1
|
Abstract
INTRODUCTION Integrins are a family of 24 cell adhesion receptors that play a role in the biggest unmet needs in medicine - cardiovascular disease, immunology and cancer. Their discovery promised huge potential for the pharmaceutical industry. Areas covered. Over 35-years since their discovery, there is little to show for the hundreds of billions of dollars of investment in anti-integrin drug discovery programmes. In this review the author discusses the reasons for the failure of this promising class of drugs and the future for this class of drugs. Expert opinion. Within 10-years, there was a plethora of potent, specific anti-integrin molecules and since their discovery, many of these agents have entered clinical trials. The success in discovering these agents was due to recently discovered monoclonal antibody technology. The integrin-recognition domain Arg-Gly-Asp (RGD) provided the basis for discovering small molecule inhibitors to integrins - both cyclic peptides and peptidomimetics. Most agents failed in the Phase III clinical trials and those agents that did make it to the market were plagued with issues of toxicity and limited efficacy and were soon replaced with non-integrin targeting agents. Their failure was due to a combination of poor pharmacokinetics and pharmacodynamics, complicated by the complex pathophysiology of integrins.
Collapse
Affiliation(s)
- Dermot Cox
- School of Pharmacy and Biomolecular Sciences, Royal College of Surgeons in Ireland , Dublin, Ireland
| |
Collapse
|
2
|
Herman FJ, Simkovic S, Pasinetti GM. Neuroimmune nexus of depression and dementia: Shared mechanisms and therapeutic targets. Br J Pharmacol 2019; 176:3558-3584. [PMID: 30632147 DOI: 10.1111/bph.14569] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2018] [Revised: 11/26/2018] [Accepted: 12/04/2018] [Indexed: 12/12/2022] Open
Abstract
Dysfunctional immune activity is a physiological component of both Alzheimer's disease (AD) and major depressive disorder (MDD). The extent to which altered immune activity influences the development of their respective cognitive symptoms and neuropathologies remains under investigation. It is evident, however, that immune activity affects neuronal function and circuit integrity. In both disorders, alterations are present in similar immune networks and neuroendocrine signalling pathways, immune responses persist in overlapping neuroanatomical locations, and morphological and structural irregularities are noted in similar domains. Epidemiological studies have also linked the two disorders, and their genetic and environmental risk factors intersect along immune-activating pathways and can be synonymous with one another. While each of these disorders individually contains a large degree of heterogeneity, their shared immunological components may link distinct phenotypes within each disorder. This review will therefore highlight the shared immune pathways of AD and MDD, their overlapping neuroanatomical features, and previously applied, as well as novel, approaches to pharmacologically manipulate immune pathways, in each neurological condition. LINKED ARTICLES: This article is part of a themed section on Therapeutics for Dementia and Alzheimer's Disease: New Directions for Precision Medicine. To view the other articles in this section visit http://onlinelibrary.wiley.com/doi/10.1111/bph.v176.18/issuetoc.
Collapse
Affiliation(s)
- Francis J Herman
- Department of Neurology, Mount Sinai School of Medicine, New York City, New York, USA
| | - Sherry Simkovic
- Department of Neurology, Mount Sinai School of Medicine, New York City, New York, USA
| | - Giulio M Pasinetti
- Department of Neurology, Mount Sinai School of Medicine, New York City, New York, USA.,Geriatrics Research. Education, and Clinical Center, JJ Peters VA Medical Center, Bronx, New York, USA
| |
Collapse
|
3
|
Théréné C, Brenaut E, Barnetche T, Misery L. Efficacy of Systemic Treatments of Psoriasis on Pruritus: A Systemic Literature Review and Meta-Analysis. J Invest Dermatol 2018; 138:38-45. [DOI: 10.1016/j.jid.2017.05.039] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2017] [Revised: 05/17/2017] [Accepted: 05/26/2017] [Indexed: 01/08/2023]
|
4
|
Ali F, Cueva A, Vyas J, Atwan A, Salek M, Finlay A, Piguet V. A systematic review of the use of quality-of-life instruments in randomized controlled trials for psoriasis. Br J Dermatol 2016; 176:577-593. [DOI: 10.1111/bjd.14788] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/23/2016] [Indexed: 01/13/2023]
Affiliation(s)
- F.M. Ali
- Department of Dermatology and Academic Wound Healing; Division of Infection and Immunity; School of Medicine; Cardiff University; 3rd Floor Glamorgan House, Heath Park Cardiff CF14 4XN U.K
| | - A.C. Cueva
- Department of Dermatology and Academic Wound Healing; Division of Infection and Immunity; School of Medicine; Cardiff University; 3rd Floor Glamorgan House, Heath Park Cardiff CF14 4XN U.K
- Centro de la Piel; Quito Ecuador
| | - J. Vyas
- Department of Dermatology and Academic Wound Healing; Division of Infection and Immunity; School of Medicine; Cardiff University; 3rd Floor Glamorgan House, Heath Park Cardiff CF14 4XN U.K
| | - A.A. Atwan
- Department of Dermatology and Academic Wound Healing; Division of Infection and Immunity; School of Medicine; Cardiff University; 3rd Floor Glamorgan House, Heath Park Cardiff CF14 4XN U.K
| | - M.S. Salek
- School of Life and Medical Sciences; University of Hertfordshire; Hatfield U.K
- Institute for Medicines Development; Cardiff U.K
| | - A.Y. Finlay
- Department of Dermatology and Academic Wound Healing; Division of Infection and Immunity; School of Medicine; Cardiff University; 3rd Floor Glamorgan House, Heath Park Cardiff CF14 4XN U.K
| | - V. Piguet
- Department of Dermatology and Academic Wound Healing; Division of Infection and Immunity; School of Medicine; Cardiff University; 3rd Floor Glamorgan House, Heath Park Cardiff CF14 4XN U.K
| |
Collapse
|
5
|
Placebo Effects on Itch: A Meta-Analysis of Clinical Trials of Patients with Dermatological Conditions. J Invest Dermatol 2015; 135:1234-1243. [DOI: 10.1038/jid.2014.522] [Citation(s) in RCA: 67] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2014] [Revised: 10/31/2014] [Accepted: 12/01/2014] [Indexed: 01/21/2023]
|
6
|
Correr CJ, Rotta I, Teles TDS, Godoy RR, Riveros BS, Garcia MM, Gonçalves PR, Otuki MF. Efficacy and safety of biologics in the treatment of moderate to severe psoriasis: a comprehensive meta-analysis of randomized controlled trials. CAD SAUDE PUBLICA 2015; 29 Suppl 1:S17-31. [PMID: 25402246 DOI: 10.1590/0102-311x00157013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2012] [Accepted: 07/04/2013] [Indexed: 01/01/2023] Open
Abstract
We conducted a systematic review and metaanalysis of randomized placebo-controlled trials in moderate-to-severe psoriasis treated with biological agents, with a follow-up of 10-14 weeks. Overall, 41 studies, with mean Jadad score of 4.4, and 15,586 patients were included. For the efficacy outcomes PASI 50, 75 and 90 our findings are not conclusive to point what biological agent has the greatest response in short term follow-up. There were no statistical differences between placebo and biologics for the occurrence of infections and serious adverse events. Ustekinumab 45 mg showed lower withdrawal due to adverse events compared with the placebo. Based on data available up to now, it is not possible to determine which biological agent is the best for PASI 50, 75 or 90 after 10-14 weeks of treatment. At the same follow-up, overall safety seems to be the same for all biological agents and Ustekinumab 45 mg the most well tolerated drug. To better understand efficacy and safety, indirect meta-analysis comparing drug-to-drug is required since randomized placebo-controlled trials may not be feasible.
