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Ion A, Dorobanțu AM, Popa LG, Mihai MM, Orzan OA. Risks of Biologic Therapy and the Importance of Multidisciplinary Approach for an Accurate Management of Patients with Moderate-Severe Psoriasis and Concomitant Diseases. BIOLOGY 2022; 11:biology11060808. [PMID: 35741329 PMCID: PMC9220356 DOI: 10.3390/biology11060808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Revised: 05/14/2022] [Accepted: 05/23/2022] [Indexed: 11/23/2022]
Abstract
Simple Summary Psoriasis is a chronic multisystem inflammatory disease associated with a wide range of comorbidities including cardiovascular disease, hypertension, diabetes, hyperlipidemia, obesity, metabolic syndrome, anxiety, depression, chronic kidney disease, and malignancy. Currently available novel therapeutic options for moderate-severe psoriasis include tumor necrosis factor alpha inhibitors, inhibitors of the interleukin 17, and inhibitors of the interleukin 23. Apart from the concomitant diseases psoriasis patients may have, biologic therapy may cause significant complications requiring close collaboration between dermatologists and physicians of different specialties. Consequently, it was our main purpose to provide an overview of each class of biologic agents, as well as of the most frequent adverse events they may cause in psoriasis patients with concomitant diseases. Abstract Psoriasis is a chronic multisystem inflammatory disease associated with a plethora of comorbidities including metabolic syndrome, cardiovascular disease, hypertension, diabetes, hyperlipidemia, obesity, anxiety, depression, chronic kidney disease, and malignancy. Advancement in unveiling new key elements in the pathophysiology of psoriasis led to significant progress in the development of biologic agents which target different signaling pathways and cytokines involved in the inflammatory cascade responsible for the clinical manifestations found in psoriasis. Currently available novel therapeutic options for moderate-severe psoriasis include tumor necrosis factor alpha inhibitors, inhibitors of the interleukin 17, and inhibitors of the interleukin 23. Nevertheless, concerns have been raised with respect to the possible risks associated with the use of biologic therapy requiring close collaboration between dermatologists and physicians of different specialties. Our aim was to perform an in-depth literature review and discuss the potential risks associated with biologic therapy in patients with psoriasis and concurrent diseases with a focus on the influence of novel therapeutic agents on liver function in the context of hepatopathies, particularly viral hepatitis. A multidisciplinary teamwork and periodic evaluation of psoriasis patients under biologic therapy is highly encouraged to obtain an accurate management for each case.
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Affiliation(s)
- Ana Ion
- Department of Dermatology, ‘Elias’ Emergency University Hospital, 011461 Bucharest, Romania; (A.M.D.); (L.G.P.); (M.M.M.); (O.A.O.)
- Correspondence: ; Tel.: +40-74-562-2801
| | - Alexandra Maria Dorobanțu
- Department of Dermatology, ‘Elias’ Emergency University Hospital, 011461 Bucharest, Romania; (A.M.D.); (L.G.P.); (M.M.M.); (O.A.O.)
| | - Liliana Gabriela Popa
- Department of Dermatology, ‘Elias’ Emergency University Hospital, 011461 Bucharest, Romania; (A.M.D.); (L.G.P.); (M.M.M.); (O.A.O.)
- ‘Carol Davila’ University of Medicine and Pharmacy, 020021 Bucharest, Romania
| | - Mara Mădălina Mihai
- Department of Dermatology, ‘Elias’ Emergency University Hospital, 011461 Bucharest, Romania; (A.M.D.); (L.G.P.); (M.M.M.); (O.A.O.)
- ‘Carol Davila’ University of Medicine and Pharmacy, 020021 Bucharest, Romania
| | - Olguța Anca Orzan
- Department of Dermatology, ‘Elias’ Emergency University Hospital, 011461 Bucharest, Romania; (A.M.D.); (L.G.P.); (M.M.M.); (O.A.O.)
