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Megna M, Ruggiero A, Martora F, Vallone Y, Guerrasio G, Potestio L. Long-Term Efficacy and Safety of Guselkumab in Psoriasis Patients Who Failed Anti-IL17: A Two-Year Real-Life Study. J Clin Med 2024; 13:2691. [PMID: 38731220 PMCID: PMC11084869 DOI: 10.3390/jcm13092691] [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: 03/26/2024] [Revised: 04/13/2024] [Accepted: 05/02/2024] [Indexed: 05/13/2024] Open
Abstract
Guselkumab is the first approved human IgG1λ monoclonal antibody selectively targeting the p19 subunit of interleukin (IL)-23. Despite its effectiveness and safety, which have been widely reported by clinical trials and real-life experiences, data regarding its use on patients who previously failed anti-IL17 are limited or characterized by a reduced follow-up period. These data are essential to guide clinicians in biologic switching, considering that anti-IL23 and anti-IL17 partially share their therapeutic targets, as well as some patients who may have to interrupt treatment with anti-IL17 for loss of efficacy over time or the development of adverse events (AEs). In this context, we performed a retrospective study with the aim of evaluating the long-term use (2 years) of guselkumab in psoriasis patients who previously failed at least one anti-IL17 in a real-life setting, also focusing attention on psoriasis located in difficult-to-treat areas (the scalp, palms or soles, fingernails, genitals). A total of 61 patients (35 male, 57.4%; mean age 57.6 ± 8.8 years) were enrolled. Of these, 30 (49.2%) patients failed secukinumab, 21 (34.4%) failed ixekizumab, 7 (11.5%) failed brodalumab, and 3 (4.9%) failed both secukinumab and ixekizumab. At the baseline, the mean PASI and BSA were 12.8 ± 8.4 and 24.5 ± 26.6, respectively. During week 16, PASI90 and PASI100 responses were achieved by 60.7% and 37.7% of patients, respectively, which continued to improve up to week 104 (PASI90: 73.8%, PASI100: 59.0%). Clinical improvement in difficult-to-treat areas was detected as well. In particular, a slower improvement for fingernails and the palmoplantar region was reported compared to scalp and genital psoriasis at week 16. However, no differences were found following 28 weeks of therapy. Primary and secondary inefficacy were reported by 1 (1.6%) and 5 (8.2%) patients. As regards safety, no severe AEs were collected.
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Affiliation(s)
- Matteo Megna
- Section of Dermatology, Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
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Rusiñol L, Carmona-Rocha E, Puig L. Durability and long-term outcomes of biologic therapies in psoriasis. Expert Rev Clin Immunol 2024; 20:71-82. [PMID: 37610817 DOI: 10.1080/1744666x.2023.2250918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2023] [Revised: 07/19/2023] [Accepted: 08/18/2023] [Indexed: 08/24/2023]
Abstract
INTRODUCTION Significant advances in psoriasis treatment have taken place since the introduction of biologics. Tumor necrosis factor inhibitors were the first class of biologics approved and at that time greatly improved psoriasis treatment. However, newer biologics, directed to interleukin(IL)-23/IL-17 pathways central to psoriasis pathogenesis, have improved complete or nearly complete clearance rates and are characterized by an excellent safety profile.Real-world setting experiences have generally confirmed the results of clinical trials, but real-world data regarding newer biologics is relatively scarce. AREAS COVERED We provide an extensive review of real-world survival of biologic treatments for moderate to severe psoriasis. EXPERT OPINION There is growing and consistent evidence of higher drug survival of IL-23 inhibitors, possibly due to their favorable efficacy and safety profiles, dosing convenience and persistence of response despite treatment interruption; eventual confirmation of their potential role as modifiers of the natural history of psoriasis might provide additional reasons for therapeutic persistence of this class of biologics.
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Affiliation(s)
- Lluís Rusiñol
- Department of dermatology, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, spain
| | - Elena Carmona-Rocha
- Department of dermatology, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, spain
| | - Lluís Puig
- Department of dermatology, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, spain
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3
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Rivera-Díaz R, Pozo T, Alfageme F, Díaz Ley B, Osorio GF, Chico R, Vilarrasa E, Silvente C, Ciudad Blanco C, Romaní J, Martorell A, Fernández P, Romero Ferreiro C, Molina Leyva A. The Effectiveness of Guselkumab in Patients With Hidradenitis Suppurativa Under Clinical Practice Conditions: A Spanish Multicentre Retrospective Study. ACTAS DERMO-SIFILIOGRAFICAS 2023; 114:T755-T762. [PMID: 37479135 DOI: 10.1016/j.ad.2023.06.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Accepted: 06/12/2023] [Indexed: 07/23/2023] Open
Abstract
BACKGROUND Hidradenitis suppurativa (HS) is a chronic skin condition causing lesions in which high levels of interleukin (IL)-23 and T-helper17 cells are found. Adalimumab remains the only approved treatment. Guselkumab, an antibody targeting the p19 protein subunit of extracellular IL-23, is approved for the treatment of moderate-severe psoriasis, but evidence on its efficacy in treating HS is limited. OBJECTIVES To assess the effectiveness and safety of guselkumab in treating moderate-severe HS under clinical practice conditions. METHODS A multicentre retrospective observational study was carried out in 13 Spanish hospitals including adult HS patients treated with guselkumab within a compassionate use programme (March 2020-March 2022). Data referred to patient demographic and clinical characteristics at treatment initiation (baseline), patient-reported outcomes (Numerical Pain Rating Scale [NPRS] and Dermatology Life Quality Index [DLQI]), physician scores (International Hidradenitis Suppurativa Severity Score System [IHS4], HS Physical Global Score [HS-PGA] and Hidradenitis Suppurativa Clinical Response [HiSCR]) were recorded at baseline and at 16, 24, and 48weeks of treatment. RESULTS A total of 69 patients were included. Most (84.10%) had severe HS (HurleyIII) and had been diagnosed for over ten years (58.80%). The patients had been subjected to multiple non-biological (mean: 3.56) or biological (mean: 1.78) therapies, and almost 90% of those treated with biologics had received adalimumab. A significant decrease in IHS4, HS-PGA, NPRS, and DLQI scores was observed from baseline to 48weeks of guselkumab treatment (all P<.01). HiSCR was achieved in 58.33% and 56.52% of the patients at 16 and 24weeks, respectively. Overall, 16 patients discontinued treatment, mostly due to inefficacy (n=7) or loss of efficacy (n=3). No serious adverse events were observed. CONCLUSIONS Our results indicate that guselkumab may be a safe and effective therapeutic alternative for patients with severe HS that fail to respond to other biologics.
