- e Department of Dermatology , University Hospitals Leuven , Leuven , Belgium , and
| | - Fabienne Willaert
- f Department of Dermatology , Erasme University Hospital , Brussels , Belgium
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46
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Lobatón T, Ferrante M, Rutgeerts P, Ballet V, Van Assche G, Vermeire S. Efficacy and safety of anti-TNF therapy in elderly patients with inflammatory bowel disease. Aliment Pharmacol Ther 2015; 42:441-51. [PMID: 26104047 DOI: 10.1111/apt.13294] [Citation(s) in RCA: 126] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2014] [Revised: 12/22/2014] [Accepted: 06/02/2015] [Indexed: 02/06/2023]
Abstract
BACKGROUND The general increased life expectancy is reflected in the age of patients with inflammatory bowel disease (IBD). The knowledge about efficacy and safety of anti-tumour necrosis factor (TNF) therapy in elderly is scarce and conflicting. AIM To assess the efficacy and safety of anti-TNF therapy in elderly patients taking into account eventual comorbidity. METHODS Observational and retrospective single-centred study where 66 IBD patients initiating anti-TNF treatment at age ≥65 years (cases: ≥65 anti-TNF) were compared with 112 IBD patients initiating anti-TNF <65 years (controls <65 anti-TNF) and 61 anti-TNF naïve IBD patients treated with immunosuppressants (IMS) and/or corticosteroids (CS) ≥65 years (controls ≥65 IMS/CS). Controls were matched to cases for IBD type, follow-up, disease duration and anti-TNF type. Comorbidity was assessed by using the Charlson Comorbidity Index (CCI). Both efficacy and safety of treatment were adjusted for comorbidity. RESULTS The short-term clinical response to anti-TNF at 10 weeks was significantly lower in cases: ≥65 anti-TNF (68% vs. 89%; P < 0.001), whereas at ≥6 months, differences were not significant (79.5% vs. 82.8%; P = 0.639). The risk for any severe adverse events was higher in cases: ≥65 anti-TNF than in controls <65 anti-TNF (RR = 4.7; P < 0.001) or controls ≥65 IMS/CS (RR = 3.09; P = 0.0008). Age older than 65 and CCI > 0 were independent risk factors for malignancy and mortality regardless of the medication. CONCLUSION Elderly patients treated with anti-TNF have a lower rate of short-term clinical response and a higher rate of severe adverse events than the younger patients under the same treatment.
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Affiliation(s)
- T Lobatón
- Department of Gastroenterology, University Hospital Gasthuisberg, Leuven, Belgium
| | - M Ferrante
- Department of Gastroenterology, University Hospital Gasthuisberg, Leuven, Belgium
| | - P Rutgeerts
- Department of Gastroenterology, University Hospital Gasthuisberg, Leuven, Belgium
| | - V Ballet
- Department of Gastroenterology, University Hospital Gasthuisberg, Leuven, Belgium
| | - G Van Assche
- Department of Gastroenterology, University Hospital Gasthuisberg, Leuven, Belgium
| | - S Vermeire
- Department of Gastroenterology, University Hospital Gasthuisberg, Leuven, Belgium
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47
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Carrascosa J, Belinchón I, de-la-Cueva P, Izu R, Luelmo J, Ruiz-Villaverde R. Expert Recommendations on Treating Psoriasis in Special Circumstances. ACTAS DERMO-SIFILIOGRAFICAS 2015. [DOI: 10.1016/j.adengl.2015.03.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Carrascosa JM, Belinchón I, de-la-Cueva P, Izu R, Luelmo J, Ruiz-Villaverde R. Expert recommendations on treating psoriasis in special circumstances. ACTAS DERMO-SIFILIOGRAFICAS 2015; 106:292-309. [PMID: 25595327 DOI: 10.1016/j.ad.2014.11.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2014] [Revised: 10/26/2014] [Accepted: 11/09/2014] [Indexed: 01/09/2023] Open
Abstract
INTRODUCTION AND OBJECTIVES A great amount of information on systemic and biologic therapies for moderate to severe psoriasis is now available. However, applying the evidence in numerous clinical scenarios has engendered debate; under these circumstances, the consensus of experts is useful. MATERIAL AND METHODS A scientific committee systematically reviewed the literature relevant to 5 clinical scenarios. An online Delphi survey of dermatologists with experience treating moderate to severe psoriasis was then carried out in order to shed light on questions that remained unresolved by the available evidence. RESULTS Twenty-three dermatologists responded to the survey and consensus was reached on 37 (56%) of the 66 statements proposed. These results led to consensus on various clinical situations even though firm evidence was lacking. Thus, intermittent therapeutic regimens and strategies for reducing the intensity of treatment are considered appropriate for optimizing biologic treatment and reducing costs. The measurement of drug and antidrug antibody levels should be included routinely when following patients on biologics to treat psoriasis. Concomitant psoriatic arthritis or a history of cardiovascular conditions will influence the choice of biologic; in these situations, an agent with anti-tumor necrosis factor properties will be preferred. Tailored management is important when the patient is pregnant or intends to conceive; drug half-life and disease severity are important factors to take into consideration in these scenarios. CONCLUSIONS A combination of systematic review of the literature and structured discussion of expert opinion facilitates decision-making in specific clinical scenarios.
