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Danis J, Göblös A, Gál B, Sulák A, Farkas K, Török D, Varga E, Korom I, Kemény L, Széll M, Bata-Csörgö Z, Nagy N. Nuclear Factor κB Activation in a Type V Pityriasis Rubra Pilaris Patient Harboring Multiple CARD14 Variants. Front Immunol 2018; 9:1564. [PMID: 30018619 PMCID: PMC6037727 DOI: 10.3389/fimmu.2018.01564] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2018] [Accepted: 06/25/2018] [Indexed: 11/13/2022] Open
Abstract
Pityriasis rubra pilaris (PRP) is a rare papulosquamous skin disorder, which is phenotypically related to psoriasis. Some familial PRP cases show autosomal dominant inheritance due to CARD14 mutations leading to increased nuclear factor κB (NFκB) activation. Moreover, CARD14 polymorphisms have also been implicated in sporadic PRP. A Hungarian PRP patient with childhood onset disease showing worsening of the symptoms in adulthood with poor therapeutic response underwent genetic screening for the CARD14 gene, revealing four genetic variants (rs117918077, rs2066964, rs28674001, and rs11652075). To confirm that the identified genetic variants would result in altered NFκB activity in the patient, functional studies were carried out. Immunofluorescent staining of the NFκB p65 subunit and NFκB-luciferase reporter assay demonstrated significantly increased NFκB activity in skin samples and keratinocytes from the PRP patient compared to healthy samples. Characterization of the cytokine profile of the keratinocytes and peripheral blood mononuclear cells demonstrated that the higher NFκB activation in PRP cells induces enhanced responses to inflammatory stimuli. These higher inflammatory reactions could not be explained solely by the observed CARD14 or other inflammation-related gene variants (determined by whole exome sequencing). Thus our study indicates the importance of investigations on other genetic factors related to PRP and their further functional characterization to bring us closer to the understanding of cellular and molecular background of disease pathogenesis.
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Affiliation(s)
- Judit Danis
- Department of Dermatology and Allergology, University of Szeged, Szeged, Hungary.,MTA-SZTE Dermatological Research Group, University of Szeged, Szeged, Hungary
| | - Anikó Göblös
- Department of Dermatology and Allergology, University of Szeged, Szeged, Hungary.,MTA-SZTE Dermatological Research Group, University of Szeged, Szeged, Hungary
| | - Brigitta Gál
- Department of Dermatology and Allergology, University of Szeged, Szeged, Hungary
| | - Adrienn Sulák
- Department of Medical Genetics, University of Szeged, Szeged, Hungary
| | - Katalin Farkas
- Department of Medical Genetics, University of Szeged, Szeged, Hungary
| | - Dóra Török
- Department of Medical Genetics, University of Szeged, Szeged, Hungary
| | - Erika Varga
- Department of Dermatology and Allergology, University of Szeged, Szeged, Hungary
| | - Irma Korom
- Department of Dermatology and Allergology, University of Szeged, Szeged, Hungary
| | - Lajos Kemény
- Department of Dermatology and Allergology, University of Szeged, Szeged, Hungary.,MTA-SZTE Dermatological Research Group, University of Szeged, Szeged, Hungary
| | - Márta Széll
- MTA-SZTE Dermatological Research Group, University of Szeged, Szeged, Hungary.,Department of Medical Genetics, University of Szeged, Szeged, Hungary
| | - Zsuzsanna Bata-Csörgö
- Department of Dermatology and Allergology, University of Szeged, Szeged, Hungary.,MTA-SZTE Dermatological Research Group, University of Szeged, Szeged, Hungary
| | - Nikoletta Nagy
- MTA-SZTE Dermatological Research Group, University of Szeged, Szeged, Hungary.,Department of Medical Genetics, University of Szeged, Szeged, Hungary
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Pacheco RL, Hosni ND, Latorraca CDOC, Martimbianco ALC, Pachito DV, Yarak S, Riera R. What do Cochrane systematic reviews say about interventions for treating psoriasis? SAO PAULO MED J 2018; 136:354-360. [PMID: 30133547 PMCID: PMC9881701 DOI: 10.1590/1516-3180.0271250618] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2018] [Accepted: 06/25/2018] [Indexed: 02/02/2023] Open
Abstract
CONTEXT AND OBJECTIVE Psoriasis is a common chronic inflammatory skin disease characterized by abnormal and increased growth of the cells that produce keratin and abnormal functioning of the immune system. We aimed to summarize the evidence available regarding interventions for patients with psoriasis. DESIGN AND SETTING Review of systematic reviews, developed in the Discipline of Evidence-Based Medicine, Escola Paulista de Medicina, Universidade Federal de São Paulo. METHODS A systematic search was conducted to identify Cochrane systematic reviews that fulfilled the eligibility criteria. Two authors screened titles and abstracts that had been retrieved through the search strategy. The results from all the Cochrane systematic reviews that were included were summarized and presented in a narrative synthesis. RESULTS We included six Cochrane systematic reviews assessing interventions for treating psoriasis. The findings from high-quality evidence were that (a) etanercept reduced the psoriasis severity index, compared with placebo and (b) steroids plus vitamin D, compared with vitamin D alone, improved the skin clearance rate, as assessed by investigators, but was associated with a higher proportion of participants who dropped out due to adverse events. For all other comparisons, the quality of the evidence ranged from moderate to very low. CONCLUSION This review included six Cochrane systematic reviews that provided evidence ranging in quality from unknown to high, regarding management of psoriasis. Further randomized controlled trials are imperative to reduce the uncertainties relating to several treatments that are already used in clinical practice.