Collapse
|
7
|
Abstract
The advent of biologics in dermatologic treatment armentarium has added refreshing dimensions, for it is a major breakthrough. Several agents are now available for use. It is therefore imperative to succinctly comprehend their pharmacokinetics for their apt use. A concerted endeavor has been made to delve on this subject. The major groups of biologics have been covered and include: Drugs acting against TNF-α, Alefacept, Ustekinumab, Rituximab, IVIG and Omalizumab. The relevant pharmacokinetic characteristics have been detailed. Their respective label (approved) and off-label (unapproved) indications have been defined, highlighting their dosage protocol, availability and mode of administration. The evidence level of each indication has also been discussed to apprise the clinician of their current and prospective uses. Individual anti-TNF drugs are not identical in their actions and often one is superior to the other in a particular disease. Hence, the section on anti-TNF agents mentions the literature on each drug separately, and not as a group. The limitations for their use have also been clearly brought out.
Collapse
Affiliation(s)
- Virendra N Sehgal
- Dermato-Venereology (Skin/VD) Center, Sehgal Nursing Home, Delhi, India
| | - Deepika Pandhi
- Department of Dermatology and STD, University College of Medical Sciences and Associated Guru Teg Bahadur Hospital, Delhi, India
| | - Ananta Khurana
- Department of Dermatology and STD, University College of Medical Sciences and Associated Guru Teg Bahadur Hospital, Delhi, India
| |
Collapse
|
8
|
Brennan M, Cox D. The therapeutic potential of I-domain integrins. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2014; 819:157-78. [PMID: 25023174 DOI: 10.1007/978-94-017-9153-3_11] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Due to their role in processes central to cancer and autoimmune disease I-domain integrins are an attractive drug target. Both antibodies and small molecule antagonists have been discovered and tested in the clinic. Much of the effort has focused on αLβ2 antagonists. Maybe the most successful was the monoclonal antibody efalizumab, which was approved for the treatment of psoriasis but subsequently withdrawn from the market due to the occurrence of a serious adverse effect (progressive multifocal leukoencephalopathy). Other monoclonal antibodies were tested for the treatment of reperfusion injury, post-myocardial infarction, but failed to progress due to lack of efficacy. New potent small molecule inhibitors of αv integrins are promising reagents for treating fibrotic disease. Small molecule inhibitors targeting collagen-binding integrins have been discovered and future work will focus on identifying molecules selectively targeting each of the collagen receptors and identifying appropriate target diseases for future clinical studies.
Collapse
Affiliation(s)
- Marian Brennan
- Molecular and Cellular Therapeutics, Royal College of Surgeons in Ireland, 123 St. Stephen's Green, Dublin 2, Ireland
| | | |
Collapse
|
9
|
Gottlieb AB, Armstrong AW. Psoriasis Outcome Measures: A Report from the GRAPPA 2012 Annual Meeting. J Rheumatol 2013; 40:1428-33. [DOI: 10.3899/jrheum.130456] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Psoriasis is a multisystem disease. The cutaneous and musculoskeletal manifestations (psoriatic arthritis) are well recognized. However, the other manifestations of psoriatic disease including metabolic syndrome, atherosclerotic cardiovascular disease, depression, poor self-esteem, and self-destructive habits including obesity, smoking and excess alcohol consumption are underappreciated. At the 2012 annual meeting of the Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA), members addressed the need to develop uniform, validated, standardized outcome measures for psoriatic disease, measures that are useful to all stakeholders including patients, physicians, regulators, and payers.
Collapse
|
10
|
Papp K, Sundaram M, Bao Y, Williams D, Gu Y, Signorovitch J, Wang Y, Valdes J, Mulani P. Effects of briakinumab treatment for moderate to severe psoriasis on health-related quality of life and work productivity and activity impairment: results from a randomized phase III study. J Eur Acad Dermatol Venereol 2013; 28:790-8. [DOI: 10.1111/jdv.12177] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2012] [Accepted: 04/08/2013] [Indexed: 12/16/2022]
Affiliation(s)
- K.A. Papp
- Probity Medical Research; Waterloo Ontario Canada
| | | | - Y. Bao
- AbbVie Inc.; North Chicago Illinois USA
| | | | - Y. Gu
- AbbVie Inc.; North Chicago Illinois USA
| | | | - Y. Wang
- AbbVie Inc.; North Chicago Illinois USA
| | | | | |
Collapse
|
11
|
Mattei PL, Corey KC, Kimball AB. Psoriasis Area Severity Index (PASI) and the Dermatology Life Quality Index (DLQI): the correlation between disease severity and psychological burden in patients treated with biological therapies. J Eur Acad Dermatol Venereol 2013; 28:333-7. [PMID: 23425140 DOI: 10.1111/jdv.12106] [Citation(s) in RCA: 186] [Impact Index Per Article: 16.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2012] [Accepted: 01/15/2013] [Indexed: 12/14/2022]
Abstract
BACKGROUND Multiple metrics evaluate the efficacy of psoriasis treatment, but interestingly, the correlation between the mostly widely used clinical trial efficacy end point, the physician-rendered Psoriasis Area Severity Index PASI score and, the most widely used quality of life metric, the Dermatology Life Quality Index DLQI, is not always high. OBJECTIVE To perform a systematic review to determine PASI to DLQI correlation. METHODS RCTs of biological agents for the treatment of moderate-to-severe psoriasis were reviewed in accordance with PRISMA guidelines. The mean percentage PASI improvement and change in mean DLQI values were recorded and compared for treatment groups from baseline to 10-16 weeks of therapy. RESULTS A search of the literature yielded 155 sources, of which 13 RCTs met inclusion and exclusion criteria. Percentage of PASI improvement from baseline correlates with DLQI changes with an r(2) value of 0.80 from baseline through weeks 10-16. When grouped by mean percentage reduction in PASI, agents demonstrating >75% mean reduction in PASI demonstrated a mean DLQI improvement over agents that achieved <75%-50% mean reduction in PASI or <50% mean reduction in PASI [minimal clinically important difference (MCID) 3.2]. In addition, a reduction in mean PASI of at least 75%, predicted a mean movement from DLQI band 3 to DLQI band 1, in all nine treatment arms demonstrating such efficacy. CONCLUSIONS Mean PASI and DLQI correlate predictably in patients with chronic moderate-to-severe plaque psoriasis undergoing treatment with biological agents. A reduction in PASI of at least 75% can translate to significant quality-of-life improvement in patients treated with these therapies.