- ‘Carol Davila’ University of Medicine and Pharmacy, 020021 Bucharest, Romania
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Poelman SM, Keeling CP, Metelitsa AI. Practical Guidelines for Managing Patients With Psoriasis on Biologics: An Update. J Cutan Med Surg 2019; 23:3S-12S. [PMID: 30789012 DOI: 10.1177/1203475418811347] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
The paradigm for treating inflammatory diseases has shifted dramatically in the past 10 to 20 years with the discovery of targeted therapeutics or "biologic" agents. Patients with rheumatoid arthritis, inflammatory bowel disease, psoriatic arthritis, and psoriasis, among others, are reaping the benefits of decades of bench to bedside research, allowing them to live more productive lives with less side effects than traditional systemic therapies. Despite these advances, many physicians unfamiliar with biologics are left to care for the basic needs of these patients and may be unaware of the multisystem comorbidities associated with psoriasis and the screening, monitoring, and other special considerations required of biologics patients. This can be overwhelming to primary care physicians and inadvertently expose patients to undue risks. The aim of this review is to provide a practical approach for all health care providers caring for patients with psoriasis being treated with biologics to facilitate communication with their treating dermatologist and ultimately provide patients with more comprehensive care.
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Affiliation(s)
- Susan M Poelman
- 1 Cumming School of Medicine, Division of Dermatology, University of Calgary, Calgary, AB, Canada
| | - Christopher P Keeling
- 2 Department of Medicine, Division of Dermatology, University of Alberta, and Symmetry Dermatology, Edmonton, AB, Canada
| | - Andrei I Metelitsa
- 1 Cumming School of Medicine, Division of Dermatology, University of Calgary, Calgary, AB, Canada
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Singh SS, Jois SD. Homo- and Heterodimerization of Proteins in Cell Signaling: Inhibition and Drug Design. ADVANCES IN PROTEIN CHEMISTRY AND STRUCTURAL BIOLOGY 2018; 111:1-59. [PMID: 29459028 DOI: 10.1016/bs.apcsb.2017.08.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Protein dimerization controls many physiological processes in the body. Proteins form homo-, hetero-, or oligomerization in the cellular environment to regulate the cellular processes. Any deregulation of these processes may result in a disease state. Protein-protein interactions (PPIs) can be inhibited by antibodies, small molecules, or peptides, and inhibition of PPI has therapeutic value. PPI drug discovery research has steadily increased in the last decade, and a few PPI inhibitors have already reached the pharmaceutical market. Several PPI inhibitors are in clinical trials. With advancements in structural and molecular biology methods, several methods are now available to study protein homo- and heterodimerization and their inhibition by drug-like molecules. Recently developed methods to study PPI such as proximity ligation assay and enzyme-fragment complementation assay that detect the PPI in the cellular environment are described with examples. At present, the methods used to design PPI inhibitors can be classified into three major groups: (1) structure-based drug design, (2) high-throughput screening, and (3) fragment-based drug design. In this chapter, we have described some of the experimental methods to study PPIs and their inhibition. Examples of homo- and heterodimers of proteins, their structural and functional aspects, and some of the inhibitors that have clinical importance are discussed. The design of PPI inhibitors of epidermal growth factor receptor heterodimers and CD2-CD58 is discussed in detail.
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Affiliation(s)
- Sitanshu S Singh
- Basic Pharmaceutical Sciences, School of Pharmacy, University of Louisiana at Monroe, Monroe, LA, United States
| | - Seetharama D Jois
- Basic Pharmaceutical Sciences, School of Pharmacy, University of Louisiana at Monroe, Monroe, LA, United States.
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Young M, Aldredge L, Parker P. Psoriasis for the primary care practitioner. J Am Assoc Nurse Pract 2017; 29:157-178. [PMID: 28233460 DOI: 10.1002/2327-6924.12443] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2016] [Revised: 12/15/2016] [Accepted: 12/16/2016] [Indexed: 01/23/2023]
Abstract
Primary care practitioners (PCPs) are playing an increasingly important role in the management and care of psoriasis. Thus, it is important for PCPs to be knowledgeable about the disease and to be able to differentiate between common myths and facts related to diagnosis and treatment. By building relationships with their patients and working collaboratively with dermatology health professionals and other specialists, PCPs can facilitate communication about the patient's treatment preferences and expectations for symptom relief, and they may be better able to work with the patient to optimize treatment adherence. This review aims to provide PCPs with a primer on psoriasis, its associated comorbidities, and its impact on patients' quality of life. Discussion topics include psoriasis epidemiology, triggering factors, clinical presentation, differential diagnosis, comorbidities, and approaches to treatment. This review also highlights the importance of staying abreast of advances in the understanding of psoriasis pathogenesis as well as emerging therapeutic treatment options, because these advances may change the treatment landscape and increase patients' expectations for skin clearance.
