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Battista T, Scalvenzi M, Martora F, Potestio L, Megna M. Nail Psoriasis: An Updated Review of Currently Available Systemic Treatments. Clin Cosmet Investig Dermatol 2023; 16:1899-1932. [PMID: 37519941 PMCID: PMC10378542 DOI: 10.2147/ccid.s417679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Accepted: 07/08/2023] [Indexed: 08/01/2023]
Abstract
Background Nail psoriasis (NP) has a prevalence that ranges from 10 to 82% among patients with psoriasis (PsO) and is one of the most common difficult to treat site of psoriasis. We performed a thorough review of the literature, exploring evidence regarding all available NP systemic treatments, describing also in detail NP dedicated clinical trials. Methods A literature search was conducted in PubMed and Embase prior to February 2023 using a combination of the terms "nail" AND "psoriasis" AND "systemic therapy" AND/OR "systemic treatment". A total of 47 original studies and case reports were reviewed in this article. Results Systemic therapies should be considered when the disorder involves more than 3 nails, has extensive skin and joint involvement, and has a significant impact on QoL, due to their best long-term efficacy. In detail, conventional and biologic systemic drugs demonstrated efficacy in recent trials, including acitretin, methotrexate, cyclosporine, apremilast, adalimumab, infliximab, etanercept, certolizumab, golimumab, ustekinumab, secukinumab, ixekizumab, brodalumab, bimekizumab, guselkumab, risankizumab and tildrakizumab. Conclusion Several therapies have demonstrated efficacy and safety in the treatment of NP; however, the choice of treatment depends not only on the severity of the nail involvement, but also on whether PsA is present, the patient's comorbidities other than PsA, previous treatment history, and the patient's drug preferences.
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Affiliation(s)
- Teresa Battista
- Section of Dermatology, Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Massimiliano Scalvenzi
- Section of Dermatology, Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Fabrizio Martora
- Section of Dermatology, Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Luca Potestio
- Section of Dermatology, Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Matteo Megna
- Section of Dermatology, Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
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2
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Abstract
Significance: Central nervous system (CNS) diseases are disorders of the brain and/or spinal cord and include neurodegenerative diseases such as Alzheimer's disease, Parkinson's disease, and multiple sclerosis. Nuclear factor erythroid 2-related factor 2 (NRF2) is a transcription factor belonging to the cap-n-collar family that harbors a unique basic leucine zipper motif and plays as a master regulator of homeostatic responses. Recent Advances: Kelch-like ECH-associated protein 1 (KEAP1) is an adaptor of the Cullin3 (CUL3)-based ubiquitin E3 ligase that enhances the ubiquitylation of NRF2, which promotes the degradation of NRF2 to suppress its transcriptional activity in the absence of stress. Cysteine residues of KEAP1 are modified under stress conditions, and NRF2 degradation is attenuated, allowing it to accumulate and induce the expression of target genes. This regulatory system is referred to as the KEAP1-NRF2 system and plays a central role in protecting cells against various stresses. NRF2 also negatively regulates the expression of inflammatory cytokine and chemokine genes and suppresses pathological inflammation. As oxidative stress, inflammation, and proteostasis are known to contribute to neurodegenerative diseases, the KEAP1-NRF2 system is an attractive target for the treatment of these diseases. Critical Issues: In mouse models of neurodegenerative diseases, Nrf2 depletion exacerbates symptoms and enhances oxidative damage and inflammation in the CNS. In contrast, chemical or genetic NRF2 activation improves these symptoms. Indeed, the NRF2-activating chemical dimethyl fumarate is now widely used for the clinical treatment of MS. Future Directions: The KEAP1-NRF2 system is a promising therapeutic target for neurodegenerative diseases.
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Affiliation(s)
- Akira Uruno
- Department of Integrative Genomics, Tohoku Medical Megabank Organization, Tohoku University, Sendai, Japan.,Department of Medical Biochemistry, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Masayuki Yamamoto
- Department of Integrative Genomics, Tohoku Medical Megabank Organization, Tohoku University, Sendai, Japan.,Department of Medical Biochemistry, Tohoku University Graduate School of Medicine, Sendai, Japan
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3
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Polymeric Nanoparticles as Tunable Nanocarriers for Targeted Delivery of Drugs to Skin Tissues for Treatment of Topical Skin Diseases. Pharmaceutics 2023; 15:pharmaceutics15020657. [PMID: 36839979 PMCID: PMC9964857 DOI: 10.3390/pharmaceutics15020657] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Revised: 02/05/2023] [Accepted: 02/07/2023] [Indexed: 02/18/2023] Open
Abstract
The topical route is the most appropriate route for the targeted delivery of drugs to skin tissues for the treatment of local skin diseases; however, the stratum corneum (SC), the foremost layer of the skin, acts as a major barrier. Numerous passive and active drug delivery techniques have been exploited to overcome this barrier; however, these modalities are associated with several detrimental effects which restrict their clinical applicability. Alternatively, nanotechnology-aided interventions have been extensively investigated for the topical administration of a wide range of therapeutics. In this review, we have mainly focused on the biopharmaceutical significance of polymeric nanoparticles (PNPs) (made from natural polymers) for the treatment of various topical skin diseases such as psoriasis, atopic dermatitis (AD), skin infection, skin cancer, acute-to-chronic wounds, and acne. The encapsulation of drug(s) into the inner core or adsorption onto the shell of PNPs has shown a marked improvement in their physicochemical properties, avoiding premature degradation and controlling the release kinetics, permeation through the SC, and retention in the skin layers. Furthermore, functionalization techniques such as PEGylation, conjugation with targeting ligand, and pH/thermo-responsiveness have shown further success in optimizing the therapeutic efficacy of PNPs for the treatment of skin diseases. Despite enormous progress in the development of PNPs, their clinical translation is still lacking, which could be a potential future perspective for researchers working in this field.