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Affiliation(s)
- Rafael Leite Pacheco
- MD. Postgraduate Student, Evidence-Based Health Program, Universidade Federal de São Paulo (UNIFESP), and Assistant Researcher, Cochrane Brazil, São Paulo (SP), Brazil.
| | - Nicole Dittrich Hosni
- Undergraduate Medical Student, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil.
| | - Carolina de Oliveira Cruz Latorraca
- MSc. Psychologist; Postgraduate Student, Evidence-Based Health Program, Universidade Federal de São Paulo (UNIFESP); and Assistant Researcher, Cochrane Brazil, São Paulo (SP), Brazil.
| | - Ana Luiza Cabrera Martimbianco
- MSc, PhD. Physiotherapist; Postdoctoral Student, Evidence-Based Health Program, Universidade Federal de São Paulo (UNIFESP); and Volunteer Researcher, Cochrane Brazil, São Paulo (SP), Brazil.
| | - Daniela Vianna Pachito
- MD, MSc. Neurologist; Postgraduate Student, Evidence-Based Health Program, Universidade Federal de São Paulo (UNIFESP); and Assistant Researcher, Cochrane Brazil, São Paulo (SP), Brazil.
| | - Samira Yarak
- MD, MSc, PhD. Dermatologist and Adjunct Professor, Department of Dermatology, Escola Paulista de Medicina (EPM), Universidade Federal de São Paulo (UNIFESP), São Paulo (SP), Brazil.
| | - Rachel Riera
- MD, MSc, PhD. Rheumatologist; Adjunct Professor, Discipline of Evidence-Based Medicine, Escola Paulista de Medicina (EPM), Universidade Federal de São Paulo (UNIFESP); and Researcher, Cochrane Brazil, São Paulo (SP), Brazil.
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Lise MLZ, Baptista TSA, Petersen LE, Bauer ME, Ungaretti CAL, Torres E, Harter K, Staub HL. Subclinical atherogenesis in patients with mild psoriasis: A role for IL-6? Rev Assoc Med Bras (1992) 2017; 63:747-752. [DOI: 10.1590/1806-9282.63.09.747] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2016] [Accepted: 02/05/2017] [Indexed: 01/10/2023] Open
Abstract
Summary Introduction: A link of psoriasis with subclinical atherosclerosis has been postulated and cytokine network might intermediate this association. Few data are available in patients with mild psoriasis. We evaluated carotid intima-media thickness (cIMT) in drug-free psoriatic individuals and controls. In parallel, we searched for associations of cIMT with disease activity indexes and serum interleukins (IL) in psoriatic patients. Method: An experienced radiologist performed the cIMT analyses. Cytokine concentrations were assessed by flow cytometry. Disease activity was evaluated based on psoriasis area and severity index (PASI) as well as body surface area (BSA). Results: Sixty-five (65) patients and 64 controls were studied. Mean age of patients (50.9 years) did not differ from controls (p=0.362). A low PASI and BSA (< 10) prevailed (69.2% and 56.9%, respectively). Median levels of IL-12p70, TNF-α, IL-1β and IL-10 were significantly lower in cases than in controls (adjusted p<0.05), while IL-6 and IL-8 medians did not differ between groups (adjusted p>0.05). Smoking habit and diabetes mellitus predominated in cases (p=0.002). An altered cIMT (≥ 0.9 mm) was more frequent in cases than in controls (23.8% versus 8.5%, adjusted p=0.045). Mean cIMT was higher in cases with a borderline significance (p=0.057). cIMT scores did not correlate to PASI (rs=0.066; p=0.250) or BSA (rs=0.175; p=0.185), but did correlate significantly with serum IL-6 (rs=0.26; p=0.005). Conclusion: Subclinical atherosclerosis was more frequent in patients with mild psoriasis than controls. cIMT in psoriatic individuals correlated with serum IL-6, pointing to an eventual proatherogenic role of IL-6 in these patients. Newer studies should clarify the connection of atherogenesis with cytokines in psoriasis.
