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Deodhar A, Blauvelt A, Lebwohl M, Feely M, Kronbergs A, Eberhart N, Zhu D, Inman E, Grace E, Holzkaemper T, Rahman P, Marzo-Ortega H, Papp KA, Merola JF, Gottlieb AB, Schwartzman S. Long-term safety of Ixekizumab in adults with psoriasis, psoriatic arthritis, or axial spondyloarthritis: a post-hoc analysis of final safety data from 25 randomized clinical trials. Arthritis Res Ther 2024; 26:49. [PMID: 38347650 PMCID: PMC10860236 DOI: 10.1186/s13075-023-03257-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Accepted: 12/27/2023] [Indexed: 02/15/2024] Open
Abstract
BACKGROUND We report long-term, end-of-study program safety outcomes from 25 randomized clinical trials (RCTs) in adult patients with psoriasis (PsO), psoriatic arthritis (PsA), or axial spondyloarthritis (axSpA) [including ankylosing spondylitis (AS) and non-radiographic axial spondyloarthritis (nr-axSpA)] who received ≥ 1 dose of Ixekizumab (IXE) over 5 years (PsO) or up to 3 years (PsA, axSpA). METHODS This integrated safety analysis consists of data from patients who received any dose of IXE, across 25 RCTs (17 PsO, 4 PsA, 4 axSpA). Rates of treatment-emergent adverse events (TEAEs), serious adverse events (SAEs) and selected adverse events (AEs) of interest were analyzed for all pooled studies by years of therapy and overall, through March 2022. Results were reported as exposure-adjusted incidence rates (IRs) per 100 patient-years (PY) overall and at successive year intervals. RESULTS Six thousand eight hundred ninety two adult patients with PsO, 1401 with PsA, and 932 with axSpA (including AS and nr-axSpA), with a cumulative IXE exposure of 22,371.1 PY were included. The most commonly reported TEAE across indications was nasopharyngitis (IRs per 100 PY: 8.8 (PsO), 9.0 (PsA), 8.4 (axSpA)). SAEs were reported by 969 patients with PsO (IR 5.4), 134 patients with PsA (IR 6.0), and 101 patients with axSpA (IR 4.8). Forty-five deaths were reported (PsO, n = 36, IR 0.2; PsA, n = 6, IR 0.3; axSpA, n = 3, IR 0.1). TEAEs did not increase during IXE exposure: IRs per 100 PY, PsO: 88.9 to 63.2 (year 0-1 to 4-5), PsA: 87 to 67.3 (year 0-1 to 2-3), axSpA: 82.1 to 55.4 (year 0-1 to > = 2). IRs per 100 PY of discontinuation from IXE due to AE were 2.9 (PsO), 5.1 (PsA), and 3.1 (axSpA). IRs per 100 PY of injection site reactions were 5.9 (PsO), 11.6 (PsA) and 7.4 (axSpA); Candida: 1.9 (PsO), 2.0 (PsA), and 1.2 (axSpA); depression, major adverse cerebro-cardiovascular events and malignancies: ≤ 1.6 across all indications. Adjudicated IRs per 100 PY of inflammatory bowel disease were ≤ 0.8 across indications (0.1 [PsO]; 0.1 [PsA]; 0.8 [axSpA]). CONCLUSIONS In this integrated safety analysis, consisting of over 22,000 PY of exposure, the long-term safety profile of IXE was found to be consistent with previous, earlier reports, with no new safety signals identified. TRIAL REGISTRATION NCT registration numbers for RCTs included in this integrated analysis can be found in Additional File 1.
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Affiliation(s)
- Atul Deodhar
- Oregon Health & Science University, Portland, OR, USA
| | | | | | - Meghan Feely
- Mount Sinai Hospital, New York, NY, USA
- Eli Lilly and Company, Indianapolis, IN, USA
- Mount Sinai West and Mount Sinai Morningside, New York, NY, USA
| | | | | | - Danting Zhu
- Eli Lilly and Company, Indianapolis, IN, USA
| | - Elsa Inman
- Eli Lilly and Company, Indianapolis, IN, USA
| | - Elsie Grace
- Eli Lilly and Company, Indianapolis, IN, USA
| | | | - Proton Rahman
- Memorial University of Newfoundland, St. John's, NL, Canada
| | - Helena Marzo-Ortega
- NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals Trust, Leeds Institute for Rheumatic and Musculoskeletal Medicine, The University of Leeds, Leeds, UK
| | - Kim A Papp
- Probity Medical Research and Alliance Clinical Trials, Waterloo, ON, Canada
- Division of Dermatology, Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Joseph F Merola
- The University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Alice B Gottlieb
- Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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Burshtein J, Shah M, Zakria D, Lockshin B, Crowley J, Merola JF, Gordon K, Shahriari M, Korman NJ, Chovatiya R, Kalb R, Lebwohl M. The Efficacy and Safety of Bimekizumab for Plaque Psoriasis: An Expert Consensus Panel. Dermatol Ther (Heidelb) 2024; 14:323-339. [PMID: 38340237 PMCID: PMC10891030 DOI: 10.1007/s13555-024-01099-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Accepted: 01/12/2024] [Indexed: 02/12/2024] Open
Abstract
INTRODUCTION Psoriasis is a chronic inflammatory condition affecting the skin, joints, and several other organ systems with significant disease burden. Bimekizumab is the first monoclonal antibody targeting both interleukin (IL)-17A and interleukin-17F and has demonstrated efficacy for treating moderate to severe psoriasis. Limited guidelines exist for incorporating this drug into clinical practice. The purpose of this study was for a panel of experts in psoriasis management to synthesize current literature and provide consensus statements with guidance on use of bimekizumab. METHODS A comprehensive literature search of PubMed, Scopus, and Google Scholar was completed for English-language original research articles on the use of bimekizumab for moderate to severe psoriasis and psoriatic arthritis. A panel of nine dermatologists with significant expertise in treatment of psoriasis gathered to review the articles and create consensus statements on this new medication. A modified Delphi process was used to approve each statement and a strength of recommendation was assigned using Strength of Recommendation Taxonomy criteria. RESULTS The literature search produced 102 articles that met criteria. A thorough screening of the studies for relevance to the research question resulted in 19 articles. These were distributed to all panelists for review prior to a roundtable discussion. The panel unanimously voted to adopt 14 consensus statements and recommendations, 12 of which were given a strength of "A", one of which was given a strength of "B", and one of which was given a strength of "C". CONCLUSION Bimekizumab results in rapid and long-lasting clinical improvement for patients with moderate to severe plaque psoriasis and psoriatic arthritis. It has demonstrated superior efficacy when compared to several other biologics. The safety profile is consistent with other biologics, except for an increased incidence of oropharyngeal candidiasis.
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Affiliation(s)
- Joshua Burshtein
- Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
| | - Milaan Shah
- Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Danny Zakria
- Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Benjamin Lockshin
- US Dermatology Partners, Rockville, MD, USA
- Department of Dermatology, Georgetown University Medical Center, Washington, DC, USA
| | - Jeff Crowley
- Bakersfield Dermatology and Skin Cancer Medical Group, Bakersfield, CA, USA
| | - Joseph F Merola
- Department of Dermatology, The University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Ken Gordon
- Medical College of Wisconsin, Milwaukee, WI, USA
| | - Mona Shahriari
- Department of Dermatology, Yale University, New Haven, CT, USA
| | - Neil J Korman
- University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Raj Chovatiya
- Department of Dermatology, Feinberg School of Medicine at Northwestern University, Chicago, IL, USA
| | - Robert Kalb
- SUNY at Buffalo School of Medicine and Biomedical Sciences, Department of Dermatology, Buffalo Medical Group, Buffalo, NY, USA
| | - Mark Lebwohl
- Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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Jung JM, Kim YJ, Chang SE, Lee MW, Won CH, Lee WJ. Cancer risks in patients with psoriasis administered biologics therapy: a nationwide population-based study. J Cancer Res Clin Oncol 2023; 149:17093-17102. [PMID: 37755577 DOI: 10.1007/s00432-023-05387-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Accepted: 09/01/2023] [Indexed: 09/28/2023]
Abstract
PURPOSE To assess cancer risks in patients with psoriasis and the effect of TNF-α inhibitor and interleukin (IL)-12/23 inhibitor therapy on those cancer risks. METHODS Using the Korean Health Insurance Review and Assessment Service database, patients with newly diagnosed psoriasis between 2008 to 2019 were included. Standardized incidence ratios (SIRs) of overall and specific cancers were calculated in patients with psoriasis. The effect of TNF-α inhibitor and IL-12/23 inhibitor exposure on the risk of cancers was assessed by multivariable Cox regression models. RESULTS In total, 191,678 patients with psoriasis were included in this study. The overall risk of cancer was significantly higher in patients with psoriasis than in the general population (SIR, 1.12; 95% confidence interval (CI), 1.09-1.14). TNF-α inhibitor users had a significantly higher risk for overall cancer (adjusted hazard ratio (aHR), 1.41; 95% CI 1.01-1.97). In contrast, IL-12/23 inhibitor exposure had a significantly lower risk for overall cancer (aHR, 0.57; 95% CI 0.37-0.87). Among specific cancers, the risks of non-Hodgkin lymphoma (aHR, 2.98; 95% CI 1.02-8.69) were increased by TNF-α inhibitor therapy, while the risk of other cancers, including nonmelanoma skin cancer (aHR, 2.31; 95% CI 0.51-10.46), was not significantly altered by TNF-α inhibitor therapy. CONCLUSION TNF-α inhibitor therapy in psoriasis is associated with a significantly increased risk of overall cancer and lymphoma, while the risk of solid organ cancer was not affected by this therapy. The IL-12/23 inhibitor is not associated with an increased risk of any cancer.
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Affiliation(s)
- Joon Min Jung
- Department of Dermatology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Korea
| | - Ye-Jee Kim
- Department of Clinical Epidemiology and Biostatistics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Sung Eun Chang
- Department of Dermatology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Korea
| | - Mi Woo Lee
- Department of Dermatology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Korea
| | - Chong Hyun Won
- Department of Dermatology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Korea.
| | - Woo Jin Lee
- Department of Dermatology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Korea.
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Balda A, Wani I, Roohi TF, Krishna KL, Mehdi S, Nadiga AP, Makkapati M, Baig MAI. Psoriasis and skin cancer - Is there a link? Int Immunopharmacol 2023; 121:110464. [PMID: 37390565 DOI: 10.1016/j.intimp.2023.110464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Revised: 05/18/2023] [Accepted: 06/05/2023] [Indexed: 07/02/2023]
Abstract
A chronic auto-immune-mediated disease Psoriasis is associated with manycoexisting or co-occurringconditions, which include a significant risk of malignancies, especiallyskin tumours. Numerous studies were done to understand whether psoriasis itself, comorbidities related to psoriasis, or psoriasis treatment might increase the risk of neoplasms. We reviewed the relation between psoriasis and cancer risk, also the significance of inflammation in cancer The various classes of drugs used to treat psoriasis, including biologics like tumour necrosis factor (TNF) inhibitors; and how they increase cancer risk are deliberated. Literature was collated for the past five years from the data bases like PubMed, Medline, Google Scholar, etc. Literatures discussing the skin cancer linked to psoriasis were reviewed. Possible mechanisms associated between inflammation and psoriasis; skin cancer was explained in the context of the several psoriasis medications that increase the likelihood of skin cancer. The risk of cancer in other cutaneous auto-inflammatory diseases is also elucidated. It is frequently observed that increased doses of PUVA therapy, immunosuppressive medications, and lifestyle changes alter the aetiology of the tumours. This review is conceptualized to shed the light on probable mechanisms involved in these connections as well as the chance of cancer in psoriasis patients.