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4
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Rosendahl J, Zarna C, Håkansson J, Chinga-Carrasco G. Gene-Expression Analysis of Human Fibroblasts Affected by 3D-Printed Carboxylated Nanocellulose Constructs. BIOENGINEERING (BASEL, SWITZERLAND) 2023; 10:bioengineering10010121. [PMID: 36671693 PMCID: PMC9854960 DOI: 10.3390/bioengineering10010121] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 01/12/2023] [Accepted: 01/13/2023] [Indexed: 01/18/2023]
Abstract
Three-dimensional (3D) printing has emerged as a highly valuable tool to manufacture porous constructs. This has major advantages in, for example, tissue engineering, in which 3D scaffolds provide a microenvironment with adequate porosity for cell growth and migration as a simulation of tissue regeneration. In this study, we assessed the suitability of three cellulose nanofibrils (CNF) that were obtained through 2,2,6,6-tetramethylpyperidine-1-oxyl (TEMPO)-mediated oxidation. The CNFs were obtained by applying three levels of carboxylation, i.e., 2.5, 3.8, and 6.0 mmol sodium hypochlorite (NaClO) per gram of cellulose. The CNFs exhibited different nanofibrillation levels, affecting the corresponding viscosity and 3D printability of the CNF gels (0.6 wt%). The scaffolds were manufactured by micro-extrusion and the nanomechanical properties were assessed with nanoindentation. Importantly, fibroblasts were grown on the scaffolds and the expression levels of the marker genes, which are relevant for wound healing and proliferation, were assessed in order to reveal the effect of the 3D-scaffold microenvironment of the cells.
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Affiliation(s)
- Jennifer Rosendahl
- Unit of Biological Function, Division Materials and Production, RISE Research Institutes of Sweden, P.O. Box 857, SE-50115 Borås, Sweden
| | - Chiara Zarna
- RISE PFI, Høgskoleringen 6b, 7491 Trondheim, Norway
| | - Joakim Håkansson
- Unit of Biological Function, Division Materials and Production, RISE Research Institutes of Sweden, P.O. Box 857, SE-50115 Borås, Sweden
- Department of Laboratory Medicine, Institute of Biomedicine, Gothenburg University, P.O. Box 440, SE-40530 Gothenburg, Sweden
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5
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Merzel Šabović EK, Starbek Zorko M, Janić M. Killing Two Birds with One Stone: Potential Therapies Targeting Psoriasis and Atherosclerosis at the Same Time. Int J Mol Sci 2022; 23:ijms23126648. [PMID: 35743091 PMCID: PMC9224172 DOI: 10.3390/ijms23126648] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Revised: 06/10/2022] [Accepted: 06/12/2022] [Indexed: 01/27/2023] Open
Abstract
Psoriasis is a chronic systemic inflammatory disease. Due to systemic inflammation, it is associated with many comorbidities. Among them, cardiovascular diseases represent the most common causes of morbidity and mortality in this population. Therefore, physicians treating patients with psoriasis should keep in mind that, as important as the treatment of psoriasis, awareness of cardiovascular risk deserves additional attention. Thus, in parallel with psoriasis treatment, a cardiovascular risk assessment must also be performed and addressed accordingly. In addition to encouraging non-pharmacologic strategies for a healthy lifestyle, physicians should be familiar with different pharmacologic options that can target psoriasis and reduce cardiovascular risk. In the present article, we present the pathophysiological mechanisms of the psoriasis and cardiometabolic interplay, our view on the interaction of psoriasis and cardiovascular disease, review the atherosclerotic effect of therapeutic options used in psoriasis, and vice versa, i.e., what the effect of medications used in the prevention of atherosclerosis could be on psoriasis.
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Affiliation(s)
- Eva Klara Merzel Šabović
- Department of Dermatovenerology, University Medical Centre Ljubljana, Gradiškova Ulica 10, SI-1000 Ljubljana, Slovenia;
- Faculty of Medicine, University of Ljubljana, Vrazov Trg 2, SI-1000 Ljubljana, Slovenia;
- Correspondence:
| | - Mateja Starbek Zorko
- Department of Dermatovenerology, University Medical Centre Ljubljana, Gradiškova Ulica 10, SI-1000 Ljubljana, Slovenia;
- Faculty of Medicine, University of Ljubljana, Vrazov Trg 2, SI-1000 Ljubljana, Slovenia;
| | - Miodrag Janić
- Faculty of Medicine, University of Ljubljana, Vrazov Trg 2, SI-1000 Ljubljana, Slovenia;
- Department of Endocrinology, Diabetes and Metabolic Diseases, University Medical Centre Ljubljana, Zaloška Cesta 7, SI-1000 Ljubljana, Slovenia
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6
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Effect of diet and weight loss on the severity of psoriasis. POSTEP HIG MED DOSW 2022. [DOI: 10.2478/ahem-2022-0039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Abstract
Psoriasis is one of the most common chronic inflammatory skin diseases, constituting a significant health and socioeconomic problem. Despite numerous therapeutic options, the results of treatment often remain insufficient. This may be due to the lack of compliance with medical prescriptions and patients’ limited knowledge of their disease. Psoriatic patient's skin well-being is affected by many factors, including lifestyle. The course of the disease is affected by obesity, improper diet, and stimulants. Often these factors coexist. Excessive weight gain in psoriasis can be caused by a decrease in physical activity, caused by feelings of social stigma, coexistence of psoriatic arthritis, depression, and increased alcohol consumption. Several studies have confirmed that the average fat, protein, and calorie content in the diet of a patient with psoriasis are above the recommended norms. On the other hand, adhering to a low calorie, reducing diet results in a clinically significant improvement in the Psoriasis Area Severity Index (PASI) and patients’ quality of life (i.e., reduction of Dermatology Life Quality Index [DLQI]). Weight reduction caused by diet and exercise reduces the severity of skin lesions, even in people who have not achieved improvement after general treatment. Therefore, it is important to educate the patient about the nature of the disease at the very beginning of treatment. Patients with moderate to severe forms of the disease are predisposed to the development of cardiovascular diseases, obesity, diabetes, and anxiety. That is why plaque psoriasis requires a comprehensive treatment and a holistic approach to the patient.