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Affiliation(s)
| | | | | | | | | | - Elton Torres
- Pontifícia Universidade Católica do Rio Grande do Sul, Brazil
| | - Karen Harter
- Pontifícia Universidade Católica do Rio Grande do Sul, Brazil
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Fumaric acid esters for psoriasis: a systematic review. Ir J Med Sci 2016; 186:161-177. [PMID: 27271164 DOI: 10.1007/s11845-016-1470-2] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2015] [Accepted: 05/16/2016] [Indexed: 11/27/2022]
Abstract
BACKGROUND Psoriasis is a chronic skin disease associated with increased morbidity and mortality. Effective and safe long term treatment options are required to manage the illness successfully. A number of systemic agents are available, however, each of them has potentially significant side effects. Fumaric acid esters (FAE) are used first line in Germany for the management of moderate to severe psoriasis, however, their use in Ireland is on an unlicensed basis (Clinical and Experimental Dermatology 37:786-801, 2012). OBJECTIVES The purpose of this literature review is to evaluate the efficacy and safety of FAEs in the management of moderate to severe psoriasis in adult patients. The reviewer intends to systematically review all available literature on the efficacy and/or safety of fumaric acid esters in the management of moderate to severe psoriasis in adult patients. METHODS A systematic review of the literature was performed by one reviewer. The PubMed, TRIP, Embase, and Cochrane Collaboration databases were systematically interrogated to include randomised controlled trials, cohort studies and case studies evaluating the efficacy and/or safety of FAEs in the management of moderate to severe psoriasis in adult patients. Inclusion criteria were studies which included adults over 18 years of age, with a diagnosis of moderate to severe chronic plaque psoriasis, who were treated with FAEs and no other systemic anti-psoriatic agents concurrently. Exclusion criteria were studies involving children, mild psoriasis, studies which did not include patients with chronic plaque psoriasis, the use of FAE for the management of illnesses other than psoriasis, and patients treated with more than one systemic anti-psoriatic agent concurrently. RESULTS In total 19 articles were selected for review including 2 randomised placebo controlled trials, 1 non-randomised comparative study, 7 retrospective cohort studies, 2 prospective cohort studies and 7 case studies. The findings suggest that FAEs are a safe and effective treatment option for the management of moderate to severe psoriasis in adult patients. Gastrointestinal side effects may occur on treatment initiation and may be minimised by slow dose titration. Lymphocytopenia and eosinophilia are common, however, they are rarely of significance and there is no high level of evidence available to suggest a resultant increased risk of infection or malignancy. Rarely alterations of renal and hepatic function may occur, however, these are largely reversible on treatment withdrawal. CONCLUSION In conclusion, the use of FAE in the management of moderate to severe psoriasis is a promising treatment option, especially for those patients intolerant of, or unresponsive to other agents. If blood parameters are closely monitored during treatment as per the European Medicine Agencies guidelines (European Medicines Agency, 'Updated recommendations to minimise the risk of the rare brain infection PML with Tecfidera', http://www.ema.europa.eu/docs/en_GB/document_library/Press_release/2015/10/WC500196017.pdf , 2015) they may be safely used in practice. The licensing of FAEs in Ireland for the treatment of moderate to severe psoriasis would be desirable, increasing available treatment options.
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Talamonti M, Galluzzo M, Bianchi L, Boca AN, Costanzo A, Chimenti S. What happened after the clinical trials: long-term safety and efficacy of ustekinumab in daily clinical practice. Dermatology 2014; 229:324-32. [PMID: 25402662 DOI: 10.1159/000365077] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2014] [Accepted: 05/27/2014] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Ustekinumab has been investigated in patients with psoriasis by randomized clinical trials. There are few data on ustekinumab use under 'real life' conditions outside long-term registries. OBJECTIVE The aim of our study was to evaluate the efficacy and safety of ustekinumab as a long-term therapy in real life. METHODS We retrospectively analyzed the data of 71 patients who had been treated with ustekinumab up to 2 years. Efficacy data were analyzed both by 'as treated' and 'intention to treat-last observation carried forward'. RESULTS A significant improvement in the Psoriasis Area and Severity Index score was observed at 4 weeks and further improvements were observed throughout the treatment. Adverse events were generally mild. CONCLUSIONS In routine administration ustekinumab seems to be more efficient than reported by randomized clinical trials. Our results are encouraging and can answer the patients' biggest concern on whether ustekinumab is an effective and safe drug for long-term use.