Collapse
Affiliation(s)
- P L Mattei
- The Johns Hopkins Hospital, Baltimore, MD, USA
| | | | | |
Collapse
|
12
|
Effect of Biologic Agents on Non-PASI Outcomes in Moderate-to-Severe Plaque Psoriasis: Systematic Review and Meta-Analyses. Dermatol Ther (Heidelb) 2012. [PMID: 23205332 PMCID: PMC3510417 DOI: 10.1007/s13555-012-0009-3] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Introduction The objective of this review was to conduct a systematic review with meta-analysis and Bayesian mixed treatment comparisons (MTC) evaluating the impact of biologics on non-Psoriasis Area and Severity Index (PASI) health outcomes in patients with moderate-to-severe plaque psoriasis. Methods MEDLINE and Cochrane Central Register of Controlled Trials were searched from 1966 to May 2009. Citations were screened for randomized, controlled trials of biologics versus either placebo or each other in adults with moderate-to-severe plaque psoriasis and reported any of several outcomes. Traditional and Bayesian MTC meta-analyses were conducted for each endpoint using either a random- or fixed-effect model where appropriate. Results Thirty-eight studies met eligibility criteria. All biologics showed significant improvement in achieving a good response on the static physician’s global assessment (PGA) versus placebo while, in the MTC, differences were noted between individual drugs. In achieving a good response on the dynamic PGA, all biologics showed significant improvements over placebo, while the MTC showed significant improvements with the anti-interleukins versus anti-T cells. Relative to placebo, antitumor necrosis factor (TNF) agents and anti-interleukins showed significant improvements in the Dermatology Life Quality Index (DLQI). Compared with placebo, the anti-TNF agents showed significant improvements in both 36-item Medical Outcomes Study Short-Form General Health Survey (SF-36) mental and physical component scores, while anti-T cell agents showed no improvements. The MTC showed no differences between any biologics for either the DLQI or SF-36. Conclusion Individual biologics and classes showed consistent benefits across non-PASI health outcomes in patients with moderate-to-severe plaque psoriasis while MTC meta-analyses suggested that some differences exist.
Collapse
|
13
|
Strand V, Sharp V, Koenig AS, Park G, Shi Y, Wang B, Zack DJ, Fiorentino D. Comparison of health-related quality of life in rheumatoid arthritis, psoriatic arthritis and psoriasis and effects of etanercept treatment. Ann Rheum Dis 2012; 71:1143-50. [PMID: 22258482 PMCID: PMC3375587 DOI: 10.1136/annrheumdis-2011-200387] [Citation(s) in RCA: 111] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Objectives To compare health-related quality of life (HRQoL) before and after treatment with etanercept in patients with moderate to severe rheumatoid arthritis (RA), psoriatic arthritis (PsA) and psoriasis using spydergram representations. Methods Data from randomised, controlled trials of etanercept in patients with RA, PsA and psoriasis were analysed. HRQoL was assessed by the medical outcomes survey short form 36 (SF-36) physical (PCS) and mental (MCS) component summary and domain scores. Baseline comparisons with age and gender-matched norms and treatment-associated changes in domain scores were quantified using spydergrams and the health utility SF-6D measure. Results Mean baseline PCS scores were lower than age and gender-matched norms in patients with RA and PsA, but near normative values in patients with psoriasis; MCS scores at baseline were near normal in PsA and psoriasis but low in RA. Treatment with etanercept resulted in improvements in PCS and MCS scores as well as individual SF-36 domains across all indications. Mean baseline SF-6D scores were higher in psoriasis than in RA or PsA; clinically meaningful improvements in SF-6D were observed in all three patient populations following treatment with etanercept. Conclusions Patients with RA, PsA and psoriasis demonstrated unique HRQoL profiles at baseline. Treatment with etanercept was associated with improvements in PCS and MCS scores as well as individual domain scores in patients with RA, PsA and psoriasis.
Collapse
Affiliation(s)
- Vibeke Strand
- Division of Immunology/Rheumatology, Stanford University, 306 Ramona Road, Portola Valley, CA 94028, USA.
| | | | | | | | | | | | | | | |
Collapse
|
14
|
Safikhani S, Sundaram M, Bao Y, Mulani P, Revicki DA. Qualitative assessment of the content validity of the Dermatology Life Quality Index in patients with moderate to severe psoriasis. J DERMATOL TREAT 2011; 24:50-9. [PMID: 22007701 DOI: 10.3109/09546634.2011.631980] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND The patient-reported Dermatology Life Quality Index (DLQI) measures the impact of dermatologic diseases on patients' lives. OBJECTIVES To evaluate the content validity of the DLQI in patients with moderate to severe plaque psoriasis. METHODS In a two-part interview, participants were first asked open-ended questions about the impact of psoriasis-related complaints and symptoms on their lives and activities. The DLQI was then administered and cognitive debriefing interviews assessed participants' understanding of the instructions, items, and response scales, and relevance of the specific items to their experience with psoriasis. RESULTS Twenty-one patients were interviewed at two US sites. Mean age was 48.8 years, 67% were white, and 43% reported Hispanic/Latino ethnicity. The majority reported living with a partner or spouse (81%) and working full time or part time (57%). Patients' spontaneous responses to open-ended questions were consistent with DLQI concepts and generally did not provide additional concepts. Most participants reported that the instructions, item content, and response scales were clear and easy to understand and relevant. CONCLUSIONS The content of the DLQI included all important and relevant concepts from the perspective of patients with moderate to severe plaque psoriasis. This study provides further support for the content validity of the DLQI in this population.