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7
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Mrowietz U, Kircik L, Reich K, Munjal S, Shenoy S, Lebwohl M. Tepilamide Fumarate (PPC-06) Extended Release Tablets in Patients with Moderate-to-Severe Plaque Psoriasis: Safety and Efficacy Results from the Randomized, Double-blind, Placebo-controlled AFFIRM Study. THE JOURNAL OF CLINICAL AND AESTHETIC DERMATOLOGY 2022; 15:53-58. [PMID: 35309277 PMCID: PMC8903235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
OBJECTIVE Safe, effective, long-term oral therapies are needed for plaque psoriasis. This study aimed to assess the safety and effectiveness of tepilamide fumarate (a fumaric acid ester) extended-release tablets. METHODS This Phase IIb, randomized, double-blind, placebo-controlled, 24-week, multicenter study treated adults with moderate-to-severe plaque psoriasis with tepilamide fumarate 400 mg once (QD) or twice daily (BID), 600 mg BID, or placebo. Coprimary endpoints were the proportion of patients achieving ≥75% reduction in the Psoriasis Area and Severity Index (PASI-75) and Investigator's Global Assessment (IGA) of clear or almost clear (≥2 points' reduction). RESULTS A total of 426 patients were randomized (mean age 49.6 [±13.0] years). There was a ≥75% PASI reduction in 39.7%, 47.2%, 44.3%, and 20.0% in the 400 mg QD, 400 mg BID, 600 mg BID, and placebo groups, respectively; IGA treatment success was 35.7%, 41.4%, 44.4%, and 22.0%, respectively. Between 50%-66% of tepilamide fumarate and 48% of placebo patients experienced ≥1 treatment-emergent adverse event. Gastrointestinal intolerance (20%-42%), infection (6%-18%), and decreased lymphocyte count (4%-9%) were more common with tepilamide fumarate. LIMITATIONS High placebo response somewhat limits the utility of these findings. CONCLUSION Patients with moderate-to-severe plaque psoriasis treated with oral tepilamide fumarate demonstrated positive response.
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Affiliation(s)
- Ulrich Mrowietz
- Dr. Mrowietz is with the Psoriasis Center at the Department of Dermatology at the University Medical Center Schleswig-Holstein in Campus Kiel, Germany
- Dr. Kircik is with DermResearch, PLLC, in Louisville, Kentucky
- Dr. Reich is with the Center of Translational Research in Inflammatory Skin Diseases, Institute for Health Services Research in Dermatology and Nursing, University Medical Center Hamburg-Eppendorf, and Skinflammation® Center in Hamburg, Germany Dr. Munjal is with Dr. Reddy's Laboratories Inc., in Princeton, New Jersey
- Dr. Shenoy is with Dr. Reddy's Laboratories Inc. in Princeton, New Jersey
- Dr. Lebwohl is with the Icahn School of Medicine at Mount Sinai in New York, New York
| | - Leon Kircik
- Dr. Mrowietz is with the Psoriasis Center at the Department of Dermatology at the University Medical Center Schleswig-Holstein in Campus Kiel, Germany
- Dr. Kircik is with DermResearch, PLLC, in Louisville, Kentucky
- Dr. Reich is with the Center of Translational Research in Inflammatory Skin Diseases, Institute for Health Services Research in Dermatology and Nursing, University Medical Center Hamburg-Eppendorf, and Skinflammation® Center in Hamburg, Germany Dr. Munjal is with Dr. Reddy's Laboratories Inc., in Princeton, New Jersey
- Dr. Shenoy is with Dr. Reddy's Laboratories Inc. in Princeton, New Jersey
- Dr. Lebwohl is with the Icahn School of Medicine at Mount Sinai in New York, New York
| | - Kristian Reich
- Dr. Mrowietz is with the Psoriasis Center at the Department of Dermatology at the University Medical Center Schleswig-Holstein in Campus Kiel, Germany
- Dr. Kircik is with DermResearch, PLLC, in Louisville, Kentucky
- Dr. Reich is with the Center of Translational Research in Inflammatory Skin Diseases, Institute for Health Services Research in Dermatology and Nursing, University Medical Center Hamburg-Eppendorf, and Skinflammation® Center in Hamburg, Germany Dr. Munjal is with Dr. Reddy's Laboratories Inc., in Princeton, New Jersey
- Dr. Shenoy is with Dr. Reddy's Laboratories Inc. in Princeton, New Jersey
- Dr. Lebwohl is with the Icahn School of Medicine at Mount Sinai in New York, New York
| | - Sagar Munjal
- Dr. Mrowietz is with the Psoriasis Center at the Department of Dermatology at the University Medical Center Schleswig-Holstein in Campus Kiel, Germany
- Dr. Kircik is with DermResearch, PLLC, in Louisville, Kentucky
- Dr. Reich is with the Center of Translational Research in Inflammatory Skin Diseases, Institute for Health Services Research in Dermatology and Nursing, University Medical Center Hamburg-Eppendorf, and Skinflammation® Center in Hamburg, Germany Dr. Munjal is with Dr. Reddy's Laboratories Inc., in Princeton, New Jersey
- Dr. Shenoy is with Dr. Reddy's Laboratories Inc. in Princeton, New Jersey
- Dr. Lebwohl is with the Icahn School of Medicine at Mount Sinai in New York, New York
| | - Srinivas Shenoy
- Dr. Mrowietz is with the Psoriasis Center at the Department of Dermatology at the University Medical Center Schleswig-Holstein in Campus Kiel, Germany
- Dr. Kircik is with DermResearch, PLLC, in Louisville, Kentucky
- Dr. Reich is with the Center of Translational Research in Inflammatory Skin Diseases, Institute for Health Services Research in Dermatology and Nursing, University Medical Center Hamburg-Eppendorf, and Skinflammation® Center in Hamburg, Germany Dr. Munjal is with Dr. Reddy's Laboratories Inc., in Princeton, New Jersey
- Dr. Shenoy is with Dr. Reddy's Laboratories Inc. in Princeton, New Jersey