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Affiliation(s)
- Melodie Young
- Modern Dermatology, Baylor-Health Texas Affiliate, Dallas, Texas
| | - Lakshi Aldredge
- Dermatology Service, Operative Care Division, VA Portland Health Care System, Portland, Oregon
| | - Patti Parker
- College of Nursing and Health Innovation, The University of Texas at Arlington, Arlington, Texas
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Providing Guidance for Patients With Moderate-to-Severe Psoriasis Who Are Candidates for Biologic Therapy. JOURNAL OF THE DERMATOLOGY NURSES' ASSOCIATION 2016; 8:14-26. [PMID: 27004085 PMCID: PMC4770271 DOI: 10.1097/jdn.0000000000000185] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/05/2022]
Abstract
Psoriasis is a chronic, immune-mediated disease characterized by itchy, scaly, and often painful plaques in the skin. Psoriasis can have significant psychosocial burdens and increased risks for numerous comorbidities, including diabetes, hypertension, and cardiovascular disease, particularly in patients with moderate-to-severe disease. Dermatology nurse practitioners and physician assistants are an important part of the healthcare team, contributing to all aspects of psoriasis management. This review reinforces the unique aspects of care that nurse practitioners and physician assistants provide to patients with psoriasis, such as facilitating conversations about managing disease, setting appropriate expectations, and considering treatment options, including when treatment response or tolerability is suboptimal. The importance of relationship building is stressed. Patient management topics discussed include helpful tips about assessing treatment options, initiating biologic therapy, optimizing patient adherence, and managing comorbidities. Also reviewed are how to deal with common barriers including lack of knowledge about psoriasis or making healthy lifestyle changes, fear of injections or side effect risks, lack of health insurance, and concerns about treatment costs. Overall, by forming meaningful relationships and engaging patients in their psoriasis care, nurse practitioners and physician assistants can help to optimize clinical efficacy outcomes and consistently manage moderate-to-severe psoriasis and its comorbidities over the patient’s life course.
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Patel S, Patel T, Kerdel FA. The risk of malignancy or progression of existing malignancy in patients with psoriasis treated with biologics: case report and review of the literature. Int J Dermatol 2015; 55:487-93. [DOI: 10.1111/ijd.13129] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2015] [Revised: 03/16/2015] [Accepted: 05/07/2015] [Indexed: 12/17/2022]
Affiliation(s)
- Shailee Patel
- Department of Dermatology & Cutaneous Surgery; University of Miami; Miami FL USA
| | - Tejas Patel
- Department of Dermatology & Cutaneous Surgery; University of Miami; Miami FL USA
| | - Francisco A. Kerdel
- Department of Dermatology & Cutaneous Surgery; University of Miami; Miami FL USA
- Florida Academic Dermatology Centers; Miami FL USA
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Ahn CS, Dothard EH, Garner ML, Feldman SR, Huang WW. To test or not to test? An updated evidence-based assessment of the value of screening and monitoring tests when using systemic biologic agents to treat psoriasis and psoriatic arthritis. J Am Acad Dermatol 2015; 73:420-8.e1. [PMID: 26184440 DOI: 10.1016/j.jaad.2015.06.004] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2015] [Revised: 06/01/2015] [Accepted: 06/03/2015] [Indexed: 12/17/2022]
Abstract
BACKGROUND Safety profiles of systemic biologic agents for the treatment of psoriasis and psoriatic arthritis (PsA) encompass a wide spectrum of adverse events. To date, no uniform evidence-based guidelines exist regarding screening and monitoring patients who are undergoing biologic therapy. OBJECTIVE We sought to identify studies evaluating screening and monitoring tests in the treatment of psoriasis and PsA with systemic biologic agents, and to propose evidence-based practical guidelines. METHODS The MEDLINE database was searched to identify data on risks associated with adalimumab, etanercept, infliximab, and ustekinumab. Articles were reviewed and graded according to methods developed by the US Preventative Services Task Force. RESULTS Evidence was strongest (grade B) for tuberculosis screening. Interferon-gamma release assay was preferable to tuberculin skin testing. Among known hepatitis B virus carriers, the evidence grade was C for monitoring liver function tests and viral load. LIMITATIONS This study was limited by the lack of high-quality controlled trials evaluating screening and monitoring tests in patients treated with biologic agents. CONCLUSIONS Baseline tuberculosis testing remains the only screening test with strong evidence to support its practice. Other screening and monitoring tests commonly performed in patients who are taking biologic agents are supported only in certain clinical settings or lack evidence to support or recommend against their practice.