Collapse
Affiliation(s)
- Shima Safikhani
- United BioSource Corporation, Outcomes Research, Bethesda, MD, USA
| | | | | | | | | |
Collapse
|
15
|
Yüksek J, Sezer E, Aksu M, Erkokmaz U. Transcutaneous electrical nerve stimulation for reduction of pruritus in macular amyloidosis and lichen simplex. J Dermatol 2011; 38:546-52. [PMID: 21352317 DOI: 10.1111/j.1346-8138.2010.01081.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Lichen simplex (LS) is characterized by circumscribed, lichenified, pruritic patches that may develop on any part of the body. Macular amyloidosis (MA) is the form of primary localized cutaneous amyloidosis. Transcutaneous electrical nerve stimulation (TENS) uses a pulsed electric current generated transcutaneously by a device to cause impulses to be carried along large-diameter afferent nerves. In this article, we report the effects of TENS on the Dermatology Life Quality Index (DLQI) measures and visual analogue scale (VAS) scores in patients with pruritus, in whom LS and MA were diagnosed. All patients with MA and six (75%) patients with LS had relief of their pruritus with TENS therapy. At week 2, there was a significant difference in median VAS scores between baseline in the group of LS (P = 0.007). At 4 weeks of therapy, statistically significant differences were observed compared with the baseline and week 2 in the median VAS scores in the group of MA (P < 0.001). There was also a statistically significant improvement in median DLQI total scores with respect to baseline, which was achieved as early as week 2 in patients with LS and MA who were on the TENS treatment (P = 0.006, P = 0.001, respectively).
Collapse
Affiliation(s)
- Jale Yüksek
- Departments of Dermatology Medical History and Deontology Biostatistics, Gaziosmanpasa University School of Medicine, Tokat, Turkey.
| | | | | | | |
Collapse
|
16
|
Cox D, Brennan M, Moran N. Integrins as therapeutic targets: lessons and opportunities. Nat Rev Drug Discov 2010; 9:804-20. [PMID: 20885411 DOI: 10.1038/nrd3266] [Citation(s) in RCA: 358] [Impact Index Per Article: 25.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
The integrins are a large family of cell adhesion molecules that are essential for the regulation of cell growth and function. The identification of key roles for integrins in a diverse range of diseases, including cancer, infection, thrombosis and autoimmune disorders, has revealed their substantial potential as therapeutic targets. However, so far, pharmacological inhibitors for only three integrins have received marketing approval. This article discusses the structure and function of integrins, their roles in disease and the chequered history of the approved integrin antagonists. Recent advances in the understanding of integrin function, ligand interaction and signalling pathways suggest novel strategies for inhibiting integrin function that could help harness their full potential as therapeutic targets.
Collapse
Affiliation(s)
- Dermot Cox
- Molecular and Cellular Therapeutics, Royal College of Surgeons in Ireland, 123 St Stephens Green, Dublin 2, Ireland.
| | | | | |
Collapse
|
17
|
Laws PM, Young HS. Update of the management of chronic psoriasis: new approaches and emerging treatment options. Clin Cosmet Investig Dermatol 2010; 3:25-37. [PMID: 21437057 PMCID: PMC3047953 DOI: 10.2147/ccid.s6497] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2010] [Indexed: 01/01/2023]
Abstract
Psoriasis is a common, chronic inflammatory skin disease which is associated with a number of significant co-morbidities including: impairment of quality of life; cardiovascular disease; and a seronegative arthritis known as psoriatic arthritis. Our understanding of the pathogenesis of psoriasis has developed at a remarkable rate in recent years. These new insights have significantly changed our perception of the condition and have led to the development of several new treatment strategies. Biological agents have proved a major step forward in therapeutic options for psoriasis. The ability to clear, or almost clear, cutaneous disease has changed the outcomes and expectations of many patients with this disease. The impact on both physical and psychological health may be great. This review covers the clinical features and management of psoriasis with specific reference to new therapeutic options.
Collapse
Affiliation(s)
- Philip M Laws
- The University of Manchester, Manchester Bioscience and Academic Health Sciences Centre, Department of Dermatology, Salford Royal Hospital (Hope), Manchester, UK
| | | |
Collapse
|
18
|
Bissonnette R, Papp K, Maari C, Yao Y, Robbie G, White WI, Le C, White B. A randomized, double-blind, placebo-controlled, phase I study of MEDI-545, an anti-interferon-alfa monoclonal antibody, in subjects with chronic psoriasis. J Am Acad Dermatol 2010; 62:427-36. [PMID: 20159310 DOI: 10.1016/j.jaad.2009.05.042] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2008] [Revised: 05/13/2009] [Accepted: 05/14/2009] [Indexed: 10/19/2022]
Abstract
BACKGROUND Interferon-alfa (IFN-alpha) has been implicated in the pathogenesis of psoriasis. OBJECTIVE To evaluate the safety profile of MEDI-545, a fully human anti-IFN-alpha monoclonal antibody and to explore its effect on the involvement of type I IFN-alpha activity in the maintenance of established plaque psoriasis. METHODS We conducted an 18-week, randomized, double-blind, placebo-controlled, dose-escalating study in 36 subjects with chronic plaque psoriasis. Subjects received one intravenous dose of MEDI-545 (0.3-30.0 mg/kg) or placebo. Study outcomes were safety profile, pharmacokinetics, immunogenicity, and clinical effects. RESULTS There was no difference in adverse events between MEDI-545 and placebo. Two serious adverse events were reported; one drug-related hypotensive infusion reaction occurred in one subject in the 30.0 mg/kg MEDI-545 dose group, causing discontinuation of study drug in that subject and study dismissal of the other subjects in the same cohort; and a myocardial infarction occurred in one subject in the 10 mg/kg MEDI-545 dose group, which was considered to be unrelated to treatment. MEDI-545 was nonimmunogenic, had a half-life of 21 days, showed no significant inhibition of the type I IFN gene signature, and had no clinical activity. LIMITATIONS The study addressed only IFN-alpha and chronic psoriatic lesions. CONCLUSION The safety profile of MEDI-545 supports further clinical development. IFN-alpha does not appear to be significantly involved in the maintenance of established plaque psoriasis.
Collapse
|
19
|
Katsambas A, Peris K, Vena G, Freidmann P, Wozel G, Daudén E, Licu D, Placchi M, De La Brassinne M. Assessing the Impact of Efalizumab on Nail, Scalp and Palmoplantar Psoriasis and on Quality of Life: Results from a Multicentre, Open-label, Phase IIIb/IV Trial. ACTA ACUST UNITED AC 2009; 2:66-70. [PMID: 20098509 PMCID: PMC2805869 DOI: 10.1111/j.1753-5174.2009.00023.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
This post-approval, open-label trial (n = 1266) assessed the efficacy of efalizumab, administered in accordance with the European label at that time, in patients with concomitant nail, scalp or palmoplantar psoriasis. Patients received subcutaneous efalizumab 1.0 mg/kg weekly for up to 20 weeks. By Week 12, an improvement from baseline of 50% or more was observed in 21.4% (181/844) of patients with nail psoriasis, 62.4% (718/1150) of patients with scalp psoriasis, and 51.4% (127/247) of patients with palmoplantar psoriasis. Quality of life improved throughout the trial, with a 50% median improvement in DLQI score after 12 weeks of treatment. Efalizumab showed promising efficacy in the treatment of nail, scalp and palmoplantar psoriasis, which was reflected in improvements in quality of life.