- Dr. Lebwohl is with the Icahn School of Medicine at Mount Sinai in New York, New York
| | - Mark Lebwohl
- Dr. Mrowietz is with the Psoriasis Center at the Department of Dermatology at the University Medical Center Schleswig-Holstein in Campus Kiel, Germany
- Dr. Kircik is with DermResearch, PLLC, in Louisville, Kentucky
- Dr. Reich is with the Center of Translational Research in Inflammatory Skin Diseases, Institute for Health Services Research in Dermatology and Nursing, University Medical Center Hamburg-Eppendorf, and Skinflammation® Center in Hamburg, Germany Dr. Munjal is with Dr. Reddy's Laboratories Inc., in Princeton, New Jersey
- Dr. Shenoy is with Dr. Reddy's Laboratories Inc. in Princeton, New Jersey
- Dr. Lebwohl is with the Icahn School of Medicine at Mount Sinai in New York, New York
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8
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Fleming P. Risankizumab vs. fumaric acid esters: a direct comparison. Br J Dermatol 2021; 186:4-5. [PMID: 34726768 DOI: 10.1111/bjd.20813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Accepted: 10/07/2021] [Indexed: 11/28/2022]
Affiliation(s)
- P Fleming
- Division of Dermatology, University of Toronto, Toronto, ON, Canada
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9
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Dinshaw IJ, Ahmad N, Salim N, Leo BF. Nanoemulsions: A Review on the Conceptualization of Treatment for Psoriasis Using a 'Green' Surfactant with Low-Energy Emulsification Method. Pharmaceutics 2021; 13:1024. [PMID: 34371716 PMCID: PMC8309190 DOI: 10.3390/pharmaceutics13071024] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2021] [Revised: 06/29/2021] [Accepted: 07/01/2021] [Indexed: 12/13/2022] Open
Abstract
Psoriasis is a skin disease that is not lethal and does not spread through bodily contact. However, this seemingly harmless condition can lead to a loss of confidence and social stigmatization due to a persons' flawed appearance. The conventional methods of psoriasis treatment include taking in systemic drugs to inhibit immunoresponses within the body or applying topical drugs onto the surface of the skin to inhibit cell proliferation. Topical methods are favored as they pose lesser side effects compared to the systemic methods. However, the side effects from systemic drugs and low bioavailability of topical drugs are the limitations to the treatment. The use of nanotechnology in this field has enhanced drug loading capacity and reduced dosage size. In this review, biosurfactants were introduced as a 'greener' alternative to their synthetic counterparts. Glycolipid biosurfactants are specifically suited for anti-psoriatic application due to their characteristic skin-enhancing qualities. The selection of a suitable oil phase can also contribute to the anti-psoriatic effect as some oils have skin-healing properties. The review covers the pathogenic pathway of psoriasis, conventional treatments, and prospective ingredients to be used as components in the nanoemulsion formulation. Furthermore, an insight into the state-of-the-art methods used in formulating nanoemulsions and their progression to low-energy methods are also elaborated in detail.
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Affiliation(s)
- Ignatius Julian Dinshaw
- Department of Chemistry, Faculty of Science, University of Malaya, Kuala Lumpur 50603, Malaysia;
| | - Noraini Ahmad
- Department of Chemistry, Faculty of Science, University of Malaya, Kuala Lumpur 50603, Malaysia;
| | - Norazlinaliza Salim
- Integrated Chemical Biophysics Research, Faculty of Science, Universiti Putra Malaysia, Serdang 43400, Malaysia
| | - Bey Fen Leo
- Nanotechnology & Catalysis Research Centre (NANOCAT), Institute of Advanced Studies, University of Malaya, Kuala Lumpur 50603, Malaysia;
- Faculty of Medicine, University of Malaya, Kuala Lumpur 50603, Malaysia
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10
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Cantrell MS, Soto-Avellaneda A, Wall JD, Ajeti AD, Morrison BE, Warner LR, McDougal OM. Repurposing Drugs to Treat Heart and Brain Illness. Pharmaceuticals (Basel) 2021; 14:ph14060573. [PMID: 34208502 PMCID: PMC8235459 DOI: 10.3390/ph14060573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2021] [Revised: 06/09/2021] [Accepted: 06/11/2021] [Indexed: 11/17/2022] Open
Abstract
Drug development is a complicated, slow and expensive process with high failure rates. One strategy to mitigate these factors is to recycle existing drugs with viable safety profiles and have gained Food and Drug Administration approval following extensive clinical trials. Cardiovascular and neurodegenerative diseases are difficult to treat, and there exist few effective therapeutics, necessitating the development of new, more efficacious drugs. Recent scientific studies have led to a mechanistic understanding of heart and brain disease progression, which has led researchers to assess myriad drugs for their potential as pharmacological treatments for these ailments. The focus of this review is to survey strategies for the selection of drug repurposing candidates and provide representative case studies where drug repurposing strategies were used to discover therapeutics for cardiovascular and neurodegenerative diseases, with a focus on anti-inflammatory processes where new drug alternatives are needed.
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Affiliation(s)
- Maranda S. Cantrell
- Biomolecular Sciences Ph.D. Program, Boise State University, Boise, ID 83725, USA; (M.S.C.); (A.S.-A.)