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Affiliation(s)
- Aayushi Balda
- Department of Pharmacology, JSS College of Pharmacy, JSS Academy of Higher Education & Research, Mysore 570015, Karnataka, India
| | - Irshad Wani
- Department of Pharmacology, JSS College of Pharmacy, JSS Academy of Higher Education & Research, Mysore 570015, Karnataka, India
| | - Tamsheel Fatima Roohi
- Department of Pharmacology, JSS College of Pharmacy, JSS Academy of Higher Education & Research, Mysore 570015, Karnataka, India
| | - K L Krishna
- Department of Pharmacology, JSS College of Pharmacy, JSS Academy of Higher Education & Research, Mysore 570015, Karnataka, India.
| | - Seema Mehdi
- Department of Pharmacology, JSS College of Pharmacy, JSS Academy of Higher Education & Research, Mysore 570015, Karnataka, India
| | - Abhishek Pr Nadiga
- Department of Pharmacology, JSS College of Pharmacy, JSS Academy of Higher Education & Research, Mysore 570015, Karnataka, India
| | - Manasa Makkapati
- Department of Pharmacology, JSS College of Pharmacy, JSS Academy of Higher Education & Research, Mysore 570015, Karnataka, India
| | - Md Awaise Iqbal Baig
- Department of Pharmacology, JSS College of Pharmacy, JSS Academy of Higher Education & Research, Mysore 570015, Karnataka, India
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Hong JJ, Hadeler EK, Mosca ML, Brownstone ND, Bhutani T, Liao WJ. TNF-alpha inhibitors and ustekinumab for the treatment of psoriasis: therapeutic utility in the era of IL-17 and IL-23 inhibitors. JOURNAL OF PSORIASIS AND PSORIATIC ARTHRITIS 2022; 7:79-92. [PMID: 35757187 PMCID: PMC9229820 DOI: 10.1177/24755303211047479] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Psoriasis is a chronic inflammatory condition for which eleven FDA-approved biologic therapies are approved. Over the past decade, studies have documented the higher efficacy of IL-17 and IL-23 inhibitors for the treatment of psoriasis compared to the TNF-alpha inhibitors and ustekinumab, an IL-12/23 inhibitor. Despite this, there remains an important role for the use of TNF-alpha inhibitors and ustekinumab in the treatment of psoriasis. Here, we review how considerations of infection and malignancy risk, patient demographics, treatment resistance, and co-morbidities may make certain TNF-alpha inhibitors or ustekinumab an excellent choice for therapy in particular patient subgroups.
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Affiliation(s)
- Julie J Hong
- University of California San Francisco, Department of Dermatology, Psoriasis and Skin Treatment Center
| | - Edward K Hadeler
- University of California San Francisco, Department of Dermatology, Psoriasis and Skin Treatment Center
| | - Megan L Mosca
- University of California San Francisco, Department of Dermatology, Psoriasis and Skin Treatment Center
| | - Nicholas D Brownstone
- University of California San Francisco, Department of Dermatology, Psoriasis and Skin Treatment Center
| | - Tina Bhutani
- University of California San Francisco, Department of Dermatology, Psoriasis and Skin Treatment Center
| | - Wilson J Liao
- University of California San Francisco, Department of Dermatology, Psoriasis and Skin Treatment Center
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Psoriasis Therapy and Skin Cancer: A Review. Life (Basel) 2021; 11:life11101109. [PMID: 34685480 PMCID: PMC8538945 DOI: 10.3390/life11101109] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Revised: 10/13/2021] [Accepted: 10/13/2021] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION psoriasis is a chronic immune-mediated disease that is associated with several comorbidities, including an increased risk of malignancies, particularly skin cancer. A large number of studies have investigated whether psoriasis itself, psoriasis-associated comorbidities, or psoriasis treatment could lead to an increased risk of neoplasms. METHODS we reviewed the literature using the most important databases (PubMed, MEDLINE, ETHERIA). All articles pertaining to skin cancer associated with psoriasis disease and psoriasis therapy were included. In this review, we also discuss some of the potential underlying mechanisms for these associations, particularly regarding the multiple psoriasis therapies currently available, and their possible implications in higher incidences of skin cancer in these patients. CONCLUSION evidence suggests that these patients might have a higher risk of cutaneous malignancies, especially for NMSC, compared with psoriasis-free patients. The reasons for this increased risk remain to be determined. However, high dose PUVA therapy, the immunosuppressive treatments used, and the comorbidities and habits frequently described in these patients seem to play a role in the pathogenesis of these tumors. Because of these facts, periodic screening for skin cancer is recommended in this population.
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Farooq M, Batool M, Kim MS, Choi S. Toll-Like Receptors as a Therapeutic Target in the Era of Immunotherapies. Front Cell Dev Biol 2021; 9:756315. [PMID: 34671606 PMCID: PMC8522911 DOI: 10.3389/fcell.2021.756315] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Accepted: 09/13/2021] [Indexed: 12/29/2022] Open
Abstract
Toll-like receptors (TLRs) are the pattern recognition receptors, which are activated by foreign and host molecules in order to initiate the immune response. They play a crucial role in the regulation of innate immunity, and several studies have shown their importance in bacterial, viral, and fungal infections, autoimmune diseases, and cancers. The consensus view from an immunological perspective is that TLR agonists can serve either as a possible therapeutic agent or as a vaccine adjuvant toward cancers or infectious diseases and that TLR inhibitors may be a promising approach to the treatment of autoimmune diseases, some cancers, bacterial, and viral infections. These notions are based on the fact that TLR agonists stimulate the secretion of proinflammatory cytokines and in general, the development of proinflammatory responses. Some of the TLR-based inhibitory agents have shown to be efficacious in preclinical models and have now entered clinical trials. Therefore, TLRs seem to hold the potential to serve as a perfect target in the era of immunotherapies. We offer a perspective on TLR-based therapeutics that sheds light on their usefulness and on combination therapies. We also highlight various therapeutics that are in the discovery phase or in clinical trials.
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Affiliation(s)
- Mariya Farooq
- Department of Molecular Science and Technology, Ajou University, Suwon, South Korea
| | - Maria Batool
- Department of Molecular Science and Technology, Ajou University, Suwon, South Korea
- S&K Therapeutics, Suwon, South Korea
| | - Moon Suk Kim
- Department of Molecular Science and Technology, Ajou University, Suwon, South Korea
| | - Sangdun Choi
- Department of Molecular Science and Technology, Ajou University, Suwon, South Korea
- S&K Therapeutics, Suwon, South Korea
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Semaka A, Salopek TG. Risk of Developing Melanoma With Systemic Agents Used to Treat Psoriasis: A Review of the Literature. J Cutan Med Surg 2021; 26:87-92. [PMID: 34392725 PMCID: PMC8750137 DOI: 10.1177/12034754211038509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Psoriasis is a chronic inflammatory skin disease induced by
autoimmune-like dysregulation of the immune system. Treatment
options have drastically evolved in recent years, and treatment
advances that target specific cytokines and other molecules
involved in dysregulation have had a profound effect in
controlling the disease. Objective We reviewed the literature to assess the risk of developing
melanoma with conventional therapies and newer agents used to
treat psoriasis. Methods A comprehensive literature search using Medline (via Ovid) and
Embase was conducted. Results The majority of studies reviewed reported insignificant results.
Potential risk for melanoma was identified for only 3 out of 15
anti-psoriatic treatments analyzed: adalimumab (relative risk
1.8, 95% CI 1.06-3.00), etanercept (relative risk 2.35, 95% CI
1.46-3.77) and infliximab (Empirical Bayes Geometric Mean 7.90,
95% CI 7.13-8.60). The confidence intervals provided are from
prior studies. There are not enough collective data on newer
agents to make any conclusions on risk. Conclusions We were unable to identify any substantial risk for developing
melanoma due to the use of anti-psoriatic treatments. Until
additional long-term registry data become available, it would be
prudent to continue screening patients with psoriasis at
baseline and periodically for melanoma when these agents are
used.
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Affiliation(s)
- Amy Semaka
- 3158 Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Thomas G Salopek
- Division of Dermatology, Department of Medicine, University of Alberta, Edmonton, AB, Canada
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Brownstone ND, Koo J. Is the Pathology in Atopic Dermatitis Limited Only to the Skin? THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2021; 8:3507. [PMID: 33161967 DOI: 10.1016/j.jaip.2020.07.045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Accepted: 07/31/2020] [Indexed: 11/16/2022]
Affiliation(s)
- Nicholas D Brownstone
- Department of Dermatology, Psoriasis and Skin Treatment Center, University of California, San Francisco, Calif.
| | - John Koo
- Department of Dermatology, Psoriasis and Skin Treatment Center, University of California, San Francisco, Calif
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Examples of adverse effects after biological therapy. Postepy Dermatol Alergol 2020; 37:712-718. [PMID: 33240011 PMCID: PMC7675069 DOI: 10.5114/ada.2020.100482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2018] [Accepted: 03/06/2019] [Indexed: 12/01/2022] Open
Abstract
Psoriasis is one of the most common, chronic skin diseases of as yet unexplained etiopathogenesis. In the recent years it has been proven that an immunological factor plays an important role in the dermatosis onset. This has led to introduction of biological drugs to the disease treatment regimen, which include, inter alia, adalimumab and ustekinumab. New therapy has become an alternative for patients with psoriasis resistant to standard treatment methods as well as an alternative form of treatment in case of occurrence of severe adverse drug reactions after administration of standard treatment. Despite good treatment results the administration of these drugs is associated with the occurrence of adverse reactions. This article presents cases of 4 patients who have been administered biological treatment and in whom there have been observed, inter alia, the occurrence of hypersensitivity reactions in the form of acute urticaria as well as skin lesions of erythema multiforme nature or positive antinuclear antibodies titre. The symptoms experienced by the presented patients posed no direct threat to life and the benefits of the drugs’ administration had a significant therapeutic importance.
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Reich K, Papp KA, Armstrong AW, Wasfi Y, Li S, Shen YK, Randazzo B, Song M, Kimball AB. Safety of guselkumab in patients with moderate-to-severe psoriasis treated through 100 weeks: a pooled analysis from the randomized VOYAGE 1 and VOYAGE 2 studies. Br J Dermatol 2020; 180:1039-1049. [PMID: 30485400 DOI: 10.1111/bjd.17454] [Citation(s) in RCA: 46] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/23/2018] [Indexed: 12/17/2022]
Abstract
BACKGROUND Long-term evaluation is required to confirm the safety profile of newer biologic agents. OBJECTIVES To report on pooled safety data from the ongoing VOYAGE 1 (NCT02207231) and VOYAGE 2 (NCT02207244) trials through 100 weeks of follow-up. METHODS Patients were randomized to either guselkumab 100 mg at weeks 0 and 4 and every 8 weeks thereafter; placebo at weeks 0, 4, 12 followed by guselkumab 100 mg at weeks 16 and 20 and every 8 weeks thereafter; or adalimumab 80 mg at week 0, 40 mg at week 1, and 40 mg every 2 weeks thereafter. Patients who received adalimumab crossed over to guselkumab at week 52 (VOYAGE 1) and at/after week 28 based on clinical response (VOYAGE 2). Open-label extensions, in which all patients received guselkumab, started at week 52 (VOYAGE 1) and week 76 (VOYAGE 2). Rates of adverse events (AEs) per 100 patient-years (PYs) are presented through 100 weeks of follow-up. RESULTS Through week 52, observed rates for guselkumab- and adalimumab-treated patients, respectively, were 262·45 per 100 PYs and 328·28 per 100 PYs for AEs, 6·20 per 100 PYs and 7·77 per 100 PYs for serious AEs (SAEs), 1·22 per 100 PYs and 1·79 per 100 PYs for serious infections (SIs), 0·28 per 100 PYs and 0·40 per 100 PYs for malignancies other than nonmelanoma skin cancers (NMSCs), 0·56 per 100 PYs and 0·40 per 100 PYs for NMSCs, and 0·47 per 100 PYs and 0·40 per 100 PYs for major adverse cardiovascular events (MACEs). Rates among patients treated with guselkumab through week 52 and week 100, respectively, were 262·45 per 100 PYs and 210·41 per 100 PYs for AEs, 6·20 and 6·29 per 100 PYs, for SAEs, 1·22 per 100 PYs and 1·06 per 100 PYs for SIs, 0·28 per 100 PYs and 0·38 per 100 PYs for malignancies, 0·56 per 100 PYs and 0·39 per 100 PYs for NMSCs, and 0·47 per 100 PYs and 0·38 per 100 PYs for MACEs. Among patients treated with adalimumab, rates of AEs, SAEs, SIs, malignancies, NMSCs, and MACEs showed some variability before and after crossover to guselkumab, although no new safety signals were noted after crossover. CONCLUSIONS The safety profile for guselkumab remains favourable through 100 weeks of treatment in patients with moderate-to-severe psoriasis.