Collapse
|
20
|
Abstract
Psoriasis is a chronic inflammatory hyperproliferative disease of the skin, scalp, nails, and joints. The physical symptoms of psoriasis include itching, irritation, burning/stinging, sensitivity, and pain. Patients also suffer psychological distress, especially as a result of stigmatization, self-consciousness, and embarrassment, which can in turn affect employment and social activities. Relatively high rates of depression are reported in patients with psoriasis. Inflammatory cytokines such as tumor necrosis factor alpha, interferon gamma, and other type 1 cytokines play an important role in the pathogenesis and comorbidities of psoriasis. Data from both animal and human studies suggest that these cytokines are linked to depression. Some psoriasis treatments have demonstrated improvements in symptoms of psoriasis as well as in measures of depression and health-related quality of life. Physicians managing patients with psoriasis must be aware of the psychological effects of psoriasis and need to use a multifaceted approach to managing this disease, focusing on both the physical and psychological aspects.
Collapse
Affiliation(s)
- Abby S Van Voorhees
- Psoriasis and Phototherapy Treatment Center, University of Pennsylvania, Dept of Dermatology, Philadelphia, PA 19104, USA.
| | | |
Collapse
|
21
|
Revicki DA, Willian MK, Menter A, Gordon KB, Kimball AB, Leonardi CL, Langley RG, Kimel M, Okun M. Impact of adalimumab treatment on patient‐reported outcomes: Results from a Phase III clinical trial in patients with moderate to severe plaque psoriasis. J DERMATOL TREAT 2009; 18:341-50. [DOI: 10.1080/09546630701646172] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
|
22
|
Lynde C. Use of biologic therapeutics in difficult-to-treat psoriasis. J Cutan Med Surg 2009; 13:6-17. [PMID: 19298766 DOI: 10.2310/7750.2008.08002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND A need for improved psoriasis management drove the development of four biologicals now approved for use in moderate to severe psoriasis: alefacept, efalizumab, etanercept, and infliximab. OBJECTIVE This review compares the recommended and practical use of biologicals in "difficult-to-treat" psoriasis. Difficult-to-treat patients, a subpopulation of particular interest to caregivers and regulators, are those for whom conventional options are unavailable, contraindicated, intolerable, or ineffective. CONCLUSIONS Despite guidance recommending that biologicals be considered among first-line antipsoriasis treatments, formulary inclusion may be influenced by the biologicals' success in controlling difficult-to-treat psoriasis. Findings from the Clinical Experience Acquired with Raptiva (CLEAR) randomized controlled trial (RCT) established efalizumab's equal efficacy in difficult-to-treat and moderate to severe psoriasis. The CLEAR data were cited in support of a regulatory recommendation to include efalizumab in Canadian provincial formularies. For some other biologicals, evidence regarding efficacy in difficult-to-treat psoriasis remains equivocal. Additional RCTs are needed to define appropriate roles for specific biologicals in difficult-to-treat patients.
Collapse
Affiliation(s)
- Charles Lynde
- Department of Medicine, University of Toronto, Toronto, ON.
| |
Collapse
|
23
|
Farhi D, Dupin N. [Biologic therapies in the treatment of psoriasis]. Presse Med 2009; 38:832-43. [PMID: 19282134 DOI: 10.1016/j.lpm.2008.07.023] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2008] [Revised: 06/20/2008] [Accepted: 07/02/2008] [Indexed: 12/23/2022] Open
Abstract
Psoriasis impairs significantly the quality of life. Systemic treatments have inconstant efficiency and dose-dependant toxicity. Since 2004, four biologic therapies - infliximab, etanercept, éfalizumab and adalimumab - are approved in Europe for the treatment of moderate to severe psoriasis, with failure, intolerance or contra-indication to at least 2 "classical" systemic treatments, including phototherapy, methotrexate and ciclosporin. The estimated rate of patients reaching PASI75 at month 3 are as follow: about 80% under infliximab (classical W0-W2-W6 regimen); about 33% and 50% under etanercept, respectively, 25 and 50mg, twice weekly; about 25% under éfalizumab (1mg/kg, weekly); about 70% under adalimumab (40mg, every other week). The 12-month efficiency of biologic therapies in psoriasis is poorly documented. The long term (5-year or more) safety of biologic therapies is not documented. New biologic therapies are under investigation in the treatment of psoriasis: ustekinumab (CNTO-1275), ABT-874, certolizumab (CDP-870), golimumab (CNTO-148). Ustekinumab is approved in Europe since January 2009.
Collapse
Affiliation(s)
- David Farhi
- Service de dermatologie et de vénéréologie, Pavillon Tarnier, Hôpital Cochin, AP-HP, Université René Descartes, F-75006 Paris, France.
| | | |
Collapse
|
24
|
Zhang Z, Schmitt J, Wozel G, Kirch W. Behandlung der Plaque-Psoriasis mit Biologics. ACTA ACUST UNITED AC 2009; 104:125-36. [DOI: 10.1007/s00063-009-1024-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2008] [Accepted: 09/18/2008] [Indexed: 11/28/2022]
|
25
|
Naldi L, Rzany B. Psoriasis (chronic plaque). BMJ CLINICAL EVIDENCE 2009; 2009:1706. [PMID: 19445765 PMCID: PMC2907770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
INTRODUCTION Psoriasis affects 1-3% of the population, in some people causing changes to the nails and joints in addition to skin lesions. METHODS AND OUTCOMES We conducted a systematic review and aimed to answer the following clinical questions: What are the effects of systemic drug treatments, topical drug treatments, and non-drug treatments (other than ultraviolet light) for chronic plaque psoriasis? What are the effects of ultraviolet light treatments for chronic plaque psoriasis? What are the effects of combined treatment with drugs plus ultraviolet light on chronic plaque psoriasis? What are the effects of combined systemic plus topical drug treatments for chronic plaque psoriasis? We searched: Medline, Embase, The Cochrane Library, and other important databases up to August 2007 (Clinical Evidence reviews are updated periodically; please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA). RESULTS We found 122 systematic reviews, RCTs, or observational studies that met our inclusion criteria. We performed a GRADE evaluation of the quality of evidence for interventions. CONCLUSIONS In this systematic review we present information relating to the effectiveness and safety of the following interventions: acupuncture, adding calcipotriol (topical) to psoralen plus ultraviolet light A or ultraviolet light B, adding oral retinoids to psoralen plus ultraviolet A (PUVA), alefacept, balneotherapy, ciclosporin, dithranol, T cell-targeted therapies, cytokine blocking agents, emollients (alone or plus ultraviolet light B), etanercept, fish oil supplementation, fumaric acid derivatives, Goeckerman treatment, heliotherapy, infliximab, Ingram regimen, keratolytics (salicylic acid, urea), leflunomide, methotrexate, oral pimecrolimus, phototherapy plus balneotherapy, psoralen plus ultraviolet A, psychotherapy, oral retinoids (alone or with ultraviolet light B), systemic drug treatments plus topical vitamin D derivatives, tars, tazarotene, topical corticosteroids (alone or plus oral retinoids), topical Vitamin D derivatives, ultraviolet light A, and ultraviolet light B.