- Department of Chemistry and Biochemistry, Boise State University, Boise, ID 83725, USA; (J.D.W.); (A.D.A.)
| | - Alejandro Soto-Avellaneda
- Biomolecular Sciences Ph.D. Program, Boise State University, Boise, ID 83725, USA; (M.S.C.); (A.S.-A.)
- Department of Biology, Boise State University, Boise, ID 83725, USA
| | - Jackson D. Wall
- Department of Chemistry and Biochemistry, Boise State University, Boise, ID 83725, USA; (J.D.W.); (A.D.A.)
| | - Aaron D. Ajeti
- Department of Chemistry and Biochemistry, Boise State University, Boise, ID 83725, USA; (J.D.W.); (A.D.A.)
| | - Brad E. Morrison
- Department of Biology, Boise State University, Boise, ID 83725, USA
- Correspondence: (B.E.M.); (L.R.W.); (O.M.M.)
| | - Lisa R. Warner
- Biomolecular Sciences Ph.D. Program, Boise State University, Boise, ID 83725, USA; (M.S.C.); (A.S.-A.)
- Correspondence: (B.E.M.); (L.R.W.); (O.M.M.)
| | - Owen M. McDougal
- Biomolecular Sciences Ph.D. Program, Boise State University, Boise, ID 83725, USA; (M.S.C.); (A.S.-A.)
- Correspondence: (B.E.M.); (L.R.W.); (O.M.M.)
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11
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Light JG, Su JJ, Feldman SR. Clinical Utility of Guselkumab in the Treatment of Moderate-to-Severe Plaque Psoriasis. Clin Cosmet Investig Dermatol 2021; 14:55-63. [PMID: 33488109 PMCID: PMC7815086 DOI: 10.2147/ccid.s235242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2020] [Accepted: 01/07/2021] [Indexed: 11/27/2022]
Abstract
Psoriasis is a chronic immune-mediated disease involving complex interaction of T cells and keratinocytes. The comprehensive pathogenesis of psoriasis is not fully understood but the IL-23/Th17 axis is a central pathway in driving disease development. Guselkumab is the first treatment of moderate-to-severe psoriasis that specifically targets the p19 subunit of IL-23. The benefit of guselkumab has been established by a number of clinical trials including demonstration of greater long-term efficacy in recent comparator trials. This review addresses the results of head-to-head trials (ECLIPSE, IXORA-R, and POLARIS) that compared guselkumab to secukinumab, ixekizumab, and fumaric acid esters. The previously demonstrated long-term efficacy of guselkumab has been corroborated by many recently published studies. The effective and safe profile, convenient dosing, and improved quality of life in patients make gulselkumab a viable first-line treatment option for moderate-to-severe psoriasis.
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Affiliation(s)
- Jeremy G Light
- Center for Dermatology Research, Department of Dermatology, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Jennifer J Su
- Center for Dermatology Research, Department of Dermatology, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Steven R Feldman
- Center for Dermatology Research, Department of Dermatology, Wake Forest School of Medicine, Winston-Salem, NC, USA.,Department of Pathology, Wake Forest School of Medicine, Winston-Salem, NC, USA.,Department of Social Sciences & Health Policy, Wake Forest School of Medicine, Winston-Salem, NC, USA.,Department of Dermatology, University of Southern Denmark, Odense, Denmark
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12
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Fereig SA, El-Zaafarany GM, Arafa MG, Abdel-Mottaleb MMA. Tackling the various classes of nano-therapeutics employed in topical therapy of psoriasis. Drug Deliv 2020; 27:662-680. [PMID: 32393082 PMCID: PMC7269080 DOI: 10.1080/10717544.2020.1754527] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Revised: 04/03/2020] [Accepted: 04/07/2020] [Indexed: 12/15/2022] Open
Abstract
Psoriasis is a dermatological chronic skin condition with underlying autoimmune etiology. It deeply affects patients' quality of life. Therefore, it was an interesting target for researchers throughout the past years. Conventionally, the treatment options include anti-inflammatory agents, immune suppressants, biologic treatment, and phototherapy. Nanotechnology offers promising characteristics that allow for tailoring a drug carrier to achieve dermal targeting, improved efficacy and minimize undesirable effects. Being the safest route, the first line of treatment and a targeted approach, we solely discussed the use of the topical route, combined with advanced drug delivery systems for the management of psoriasis in this article. Advanced systems include polymeric, metallic, lipidic and hybrid nanocarriers incorporating different active agents. All formerly mentioned types of drug delivery systems were investigated through the past decades for the purpose of topical application on psoriatic plaques. Scientists' efforts are promising to reach an optimized formula with a convenient dosage form to improve efficacy, safety, and compliance for the treatment of psoriasis. Accordingly, it will offer a better quality of life for patients.