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Affiliation(s)
- K Reich
- Dermatologikum Berlin and SCIderm Research Institute, Hamburg, Germany
| | - K A Papp
- K Papp Clinical Research and Probity Research, Inc., Waterloo, Canada
| | - A W Armstrong
- University of Southern California, Los Angeles, CA, U.S.A
| | - Y Wasfi
- Janssen Research & Development, LLC, Spring House, PA, U.S.A
| | - S Li
- Janssen Research & Development, LLC, Spring House, PA, U.S.A
| | - Y K Shen
- Janssen Research & Development, LLC, Spring House, PA, U.S.A
| | - B Randazzo
- Janssen Research & Development, LLC, Spring House, PA, U.S.A
| | - M Song
- Janssen Research & Development, LLC, Spring House, PA, U.S.A
| | - A B Kimball
- Harvard Medical School and Beth Israel Deaconess Medical Center, Inc., Boston, MA, U.S.A
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Armstrong A, Paul C, Puig L, Boehncke WH, Freeman M, Torii H, Papp K, Griffiths CEM, Blauvelt A, Reich K, Gooderham M, Terui T, Renda L, Agada N, Xu W, Gallo G, Lebwohl MG. Safety of Ixekizumab Treatment for up to 5 Years in Adult Patients with Moderate-to-Severe Psoriasis: Results from Greater Than 17,000 Patient-Years of Exposure. Dermatol Ther (Heidelb) 2020; 10:133-150. [PMID: 31749092 PMCID: PMC6994584 DOI: 10.1007/s13555-019-00340-3] [Citation(s) in RCA: 47] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Indexed: 12/20/2022] Open
Abstract
INTRODUCTION Long-term safety data are critical for evaluating therapies for psoriasis. Ixekizumab has demonstrated efficacy and is well tolerated for the treatment of moderate-to-severe plaque psoriasis. We examined the safety and tolerability of up to 5 years of ixekizumab therapy in patients with psoriasis. METHODS Integrated safety data were analyzed from 13 ixekizumab clinical studies. Rates of treatment-emergent adverse events (TEAEs), serious AEs (SAEs) and AEs of special interest were analyzed for the 12-week induction period in the combined pivotal studies, and for all pooled studies by year(s) of therapy and overall, reported as exposure-adjusted incidence rates (IRs) per 100 patient-years (p-y) and/or frequencies. RESULTS Total ixekizumab exposure was 17,003.4 p-y (N = 5898); 2749 patients had ≥ 4 years of exposure. When compared across years of exposure, rates for AEs remained largely stable or declined, including TEAEs leading to discontinuation (3.8/100 p-y in year 1, declining to 2.0/100 p-y in year 5); SAEs (range 6.2-7.0/100 p-y); serious infections (range 1.3-1.7/100 p-y); nonmelanoma skin cancer (ranging from 0.5/100 p-y in year 1 to 0.2/100 p-y in years 4-5); other malignancies (range 0.4-0.6/100 p-y); inflammatory bowel disease including ulcerative colitis and Crohn's disease (IR 0.2/100 p-y); and major adverse cardiovascular events (MACE) (range 0.3-0.7/100 p-y). Candidiasis was reported in 327 patients (IR 1.9/100 p-y), with the majority identified as mucocutaneous. The rate of injection site reactions was 15.5/100 p-y during year 1 and 2.0-2.3/100 p-y by years 3-5. CONCLUSIONS The decrease in rates of TEAEs and the stable rates of SAEs, other malignancies and MACE during up to 5 years of ixekizumab dosing are consistent with previous reports describing a favorable safety profile of ixekizumab following shorter durations of exposure. FUNDING Eli Lilly and Company.
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Affiliation(s)
- April Armstrong
- Department of Clinical Research, Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA.
| | - Carle Paul
- Dermatology Department, Toulouse University Hospital (CHU), Paul Sabatier University, Toulouse, France
| | - Luis Puig
- Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Wolf Henning Boehncke
- Division of Dermatology and Venereology, Geneva University Hospitals, Geneva, Switzerland
- Department of Pathology and Immunology, University of Geneva, Geneva, Switzerland
| | | | - Hideshi Torii
- Division of Dermatology, Tokyo Yamate Medical Center, Tokyo, Japan
| | - Kim Papp
- K Papp Clinical Research and Probity Medical Research, Waterloo, ON, Canada
| | - Christopher E M Griffiths
- Dermatology Centre, Salford Royal Hospital, University of Manchester, NIHR Manchester Biomedical Research Centre, Manchester, UK
| | | | - Kristian Reich
- Center for Translational Research in Inflammatory Skin Diseases, Institute for Health Services Research in Dermatology and Nursing, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Skinflammation® Center, Hamburg, Germany
| | - Melinda Gooderham
- Centre for Dermatology and Probity Medical Research, Peterborough, ON, Canada
| | - Tadashi Terui
- Department of Dermatology, Nihon University School of Medicine, Tokyo, Japan
| | - Lisa Renda
- Eli Lilly and Company, Indianapolis, IN, USA
| | - Noah Agada
- Eli Lilly and Company, Indianapolis, IN, USA
| | - Wen Xu
- Eli Lilly and Company, Indianapolis, IN, USA
| | - Gaia Gallo
- Eli Lilly and Company, Indianapolis, IN, USA
| | - Mark G Lebwohl
- Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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13
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Burmester GR, Gordon KB, Rosenbaum JT, Arikan D, Lau WL, Li P, Faccin F, Panaccione R. Long-Term Safety of Adalimumab in 29,967 Adult Patients From Global Clinical Trials Across Multiple Indications: An Updated Analysis. Adv Ther 2020; 37:364-380. [PMID: 31748904 PMCID: PMC6979455 DOI: 10.1007/s12325-019-01145-8] [Citation(s) in RCA: 45] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Indexed: 12/17/2022]
Abstract
INTRODUCTION The safety profile of adalimumab was previously reported in 23,458 patients across multiple indications. Here we report the long-term safety of adalimumab in adults with plaque psoriasis (Ps), hidradenitis suppurativa (HS), rheumatoid arthritis (RA), ankylosing spondylitis, psoriatic arthritis, non-radiographic axial spondyloarthritis, peripheral spondyloarthritis, Crohn's disease (CD), ulcerative colitis (UC), and non-infectious uveitis (UV). METHODS Safety data from 77 clinical trials were pooled. Safety assessments included adverse events (AEs) and serious AEs (SAEs) that occurred after the first study dose and within 70 days (5 half-lives) after the last study dose. RESULTS A total of 29,967 patients were included, representing 56,916 patient-years (PY) of exposure. The most frequently reported SAE of interest was infection (3.7/100 PY) with highest incidences in CD, RA, UV, and UC (3.5/100 PY-6.9/100 PY); serious infections in Ps (1.8/100 PY) and HS (2.8/100 PY) were lower. The observed number of deaths was below what would be expected in an age- and sex-adjusted population for most adalimumab-treated patients (including Ps). Lack of real-life data and limited long-term data (> 5 years) for most patients are limitations of this analysis. CONCLUSION The safety profile of adalimumab was consistent with previous findings and no new safety signals were observed.
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Affiliation(s)
| | | | - James T Rosenbaum
- Oregon Health and Science University and Legacy Devers Eye Institute, Portland, OR, USA
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14
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Thaçi D, Papp K, Marcoux D, Weibel L, Pinter A, Ghislain PD, Landells I, Hoeger PH, Unnebrink K, Seyger MMB, Williams DA, Rubant S, Philipp S. Sustained long-term efficacy and safety of adalimumab in paediatric patients with severe chronic plaque psoriasis from a randomized, double-blind, phase III study. Br J Dermatol 2019; 181:1177-1189. [PMID: 31017657 PMCID: PMC6916374 DOI: 10.1111/bjd.18029] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/22/2019] [Indexed: 12/13/2022]
Abstract
BACKGROUND Adalimumab (ADA) (Humira® , AbbVie Inc., U.S.A.) is approved by the European Medicines Agency for children aged ≥ 4 years with severe plaque psoriasis. OBJECTIVES To evaluate the long-term efficacy and safety of ADA in children with severe plaque psoriasis. METHODS Results are presented from the 52-week long-term extension (LTE) of the randomized, double-blind, double-dummy, phase III trial, in children with severe plaque psoriasis (results from prior periods have been published). Patients aged ≥ 4 and < 18 years were randomized 1 : 1 : 1 to ADA 0·8 mg kg-1 (40 mg maximum) or 0·4 mg kg-1 (20 mg maximum) every other week or to methotrexate (MTX) 0·1-0·4 mg kg-1 (25 mg maximum) weekly. The 16-week initial treatment (IT) period was followed by a 36-week withdrawal period and a 16-week retreatment period. Patients could enter the LTE at prespecified time points to receive ADA 0·8 mg kg-1 (blinded or open label) or ADA 0·4 mg kg-1 (blinded), or to remain off treatment. Efficacy is reported for patient groups according to doses received in the IT and LTE periods. RESULTS Of the 114 patients randomized in the IT period, 108 entered the LTE (n = 36 in each group); 93 received ADA 0·8 mg kg-1 . Efficacy (≥ 75% improvement from baseline in Psoriasis Area and Severity Index) was maintained or improved from entry to the end of the LTE: MTX(IT)/ADA 0·8(LTE) 31-86% of patients; ADA 0·4(IT)/0·4 or 0·8(LTE) 28-47%; ADA 0·8(IT)/0·8(LTE) 50-72%. No serious infections occurred in the LTE. CONCLUSIONS After 52 weeks of long-term ADA treatment in children aged 4-18 years with severe plaque psoriasis, disease severity was reduced and maintained or further improved, as demonstrated by efficacy outcomes. No new safety risks were identified. What's already known about this topic? The results from the first three periods of this phase III trial in children aged 4-18 years with severe plaque psoriasis suggest that adalimumab is a safe and efficacious treatment option in this population. What does this study add? This is the first study to evaluate long-term treatment of adalimumab in children with severe psoriasis, and the first to evaluate switching from methotrexate to adalimumab in this population.
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Affiliation(s)
- D Thaçi
- Institute and Comprehensive Center for Inflammation Medicine, University of Lübeck, Ratzeburger Allee 160, 23435, Lübeck, Germany
| | - K Papp
- K Papp Clinical Research and Probity Medical Research, University of Western Ontario, Waterloo, ON, Canada
| | - D Marcoux
- CHU Sainte-Justine Montreal, Montreal, QC, Canada
| | - L Weibel
- Pediatric Dermatology Department, University Children's Hospital Zurich, and Dermatology Department, University Hospital Zurich, Zurich, Switzerland
| | - A Pinter
- University Clinic of Frankfurt am Main, Department of Dermatology, Venereology and Allergology, Frankfurt am Main, Germany
| | | | - I Landells
- Nexus Clinical Research and Memorial University of Newfoundland, St John's, NL, Canada
| | - P H Hoeger
- Department of Pediatric Dermatology, Catholic Children's Hospital, Hamburg, Germany
| | - K Unnebrink
- AbbVie Deutschland GmbH & Co. KG, Ludwigshafen, Germany
| | - M M B Seyger
- Department of Dermatology and Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, the Netherlands
| | | | - S Rubant
- AbbVie Deutschland GmbH & Co. KG, Ludwigshafen, Germany
| | - S Philipp
- Department of Dermatology, Venerology and Allergy, Charité Universitätsmedizin Berlin, Berlin, Germany
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15
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Elmets CA, Leonardi CL, Davis DMR, Gelfand JM, Lichten J, Mehta NN, Armstrong AW, Connor C, Cordoro KM, Elewski BE, Gordon KB, Gottlieb AB, Kaplan DH, Kavanaugh A, Kivelevitch D, Kiselica M, Korman NJ, Kroshinsky D, Lebwohl M, Lim HW, Paller AS, Parra SL, Pathy AL, Prater EF, Rupani R, Siegel M, Stoff B, Strober BE, Wong EB, Wu JJ, Hariharan V, Menter A. Joint AAD-NPF guidelines of care for the management and treatment of psoriasis with awareness and attention to comorbidities. J Am Acad Dermatol 2019; 80:1073-1113. [PMID: 30772097 DOI: 10.1016/j.jaad.2018.11.058] [Citation(s) in RCA: 235] [Impact Index Per Article: 47.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2018] [Revised: 11/26/2018] [Accepted: 11/27/2018] [Indexed: 02/08/2023]
Abstract
Psoriasis is a chronic, inflammatory, multisystem disease that affects up to 3.2% of the US population. This guideline addresses important clinical questions that arise in psoriasis management and care, providing recommendations on the basis of available evidence.