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Affiliation(s)
- J M Carrascosa
- Servei de Dermatologia, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, España.
| | - I Belinchón
- Servicio de Dermatología, Hospital General Universitario de Alicante, Alicante, España
| | - P de-la-Cueva
- Servicio de Dermatología, Hospital Universitario Infanta Leonor, Madrid, España
| | - R Izu
- Servicio de Dermatología, Hospital Universitario Basurto, Universidad del País Vasco, Bilbao, España
| | - J Luelmo
- Servicio de Dermatología, Hospital Universitario ParcTaulí de Sabadell, Universidad Autónoma de Barcelona, Barcelona, España
| | - R Ruiz-Villaverde
- Servicio de Dermatología, Hospital Universitario Virgen de las Nieves, Granada, España
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49
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Abstract
The change in the population's age structure in most industrial countries, as in Germany, requires geriatric medicine to play an increasingly important role. Dermatology also has to meet the new challenges by expert discussion and ethical considerations. The physiological aging process is influenced by intrinsic and extrinsic factors and causes a variety of morphological and functional alterations in the skin. Those alterations are the cause for an increasing prevalence of many dermatoses. Infections, wound healing disorders, inflammatory diseases, tumors and associated paraneoplastic syndromes are of particular importance. The structural and functional characteristics of aging skin in combination with the reduced mobility and declining cognitive abilities in elder patients require specific recommendations for skin protection as well as qualified advice about topical and systemic use of medications.
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Affiliation(s)
- J Wohlrab
- Universitätsklinik und Poliklinik für Dermatologie und Venerologie, Martin-Luther-Universität Halle-Wittenberg, Ernst-Grube-Straße 40, 06097, Halle (Saale), Deutschland,
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50
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Medina C, Carretero G, Ferrandiz C, Dauden E, Vanaclocha F, Gómez-García F, Herrera-Ceballos E, De la Cueva-Dobao P, Belinchón I, Sánchez-Carazo J, Alsina M, López-Estebaranz J, Ferrán M, Carrascosa J, Torrado R, Argila D, Rivera R, Jiménez-Puya R, García-Doval I. Safety of classic and biologic systemic therapies for the treatment of psoriasis in elderly: an observational study from national BIOBADADERM registry. J Eur Acad Dermatol Venereol 2014; 29:858-64. [DOI: 10.1111/jdv.12688] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2014] [Accepted: 07/15/2014] [Indexed: 11/27/2022]
Affiliation(s)
- C. Medina
- Hospital Universitario de Gran Canaria Dr Negrín; Las Palmas de Gran Canaria Spain
| | - G. Carretero
- Hospital Universitario de Gran Canaria Dr Negrín; Las Palmas de Gran Canaria Spain
| | - C. Ferrandiz
- Hospital Universitario Germans Trias i Pujol; Badalona Spain
| | - E. Dauden
- Hospital Universitario la Princesa; Madrid Spain
| | | | | | | | | | - I. Belinchón
- Hospital General Universitario de Alicante; Alicante Spain
| | | | - M. Alsina
- Hospital Clinic de Barcelona; Barcelona Spain
| | | | - M. Ferrán
- Hospital del Mar; Parc de Salut Mar; Barcelona Spain
| | - J.M. Carrascosa
- Hospital Universitario Germans Trias i Pujol; Badalona Spain
| | - R. Torrado
- Hospital Universitario de Gran Canaria Dr Negrín; Las Palmas de Gran Canaria Spain
| | - D. Argila
- Hospital Universitario la Princesa; Madrid Spain
| | - R. Rivera
- Hospital Universitario 12 de Octubre; Córdoba Spain
| | | | - I. García-Doval
- Research Unit.; Fundación Academia Española de Dermatología y Venereología; Madrid Spain
- Complexo Hospitalario Universitario de Vigo; Vigo Spain
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