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Affiliation(s)
- Salma A. Fereig
- Faculty of Pharmacy, Department of Pharmaceutics and Pharmaceutical Technology, The British University in Egypt (BUE), El Sherouk City, Egypt
| | - Ghada M. El-Zaafarany
- Faculty of Pharmacy, Department of pharmaceutics and Industrial Pharmacy, Ain Shams University, Cairo, Egypt
| | - Mona G. Arafa
- Faculty of Pharmacy, Department of Pharmaceutics and Pharmaceutical Technology, The British University in Egypt (BUE), El Sherouk City, Egypt
- Chemotherapeutic Unit, Mansoura University Hospitals, Mansoura, Egypt
| | - Mona M. A. Abdel-Mottaleb
- Faculty of Pharmacy, Department of pharmaceutics and Industrial Pharmacy, Ain Shams University, Cairo, Egypt
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13
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O’Brien J, Wendell SG. Electrophile Modulation of Inflammation: A Two-Hit Approach. Metabolites 2020; 10:metabo10110453. [PMID: 33182676 PMCID: PMC7696920 DOI: 10.3390/metabo10110453] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Revised: 11/04/2020] [Accepted: 11/05/2020] [Indexed: 12/11/2022] Open
Abstract
Electrophilic small molecules have gained significant attention over the last decade in the field of covalent drug discovery. Long recognized as mediators of the inflammatory process, recent evidence suggests that electrophiles may modulate the immune response through the regulation of metabolic networks. These molecules function as pleiotropic signaling mediators capable of reversibly reacting with nucleophilic biomolecules, most notably at reactive cysteines. More specifically, electrophiles target critical cysteines in redox regulatory proteins to activate protective pathways such as the nuclear factor erythroid 2-related factor 2-Kelch-like ECH-associated protein 1 (Nrf2-Keap1) antioxidant signaling pathway while also inhibiting Nuclear Factor κB (NF-κB). During inflammatory states, reactive species broadly alter cell signaling through the oxidation of lipids, amino acids, and nucleic acids, effectively propagating the inflammatory sequence. Subsequent changes in metabolic signaling inform immune cell maturation and effector function. Therapeutic strategies targeting inflammatory pathologies leverage electrophilic drug compounds, in part, because of their documented effect on the redox balance of the cell. With mounting evidence demonstrating the link between redox signaling and metabolism, electrophiles represent ideal therapeutic candidates for the treatment of inflammatory conditions. Through their pleiotropic signaling activity, electrophiles may be used strategically to both directly and indirectly target immune cell metabolism.
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Bakshi H, Nagpal M, Singh M, Dhingra GA, Aggarwal G. Treatment of Psoriasis: A Comprehensive Review of Entire Therapies. Curr Drug Saf 2020; 15:82-104. [DOI: 10.2174/1574886315666200128095958] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Revised: 12/03/2019] [Accepted: 12/05/2019] [Indexed: 12/19/2022]
Abstract
Background:
Psoriasis is an autoimmune disease that ingeminates itself with the repeated
proliferation of keratinocytes. It globally strikes a 2-5 % population on an average. Management
of psoriasis remains a daunting task with various challenges influencing treatment, such as patient
conformity and adherence to therapy, delicate patient profiles, psychological aspects, and skin as a
barrier to topical delivery. The first part reviewed pathophysiology, triggering factors, and clinical
classification. The second part reviewed all the therapies, such as topical, oral, biological, parenteral
therapy, phototherapy, and the phyto-pharmaceuticals.
Methods:
The research data related to the existing and upcoming therapies for psoriasis treatment,
several nanocarriers, existing marketed formulations, and detailed description of phytopharmaceuticals
with their mechanism.
Results:
Topical therapy is the mainstay treatment option with limited adverse effects. Biological therapy
has reformed conventional psoriasis treatment by being more efficacious and has increased patient
acceptance due to decreased adverse events. Nanoformulations present an edge over conventional
therapy due to improved anti-psoriatic effect and decreased side effects. Phyto-pharmaceuticals act as
a complementary and alternative therapy for diminishing psoriasis symptoms.
Conclusion:
A rationalized cost-effective patient compliant therapy is required for effective management
and complete cure of psoriasis.
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Affiliation(s)
- Harman Bakshi
- Chitkara College of Pharmacy, Chitkara University, Chandigarh-Patiala, NH 7, 64, Tehsil, Rajpura, Punjab, India
| | - Manju Nagpal
- Chitkara College of Pharmacy, Chitkara University, Chandigarh-Patiala, NH 7, 64, Tehsil, Rajpura, Punjab, India
| | - Manjinder Singh
- Chitkara College of Pharmacy, Chitkara University, Chandigarh-Patiala, NH 7, 64, Tehsil, Rajpura, Punjab, India
| | | | - Geeta Aggarwal
- Delhi Pharmaceutical Sciences and Research University, New Delhi-110017, India
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Fumaric acid protect the cadmium-induced hepatotoxicity in rats: owing to its antioxidant, anti-inflammatory action and aid in recast the liver function. Naunyn Schmiedebergs Arch Pharmacol 2020; 393:1911-1920. [PMID: 32440768 DOI: 10.1007/s00210-020-01900-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Accepted: 05/08/2020] [Indexed: 01/01/2023]
Abstract
In the modern world, indiscriminate human activities impelled environmental toxicity through heavy metals such as cadmium (Cd) that poses significant health hazards to the flora and fauna. Multiple mechanisms such as oxidative stress, inflammation, apoptotic cell death, and chromosomal aberrations underlie the Cd-induced organ toxicity with the liver and kidneys bearing most of the brunt. Fumaric acid (FA) is an organic acid (C4H4O4) omnipresent in nature and attributed with such properties (e.g., antioxidant, anti-inflammatory, analgesic, chemopreventive, anti-psoriatic, immunomodulatory, and neuroprotective) that may bestow relief in Cd-induced liver damage. Hence, in the present study, the protective effects of FA were determined in Cd-induced hepatotoxicity in rats. Wistar rats were chronically exposed to Cd (5 mg/kg, p.o.) to induce liver dysfunction. The rats were subjected to FA (1.25, 2.5, 5 mg/kg; p.o.) pre-treatment for 28 days to observe effects on liver and serum biomarkers of oxidative stress, enzymatic activities, and hepatic damage (liver histopathology). Body weights, feed/water intake, body mass index (BMI), and non-invasive parameters (FIB-4 score; AST/ALT ratio) were quantified. Cd-triggered hepatic injury in rats through oxidative stress, derangement of hepatic serum biomarkers (ALT, AST, ALP, LDH, bilirubin, cholesterol, triglycerides, uric acid, and platelet count), and pathogenic alteration in non-invasive parameters. FA pre-treatment significantly protected rat livers against Cd toxicity by decreasing oxidative stress and improving the hepatic serum biomarkers and non-invasive parameters. In a histopathological analysis, FA prevented Cd-accrued hepatocellular damage. Fumaric acid showed potential to avert hepatic injury against cadmium in rats. Graphical abstract.