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Affiliation(s)
| | | | | | - Joel M Gelfand
- University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | | | - Nehal N Mehta
- National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | | | | | - Kelly M Cordoro
- Department of Dermatology, University of California San Francisco School of MedicineSan Francisco, California
| | | | | | - Alice B Gottlieb
- Department of Dermatology, Icahn School of Medicine at Mt. Sinai, New York, New York
| | | | | | | | | | - Neil J Korman
- University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | | | - Mark Lebwohl
- Department of Dermatology, Icahn School of Medicine at Mt. Sinai, New York, New York
| | - Henry W Lim
- Department of Dermatology, Henry Ford Hospital, Detroit, Michigan
| | - Amy S Paller
- Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | | | - Arun L Pathy
- Colorado Permanente Medical Group, Centennial, Colorado
| | | | - Reena Rupani
- Icahn School of Medicine at Mount Sinai, New York, New York
| | | | | | - Bruce E Strober
- University of Connecticut, Farmington, Connecticut; Probity Medical Research, Waterloo, Canada
| | - Emily B Wong
- San Antonio Uniformed Services Health Education Consortium, Joint-Base San Antonio, Texas
| | - Jashin J Wu
- Dermatology Research and Education Foundation, Irvine, California
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16
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Smith K, Golder S, Sarker A, Loke Y, O'Connor K, Gonzalez-Hernandez G. Methods to Compare Adverse Events in Twitter to FAERS, Drug Information Databases, and Systematic Reviews: Proof of Concept with Adalimumab. Drug Saf 2018; 41:1397-1410. [PMID: 30167992 PMCID: PMC6223697 DOI: 10.1007/s40264-018-0707-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
INTRODUCTION Adverse drug reactions (ADRs) are associated with significant health-related and financial burden, and multiple sources are currently utilized to actively discover them. Social media has been proposed as a potential resource for monitoring ADRs, but drug-specific analytical studies comparing social media with other sources are scarce. OBJECTIVES Our objective was to develop methods to compare ADRs mentioned in social media with those in traditional sources: the US FDA Adverse Event Reporting System (FAERS), drug information databases (DIDs), and systematic reviews. METHODS A total of 10,188 tweets mentioning adalimumab collected between June 2014 and August 2016 were included. ADRs in the corpus were extracted semi-automatically and manually mapped to standardized concepts in the Unified Medical Language System. ADRs were grouped into 16 biologic categories for comparisons. Frequencies, relative frequencies, disproportionality analyses, and rank ordering were used as metrics. RESULTS There was moderate agreement between ADRs in social media and traditional sources. "Local and injection site reactions" was the top ADR in Twitter, DIDs, and systematic reviews by frequency, ranked frequency, and index ranking. The next highest ADR in Twitter-fatigue-ranked fifth and seventh in FAERS and DIDs. CONCLUSION Social media posts often express mild and symptomatic ADRs, but rates are measured differently in scientific sources. ADRs in FAERS are reported as absolute numbers, in DIDs as percentages, and in systematic reviews as percentages, risk ratios, or other metrics, which makes comparisons challenging; however, overlap is substantial. Social media analysis facilitates open-ended investigation of patient perspectives and may reveal concepts (e.g. anxiety) not available in traditional sources.
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Affiliation(s)
- Karen Smith
- Rueckert-Hartman College for Health Professions, Regis University, Denver, CO, USA
| | - Su Golder
- Department of Health Sciences, University of York, York, UK
| | - Abeed Sarker
- Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Yoon Loke
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - Karen O'Connor
- Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Graciela Gonzalez-Hernandez
- Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
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17
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Leonardi C, Papp K, Strober B, Thaçi D, Warren RB, Tyring S, Arikan D, Karunaratne M, Valdecantos WC. Comprehensive long-term safety of adalimumab from 18 clinical trials in adult patients with moderate-to-severe plaque psoriasis. Br J Dermatol 2018; 180:76-85. [PMID: 30169904 DOI: 10.1111/bjd.17084] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/01/2018] [Indexed: 01/17/2023]
Abstract
BACKGROUND Adalimumab (Humira® , AbbVie Inc., North Chicago, IL, U.S.A.) is a fully human monoclonal antibody specific for tumour necrosis factor-α that is approved to treat adults with moderate-to-severe chronic plaque psoriasis. OBJECTIVES To assess long-term safety for patients with psoriasis receiving adalimumab in clinical studies. METHODS Adalimumab safety data from adults with psoriasis who received at least one adalimumab dose in 18 clinical trials were evaluated. Adalimumab was delivered subcutaneously in all treatment regimens. Treatment-emergent adverse events (AEs) were collected from the first dose to 70 days after the last dose or cut-off date (31 December 2015). AE incidence rates were expressed as events per 100 patient-years (E/100 PYs) of adalimumab exposure. Standardized incidence ratios (SIRs) for malignancies and standardized mortality ratios (SMRs) were calculated. RESULTS Cumulative exposure was 5429·7 PYs in 3727 patients. Overall, there were 16 536 AEs (304·6 E/100 PYs). The most common AEs were nasopharyngitis, upper respiratory infection and headache (23·7, 12·9 and 7·9 E/100 PYs, respectively). Incidence rates for serious infections, tuberculosis and opportunistic infections were 1·8, 0·3 and 0·02 E/100 PYs, respectively. Incidence of malignancy excluding nonmelanoma skin cancer (NMSC) was 0·8 E/100 PYs [SIR 0·86, 95% confidence interval (CI) 0·58-1·23]. Incidences of NMSC and melanoma were 0·6 and 0·2 E/100 PYs, respectively. The SIR was 1·55 (95% CI 1·10-2·13) for NMSC and 3·04 (95% CI 1·11-6·62) for melanoma. The SMR was 0·34 (95% CI 0·16-0·65). CONCLUSIONS AE rates remained stable in this analysis of patients with psoriasis receiving adalimumab; no new safety signals were identified compared with earlier analyses.
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Affiliation(s)
- C Leonardi
- Department of Dermatology, St. Louis University, St. Louis, MO, U.S.A
| | - K Papp
- Probity Medical Research and K. Papp Clinical Research, Waterloo, ON, Canada
| | - B Strober
- Department of Dermatology and Probity Medical Research, University of Connecticut, Farmington, CT, U.S.A
| | - D Thaçi
- Comprehensive Center for Inflammation Medicine, University of Lübeck, Lübeck, Germany
| | - R B Warren
- Dermatology Centre, Salford Royal NHS Foundation Trust, NIHR Manchester Biomedical Research Centre, The University of Manchester, Manchester Academic Health Science Centre, Manchester, M13 9PT, U.K
| | - S Tyring
- Department of Dermatology, University of Texas Health Science Center at Houston, Houston, TX, U.S.A
| | - D Arikan
- AbbVie Inc., North Chicago, IL, U.S.A
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18
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Strober B, Crowley J, Langley RG, Gordon K, Menter A, Leonardi C, Arikan D, Valdecantos WC. Systematic review of the real-world evidence of adalimumab safety in psoriasis registries. J Eur Acad Dermatol Venereol 2018; 32:2126-2133. [PMID: 30067882 DOI: 10.1111/jdv.15203] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2018] [Accepted: 07/06/2018] [Indexed: 12/27/2022]
Abstract
Long-term safety of adalimumab in psoriasis clinical studies has been established. The objective of this research was to review real-world evidence of adalimumab safety from registries of adult patients with psoriasis treated in clinical practice. Databases (BIOSIS Previews, Current Contents Search, Derwent Drug File, EMBASE, EMBASE Alert, EMCare, MEDLINE, SciSearch) were searched for psoriasis registries with adalimumab safety data. Eligible papers were English language manuscripts (conference abstracts excluded) from psoriasis registries presenting safety data for adult patients with psoriasis receiving adalimumab. The incidence and rate (events/100 patient-years [PY]) of adverse events (AEs), serious AEs (SAEs) and AEs of special interest are reported. Abstracts of 425 publications were screened, and 401 publications excluded (208 conference abstracts; 193 papers). Remaining manuscripts were fully screened; 14 were excluded (no adalimumab data, n = 10; no safety data, n = 2; no on-treatment data, n = 1; not English, n = 1), and 10 selected. Overall rates of AEs (4273 [22.2/100PY]) and SAEs (827 [4.3/100PY]) were reported in the ESPRIT registry (N = 6059). Rates of infections (7.7-14.7/100PY) and serious infections (<0.6-2.0/100PY) were reported in four studies. Cardiovascular-related events were reported in three studies: ≤0.1/100PY per major cardiac event in ESPRIT, <0.5/100PY major cardiac events in PsoBest and serious cardiovascular events in two patients (<1%) in DERMBIO. Malignancies were reported in three studies (any malignancy, 0.9/100PY; malignancies excluding non-melanoma skin cancer [NMSC], <0.6/100PY; NMSC, 0.6-<0.5/100PY). These findings suggest that real-world safety of adalimumab is consistent across different psoriasis registries, which supports the existing long-term safety profile of adalimumab from clinical studies.
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Affiliation(s)
- B Strober
- Department of Dermatology, University of Connecticut, Farmington, CT, USA.,Probity Medical Research, Waterloo, ON, Canada
| | - J Crowley
- Bakersfield Dermatology, Bakersfield, CA, USA
| | | | - K Gordon
- Medical College of Wisconsin, Milwaukee, WI, USA
| | - A Menter
- Baylor University Medical Center, Dallas, TX, USA
| | - C Leonardi
- Saint Louis University, St. Louis, MO, USA
| | - D Arikan
- AbbVie Inc., North Chicago, IL, USA
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19
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DʼHaens G, Reinisch W, Panaccione R, Satsangi J, Petersson J, Bereswill M, Arikan D, Perotti E, Robinson AM, Kalabic J, Alperovich G, Thakkar R, Loftus EV. Lymphoma Risk and Overall Safety Profile of Adalimumab in Patients With Crohn's Disease With up to 6 Years of Follow-Up in the Pyramid Registry. Am J Gastroenterol 2018; 113:872-882. [PMID: 29867173 DOI: 10.1038/s41395-018-0098-4] [Citation(s) in RCA: 53] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2017] [Accepted: 04/04/2018] [Indexed: 12/11/2022]
Abstract
OBJECTIVES Real-world, prospective, long-term studies in Crohn's disease (CD) characterizing adalimumab safety data and lymphoma risk were lacking. We present the final results from the PYRAMID registry, which was designed to rule out a doubling of lymphoma risk in adalimumab-treated patients with CD. METHODS Patients with moderately to severely active CD newly prescribed or currently receiving adalimumab according to local product labels were followed for up to 6 years and analyzed for adverse events (AEs). The registry exposure-adjusted observed rate of lymphoma was compared with the estimated background lymphoma rate from a sex-matched general population in the Surveillance, Epidemiology, and End Results 17 Registry database adjusted for anticipated prior or concurrent thiopurine use in a CD population. RESULTS A total of 5025 patients were evaluated (16680.4 PY of adalimumab registry exposure, ≈3 years/patient mean follow-up). Registry treatment-emergent AEs included 4129 serious AEs (n = 1853 [36.9%]; 24.8 E/100 PY), 792 serious infections (n = 556 [11.1%]; 4.7 E/100 PY), and 134 malignancies (n = 116 [2.3%]; 0.8 E/100 PY), including ten lymphomas. The observed lymphoma rate (0.060 E/100 PY) was lower than the estimated background rate (0.084 E/100 PY), and the upper bound of the one-sided 95% CI of the observed rate (0.102 E/100 PY) was lower than double the estimated rate (0.168 E/100 PY). CONCLUSIONS PYRAMID is the longest prospective adalimumab study in routine clinical practice, with up to 6 years of follow-up. No new safety signals were reported. The pre-specified registry objective of ruling out a doubling of lymphoma risk with adalimumab was met.