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Affiliation(s)
- Christine S Ahn
- Department of Dermatology, Center for Dermatology Research, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Emily H Dothard
- Department of Dermatology, Center for Dermatology Research, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Michael L Garner
- University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | - Steven R Feldman
- Department of Dermatology, Center for Dermatology Research, Wake Forest School of Medicine, Winston-Salem, North Carolina; Department of Pathology, Wake Forest School of Medicine, Winston-Salem, North Carolina; Department of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - William W Huang
- Department of Dermatology, Center for Dermatology Research, Wake Forest School of Medicine, Winston-Salem, North Carolina.
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Kimball AB, Rothman KJ, Kricorian G, Pariser D, Yamauchi PS, Menter A, Teller CF, Aras G, Accortt NA, Hooper M, Rice KC, Gelfand JM. OBSERVE-5: observational postmarketing safety surveillance registry of etanercept for the treatment of psoriasis final 5-year results. J Am Acad Dermatol 2014; 72:115-22. [PMID: 25264239 DOI: 10.1016/j.jaad.2014.08.050] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2014] [Revised: 08/14/2014] [Accepted: 08/26/2014] [Indexed: 10/24/2022]
Abstract
BACKGROUND OBSERVE-5 was a 5-year Food and Drug Administration-mandated surveillance registry of patients with psoriasis. OBJECTIVE We sought to assess long-term etanercept safety and effectiveness. METHODS Patients with moderate to severe psoriasis enrolled; a single baseline dose of etanercept was required. Key outcome measures included serious adverse events, serious infectious events, events of medical interest, psoriasis-affected body surface area, physician global assessment score, and Dermatology Life Quality Index score. Safety outcomes were assessed relative to data from the MarketScan database. RESULTS For 2510 patients, 5-year cumulative incidence was 22.2% (95% confidence interval [CI] 20.3%-24.2%) for serious adverse events; 6.5% (95% CI 5.4%-7.7%) for serious infectious events; 3.2% (95% CI 2.3%-4.1%) for malignancies excluding nonmelanoma skin cancer; 3.6% (95% CI 2.7%-4.5%) for nonmelanoma skin cancer; 2.8% (95% CI 2.0%-3.6%) for coronary artery disease; 0.7% (95% CI 0.3%-1.2%) for psoriasis worsening; 0.2% (95% CI 0.0%-0.4%) for central nervous system demyelinating disorder; 0.1% (95% CI 0.0%-0.3%) for lymphoma and for tuberculosis; and 0.1% (95% CI 0.0%-0.2%) for opportunistic infection and for lupus; 55 fatal events were reported. Rates of malignancies, lymphomas, nonmelanoma skin cancer, and hospitalization-associated infections were not higher than expected relative to administrative claims data. The percentage of patients rated as clear/almost clear was 12% at baseline, which increased to 51% at month 6 and remained relatively stable throughout 5 years. LIMITATIONS No internal comparator group was included; rare events may not have been detected. CONCLUSION No new safety signals were observed with long-term, real-world etanercept use.