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Thaçi D, Pinter A, Sebastian M, Termeer C, Sticherling M, Gerdes S, Wegner S, Krampe S, Bartz H, Rausch C, Mensch A, Eyerich K. Guselkumab is superior to fumaric acid esters in patients with moderate‐to‐severe plaque psoriasis who are naive to systemic treatment: results from a randomized, active‐comparator‐controlled phase IIIb trial (POLARIS). Br J Dermatol 2020; 183:265-275. [DOI: 10.1111/bjd.18696] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/07/2019] [Indexed: 02/06/2023]
Affiliation(s)
- D. Thaçi
- Institute and Comprehensive Centre for Inflammation Medicine University of Lübeck Lübeck Germany
| | - A. Pinter
- Department of Dermatology, Venereology and Allergology University Hospital of Frankfurt am Main Frankfurt am Main Germany
| | - M. Sebastian
- Dermatological Practice Dr. med. Michael Sebastian Mahlow Germany
| | - C. Termeer
- Dermatological Practice Prof. Dr. med. Christian Termeer Stuttgart Germany
- Department of Dermatology University of Freiburg Freiburg Germany
| | - M. Sticherling
- Department of Dermatology University Hospital of Erlangen Erlangen Germany
| | - S. Gerdes
- Psoriasis‐Center Department of Dermatology, Venerology and Allergology University Hospital Schleswig‐Holstein Campus Kiel Kiel Germany
| | | | | | - H. Bartz
- Janssen‐Cilag GmbH Neuss Germany
| | | | | | - K. Eyerich
- Department of Dermatology and Allergy Technical University of Munich Munich Germany
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18
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Rommer PS, Sellner J. Repurposing multiple sclerosis drugs: a review of studies in neurological and psychiatric conditions. Drug Discov Today 2019; 24:1398-1404. [PMID: 31100209 DOI: 10.1016/j.drudis.2019.05.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Revised: 03/27/2019] [Accepted: 05/09/2019] [Indexed: 12/13/2022]
Abstract
Treatment options for multiple sclerosis (MS) have improved in the past 20 years, with new oral disease-modifying drugs and monoclonal antibodies becoming available. The success seen with these drugs in MS, and their various mechanisms of action, has led to them being investigated in other neurological and psychiatric disorders. This review article summarises the ongoing and completed studies of MS drugs in neurological and psychiatric conditions other than MS. The most promising results are for interferon beta in human T cell leukaemia virus 1 associated myelopathy/tropical spastic paraparesis and glioma, and for fingolimod in acute ischaemic stroke and intracerebral haemorrhage. The coming years could see the arrival of exciting new therapies for disorders that neurologists have historically found difficult to treat and that represent a significant unmet clinical need.
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Affiliation(s)
| | - Johann Sellner
- Department of Neurology, Christian Doppler Medical Center, Paracelsus Medical University, Salzburg, Austria
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Dickel H, Bruckner T, Höxtermann S, Dickel B, Trinder E, Altmeyer P. Fumaric acid ester-induced T-cell lymphopenia in the real-life treatment of psoriasis. J Eur Acad Dermatol Venereol 2019; 33:893-905. [PMID: 30680823 PMCID: PMC6593701 DOI: 10.1111/jdv.15448] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Accepted: 12/19/2018] [Indexed: 12/31/2022]
Abstract
BACKGROUND Fumaric acid esters (FAEs) are used to treat psoriasis and are known to cause lymphopenia in roughly 60% of the patients. Much remains to be elucidated about the biological effects of FAEs on lymphocytes. OBJECTIVE To evaluate the influence of long-term FAE (Fumaderm® ) treatment on peripheral blood CD4+ and CD8+ T cells, CD19+ B cells and CD56+ natural killer (NK) cells in psoriasis. METHODS In this single-centre retrospective observational subcohort study, we obtained leucocyte and lymphocyte subset counts before initiating FAE therapy in 371 psoriasis patients (mean age, 47.8 years; 63.3% males) and monitored them during treatment (mean treatment duration, 2.9 years). Multiparametric flow cytometry was used for immunophenotyping. RESULTS FAEs significantly reduced the numbers of CD4+ T, CD8+ T, CD19+ B and CD56+ NK cells. Among lymphocyte subsets, the mean percentage reduction from baseline was always highest for CD8+ T cells, with a peak of 55.7% after 2 years of therapy. The risk of T-cell lymphopenia increased significantly with the age of the psoriasis patients at the time that FAE therapy was initiated. It was significantly decreased for the combination therapy with methotrexate and folic acid (vitamin B9) supplementation. Supporting evidence was found suggesting that T-cell lymphopenia enhances the effectiveness of FAE therapy. CONCLUSIONS Monitoring distinct T-cell subsets rather than just absolute lymphocyte counts may provide more meaningful insights into both the FAE treatment safety and efficacy. We therefore suggest optimizing pharmacovigilance by additionally monitoring CD4+ and CD8+ T-cell counts at regular intervals, especially in patients of middle to older age. Thus, further prospective studies are needed to establish evidence-based recommendations to guide dermatologists in the management of psoriasis patients who are taking FAEs and who develop low absolute T-cell counts.