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Affiliation(s)
- Geert DʼHaens
- Academic Medical Center, Amsterdam, Netherlands. Medical university of Vienna, Vienna, Austria. Department of Medicine, university of Calgary, Calgary, Canada. Gastrointestinal Unit, Western General Hospital, Edinburgh, UK. AbbVie Inc., North Chicago, IL, USA. AbbVie Deutschland GmbH & Co. KG, Ludwigshafen, Germany. AbbVie Spain S.L.U., Madrid, Spain. Mayo Clinic, Division of Gastroenterology and Hepatology, Rochester, NY, USA
| | - Walter Reinisch
- Academic Medical Center, Amsterdam, Netherlands. Medical university of Vienna, Vienna, Austria. Department of Medicine, university of Calgary, Calgary, Canada. Gastrointestinal Unit, Western General Hospital, Edinburgh, UK. AbbVie Inc., North Chicago, IL, USA. AbbVie Deutschland GmbH & Co. KG, Ludwigshafen, Germany. AbbVie Spain S.L.U., Madrid, Spain. Mayo Clinic, Division of Gastroenterology and Hepatology, Rochester, NY, USA
| | - Remo Panaccione
- Academic Medical Center, Amsterdam, Netherlands. Medical university of Vienna, Vienna, Austria. Department of Medicine, university of Calgary, Calgary, Canada. Gastrointestinal Unit, Western General Hospital, Edinburgh, UK. AbbVie Inc., North Chicago, IL, USA. AbbVie Deutschland GmbH & Co. KG, Ludwigshafen, Germany. AbbVie Spain S.L.U., Madrid, Spain. Mayo Clinic, Division of Gastroenterology and Hepatology, Rochester, NY, USA
| | - Jack Satsangi
- Academic Medical Center, Amsterdam, Netherlands. Medical university of Vienna, Vienna, Austria. Department of Medicine, university of Calgary, Calgary, Canada. Gastrointestinal Unit, Western General Hospital, Edinburgh, UK. AbbVie Inc., North Chicago, IL, USA. AbbVie Deutschland GmbH & Co. KG, Ludwigshafen, Germany. AbbVie Spain S.L.U., Madrid, Spain. Mayo Clinic, Division of Gastroenterology and Hepatology, Rochester, NY, USA
| | - Joel Petersson
- Academic Medical Center, Amsterdam, Netherlands. Medical university of Vienna, Vienna, Austria. Department of Medicine, university of Calgary, Calgary, Canada. Gastrointestinal Unit, Western General Hospital, Edinburgh, UK. AbbVie Inc., North Chicago, IL, USA. AbbVie Deutschland GmbH & Co. KG, Ludwigshafen, Germany. AbbVie Spain S.L.U., Madrid, Spain. Mayo Clinic, Division of Gastroenterology and Hepatology, Rochester, NY, USA
| | - Mareike Bereswill
- Academic Medical Center, Amsterdam, Netherlands. Medical university of Vienna, Vienna, Austria. Department of Medicine, university of Calgary, Calgary, Canada. Gastrointestinal Unit, Western General Hospital, Edinburgh, UK. AbbVie Inc., North Chicago, IL, USA. AbbVie Deutschland GmbH & Co. KG, Ludwigshafen, Germany. AbbVie Spain S.L.U., Madrid, Spain. Mayo Clinic, Division of Gastroenterology and Hepatology, Rochester, NY, USA
| | - Dilek Arikan
- Academic Medical Center, Amsterdam, Netherlands. Medical university of Vienna, Vienna, Austria. Department of Medicine, university of Calgary, Calgary, Canada. Gastrointestinal Unit, Western General Hospital, Edinburgh, UK. AbbVie Inc., North Chicago, IL, USA. AbbVie Deutschland GmbH & Co. KG, Ludwigshafen, Germany. AbbVie Spain S.L.U., Madrid, Spain. Mayo Clinic, Division of Gastroenterology and Hepatology, Rochester, NY, USA
| | - Eva Perotti
- Academic Medical Center, Amsterdam, Netherlands. Medical university of Vienna, Vienna, Austria. Department of Medicine, university of Calgary, Calgary, Canada. Gastrointestinal Unit, Western General Hospital, Edinburgh, UK. AbbVie Inc., North Chicago, IL, USA. AbbVie Deutschland GmbH & Co. KG, Ludwigshafen, Germany. AbbVie Spain S.L.U., Madrid, Spain. Mayo Clinic, Division of Gastroenterology and Hepatology, Rochester, NY, USA
| | - Anne M Robinson
- Academic Medical Center, Amsterdam, Netherlands. Medical university of Vienna, Vienna, Austria. Department of Medicine, university of Calgary, Calgary, Canada. Gastrointestinal Unit, Western General Hospital, Edinburgh, UK. AbbVie Inc., North Chicago, IL, USA. AbbVie Deutschland GmbH & Co. KG, Ludwigshafen, Germany. AbbVie Spain S.L.U., Madrid, Spain. Mayo Clinic, Division of Gastroenterology and Hepatology, Rochester, NY, USA
| | - Jasmina Kalabic
- Academic Medical Center, Amsterdam, Netherlands. Medical university of Vienna, Vienna, Austria. Department of Medicine, university of Calgary, Calgary, Canada. Gastrointestinal Unit, Western General Hospital, Edinburgh, UK. AbbVie Inc., North Chicago, IL, USA. AbbVie Deutschland GmbH & Co. KG, Ludwigshafen, Germany. AbbVie Spain S.L.U., Madrid, Spain. Mayo Clinic, Division of Gastroenterology and Hepatology, Rochester, NY, USA
| | - Gabriela Alperovich
- Academic Medical Center, Amsterdam, Netherlands. Medical university of Vienna, Vienna, Austria. Department of Medicine, university of Calgary, Calgary, Canada. Gastrointestinal Unit, Western General Hospital, Edinburgh, UK. AbbVie Inc., North Chicago, IL, USA. AbbVie Deutschland GmbH & Co. KG, Ludwigshafen, Germany. AbbVie Spain S.L.U., Madrid, Spain. Mayo Clinic, Division of Gastroenterology and Hepatology, Rochester, NY, USA
| | - Roopal Thakkar
- Academic Medical Center, Amsterdam, Netherlands. Medical university of Vienna, Vienna, Austria. Department of Medicine, university of Calgary, Calgary, Canada. Gastrointestinal Unit, Western General Hospital, Edinburgh, UK. AbbVie Inc., North Chicago, IL, USA. AbbVie Deutschland GmbH & Co. KG, Ludwigshafen, Germany. AbbVie Spain S.L.U., Madrid, Spain. Mayo Clinic, Division of Gastroenterology and Hepatology, Rochester, NY, USA
| | - Edward V Loftus
- Academic Medical Center, Amsterdam, Netherlands. Medical university of Vienna, Vienna, Austria. Department of Medicine, university of Calgary, Calgary, Canada. Gastrointestinal Unit, Western General Hospital, Edinburgh, UK. AbbVie Inc., North Chicago, IL, USA. AbbVie Deutschland GmbH & Co. KG, Ludwigshafen, Germany. AbbVie Spain S.L.U., Madrid, Spain. Mayo Clinic, Division of Gastroenterology and Hepatology, Rochester, NY, USA
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Safety of Adalimumab Dosed Every Week and Every Other Week: Focus on Patients with Hidradenitis Suppurativa or Psoriasis. Am J Clin Dermatol 2018; 19:437-447. [PMID: 29380251 PMCID: PMC5945711 DOI: 10.1007/s40257-017-0341-6] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Background Adalimumab is approved for the treatment of hidradenitis suppurativa (HS), plaque psoriasis, and other inflammatory conditions. Objective Our objective was to examine the safety of adalimumab administered every other week (EOW) and every week (EW) in patients with HS and psoriasis and to investigate informative data from non-dermatologic indications. Methods The safety of adalimumab 40-mg EOW versus EW dosing was examined during placebo-controlled and open-label study periods in patients with HS (three studies), psoriasis (two studies), Crohn’s disease (six studies), ulcerative colitis (three studies), and rheumatoid arthritis (one study). Results No new safety risks or increased rates of particular adverse events (AEs) were identified with EW dosing. In patients with HS or psoriasis, the overall safety of adalimumab 40-mg EOW and EW was generally comparable. In studies of adalimumab for non-dermatologic indications, including Crohn’s disease, ulcerative colitis, and rheumatoid arthritis, the overall AE rates were similar for EW and EOW dosing. Conclusion In patients with HS or psoriasis, the safety of adalimumab EW and EOW was comparable and consistent with the expected adalimumab AE profile. The safety of adalimumab EW dosing in patients with dermatologic conditions is supported by data comparing adalimumab EW and EOW dosing for Crohn’s disease, ulcerative colitis, and rheumatoid arthritis. Trial registration ClinicalTrials.gov NCT00918255, NCT01468207, NCT01468233, NCT00645814, NCT00077779, NCT00055497, NCT01070303, NCT00195715, NCT00348283, NCT00385736, NCT00408629, and NCT00573794.
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Peleva E, Exton L, Kelley K, Kleyn C, Mason K, Smith C. Risk of cancer in patients with psoriasis on biological therapies: a systematic review. Br J Dermatol 2017; 178:103-113. [DOI: 10.1111/bjd.15830] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/11/2017] [Indexed: 02/06/2023]
Affiliation(s)
- E. Peleva
- St John's Institute of Dermatology Guy's and St Thomas’ NHS Foundation Trust London U.K
| | - L.S. Exton
- British Association of Dermatologists London U.K
| | - K. Kelley
- National Clinical Guidelines Centre London U.K
| | - C.E. Kleyn
- Dermatology Centre Salford Royal NHS Foundation Trust Manchester U.K
- Division of Musculoskeletal and Dermatological Sciences The University of Manchester Manchester U.K
| | - K.J. Mason
- Division of Musculoskeletal and Dermatological Sciences The University of Manchester Manchester U.K
| | - C.H. Smith
- St John's Institute of Dermatology Guy's and St Thomas’ NHS Foundation Trust London U.K
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Abstract
INTRODUCTION Childhood psoriasis is a special situation that is a management challenge for the treating dermatologist. As is the situation with traditional systemic agents, which are commonly used in managing severe psoriasis in children, the biologics are being increasingly used in the recalcitrant disease despite limited data on long term safety. AREAS COVERED We performed an extensive literature search to collect evidence-based data on the use of biologics in pediatric psoriasis. The relevant literature published from 2000 to September 2017 was obtained from PubMed, using the MeSH words 'biologics', 'biologic response modifiers' and 'treatment of pediatric/childhood psoriasis'. All clinical trials, randomized double-blind or single-blind controlled trials, open-label studies, retrospective studies, reviews, case reports and letters concerning the use of biologics in pediatric psoriasis were screened. Articles covering the use of biologics in pediatric psoriasis were screened and reference lists in the selected articles were scrutinized to identify other relevant articles that had not been found in the initial search. Articles without relevant information about biologics in general (e.g. its mechanism of action, pharmacokinetics and adverse effects) and its use in psoriasis in particular were excluded. We screened 427 articles and finally selected 41 relevant articles. EXPERT OPINION The available literature on the use of biologics such as anti-tumor necrosis factor (TNF)-α agents, and anti-IL-12/23 agents like ustekinumab suggests that these are effective and safe in managing severe pediatric psoriasis although there is an urgent need to generate more safety data. Dermatologists must be careful about the potential adverse effects of the biologics before administering them to children with psoriasis. It is likely that with rapidly evolving scenario of biologics in psoriasis, these will prove to be very useful molecules particularly in managing severe and recalcitrant psoriasis in pediatric age group.
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Affiliation(s)
- Sunil Dogra
- a Department of Dermatology, Venereology, and Leprology , Postgraduate Institute of Medical Education and Research , Chandigarh , India
| | - Rahul Mahajan
- a Department of Dermatology, Venereology, and Leprology , Postgraduate Institute of Medical Education and Research , Chandigarh , India
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Dobry AS, Quesenberry CP, Ray GT, Geier JL, Asgari MM. Serious infections among a large cohort of subjects with systemically treated psoriasis. J Am Acad Dermatol 2017; 77:838-844. [PMID: 28917384 DOI: 10.1016/j.jaad.2017.07.047] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2017] [Revised: 07/26/2017] [Accepted: 07/30/2017] [Indexed: 12/21/2022]
Abstract
BACKGROUND Biologic therapy is effective for treatment of moderate-to-severe psoriasis but may be associated with an increased risk for serious infection. OBJECTIVE To estimate the serious infection rate among patients with psoriasis treated with biologic as compared with nonbiologic systemic agents within a community-based health care delivery setting. METHODS We identified 5889 adult Kaiser Permanente Northern California health plan members with psoriasis who had ever been treated with systemic therapies and calculated the incidence rates and 95% confidence intervals (CIs) for serious infections over 29,717 person-years of follow-up. Adjusted hazard ratios (aHRs) were calculated using Cox regression. RESULTS Adjusting for age, sex, race or ethnicity, and comorbidities revealed a significantly increased risk for overall serious infection among patients treated with biologics as compared with those treated with nonbiologics (aHR, 1.31; 95% CI, 1.02-1.68). More specifically, there was a significantly elevated risk for skin and soft tissue infection (aHR, 1.75; 95% CI, 1.19-2.56) and meningitis (aHR, 9.22; 95% CI, 1.77-48.10) during periods of active biologic use. LIMITATIONS Risk associated with individual drugs was not examined. CONCLUSION We found an increased rate of skin and soft tissue infections among patients with psoriasis treated with biologic agents. There also was a signal suggesting increased risk for meningitis. Clinicians should be aware of these potential adverse events when prescribing biologic agents.