Collapse
|
26
|
Frampton JE, Plosker GL. Efalizumab: a review of its use in the management of chronic moderate-to-severe plaque psoriasis. Am J Clin Dermatol 2009; 10:51-72. [PMID: 19170413 DOI: 10.2165/0128071-200910010-00009] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
Efalizumab (Raptiva) is a recombinant, humanized, monoclonal antibody that targets CD11a, the alpha-subunit of the heterodimeric lymphocyte surface protein lymphocyte function-associated antigen-1 (LFA-1). It is approved for the treatment of adult patients (aged > or = 18 years) with chronic moderate-to-severe plaque psoriasis who are candidates for systemic therapy or phototherapy (in the US), or who have failed to respond to, have a contraindication to, or are intolerant of, other systemic therapies, including cyclosporine (ciclosporin), methotrexate, and psoralen plus UVA photochemotherapy (in the EU). Weekly subcutaneous injections of efalizumab are effective and generally well tolerated in the treatment of adults with chronic moderate-to-severe plaque psoriasis, including high-need individuals (i.e. those for whom at least two currently available systemic therapies are unsuitable due to lack of efficacy, intolerance, or contraindication), and patients with difficult-to-treat forms of the disease affecting the scalp, hands/feet, or nails. Clinical improvements are maintained, with no evidence of cumulative or end-organ toxicity, during continuous administration of efalizumab for up to 3 years; 4-, 5-, and 7-year safety data are being collected. The therapeutic profile of efalizumab cannot be directly compared with that of other antipsoriasis agents because of a lack of head-to-head comparative studies. Nonetheless, a considerable body of data indicates that efalizumab is an appropriate alternative to other biologic or nonbiologic therapies for the treatment of chronic moderate-to-severe plaque psoriasis that, additionally, offers the potential convenience of self-injection at home.
Collapse
Affiliation(s)
- James E Frampton
- Wolters Kluwer Health/Adis, 41 Centorian Drive, Private Bag 65901, Mairangi Bay, North Shore 0754, Auckland, New Zealand.
| | | |
Collapse
|
27
|
Toth DP, Papp K, Gratton D. Long-term efficacy of up to 15 months’ efalizumab therapy in patients with moderate-to-severe chronic plaque psoriasis. Dermatol Ther 2008; 21 Suppl 3:S6-14. [DOI: 10.1111/j.1529-8019.2008.00235.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
|
28
|
Basra MKA, Fenech R, Gatt RM, Salek MS, Finlay AY. The Dermatology Life Quality Index 1994-2007: a comprehensive review of validation data and clinical results. Br J Dermatol 2008; 159:997-1035. [PMID: 18795920 DOI: 10.1111/j.1365-2133.2008.08832.x] [Citation(s) in RCA: 254] [Impact Index Per Article: 15.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND The Dermatology Life Quality Index (DLQI) is one of the most widely used dermatology-specific quality of life instruments. Over the last 5 years there has been great interest in its use. OBJECTIVES To collect and present all information regarding the technical properties and the clinical use of the DLQI from the date it was published to the end of 2007 for use as a single source of reference. METHODS A detailed literature search was conducted using electronic reference databases and the DLQI library in the Department of Dermatology, Cardiff University. All publications mentioning any aspect of the DLQI, from the time of its development to the end of 2007, were identified and the data concerning the DLQI in terms of its psychometric analysis, and use in clinical trials, epidemiological studies and health services research, were extracted and tabulated with all the relevant references. RESULTS In total, 272 full articles which have included the DLQI were reviewed. Studies described in these articles were divided into five main categories: psychometric studies, descriptive/epidemiological studies, drug (topical and systemic) trials, clinical practice research, and therapeutic interventions. The DLQI has been used in 33 different skin conditions in 32 countries and is available in 55 languages. Psychometric aspects of the DLQI such as validity, reliability, responsiveness to change, factor structure, and minimal important difference were described in 115 studies. The DLQI has been used in 33 studies assessing the effectiveness of 14 different types of therapeutic interventions and in 37 studies evaluating nine types of clinical practice research. Sixty studies have used it alone or in parallel with other instruments as an outcome measure in clinical trials of 18 systemic drugs while 22 studies have used it in 14 different topical drug trials. The DLQI has also been used in 27 multinational studies. CONCLUSIONS During the last 14 years there has been a gradual increase in the international use of the DLQI. The brevity and simplicity of use of the DLQI has resulted in its popularity both in clinical practice and in research. However, there are various issues in particular regarding its unidimensionality, differential item functioning, and minimal clinically important difference, which require further research. This article should facilitate the work of potential users of the DLQI by providing a readily available source of references for different aspects of the DLQI.
Collapse
Affiliation(s)
- M K A Basra
- Department of Dermatology, School of Medicine, Cardiff University, Heath Park, Cardiff CF14 4XN, U.K.
| | | | | | | | | |
Collapse
|
29
|
Schmitt J, Zhang Z, Wozel G, Meurer M, Kirch W. Efficacy and tolerability of biologic and nonbiologic systemic treatments for moderate-to-severe psoriasis: meta-analysis of randomized controlled trials. Br J Dermatol 2008; 159:513-26. [DOI: 10.1111/j.1365-2133.2008.08732.x] [Citation(s) in RCA: 146] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
30
|
|
31
|
Menter A, Gottlieb A, Feldman SR, Van Voorhees AS, Leonardi CL, Gordon KB, Lebwohl M, Koo JYM, Elmets CA, Korman NJ, Beutner KR, Bhushan R. Guidelines of care for the management of psoriasis and psoriatic arthritis: Section 1. Overview of psoriasis and guidelines of care for the treatment of psoriasis with biologics. J Am Acad Dermatol 2008; 58:826-50. [PMID: 18423260 DOI: 10.1016/j.jaad.2008.02.039] [Citation(s) in RCA: 907] [Impact Index Per Article: 56.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2008] [Revised: 02/27/2008] [Accepted: 02/28/2008] [Indexed: 10/22/2022]
Abstract
Psoriasis is a common, chronic, inflammatory, multisystem disease with predominantly skin and joint manifestations affecting approximately 2% of the population. In this first of 5 sections of the guidelines of care for psoriasis, we discuss the classification of psoriasis; associated comorbidities including autoimmune diseases, cardiovascular risk, psychiatric/psychologic issues, and cancer risk; along with assessment tools for skin disease and quality-of-life issues. Finally, we will discuss the safety and efficacy of the biologic treatments used to treat patients with psoriasis.