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Affiliation(s)
- H. Dickel
- Department of Dermatology, Venereology and AllergologyRuhr University BochumBochumGermany
| | - T. Bruckner
- Institute of Medical Biometry and Informatics (IMBI)University Hospital HeidelbergHeidelbergGermany
| | - S. Höxtermann
- Department of Dermatology, Venereology and AllergologyRuhr University BochumBochumGermany
| | - B. Dickel
- Dermatology Practice Peter WenzelMDHattingenGermany
| | - E. Trinder
- Department of Dermatology, Venereology and AllergologyRuhr University BochumBochumGermany
| | - P. Altmeyer
- Department of Dermatology, Venereology and AllergologyRuhr University BochumBochumGermany
- Dermatology Practice at City ParkBochumGermany
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Dickel H, Bruckner T, Altmeyer P. Long-term real-life safety profile and effectiveness of fumaric acid esters in psoriasis patients: a single-centre, retrospective, observational study. J Eur Acad Dermatol Venereol 2018; 32:1710-1727. [PMID: 29705996 PMCID: PMC6221124 DOI: 10.1111/jdv.15019] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2017] [Accepted: 04/04/2018] [Indexed: 12/19/2022]
Abstract
BACKGROUND Fumaric acid esters (FAEs) are an established systemic treatment for moderate-to-severe psoriasis. However, the long-term clinical safety and effectiveness of continuous FAE monotherapy and combination therapy have not been established. OBJECTIVE To examine the long-term safety and effectiveness of FAEs as monotherapy and in combination with phototherapy or methotrexate in patients with psoriasis treated at a single centre in Germany. METHODS This monocentric, retrospective observational study, with a follow-up period of up to 32.5 years, included 859 patients: 626 received FAE monotherapy, 123 received FAEs with concomitant phototherapy and 110 received FAEs with methotrexate. RESULTS Approximately half of patients (49.0%) reported adverse events (566 total events), most of which involved the gastrointestinal tract. Serious adverse events were reported in 2.3% of patients, but none were deemed to have a causal relationship with any of the treatment regimens. Adverse events leading to treatment discontinuation were observed in 12.9% of patients. A median duration of 1 year was observed in all three treatment subcohorts (P = 0.70) from initiation of FAE treatment to a 50% response rate, where response was defined as achieving a cumulative static Physician's Global Assessment (PGA) score of 'light' and at least a 2-point reduction in baseline PGA. A 50% response rate for the cumulative Psoriasis Area and Severity Index 75 was achieved in the FAE monotherapy subcohort after a median of 3 years of treatment, in the FAEs + phototherapy subcohort after 6.7 years and in the FAEs + methotrexate subcohort after 8.1 years (P = 0.001). CONCLUSION According to our data, FAEs as monotherapy or in combination with phototherapy or methotrexate are safe and beneficial for long-term clinical use. However, multicentre, randomized controlled trials are required to establish the clinical value of monotherapy versus combination therapy and the optimal treatment duration.
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Affiliation(s)
- H. Dickel
- Department of Dermatology, Venereology and AllergologyRuhr University BochumBochumGermany
| | - T. Bruckner
- Institute of Medical Biometry and Informatics (IMBI)University Hospital HeidelbergHeidelbergGermany
| | - P. Altmeyer
- Department of Dermatology, Venereology and AllergologyRuhr University BochumBochumGermany
- Dermatology Practice at City ParkBochumGermany
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Mrowietz U, Szepietowski J, Loewe R, van de Kerkhof P, Lamarca R, Ocker W, Tebbs V, Pau-Charles I. Efficacy and safety of LAS41008 (dimethyl fumarate) in adults with moderate-to-severe chronic plaque psoriasis: a randomized, double-blind, Fumaderm®- and placebo-controlled trial (BRIDGE). Br J Dermatol 2016; 176:615-623. [DOI: 10.1111/bjd.14947] [Citation(s) in RCA: 80] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/09/2016] [Indexed: 01/05/2023]
Affiliation(s)
- U. Mrowietz
- Psoriasis Center at the Department of Dermatology; University Medical Center Schleswig-Holstein, Campus Kiel; Schittenhelmstraße 7 24105 Kiel Germany
| | - J.C. Szepietowski
- Department of Dermatology, Venereology and Allergology; Wroclaw Medical University; Wroclaw Poland
| | - R. Loewe
- Department of Dermatology; Medical University of Vienna; Vienna Austria
| | - P. van de Kerkhof
- Department of Dermatology; Radboud University Medical Center; Nijmegen the Netherlands
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Saracino AM, Orteu CH. Severe recalcitrant cutaneous manifestations in systemic lupus erythematosus successfully treated with fumaric acid esters. Br J Dermatol 2016; 176:472-480. [PMID: 27105770 DOI: 10.1111/bjd.14698] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/17/2016] [Indexed: 12/29/2022]
Abstract
Fumaric acid esters (FAEs) have proven efficacy in the treatment of psoriasis and have been in use for decades. More recently, as their mechanism of action and abundant immunomodulatory effects become clearer, the potential benefits of treating other inflammatory skin conditions using FAEs are increasingly being recognized. The use of FAEs as combination systemic therapy has not been well studied and data are lacking regarding the safety and efficacy of this type of therapy. In this case report, three patients with severe, extensive and recalcitrant cutaneous manifestations of systemic lupus erythematosus (SLE) (one case of disseminated discoid lesions and two with severe chilblain lesions) were treated with Fumaderm® (containing the FAE dimethylfumarate and monoethylhydrogen fumarate salts), after failing to respond to a multitude of other monotherapies and combination therapies. All patients showed a substantial clinical response when FAEs were added to their treatment, with concurrent improvements in quality-of-life instrument scores. The treatment was well tolerated in the context of systemic organ involvement and as combination therapy with other agents, such as hydroxychloroquine and mycophenolate mofetil. These cases of SLE illustrate the potential use of FAEs in severe, disfiguring and otherwise therapy-resistant skin lesions, including, to our knowledge, the first two reported cases of FAE-treated chilblain lupus erythematosus.
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Affiliation(s)
- A M Saracino
- Department of Dermatology, The Royal Free London NHS Foundation Trust, London, U.K
| | - C H Orteu
- Department of Dermatology, The Royal Free London NHS Foundation Trust, London, U.K
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