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Affiliation(s)
- Allison S Dobry
- Department of Dermatology, Massachusetts General Hospital, Boston, Massachusetts; Department of Population Medicine, Harvard Medical School, Boston, Massachusetts
| | | | - G Thomas Ray
- Division of Research, Kaiser Permanente Northern California, Oakland, California
| | | | - Maryam M Asgari
- Department of Dermatology, Massachusetts General Hospital, Boston, Massachusetts; Department of Population Medicine, Harvard Medical School, Boston, Massachusetts; Division of Research, Kaiser Permanente Northern California, Oakland, California
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Long-Term Safety and Effectiveness of Adalimumab for Moderate to Severe Psoriasis: Results from 7-Year Interim Analysis of the ESPRIT Registry. Dermatol Ther (Heidelb) 2017; 7:365-381. [PMID: 28815476 PMCID: PMC5574748 DOI: 10.1007/s13555-017-0198-x] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2017] [Indexed: 12/20/2022] Open
Abstract
INTRODUCTION ESPRIT (NCT00799877) is an ongoing 10-year international prospective observational registry evaluating the long-term safety and effectiveness of originator adalimumab in routine clinical practice for adult patients with chronic plaque psoriasis. Herein, we report the long-term safety, effectiveness, and patient-reported outcomes (PROs) following adalimumab treatment over the first 7 years of the ESPRIT registry. METHODS All treatment-emergent (All-TE) adverse events (AE) since the initial (first ever) dose of adalimumab were assessed. Physician Global Assessment (PGA) and PROs (PROs for US patients only) were evaluated during registry participation. RESULTS As of 30 November 2015, 6051 patients in the ESPRIT registry were analyzed, representing 23,660.1 patient-years (PY) of overall adalimumab exposure. The incidence rates for All-TE serious AEs, serious infections, and malignancies were 4.4, 1.0, and 1.0 events per 100 PY (E/100PY), respectively. The standardized mortality ratio for TE deaths in the registry was 0.27 (95% CI 0.18-0.38). During the registry's first 7 years, PGA "clear" or "minimal" was achieved by >50% of patients at each annual visit, and among US patients, the mean improvement from baseline in different PROs was maintained. CONCLUSION No new safety signals were identified during the first 7 years of the registry, and safety was consistent with the known safety profile of adalimumab. The number of TE deaths was below the expected rate. During the registry's first 7 years, most of the patients remained free of All-TE cardiovascular events, serious infections, and malignancy. As-observed effectiveness of adalimumab and improvements from baseline in PROs were maintained through 7 years of registry participation. FUNDING Abbvie. TRIAL REGISTRATION ClinicalTrials.gov identifier, NCT00799877.
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Natural Modulators of Endosomal Toll-Like Receptor-Mediated Psoriatic Skin Inflammation. J Immunol Res 2017; 2017:7807313. [PMID: 28894754 PMCID: PMC5574364 DOI: 10.1155/2017/7807313] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2017] [Accepted: 07/25/2017] [Indexed: 02/08/2023] Open
Abstract
Psoriasis is a chronic inflammatory autoimmune disease that can be initiated by excessive activation of endosomal toll-like receptors (TLRs), particularly TLR7, TLR8, and TLR9. Therefore, inhibitors of endosomal TLR activation are being investigated for their ability to treat this disease. The currently approved biological drugs adalimumab, etanercept, infliximab, ustekinumab, ixekizumab, and secukizumab are antibodies against effector cytokines that participate in the initiation and development of psoriasis. Several immune modulatory oligonucleotides and small molecular weight compounds, including IMO-3100, IMO-8400, and CPG-52364, that block the interaction between endosomal TLRs and their ligands are under clinical investigation for their effectiveness in the treatment of psoriasis. In addition, several chemical compounds, including AS-2444697, PF-05387252, PF-05388169, PF-06650833, ML120B, and PHA-408, can inhibit TLR signaling. Although these compounds have demonstrated anti-inflammatory activity in animal models, their therapeutic potential for the treatment of psoriasis has not yet been tested. Recent studies demonstrated that natural compounds derived from plants, fungi, and bacteria, including mustard seed, Antrodia cinnamomea extract, curcumin, resveratrol, thiostrepton, azithromycin, and andrographolide, inhibited psoriasis-like inflammation induced by the TLR7 agonist imiquimod in animal models. These natural modulators employ different mechanisms to inhibit endosomal TLR activation and are administered via different routes. Therefore, they represent candidate psoriasis drugs and might lead to the development of new treatment options.
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Karube H, Kamoi K, Ohno-Matsui K. Anti-TNF therapy in the management of ocular attacks in an elderly patient with long-standing Behçet's disease. Int Med Case Rep J 2016; 9:301-304. [PMID: 27729816 PMCID: PMC5045905 DOI: 10.2147/imcrj.s117731] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Ocular symptoms in Behçet's disease (BD) begin mostly before 30 years of age according to international surveys, and BD activity may decrease with age. Information regarding the treatment of ocular symptoms in elderly BD patients is thus scant. Anti-TNFα antibody has recently demonstrated strong effects against recurrent uveitis in BD, but the efficacy and safety of anti-TNFα therapy in elderly patients remain unclear. We report herein the case of an elderly patient with long-standing uveitis due to BD who was successfully treated with two types of anti-TNF therapy. CASE An 81-year-old Japanese man presented with a 33-year history of ocular inflammation due to BD. As immunosuppressive agents, such as cyclosporine A, were difficult to use because he had undergone removal of the left kidney due to cancer, he was treated with colchicine. However, attacks of ocular inflammation persisted around nine times a year. After colchicine had been changed to infliximab, ocular inflammation was fairly well controlled, but ocular attacks still occurred once or twice a year. As soon as intestinal hemorrhage related to BD occurred, infliximab was switched to adalimumab. After this switch, ocular attacks resolved and visual acuity was maintained at 1.0. Intestinal lesions were also well controlled, and no side effects were seen. CONCLUSION This represents the first report of the application of two types of anti-TNFα therapy for ocular attacks in an elderly BD patient. In addition to infliximab, adalimumab appears to offer an alternative therapy for refractory, long-standing BD-related uveitis in elderly patients.
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Affiliation(s)
- Hisako Karube
- Department of Ophthalmology and Visual Science, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Koju Kamoi
- Department of Ophthalmology and Visual Science, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Kyoko Ohno-Matsui
- Department of Ophthalmology and Visual Science, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
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Singh RK, Lee KM, Ucmak D, Brodsky M, Atanelov Z, Farahnik B, Abrouk M, Nakamura M, Zhu TH, Liao W. Erythrodermic psoriasis: pathophysiology and current treatment perspectives. PSORIASIS (AUCKLAND, N.Z.) 2016; 6:93-104. [PMID: 28856115 PMCID: PMC5572467 DOI: 10.2147/ptt.s101232] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Erythrodermic psoriasis (EP) is a rare and severe variant of psoriasis vulgaris, with an estimated prevalence of 1%-2.25% among psoriatic patients. The condition presents with distinct histopathologic and clinical findings, which include a generalized inflammatory erythema involving at least 75% of the body surface area. The pathogenesis of EP is not well understood; however, several studies suggest that the disease is associated with a predominantly T helper 2 (Th2) phenotype. Given the morbidity and potential mortality associated with the condition, there is a need for a better understanding of its pathophysiology. The management of EP begins with a comprehensive assessment of the patient's presentation and often requires multidisciplinary supportive measures. In 2010, the medical board of the US National Psoriasis Foundation published consensus guidelines advocating the use of cyclosporine or infliximab as first-line therapy in unstable cases, with acitretin and methotrexate reserved for more stable cases. Since the time of that publication, additional information regarding the efficacy of newer agents has emerged. We review the latest data with regard to the treatment of EP, which includes biologic therapies such as ustekinumab and ixekizumab.
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Affiliation(s)
- Rasnik K Singh
- Department of Medicine, University of California – Los Angeles, David Geffen School of Medicine, Los Angeles
| | - Kristina M Lee
- Department of Dermatology, University of California – San Francisco, San Francisco
| | - Derya Ucmak
- Department of Dermatology, University of California – San Francisco, San Francisco
| | - Merrick Brodsky
- Department of Medicine, University of California – Irvine, School of Medicine, Irvine, CA
| | - Zaza Atanelov
- Department of Medicine, New York Medical College, Valhalla, NY
| | - Benjamin Farahnik
- Department of Medicine, University of Vermont College of Medicine, Burlington, VT
| | - Michael Abrouk
- Department of Medicine, University of California – Irvine, School of Medicine, Irvine, CA
| | - Mio Nakamura
- Department of Dermatology, University of California – San Francisco, San Francisco
| | - Tian Hao Zhu
- Department of Medicine, University of Southern California Keck School of Medicine, Los Angeles, CA, USA
| | - Wilson Liao
- Department of Dermatology, University of California – San Francisco, San Francisco
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Secukinumab long-term safety experience: A pooled analysis of 10 phase II and III clinical studies in patients with moderate to severe plaque psoriasis. J Am Acad Dermatol 2016; 75:83-98.e4. [DOI: 10.1016/j.jaad.2016.03.024] [Citation(s) in RCA: 217] [Impact Index Per Article: 27.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2016] [Revised: 03/16/2016] [Accepted: 03/21/2016] [Indexed: 12/14/2022]
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30
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Abstract
Erythrodermic psoriasis (EP) is a severe form of psoriasis that may be associated with serious and sometimes fatal complications. The treatment of EP is often a challenge, since several factors, including treatment failure or possible complications, may limit favorable outcomes with traditional drugs. Recent evidence suggests that biological drugs, including both anti-tumor necrosis factor alpha agents and ustekinumab, may be useful in improving the management of EP. Unfortunately, since subjects with EP are usually excluded from pivotal trials involving biological agents, this evidence is currently dispersed in small case series and single case reports. In this paper, we briefly analyze conventional therapies for EP, before going on to critically evaluate the existing clinical evidence for the role of current biological drugs, namely infliximab, etanercept, adalimumab, and ustekinumab. Finally, we discuss the potential benefits that newer/developmental biological agents could bring to the management of EP.
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Menter A, Thaçi D, Papp KA, Wu JJ, Bereswill M, Teixeira HD, Rubant S, Williams DA. Five-year analysis from the ESPRIT 10-year postmarketing surveillance registry of adalimumab treatment for moderate to severe psoriasis. J Am Acad Dermatol 2015; 73:410-9.e6. [DOI: 10.1016/j.jaad.2015.06.038] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2015] [Revised: 06/09/2015] [Accepted: 06/14/2015] [Indexed: 02/08/2023]
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Asahina A, Ohtsuki M, Etoh T, Gu Y, Okun MM, Teixeira HD, Yamaguchi Y, Nakagawa H. Adalimumab treatment optimization for psoriasis: Results of a long-term phase 2/3 Japanese study. J Dermatol 2015; 42:1042-52. [DOI: 10.1111/1346-8138.13001] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2015] [Accepted: 05/17/2015] [Indexed: 11/29/2022]
Affiliation(s)
- Akihiko Asahina
- Department of Dermatology; The Jikei University School of Medicine; Tokyo Japan
| | - Mamitaro Ohtsuki
- Department of Dermatology; Jichi Medical University; Shimotsuke Japan
| | - Takafumi Etoh
- Division of Dermatology; Tokyo Teishin Postal Services Agency Hospital; Tokyo Japan
| | - Yihua Gu
- Global Pharmaceutical Research and Development; AbbVie; North Chicago Illinois USA
| | - Martin M. Okun
- Global Pharmaceutical Research and Development; AbbVie; North Chicago Illinois USA
| | - Henrique D. Teixeira
- Global Pharmaceutical Research and Development; AbbVie; North Chicago Illinois USA
| | - Yuji Yamaguchi
- Global Pharmaceutical Research and Development; AbbVie; North Chicago Illinois USA
| | - Hidemi Nakagawa
- Department of Dermatology; The Jikei University School of Medicine; Tokyo Japan
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Sorenson E, Koo J. Evidence-based adverse effects of biologic agents in the treatment of moderate-to-severe psoriasis: Providing clarity to an opaque topic. J DERMATOL TREAT 2015; 26:493-501. [PMID: 25886082 DOI: 10.3109/09546634.2015.1027167] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Biologic agents have greatly enhanced the treatment of moderate-to-severe plaque psoriasis. Previous reviews of the safety of biologic agents have included patients with conditions other than psoriasis and/or have not used statistical significance as the primary analytic focus. Our aim was to review the current literature to identify significantly increased adverse events associated with the use of etanercept, adlimumab and ustekinumab for the treatment of moderate-to-severe plaque psoriasis. METHODS We performed a search of Ovid MEDLINE and the Cochrane Library to identify clinical trials, open-label extension studies and meta-analyses reporting statistical analysis of adverse events associated with the use of etanercept, adlimumab and ustekinumab for the treatment of moderate-to-severe plaque psoriasis. RESULTS We identified 17 clinical trials, 2 open-label extension studies and 8 meta-analyses. Adverse events reported to be significantly increased included squamous cell carcinoma (SCC), injection-site reaction, and headache associated with etanercept, overall nonmelanoma skin cancer (NMSC), SCC, and upper respiratory tract infection associated with adalimumab, and no significantly increased adverse events associated with ustekinumab. CONCLUSION Current evidence suggests that when analyzed among patients with plaque psoriasis, few adverse effects of the biologic agents etanercept, adalimumab and ustekinumab have reached statistical significance. Further long-term studies conducting analysis of statistical significance should be performed.