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Affiliation(s)
- Marina Talamonti
- Department of Dermatology, University of Rome 'Tor Vergata', Rome, Italy
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Torbica A, Fattore G, Ayala F. Eliciting preferences to inform patient-centred policies: the case of psoriasis. PHARMACOECONOMICS 2014; 32:209-223. [PMID: 24446282 DOI: 10.1007/s40273-013-0126-6] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
OBJECTIVE To assess patient preferences for psoriasis treatment features and to investigate the heterogeneity of preferences among patients with different socio-demographic and disease-related characteristics. METHODOLOGY A discrete choice experiment was conducted on adult patients with moderate to severe plaque-type psoriasis during a routine visit to their physician at 15 centres in Italy. We investigated the preferences of patients with respect to five treatment attributes: (1) mode and frequency of administration; (2) time to improvement; (3) time free of symptoms; (4) unintended life expectancy reduction resulting from treatment; and (5) monthly treatment cost. The heterogeneity of preferences was investigated in a mixed logit model with normally distributed random coefficients. RESULTS Overall, patients preferred the subcutaneous or intravenous route of administration (versus oral administration) and treatments that took less time to show improvement, ensured a longer time free of symptoms, involved a lesser reduction in life expectancy and had lower costs. There was significant preference heterogeneity for all attributes. The cost attribute was found to be significantly more important to females and to older patients (above 60 years of age). Older patients placed significantly greater emphasis on reduced life expectancy, whereas the time free of symptoms was significantly less important to them than to patients under 60 years of age. Patients with higher scores on the Dermatology Life Quality Index (DLQI) placed higher value on the time free of symptoms than those with lower DLQI scores. For the overall sample, the marginal willingness to pay (WTP) for a month's reduction in the time to improvement was <euro>32.4, whereas the WTP for one additional month without symptoms was significantly higher (<euro>68.2). CONCLUSION Patient-centred policies should consider the heterogeneity of patients' expectations to identify individualized treatments that would aid in optimizing patient satisfaction and wellbeing, as well as overall treatment effectiveness.
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Affiliation(s)
- Aleksandra Torbica
- Department of Policy Analysis and Public Management, Università Commerciale Luigi Bocconi, Via Roentgen 1, 20136, Milan, Italy
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da Silva CAP, Von Kossel K, Leszczynski M, Melnik T, Riera R. Methotrexate for psoriasis. THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2013. [DOI: 10.1002/14651858.cd010498] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- Carolina AP da Silva
- Universidade Federal de São Paulo; Brazilian Cochrane Centre; Rua Pedro de Toledo, 598 São Paulo São Paulo Brazil 04039-001
| | - Karen Von Kossel
- Universidade Federal de São Paulo; Brazilian Cochrane Centre; Rua Pedro de Toledo, 598 São Paulo São Paulo Brazil 04039-001
| | - Marcos Leszczynski
- Universidade Federal de São Paulo; Brazilian Cochrane Centre; Rua Pedro de Toledo, 598 São Paulo São Paulo Brazil 04039-001
| | - Tamara Melnik
- Universidade Federal de São Paulo; Brazilian Cochrane Centre; Rua Pedro de Toledo, 598 São Paulo São Paulo Brazil 04039-001
| | - Rachel Riera
- Centro de Estudos de Medicina Baseada em Evidências e Avaliação Tecnológica em Saúde; Brazilian Cochrane Centre; R. Borges Lagoa, 564 cj 63 São Paulo São Paulo Brazil 04038000
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Emerit I, Antunes J, Silva JM, Freitas J, Pinheiro T, Filipe P. Clastogenic plasma factors in psoriasis--comparison of phototherapy and anti-TNF-α treatments. Photochem Photobiol 2011; 87:1427-32. [PMID: 21824151 DOI: 10.1111/j.1751-1097.2011.00982.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
As previously described, Psoralen plus UVA (PUVA) therapy induces chromosome damage in psoriatic patients. This study evaluates whether these effects are transitory or persistent. In addition, we studied these effects after narrowband UVB (nUVB) and anti-tumor necrosis factor (TNF)-α treatments. Among 40 responder patients, 10 received PUVA, 10 nUVB, 10 Infliximab and 10 Etanercept. Disease activity was determined with Psoriasis Area and Severity Index. Chromosomal breakage was evaluated by the clastogenic factor (CF) test. Potential clastogenic agents, malondialdehyde (MDA) and TNF-α were measured. Before treatment, the plasma-adjusted clastogenic scores (ACS) of patients were increased. During treatment, a further increase in ACS was observed in both phototherapy groups. Chromosome damage persisted for PUVA patients at week 32, while it diminished after nUVB to ACS values lower than before treatment. MDA and TNF-α values were also increased at baseline. MDA decreased during treatment in all groups, but without reaching normal levels. Plasma TNF-α remained unchanged in PUVA and nUVB but decreased in both anti-TNF-α treatment groups. Psoriasis is accompanied by CF-induced chromosomal breakage that increases during PUVA and nUVB treatments. Plasma clastogenic activity persisted in the follow-up after PUVA, while after nUVB ACS returned to values even lower than baseline. Clastogenic activity during the induction phase with anti-TNF-α remained unchanged.