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Affiliation(s)
| | - Kenneth J Rothman
- RTI Health Solutions, RTI International, Research Triangle Park, North Carolina
| | | | - David Pariser
- Eastern Virginia Medical School and Virginia Clinical Research Inc, Norfolk, Virginia
| | - Paul S Yamauchi
- Dermatology Institute and Skin Care Center, Santa Monica, California
| | | | | | | | | | | | | | - Joel M Gelfand
- University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
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Pleyer U, Stübiger N. New pharmacotherapy options for noninfectious posterior uveitis. Expert Opin Biol Ther 2014; 14:1783-99. [DOI: 10.1517/14712598.2014.956074] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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Hägg D, Sundström A, Eriksson M, Schmitt-Egenolf M. Decision for biological treatment in real life is more strongly associated with the Psoriasis Area and Severity Index (PASI) than with the Dermatology Life Quality Index (DLQI). J Eur Acad Dermatol Venereol 2014; 29:452-6. [DOI: 10.1111/jdv.12576] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2014] [Accepted: 04/30/2014] [Indexed: 12/30/2022]
Affiliation(s)
- D. Hägg
- Dermatology, Medicine; Department of Public Health and Clinical Medicine; Umeå University Umeå; Umeå Sweden
- Industrial Doctoral School; Umeå University; Umeå Sweden
| | - A. Sundström
- Karolinska Institutet; Centre for Pharmacoepidemiology; Solna Sweden
| | - M. Eriksson
- Department of Statistics; Umeå School of Business and Economics; Umeå University; Umeå Sweden
| | - M. Schmitt-Egenolf
- Dermatology, Medicine; Department of Public Health and Clinical Medicine; Umeå University Umeå; Umeå Sweden
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Abstract
PURPOSE To enhance the learner's competence with knowledge of the clinical variants and management of psoriasis. TARGET AUDIENCE This continuing education activity is intended for physicians and nurses with an interest in skin and wound care. OBJECTIVES After participating in this educational activity, the participant should be better able to:1. Demonstrate knowledge of the types, symptoms, and diagnostic testing of psoriasis.2. Apply knowledge of psoriasis treatment to patient care scenarios. ABSTRACT Psoriasis is an inflammatory skin condition that is associated with various comorbidities. To the wound care physician, the Koebner phenomenon is of importance, as any superficial trauma can induce psoriasis. Particularly, periwound and joints are particularly susceptible to flare-ups of this condition. This review highlights the epidemiology and treatment of psoriasis.
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Gonçalves DC, Evangelista RC, da Silva RR, Santos MJS, Silva FS, Aragão KS, Brito GAC, Lucena HBM, Leitão RC, Oriá RB. Infliximab attenuates inflammatory osteolysis in a model of periodontitis in Wistar rats. Exp Biol Med (Maywood) 2014; 239:442-53. [DOI: 10.1177/1535370213520114] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Periodontitis is a chronic inflammatory disease related to tooth loss in adults. Infliximab is a chimeric monoclonal antibody against TNF-α and is prescribed for the treatment of systemic inflammatory diseases. This study aimed to investigate the role of infliximab on experimental periodontal disease (EPD). EPD was induced by passing a 3.0 nylon thread around the upper left second molar in Wistar rats. Animals were either treated with intravenous infliximab (1, 5, 7, and 10 mg/kg) or saline solution 30 min before the periodontitis induction and were followed until they were sacrificed on the 11th day. A subset of rats was euthanized on the third day for analysis of gingival myeloperoxidase (MPO) and the blood MPO granulocyte index. In addition, we analyzed the bone loss index (BLI), the periodontal histopathological score, and the periodontal collagen network using confocal microscopy. We also analyzed metalloproteinase-1/-8, RANK, RANK-L, and osteoprotegerin in maxillary tissue by immunohistochemistry Gingival MPO, IL-1β, TNF-α were measured by ELISA. EPD caused leukocytosis, significant increases in BLI and gingival pro-inflammatory cytokines and cell infiltrates, with worse histopathological scores and periodontal collagen derangement. Infliximab (5 mg/kg) reduced granulocyte blood counts, gingival IL-1β, TNF-α, and MPO levels, diminished MMP-1/-8, RANK, and RANK-L bone immunolabeling with better periodontal histopathological scores and collagen network in comparison with the challenged saline group. We concluded that infliximab had significant anti-inflammatory and bone-protective effects in Wistar rats challenged by periodontitis.