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Affiliation(s)
- Eric Sorenson
- a Keck School of Medicine of the University of Southern California , Los Angeles , CA , USA and
| | - John Koo
- b Department of Dermatology , University of California San Francisco Psoriasis Treatment Center , San Francisco , CA , USA
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Sousa M, Freitas JP, Antunes J, Soares-de-Almeida L, Filipe PL. Appearance of de novo dysplastic spitzoid compound naevus in an adalimumab-treated psoriatic patient: case report and review of the possible causal relationship with TNF-α blockers. Australas J Dermatol 2015; 55:156-7. [PMID: 24720429 DOI: 10.1111/ajd.12170] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Marisa Sousa
- Clínica Universitária de Dermatologia, Faculdade de Medicina da Universidade de Lisboa; Dermatology Research Unit, Institute of Molecular Medicine, Lisboa, Portugal
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Papp K, Gottlieb AB, Naldi L, Pariser D, Ho V, Goyal K, Fakharzadeh S, Chevrier M, Calabro S, Langholff W, Krueger G. WITHDRAWN: Experience with ustekinumab in patients with psoriasis enrolled in a large, multicenter, prospective, disease-based registry (Psoriasis Longitudinal Assessment and Registry [PSOLAR]). J Am Acad Dermatol 2015:S0190-9622(14)02102-1. [PMID: 25582533 DOI: 10.1016/j.jaad.2014.10.025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2014] [Revised: 10/17/2014] [Accepted: 10/21/2014] [Indexed: 11/28/2022]
Abstract
The above-referenced article has been voluntarily withdrawn by the authors in order to present more updated data in a subsequent manuscript. The full Elsevier Policy on Article Withdrawal can be found at http://www.elsevier.com/locate/withdrawalpolicy.
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Affiliation(s)
- Kim Papp
- Probity Medical Research, Waterloo, Ontario, Canada
| | | | - Luigi Naldi
- Centro Studi Gruppo Italiano Studi Epidemiologici in Dermatologia (GISED), Azienda Ospedaliera Papa Giovanni XXIII, Bergamo, Italy
| | - David Pariser
- Eastern Virginia Medical School and Virginia Clinical Research Inc, Norfolk, Virginia
| | - Vincent Ho
- University of British Columbia, Vancouver, British Columbia, Canada
| | - Kavitha Goyal
- Janssen Scientific Affairs LLC, Horsham, Pennsylvania
| | | | - Marc Chevrier
- Janssen Scientific Affairs LLC, Horsham, Pennsylvania
| | | | | | - Gerald Krueger
- University of Utah Health Sciences Center, Salt Lake City, Utah
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van den Reek JMPA, Zweegers J, Kievit W, Otero ME, van Lümig PPM, Driessen RJB, Ossenkoppele PM, Njoo MD, Mommers JM, Koetsier MIA, Arnold WP, Sybrandy-Fleuren BAM, Kuijpers ALA, Andriessen MPM, van de Kerkhof PCM, Seyger MMB, de Jong EMGJ. 'Happy' drug survival of adalimumab, etanercept and ustekinumab in psoriasis in daily practice care: results from the BioCAPTURE network. Br J Dermatol 2014; 171:1189-96. [PMID: 24807471 DOI: 10.1111/bjd.13087] [Citation(s) in RCA: 77] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/24/2014] [Indexed: 12/26/2022]
Abstract
BACKGROUND Drug survival is a marker for treatment success. To date, no analyses relating dermatological quality-of-life measures to drug survival have been published. OBJECTIVES (i) To describe 1-year drug survival for adalimumab, etanercept and ustekinumab in a daily practice psoriasis cohort, and (ii) to introduce the concept of 'happy' drug survival, defined as Dermatology Life Quality Index (DLQI) ≤ 5 combined with being 'on drug' at a specific time point. METHODS Data were extracted from a prospective registry. Drug survival was analysed using Kaplan-Meier estimates. 'Happy' drug survival was calculated, with data split into 'happy' (DLQI ≤ 5) vs. 'unhappy' (DLQI > 5) at baseline and months 3, 6, 9 and 12. RESULTS 249 treatment episodes were included (101 adalimumab, 82 etanercept, 66 ustekinumab). The 1-year drug survival rates for ustekinumab, adalimumab and etanercept were 85%, 74% and 68%, respectively. Ustekinumab showed a better confounder-corrected drug survival vs. etanercept [hazard ratio (HR) 3·8, P = 0·02] and a trend towards better survival vs. adalimumab (HR 2·3, P = 0·1). At baseline, the majority (n = 115, 73%) was considered 'unhappy' and a minority 'happy' (n = 42, 27%) (ratio 'happy':'unhappy' was 1 : 2.7). The percentage of treatment episodes with 'happy' on-drug patients increased to 79% after 1 year. CONCLUSIONS Ustekinumab showed a better overall drug survival than etanercept, and a trend towards a better overall drug survival than adalimumab. After 1 year, patients reported to be 'happy' in 79% of episodes and 'unhappy' in 21%. We introduced the new concept of 'happy' drug survival because the proportion of on-drug patients with good quality of life is an important indicator for treatment success.
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Affiliation(s)
- J M P A van den Reek
- Department of Dermatology, Radboud University Medical Center, Nijmegen, the Netherlands
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Silva LMA, Rocha BDO, Nobre ACP, Rêgo VRPDA, Follador I, Oliveira MDFSPD. Anti-TNFα therapy in the management of psoriasis: experience of a state referral center. An Bras Dermatol 2014; 89:436-40. [PMID: 24937817 PMCID: PMC4056701 DOI: 10.1590/abd1806-4841.20142613] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2013] [Accepted: 07/29/2013] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Psoriasis is a chronic immune-mediated disease, characterized by increased levels of TNFα. Anti-TNFα agents have revolutionized the treatment of severe psoriasis by targeting an important molecule involved in its pathogenesis. OBJECTIVES We report the experience of a state referral center that uses anti-TNFα agents for psoriasis. METHODS We conducted a retrospective case series. Seventy-four out of 120 patients met the inclusion criteria. Clinical and laboratory data was analyzed using the chi-squared, Wicoxon and McNemar's tests. Associations were considered statistically significant when p-value<0.05. RESULTS Forty-one subjects (55.40%) were male, with a mean age of 47.69 ± 14.99 years. Median disease duration and pre-treatment PASI were 14.0 months (IQR 9.0-20.0), and 13.55 points (IQR 8.5-20.32). Sixty patients (81.10%) had arthropathic psoriasis. Forty-six subjects (62.20%) had comorbidities; the most frequent was dyslipidemia (25.70%). In 55.40% of patients, insufficient response to conventional therapies was the principal indication for using anti-TNFα drugs. Clinical improvement occurred in 93.20% of cases, and the post-treatment PASI median was 0.0 points (IQR 0.0-0.0). Adverse effects occurred in 6.80% of patients. Infections and elevation of transaminases occurred in 28.40% and 8.10% of cases, respectively. CONCLUSION Post-treatment reduction in PASI was satisfactory and the occurrence of adverse effects was minor, mostly mild infusion effects and local reactions at drug administration sites.
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Jourabchi N, Adelzadeh L, Wu J. The risk of deep fungal infections during biologic therapy for psoriasis. J Eur Acad Dermatol Venereol 2014; 28:1277-85. [DOI: 10.1111/jdv.12508] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2013] [Accepted: 03/10/2014] [Indexed: 12/01/2022]
Affiliation(s)
- N. Jourabchi
- Department of Dermatology; Johns Hopkins University School of Medicine; Baltimore MD USA
- David Geffen School of Medicine at UCLA; Los Angeles CA USA
| | - L. Adelzadeh
- David Geffen School of Medicine at UCLA; Los Angeles CA USA
| | - J.J. Wu
- Department of Dermatology; Kaiser Permanente Los Angeles Medical Center; Los Angeles CA USA
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Semble AL, Davis SA, Feldman SR. Safety and tolerability of tumor necrosis factor-α inhibitors in psoriasis: a narrative review. Am J Clin Dermatol 2014; 15:37-43. [PMID: 24281790 DOI: 10.1007/s40257-013-0053-5] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Tumor necrosis factor (TNF)-α inhibitors are an alternative to oral systemic therapies for psoriasis. Data regarding the safety of TNF-α inhibitors from randomized clinical trials may not fully reflect the effects on the clinic patient population receiving the therapy, but other sources of information are available. We performed a literature review to assess the safety and tolerability of the treatment of moderate-to-severe plaque psoriasis with TNF-α inhibitors. A literature search was conducted using PubMed for articles dating from January 2000 to October 2013. Randomized controlled, cohort, open-label, and observational studies were included, as well as case reports and letters to the editor. Articles found on PubMed describing the safety of anti-TNF-α therapy in psoriasis patients were included, while studies highlighting interleukin (IL)-12 and IL-23 inhibitors were excluded, as were non-English articles. In total, 58 articles were included in the review. TNF-α inhibitors exhibit both efficacy and tolerability in patients with moderate-to-severe plaque psoriasis. Adverse effects associated with these medications are not common and can be minimized with routine clinical monitoring and patient education. While the risk of severe adverse events is low, the lack of very large, long-term, randomized safety trials limits the ability to fully define the safety of these agents. TNF-α inhibitors have a good efficacy/safety ratio for use in patients with moderate-to-severe psoriasis. Serious adverse effects are not common, and common injection-site reactions are usually manageable. The benefits of TNF-α inhibitors outweigh the risks for moderate-to-severe psoriasis; however, there are potential adverse effects and the patient populations at highest risk include the elderly and those with a history of malignancy.
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Affiliation(s)
- Ashley L Semble
- Center for Dermatology Research, Department of Dermatology, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC, 27157-1071, USA
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Dommasch ED, Troxel AB, Gelfand JM. Counterpoint: A tale of two meta-analyses revisited. J Am Acad Dermatol 2014; 70:381-3. [PMID: 24438955 PMCID: PMC4350774 DOI: 10.1016/j.jaad.2013.10.053] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2013] [Accepted: 10/21/2013] [Indexed: 01/12/2023]
Affiliation(s)
| | - Andrea B Troxel
- Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, Pennsylvania; Department of Biostatistics and Epidemiology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Joel M Gelfand
- Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, Pennsylvania; Department of Biostatistics and Epidemiology, University of Pennsylvania, Philadelphia, Pennsylvania; Department of Dermatology, University of Pennsylvania, Philadelphia, Pennsylvania
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Lynch M, Kirby B, Warren RB. Treating moderate to severe psoriasis – best use of biologics. Expert Rev Clin Immunol 2013; 10:269-79. [DOI: 10.1586/1744666x.2014.873701] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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Papp KA, Griffiths CEM, Gordon K, Lebwohl M, Szapary PO, Wasfi Y, Chan D, Hsu MC, Ho V, Ghislain PD, Strober B, Reich K. Long-term safety of ustekinumab in patients with moderate-to-severe psoriasis: final results from 5 years of follow-up. Br J Dermatol 2013; 168:844-54. [PMID: 23301632 DOI: 10.1111/bjd.12214] [Citation(s) in RCA: 302] [Impact Index Per Article: 27.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Long-term safety evaluations of biologics are needed to inform patient management decisions. OBJECTIVES To evaluate the safety of ustekinumab in patients with moderate-to-severe psoriasis treated for up to 5 years. METHODS Safety data were pooled from four studies of ustekinumab for psoriasis. Rates of adverse events (AEs), serious AEs (SAEs) and AEs of interest [infections, nonmelanoma skin cancers (NMSCs), other malignancies and major adverse cardiovascular events (MACE)] per 100 patient-years (PY) of follow-up were analysed by ustekinumab dose (45 or 90 mg) and by year of follow-up (years 1-5) to evaluate the dose response and impact of cumulative exposure. Observed rates of overall mortality and other malignancies were compared with those expected in the general U.S. population. RESULTS Analyses included 3117 patients (8998 PY) who received one or more doses of ustekinumab, with 1482 patients treated for ≥4 years (including 838 patients ≥5 years). At year 5, event rates (45 mg, 90 mg, respectively) for overall AEs (242·6, 225·3), SAEs (7·0, 7·2), serious infections (0·98, 1·19), NMSCs (0·64, 0·44), other malignancies (0·59, 0·61) and MACE (0·56, 0·36) were comparable between dose groups. Year-to-year variability was observed, but no increasing trend was evident. Rates of overall mortality and other malignancies were comparable with those expected in the general U.S. population. CONCLUSIONS No dose-related or cumulative toxicity was observed with increasing duration of ustekinumab exposure for up to 5 years. Rates of AEs reported in ustekinumab psoriasis trials are generally comparable with those reported for other biologics approved for the treatment of moderate-to-severe psoriasis.