Collapse
Affiliation(s)
- Alan Menter
- Baylor University Medical Center, Dallas, Texas, USA
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
32
|
Kwan JM, Reese AM, Trafeli JP. Delayed autoimmune hemolytic anemia in efalizumab-treated psoriasis. J Am Acad Dermatol 2008; 58:1053-5. [PMID: 18328597 DOI: 10.1016/j.jaad.2008.01.021] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2007] [Revised: 12/19/2007] [Accepted: 01/27/2008] [Indexed: 11/25/2022]
Abstract
Efalizumab, a humanized anti-CD11a monoclonal antibody, has been shown to treat plaque psoriasis. A known association between this drug and autoimmune thrombocytopenia has already been established. More recently publicized, however, is efalizumab's ability to affect another cell line--that of the erythrocyte--and cause an autoimmune hemolytic anemia that typically occurs 4 to 6 months after initiating therapy. In this article, we report the case of a patient who developed autoimmune hemolytic anemia after 8 months of successful treatment with efalizumab. His delayed presentation suggests that monitoring of blood cell counts longer than 6 months may be warranted.
Collapse
Affiliation(s)
- Julia M Kwan
- Graduate Medical Education, Clinical Investigation Department, Naval Medical Center San Diego, San Diego, CA 92134, USA.
| | | | | |
Collapse
|
33
|
Tsai TF, Liu MT, Liao YH, Licu D. Clinical effectiveness and safety experience with efalizumab in the treatment of patients with moderate-to-severe plaque psoriasis in Taiwan: results of an open-label, single-arm pilot study. J Eur Acad Dermatol Venereol 2008; 22:345-52. [DOI: 10.1111/j.1468-3083.2007.02430.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
34
|
Revicki DA, Willian MK, Menter A, Saurat JH, Harnam N, Kaul M. Relationship between Clinical Response to Therapy and Health-Related Quality of Life Outcomes in Patients with Moderate to Severe Plaque Psoriasis. Dermatology 2008; 216:260-70. [DOI: 10.1159/000113150] [Citation(s) in RCA: 86] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2007] [Accepted: 09/13/2007] [Indexed: 11/19/2022] Open
|
35
|
Nelson AA, Pearce DJ, Fleischer AB, Balkrishnan R, Feldman SR. Cost-effectiveness of biologic treatments for psoriasis based on subjective and objective efficacy measures assessed over a 12-week treatment period. J Am Acad Dermatol 2008; 58:125-35. [DOI: 10.1016/j.jaad.2007.09.018] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2004] [Revised: 09/09/2007] [Accepted: 09/20/2007] [Indexed: 11/25/2022]
|
36
|
Revicki D, Willian M, Saurat JH, Papp K, Ortonne JP, Sexton C, Camez A. Impact of adalimumab treatment on health-related quality of life and other patient-reported outcomes: results from a 16-week randomized controlled trial in patients with moderate to severe plaque psoriasis. Br J Dermatol 2007; 158:549-57. [DOI: 10.1111/j.1365-2133.2007.08236.x] [Citation(s) in RCA: 121] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
|
37
|
Le Cleach L, Chassany O, Levy A, Wolkenstein P, Chosidow O. Poor Reporting of Quality of Life Outcomes in Dermatology Randomized Controlled Clinical Trials. Dermatology 2007; 216:46-55. [DOI: 10.1159/000109358] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2007] [Accepted: 05/25/2007] [Indexed: 11/19/2022] Open
|
38
|
Isaacs JD. T cell immunomodulation--the Holy Grail of therapeutic tolerance. Curr Opin Pharmacol 2007; 7:418-25. [PMID: 17611158 DOI: 10.1016/j.coph.2007.05.001] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2007] [Accepted: 05/01/2007] [Indexed: 01/06/2023]
Abstract
The concept and practice of therapeutic tolerance has successfully been applied to animal models of autoimmunity and transplantation for more than 2 decades. Finally, there are encouraging signs of its translation to clinical practice. Short courses of anti-CD3 monoclonal antibody therapy have provided lasting benefits in recent-onset type 1 diabetes in association with evidence for the induction of immunoregulatory mechanisms. Co-stimulation blockade with abatacept (CTLA4-Ig) will soon be licensed for the treatment of rheumatoid arthritis - over the past year phase III studies have demonstrated impressive improvement in subjective and objective signs of the disease. T cell depletion is in development for several conditions, again with recent studies demonstrating evidence of immune regulation in some instances. More specific antigen-directed peptide therapies have also been applied to atopic asthma, type 1 diabetes, and adult and juvenile arthritis. The tragic sequelae of the phase I trial of TGN1412 at Northwick Park demonstrated the delicate, but unpredictable, therapeutic ratio of some T-cell-directed treatments and, in the UK, have led to new guidelines for early-phase clinical trials of immune-directed therapies.
Collapse
Affiliation(s)
- John D Isaacs
- Wilson Horne Immunotherapy Centre and Musculoskeletal Research Group, Institute of Cellular Medicine, Catherine Cookson Building, Framlington Place, Newcastle-upon-Tyne NE2 4HH, United Kingdom.
| |
Collapse
|
39
|
Katugampola RP, Lewis VJ, Finlay AY. The Dermatology Life Quality Index: assessing the efficacy of biological therapies for psoriasis. Br J Dermatol 2007; 156:945-50. [PMID: 17388922 DOI: 10.1111/j.1365-2133.2007.07817.x] [Citation(s) in RCA: 62] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Clinical trials show improvement in physical and health-related quality of life (HRQoL) measures in patients with psoriasis treated with biologics compared with placebo. However, these reports only give limited interpretation of the meaning of Dermatology Life Quality Index (DLQI) scores and provide limited comparison data. OBJECTIVES The aim of this paper is to identify which biological therapy provides the greatest improvement in HRQoL following treatment of patients with chronic plaque psoriasis, as assessed by the DLQI. METHODS We reviewed all data published up to August 2006 of randomized placebo-controlled trials (RCTs) of the four biologics currently licensed in some countries for clinical use in chronic plaque psoriasis (alefacept, efalizumab, etanercept and infliximab) which have used the DLQI as an outcome measure. The DLQI data were assessed based on overall improvement according to the DLQI descriptor bands and on clinically meaningful improvement of > or = 5. RESULTS Fifteen peer-reviewed articles and 59 abstracts describing 11 multicentre, double-blind RCTs were reviewed. Treatment with any one of the four biologics led to a clinically meaningful improvement in the DLQI of > or = 5. However, when applying the DLQI banding concept, infliximab and etanercept provided the greatest improvement in the overall HRQoL from a 'very large effect on overall HRQoL' at baseline to 'a small effect on overall HRQoL' following treatment. CONCLUSIONS The DLQI banding concept provides a further tool to assess the impact of biologics on HRQoL of patients with psoriasis. Based on retrospective application of DLQI bands to published RCT data, infliximab, followed by etanercept, showed the greatest improvement in the overall HRQoL paralleled by a 75% improvement in the Psoriasis Area and Severity Index. However, some publications did not provide absolute baseline DLQI values, making interpretation of data and comparison between the agents difficult. Side-to-side comparative studies between biologics and between biologics and nonbiological psoriasis treatments will aid evidence-based psoriasis management decisions in the future.