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Affiliation(s)
- Davi C Gonçalves
- Laboratory of the Biology of Tissue Healing, Ontogeny and Nutrition, Department of Morphology and Institute of Biomedicine, School of Medicine, Federal University of Ceara, Rua Cel. Nunes de Melo, 1315 Fortaleza, CE, Brazil
| | - Rakel C Evangelista
- Laboratory of the Biology of Tissue Healing, Ontogeny and Nutrition, Department of Morphology and Institute of Biomedicine, School of Medicine, Federal University of Ceara, Rua Cel. Nunes de Melo, 1315 Fortaleza, CE, Brazil
| | - Rafael R da Silva
- Laboratory of the Biology of Tissue Healing, Ontogeny and Nutrition, Department of Morphology and Institute of Biomedicine, School of Medicine, Federal University of Ceara, Rua Cel. Nunes de Melo, 1315 Fortaleza, CE, Brazil
| | - Maria JS Santos
- Laboratory of the Biology of Tissue Healing, Ontogeny and Nutrition, Department of Morphology and Institute of Biomedicine, School of Medicine, Federal University of Ceara, Rua Cel. Nunes de Melo, 1315 Fortaleza, CE, Brazil
| | - Francisco S Silva
- Division of Rheumatology, Department of Clinical Medicine, School of Medicine, Federal University of Ceara, Rua Cel. Nunes de Melo, 1315 Fortaleza, CE, Brazil
| | - Karoline S Aragão
- Department of Physiology and Pharmacology and Institute of Biomedicine, School of Medicine, Federal University of Ceara, Rua Cel. Nunes de Melo, 1315 Fortaleza, CE, Brazil
| | - Gerly AC Brito
- Department of Physiology and Pharmacology and Institute of Biomedicine, School of Medicine, Federal University of Ceara, Rua Cel. Nunes de Melo, 1315 Fortaleza, CE, Brazil
- Microscopy and Imaging Core, Department of Morphology and Institute of Biomedicine, School of Medicine, Federal University of Ceara, Rua Cel. Nunes de Melo, 1315 Fortaleza, CE, Brazil
| | - Herene BM Lucena
- Laboratory of the Biology of Tissue Healing, Ontogeny and Nutrition, Department of Morphology and Institute of Biomedicine, School of Medicine, Federal University of Ceara, Rua Cel. Nunes de Melo, 1315 Fortaleza, CE, Brazil
| | - Renata C Leitão
- Department of Physiology and Pharmacology and Institute of Biomedicine, School of Medicine, Federal University of Ceara, Rua Cel. Nunes de Melo, 1315 Fortaleza, CE, Brazil
- Microscopy and Imaging Core, Department of Morphology and Institute of Biomedicine, School of Medicine, Federal University of Ceara, Rua Cel. Nunes de Melo, 1315 Fortaleza, CE, Brazil
| | - Reinaldo B Oriá
- Laboratory of the Biology of Tissue Healing, Ontogeny and Nutrition, Department of Morphology and Institute of Biomedicine, School of Medicine, Federal University of Ceara, Rua Cel. Nunes de Melo, 1315 Fortaleza, CE, Brazil
- Microscopy and Imaging Core, Department of Morphology and Institute of Biomedicine, School of Medicine, Federal University of Ceara, Rua Cel. Nunes de Melo, 1315 Fortaleza, CE, Brazil
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Ramonda R, Foresta C, Ortolan A, Bertoldo A, Oliviero F, Lorenzin M, Pizzol D, Punzi L, Garolla A. Influence of tumor necrosis factor α inhibitors on testicular function and semen in spondyloarthritis patients. Fertil Steril 2013; 101:359-65. [PMID: 24332378 DOI: 10.1016/j.fertnstert.2013.10.048] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2013] [Revised: 10/27/2013] [Accepted: 10/29/2013] [Indexed: 12/20/2022]
Abstract
OBJECTIVE To evaluate sperm parameters and sexual hormones in young males affected with spondyloarthritis (SpA) before and after 1 year of anti-tumor necrosis factor (TNF) α treatment. DESIGN Prospective case-control study. SETTING Rheumatology and human reproduction pathology units at a university hospital. PATIENTS Ten SpA outpatients attending the rheumatology clinic; 20 healthy control subjects attending the unit of human reproduction pathology within an infertility prevention program. INTERVENTIONS At baseline and after a 12-month treatment, disease activity was assessed and an andrologic evaluation made. MAIN OUTCOME MEASURE(S) Rheumatologists assessed anamnestic, clinical, functional, and biomarker data. Andrologists evaluated semen analysis, fluorescence in situ hybridization for chromosomes X, Y, 13, 18, and 21, FSH, LH, and T plasma levels, and testicular color Doppler ultrasound. RESULTS At baseline, SpA patients showed reduced sperm motility, higher plasma LH and FSH, and lower T levels compared with control subjects; a significant correlation between disease activity and sperm quality was found. After treatment, a statistically significant decrease in sperm aneuploidies and normal hormone levels were observed. CONCLUSIONS Although inflammation in SpA appears to be related to impaired testicular function, anti-TNF-α agents seem to be safe on testicular function and fertility.