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Affiliation(s)
- K A Papp
- Probity Medical Research, 135 Union Street East, Waterloo, ON N2J1C4, Canada.
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Saraceno R, Bavetta M, Zangrilli A, Chiricozzi A, Potenza C, Chimenti S, Chimenti MS. Adalimumab in the treatment of plaque-type psoriasis and psoriatic arthritis. Expert Opin Biol Ther 2013; 13:1325-34. [DOI: 10.1517/14712598.2013.820701] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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Kumar N, Narang K, Cressey BD, Gottlieb AB. Long-term safety of ustekinumab for psoriasis. Expert Opin Drug Saf 2013; 12:757-65. [DOI: 10.1517/14740338.2013.808330] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Burmester GR, Panaccione R, Gordon KB, McIlraith MJ, Lacerda APM. Adalimumab: long-term safety in 23 458 patients from global clinical trials in rheumatoid arthritis, juvenile idiopathic arthritis, ankylosing spondylitis, psoriatic arthritis, psoriasis and Crohn's disease. Ann Rheum Dis 2013; 72:517-24. [PMID: 22562972 PMCID: PMC3595151 DOI: 10.1136/annrheumdis-2011-201244] [Citation(s) in RCA: 391] [Impact Index Per Article: 35.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/09/2012] [Indexed: 12/22/2022]
Abstract
BACKGROUND As long-term treatment with antitumour necrosis factor (TNF) drugs becomes accepted practice, the risk assessment requires an understanding of anti-TNF long-term safety. Registry safety data in rheumatoid arthritis (RA) are available, but these patients may not be monitored as closely as patients in a clinical trial. Cross-indication safety reviews of available anti-TNF agents are limited. OBJECTIVE To analyse the long-term safety of adalimumab treatment. METHODS This analysis included 23 458 patients exposed to adalimumab in 71 global clinical trials in RA, juvenile idiopathic arthritis, ankylosing spondylitis (AS), psoriatic arthritis, psoriasis (Ps) and Crohn's disease (CD). Events per 100 patient-years were calculated using events reported after the first dose through 70 days after the last dose. Standardised incidence rates for malignancies were calculated using a National Cancer Institute database. Standardised death rates were calculated using WHO data. RESULTS The most frequently reported serious adverse events across indications were infections with greatest incidence in RA and CD trials. Overall malignancy rates for adalimumab-treated patients were as expected for the general population; the incidence of lymphoma was increased in patients with RA, but within the range expected in RA without anti-TNF therapy; non-melanoma skin cancer incidence was raised in RA, Ps and CD. In all indications, death rates were lower than, or equivalent to, those expected in the general population. CONCLUSIONS Analysis of adverse events of interest through nearly 12 years of adalimumab exposure in clinical trials across indications demonstrated individual differences in rates by disease populations, no new safety signals and a safety profile consistent with known information about the anti-TNF class.
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MESH Headings
- Adalimumab
- Antibodies, Monoclonal, Humanized/administration & dosage
- Antibodies, Monoclonal, Humanized/adverse effects
- Antirheumatic Agents/administration & dosage
- Antirheumatic Agents/adverse effects
- Arthritis, Juvenile/drug therapy
- Arthritis, Juvenile/mortality
- Arthritis, Psoriatic/drug therapy
- Arthritis, Psoriatic/mortality
- Arthritis, Rheumatoid/drug therapy
- Arthritis, Rheumatoid/mortality
- Crohn Disease/drug therapy
- Crohn Disease/mortality
- Global Health
- Humans
- Psoriasis/drug therapy
- Psoriasis/mortality
- Rheumatic Diseases/drug therapy
- Rheumatic Diseases/mortality
- Spondylitis, Ankylosing/drug therapy
- Spondylitis, Ankylosing/mortality
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Affiliation(s)
- Gerd R Burmester
- Correspondence to Professor G R Burmester, Department of Rheumatology and Clinical Immunology, Charité - University Medicine Berlin, Charitéplatz 1, 10117 Berlin, Germany.
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Puig L. Riesgo cardiovascular y psoriasis: papel de la terapia biológica. ACTAS DERMO-SIFILIOGRAFICAS 2012; 103:853-862. [DOI: 10.1016/j.ad.2012.02.003] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2011] [Revised: 02/06/2012] [Accepted: 02/08/2012] [Indexed: 12/11/2022] Open
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Kavanaugh A, McInnes IB, Mease PJ, Krueger GG, Gladman DD, van der Heijde D, Mudivarthy S, Xu W, Mack M, Xu Z, Beutler A. Clinical efficacy, radiographic and safety findings through 2 years of golimumab treatment in patients with active psoriatic arthritis: results from a long-term extension of the randomised, placebo-controlled GO-REVEAL study. Ann Rheum Dis 2012; 72:1777-85. [PMID: 23161902 PMCID: PMC3812864 DOI: 10.1136/annrheumdis-2012-202035] [Citation(s) in RCA: 69] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Objectives To assess long-term golimumab efficacy/safety in patients with active psoriatic arthritis (PsA). Methods Adult PsA patients (≥3 swollen, ≥3 tender joints, active psoriasis) were randomly assigned to subcutaneous injections of placebo, golimumab 50 mg or 100 mg every 4 weeks (q4wks) through week 20. All patients received golimumab 50 or 100 mg beginning week 24. Findings through 2 years are reported. Efficacy evaluations included ≥20% improvement in American College of Rheumatology (ACR20) response, good/moderate response in Disease Activity Scores incorporating 28 joints and C-reactive protein (DAS28-CRP), ≥75% improvement in Psoriasis Area and Severity Index (PASI75) and changes in PsA-modified Sharp/van der Heijde scores (SHS). Results Golimumab treatment through 2 years was effective in maintaining clinical response (response rates: ACR20 63%–70%, DAS28-CRP 77%–86%, PASI75 56%–72%) and inhibiting radiographic progression (mean change in PsA-modified SHS in golimumab-treated patients: −0.36), with no clear difference between doses. No new safety signals were identified through 2 years. With the study's tuberculosis screening and prophylactic measures, no patient developed active tuberculosis through 2 years. Conclusions Golimumab 50 and 100 mg for up to 2 years yielded sustained clinical and radiographic efficacy when administered to patients with active PsA. Increasing the golimumab dose from 50 to 100 mg q4wks added limited benefit. Golimumab safety through up to 2 years was consistent with other antitumour necrosis factor α agents used to treat PsA. Treatment of patients with latent tuberculosis identified at baseline appeared to be effective in inhibiting the development of active tuberculosis.
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Affiliation(s)
- Arthur Kavanaugh
- Division of Rheumatology, Allergy, Immunology, University of California, , San Diego, La Jolla, California, USA
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Langley RG, Papp K, Gottlieb AB, Krueger GG, Gordon KB, Williams D, Valdes J, Setze C, Strober B. Safety results from a pooled analysis of randomized, controlled phase II and III clinical trials and interim data from an open-label extension trial of the interleukin-12/23 monoclonal antibody, briakinumab, in moderate to severe psoriasis. J Eur Acad Dermatol Venereol 2012; 27:1252-61. [PMID: 23157612 DOI: 10.1111/j.1468-3083.2012.04705.x] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
BACKGROUND Anti-interleukin-12/23 treatment (anti-IL-12/23) has recently demonstrated significant efficacy for moderate to severe psoriasis, yet potential safety signals warrant further investigation. OBJECTIVES Expand safety findings for the anti-IL-12/23, briakinumab, beyond individual phase II and III clinical trials. METHODS Safety data pooled from five phase II and III clinical trials (parent studies) and an open-label extension study (OLE), through 22 October 2010; patients with ≥ 1 dose of briakinumab in a parent study or the OLE are included. All parent study briakinumab treatment groups were combined with the OLE population, which received 100-mg briakinumab every 4 weeks. Adverse events (AEs) were collected from the first dose of briakinumab, whether in a parent study or the OLE, through 45 days post-last dose. RESULTS Two thousand five hundred and twenty patients (4704 patient-years drug exposure) received ≥ 1 dose of briakinumab during the interim period: 5.6% withdrew due to AEs. Serious infections occurred in 1.3% and malignancies in 2.6% (including 1.0% basal cell carcinoma, 0.8% squamous cell carcinoma). Twenty-seven major adverse cardiovascular events (MACE) occurred, seven in one parent study and 20 in the OLE (incidence = 0.57 events/100 PY). Four cardiovascular risk factors were retrospectively found to be significant predictors for MACE during briakinumab exposure: history of cardiovascular disease, diabetes, body mass index (≥ 30) and baseline blood pressure (systolic ≥ 140 or diastolic ≥ 90). CONCLUSIONS Pooled briakinumab safety results from five parent studies and an OLE suggest increased rates of infections, malignancies and MACE, and that patients receiving anti-IL-12/23 treatment for moderate to severe psoriasis should be monitored for these potential safety signals.
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Affiliation(s)
- R G Langley
- Dalhousie University, Halifax, NS, Canada Probity Medical Research, Waterloo, ON, Canada Tufts Medical Centre, Boston, MA, USA University of Utah Health Sciences Centre, Salt Lake City, UT, USA Northwestern University, Evanston, IL, USA Abbott Laboratories, Abbott Park, IL, USA University of Connecticut School of Medicine, Farmington, CT, USA
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Kimball AB, Gordon KB, Fakharzadeh S, Yeilding N, Szapary PO, Schenkel B, Guzzo C, Li S, Papp KA. Long-term efficacy of ustekinumab in patients with moderate-to-severe psoriasis: results from the PHOENIX 1 trial through up to 3 years. Br J Dermatol 2012; 166:861-72. [PMID: 22356258 DOI: 10.1111/j.1365-2133.2012.10901.x] [Citation(s) in RCA: 95] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND An unmet need remains for safe and effective long-term treatments of psoriasis. OBJECTIVES To evaluate ustekinumab efficacy and safety for up to 3 years in the PHOENIX 1 trial. METHODS Patients (n = 766) with moderate-to-severe psoriasis were randomized to ustekinumab 45 mg or 90 mg at weeks 0 and 4, and then every 12 weeks, or placebo at weeks 0 and 4, with crossover to ustekinumab at week 12. Ustekinumab responders [≥ 75% improvement from baseline in the Psoriasis Area and Severity Index (PASI 75) at weeks 28 and 40] were re-randomized at week 40 to continue or withdraw from treatment until psoriasis recurrence. Partial responders (week 28: PASI 50-74; week 40: < PASI 75) switched to dosing every 8 weeks. Clinical efficacy was assessed by PASI, the Physician's Global Assessment (PGA), and the Dermatology Life Quality Index (DLQI) measures. RESULTS Overall, 79·8% of the ustekinumab-treated patients remained in the study for 3 years. PASI 75 response rates (45 mg: 61·2%; 90 mg: 72·4%) at week 76 were maintained through year 3 (45 mg: 62·7%; 90 mg: 72·2%); PGA response was similarly durable. At year 3, 80·9% (45 mg) and 82·7% (90 mg) of week 40 responders continuing treatment every 12 weeks achieved a PASI 75 response, while 42·6% (45 mg) and 58·0% (90 mg) achieved a PASI 90 response. Among partial responders adjusted to dosing every 8 weeks, 50·9% (45 mg) and 52·0% (90 mg) had a PASI 75 response at year 3. DLQI responses paralleled the PASI responses. Through year 3, no dose response was observed in rates of adverse events (AEs), overall infections, serious AEs, or AEs leading to discontinuation; nor was there evidence of cumulative organ toxicity. CONCLUSIONS; Continuous, stable, maintenance dosing with ustekinumab was generally well tolerated and sustained durable efficacy for up to 3 years of treatment.
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Affiliation(s)
- A B Kimball
- Department of Dermatology, Harvard Medical School, Boston, MA 02114, USA.
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Tichy M, Zapletalova J. Experience with the systemic treatment of severe forms of psoriasis. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub 2012; 156:29-40. [DOI: 10.5507/bp.2012.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
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