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Affiliation(s)
- Ingrid Emerit
- Université Paris VI et CNRS France, 132 rue Léon Maurice Nordmann, Paris, France.
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Al Raddadi AA, Fatani MI, Shaikh YH, Thaci D, Al Reshaid AA, Al-Eisa AM, Alghamdi WA, Abdulfattah HY, Al Belbisi ZM, Atawi AC, Alajroush WA, Al Fadly AA, El-Shamy SI, Zimmo SK, Alqahtani AA, Abdulghani MM, Al Abod KM, Al Attas KM, Al Ayouby MF, Qari MS, Al Ghanim AS. Adopted guidelines of care for the topical management of psoriasis from American and German guidelines. ACTA ACUST UNITED AC 2011. [DOI: 10.1016/j.jssdds.2010.10.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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Ashcroft DM, Seston E, Griffiths CEM. Trade-offs between the benefits and risks of drug treatment for psoriasis: a discrete choice experiment with U.K. dermatologists. Br J Dermatol 2006; 155:1236-41. [PMID: 17107395 DOI: 10.1111/j.1365-2133.2006.07535.x] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND The choice of drug treatment for an individual patient is a complex matter. In the case of psoriasis there is a range of treatments available, with varying degrees of efficacy and risk of adverse events. OBJECTIVES To examine the extent to which the attributes of a treatment affect dermatologists' choice of drug therapy and explore the magnitude and nature of the trade-offs between the risks and benefits of treatment. METHODS A postal questionnaire was sent to members of the British Association of Dermatologists (BAD). The questionnaire used a discrete choice experiment (DCE) to elicit dermatologists' preferences for the treatment of psoriasis. In all, 227 dermatologists completed the questionnaire. The results indicated that time to moderate improvement, time to relapse, risk of hypertension, liver damage, skin cancer and skin irritation were all important factors affecting dermatologists' choice of treatment. Comparing the coefficients for the different side-effects indicated that the dermatologists considered the risk of liver damage to be the most important side-effect, followed by the risk of skin cancer. The time to achieve a moderate (50%) improvement in psoriasis was prioritized over the time to relapse. CONCLUSIONS This study has provided novel insight into the trade-offs that dermatologists face when selecting treatment for psoriasis patients. Future research should explore the extent to which dermatologists' preferences for treatment match those of psoriasis sufferers.
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Affiliation(s)
- D M Ashcroft
- School of Pharmacy and Pharmaceutical Sciences, The University of Manchester, Oxford Road, Manchester, UK.
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Abstract
Maintenance therapy in the interval between flares is an essential part of the therapeutic approach to psoriasis. The therapeutic effectiveness of maintenance therapy results from a positive influence on the physicochemical characteristics of individual compartments of the skin, especially the stratum corneum and the epidermis. The objective is revert from a pathological milieu toward a physiological one. These effects may be supplemented by pharmacological or biochemical effects of the active substances or substance mixtures. Focal points are the use of lipophilic bases as well as keratoplastic, antiseptic and antipruriginous additives.
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Affiliation(s)
- J Wohlrab
- Universitätsklinik und Poliklinik für Dermatologie und Venerologie, Institut für angewandte Dermatopharmazie, Martin-Luther-Universität Halle-Wittenberg, Ernst-Kromayer-Strasse 5, 06097, Halle, Germany.
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