Collapse
Affiliation(s)
- R P Katugampola
- Department of Dermatology, School of Medicine, Cardiff University, Heath Park, Cardiff, UK.
| | | | | |
Collapse
|
40
|
|
41
|
Abstract
Efalizumab (Raptiva, Serono) is a humanised monoclonal antibody (IgG1) produced by biotechnology. This antibody has a novel place among biotherapies for psoriasis. It is bound to the CD11a subunit of a surface molecule of the T lymphocyte LFA-1 (Leucocyte Function-associated Antigen-1). This molecule is essential for binding of T lymphocytes to the ICAM-1 molecule (Intercellular Adhesion Molecule-1) found on antigen-presenting cells, endothelial cells and keratinocytes. Binding of efalizumab to CD11a prevents binding of LFA-1 to ICAM-1, thus inhibiting several steps in the immunological process responsible for formation of psoriatic plaque (activation of naive T lymphocytes to memory T lymphocytes, lymphocyte migration and reactivation of T lymphocytes in skin). Efalizumab was approved in the United States by the FDA (Food and Drug Administration) in 2003 for the treatment of moderate-to-severe psoriasis requiring systemic therapy. It may be used as first-line therapy in the United States in this indication. In France, marketing authorisation (MA) was granted more recently in September 2005. The indications are moderate-to-severe cutaneous plaque psoriasis in adults in cases of failure, intolerance or contraindication of at least two systemic treatments including phototherapy, methotrexate and cyclosporine. Current clinical trial data is available for 3500 patients with plaque psoriasis. A 75% improvement in PASI score was seen in between 22 and 39% of patients treated with efalizumab (vs. 2 to 5% for patients on placebo) in a single weekly subcutaneous injection (1 mg/kg). A study in good responders confirms the continuing long-term efficacy of prescription of the drug up to 36 months (with at least a 75% improvement in PASI score in 53% of patients). However, it is not effective against joint involvement in psoriasis. The most common side-effects (incidence >1/100) are influenza-like syndrome, risk of outbreak of cutaneous psoriasis during or after discontinuation of treatment, worsening of arthralgia, minor hypersensitivity reactions, reversible changes in laboratory values (hyperlymphocytosis, elevated alkaline phosphatases and transaminases). Because of rare cases of thrombocytopenia (incidence<1/100), reversible on discontinuation of treatment, monthly monitoring of platelet counts is required over the first 3 months of therapy. There are currently no randomised studies comparing the various systemic treatments (standard therapy and biotherapy) for psoriasis. However, on extrapolation of the available results concerning efficacy (PASI-75 after 12 weeks of treatment), efalizumab appears to be less efficacious than anti-TNF alpha agents. This drug constitutes an additional treatment option and its position in the therapeutic arsenal will depend upon its long-term benefit/risk ratio in relation to other biotherapies.
Collapse
Affiliation(s)
- V Descamps
- Université Paris VII Denis-Diderot, Service de Dermatologie, Hôpital Bichat Claude Bernard, APHP, 75018 Paris, France.
| |
Collapse
|
42
|
Abstract
A number of different studies have shown a clear reduction in the quality of life of hepatitis C virus (HCV)-related liver-disease patients. Quality of life can be assessed by means of both generic and specific instruments, depending on the aim of the study and the population being studied. The application of a specific instrument to patients with liver diseases provides a broader assessment of different parameters related to hepatic disorders. In hepatitis C, alterations such as the stigma of liver disease, concerns about the disease and symptoms of the disease could be demonstrated with this type of instrument. The impact of the diagnosis of hepatitis C, a potentially serious disease, and the presence of comorbidities such as alcohol and drugs may lead to lower quality of life. Longitudinal studies have proved that, following diagnosis, the stigma of liver disease becomes more apparent over time. Women report worse quality of life than men, supporting that gender differences in hepatitis are also important when assessing quality of life. Alterations in the quality of life of patients submitted to treatment are mainly related to the somatic side effects of Interferon and Ribavirin and are most noticeable in the first weeks of therapy. Early improvement in the quality of life of patients who become HCV-RNA negative suggests that the virus itself plays a biological role. There is no doubt that liver transplantation leads to an improvement in quality of life. Nevertheless, a major concern is the relapse of HCV, with the associated lower quality of life.
Collapse
Affiliation(s)
- Edna Strauss
- Department of Pathology, School of Medicine, University of São Paulo, SP, Brazil.
| | | |
Collapse
|
43
|
Bhosle MJ, Kulkarni A, Feldman SR, Balkrishnan R. Quality of life in patients with psoriasis. Health Qual Life Outcomes 2006; 4:35. [PMID: 16756666 PMCID: PMC1501000 DOI: 10.1186/1477-7525-4-35] [Citation(s) in RCA: 194] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2006] [Accepted: 06/06/2006] [Indexed: 12/22/2022] Open
Abstract
Psoriasis is one of the prevalent skin conditions in the United States. This chronic condition has a significant negative impact on patients' quality of life. Psoriasis has been linked to the depression and suicidal tendencies in the patients. The costs associated with decrements in quality of life, lost productivity, and work absenteeism may be enormous, increasing overall costs associated with the disease management. This review attempts to outline different quality of life measures available for psoriasis and describes their use in studies examining patient reported outcomes associated with pharmacological interventions for psoriasis. Factors associated with quality of life in psoriasis patients are described. It further describes physician's role in the psoriasis management to improve patients' overall well-being.
Collapse
Affiliation(s)
- Monali J Bhosle
- Ohio State University College of Pharmacy and School of Public Health, 500 W. 12th Avenue, Columbus, OH 43210, USA
| | - Amit Kulkarni
- Ohio State University College of Pharmacy and School of Public Health, 500 W. 12th Avenue, Columbus, OH 43210, USA
| | - Steven R Feldman
- Center for Dermatology Research, Department of Dermatology, Wake Forest University School of Medicine, Medical Center Boulevard, Winston-Salem, North Carolina, 27157-1071, USA
| | - Rajesh Balkrishnan
- Ohio State University College of Pharmacy and School of Public Health, 500 W. 12th Avenue, Columbus, OH 43210, USA
| |
Collapse
|