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Affiliation(s)
- Roberta Ramonda
- Rheumatology Unit, Department of Medicine, University of Padua, Padua, Italy
| | - Carlo Foresta
- Unit of Human Reproduction Pathology, Department of Molecular Medicine, University of Padua, Padua, Italy
| | - Augusta Ortolan
- Rheumatology Unit, Department of Medicine, University of Padua, Padua, Italy
| | - Alessandro Bertoldo
- Unit of Human Reproduction Pathology, Department of Molecular Medicine, University of Padua, Padua, Italy
| | - Francesca Oliviero
- Rheumatology Unit, Department of Medicine, University of Padua, Padua, Italy
| | | | - Damiano Pizzol
- Unit of Human Reproduction Pathology, Department of Molecular Medicine, University of Padua, Padua, Italy
| | - Leonardo Punzi
- Rheumatology Unit, Department of Medicine, University of Padua, Padua, Italy
| | - Andrea Garolla
- Unit of Human Reproduction Pathology, Department of Molecular Medicine, University of Padua, Padua, Italy.
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Barygina VV, Becatti M, Soldi G, Prignano F, Lotti T, Nassi P, Wright D, Taddei N, Fiorillo C. Altered redox status in the blood of psoriatic patients: involvement of NADPH oxidase and role of anti-TNF-α therapy. Redox Rep 2013; 18:100-6. [PMID: 23601139 DOI: 10.1179/1351000213y.0000000045] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Psoriasis is a chronic hyperproliferative inflammatory skin disease, characterized by a generalized redox imbalance. Anti-tumor necrosis factor (TNF)-α therapy is widely used for the treatment of this disease, but its effect on blood redox status hasn't been explored. OBJECTIVE To investigate the effects of anti-TNF-α therapy on blood redox status in psoriatic patients. METHODS Twenty-nine psoriatic patients (PSO) were divided into two groups: one remained untreated (NRT) and to another the anti-TNF-α therapy was prescribed (TR). The levels of main oxidative stress markers and total antioxidant capacity (TAC) in plasma, levels of total reactive oxygen species (ROS) production, lipoperoxidation, TAC, glutathione content, and activity of NADPH oxidase in white blood cells (WBC) were evaluated in PSO, in NTR and TR after 6 months of the study. RESULTS Plasma levels of malondialdehyde (MDA) and protein carbonyl content (PCO), ROS production, lipoperoxidation, and glutathione content in WBC were increased, while TAC in both plasma and WBC was decreased in PSO with respect to controls. In the plasma of TR, levels of MDA and PCO were significantly lower with respect to PSO and NTR. The activity of NADPH oxidase was significantly increased in WBC of PSO and NTR but not in TR versus controls. DISCUSSION Our results represent novel data about the redox status of WBC in psoriatic patients. A significant redox-balancing effect of anti-TNF-α therapy, probably associated with the normalization of NADPH oxidase activity in WBC, was demonstrated.
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Affiliation(s)
- V V Barygina
- Department of Biochemical Sciences, University of Florence, Florence, Italy
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CD30-positives anaplastisch großzelliges T-Zell-Lymphom unter immunsuppressiver Therapie einer Pityriasis rubra pilaris mit Ustekinumab. Hautarzt 2013; 64:190-4. [DOI: 10.1007/s00105-012-2526-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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