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Affiliation(s)
- R Rivera-Díaz
- Departamento de Dermatología, Hospital Universitario 12 de Octubre, Universidad Complutense, Madrid, España.
| | - T Pozo
- Departamento de Dermatología, Hospital Rio Hortega, Valladolid, España
| | - F Alfageme
- Departamento de Dermatología, Hospital Universitario Puerta de Hierro Majadahonda, Majadahonda, Madrid, España
| | - B Díaz Ley
- Departamento de Dermatología, Hospital Universitario del Sureste, Arganda del Rey, Madrid, España
| | - G F Osorio
- Departamento de Dermatología, Hospital Universitario Virgen del Rocío, Universidad de Sevilla, Sevilla, España
| | - R Chico
- Departamento de Dermatología, Hospital Infanta Sofía, Alcobendas, Madrid, España
| | - E Vilarrasa
- Departamento de Dermatología, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, España
| | - C Silvente
- Departamento de Dermatología, Hospital Universitario Infanta Leonor, Madrid, España
| | - C Ciudad Blanco
- Departamento de Dermatología, Hospital Universitario Gregorio Marañón, Universidad Complutense, Madrid, España
| | - J Romaní
- Departamento de Dermatología, Hospital General de Granollers, Granollers, Barcelona, España
| | - A Martorell
- Departamento de Dermatología, Hospital de Manises, Manises, Valencia, España
| | - P Fernández
- Departamento de Dermatología, Hospital Universitario Ramón y Cajal, Madrid, España
| | - C Romero Ferreiro
- Scientific Support Unit, Instituto de Investigación Sanitaria Hospital Universitario, 12 de Octubre (imas12), Madrid, España; Facultad de Ciencias de la Salud, Universidad Francisco de Vitoria, Pozuelo de Alarcón, Madrid, España
| | - A Molina Leyva
- Departamento de Dermatología, Hospital Universitario Virgen de las Nieves, Granada, España; European Hidradenitis Suppurativa Foundation (EHSF), Dessau-Roßlau, Alemania
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4
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Rivera-Díaz R, Pozo T, Alfageme F, Díaz Ley B, Osorio GF, Chico R, Vilarrasa E, Silvente C, Ciudad Blanco C, Romaní J, Martorell A, Fernández P, Romero Ferreiro C, Molina Leyva A. The Effectiveness of Guselkumab in Patients With Hidradenitis Suppurativa Under Clinical Practice Conditions: A Spanish Multicentre Retrospective Study. ACTAS DERMO-SIFILIOGRAFICAS 2023; 114:755-762. [PMID: 37331620 DOI: 10.1016/j.ad.2023.06.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Revised: 05/26/2023] [Accepted: 06/12/2023] [Indexed: 06/20/2023] Open
Abstract
BACKGROUND Hidradenitis suppurativa (HS) is a chronic skin condition causing lesions in which high levels of interleukin (IL)-23 and T-helper 17 cells are found. Adalimumab remains the only approved treatment. Guselkumab, an antibody targeting the p19 protein subunit of extracellular IL-23, is approved for the treatment of moderate-severe psoriasis, but evidence on its efficacy in treating HS is limited. OBJECTIVES To assess the effectiveness and safety of guselkumab in treating moderate-severe HS under clinical practice conditions. METHODS A multicentre retrospective observational study was carried out in 13 Spanish Hospitals including adult HS patients treated with guselkumab within a compassionate use programme (March 2020-March 2022). Data referred to patient demographic and clinical characteristics at treatment initiation (baseline), patient-reported outcomes (Numerical Pain Rating Scale [NPRS] and Dermatology Life Quality Index [DLQI]), physician scores (International Hidradenitis Suppurativa Severity Score System [IHS4], HS Physical Global Score [HS-PGA] and Hidradenitis Suppurativa Clinical Response [HiSCR]) were recorded at baseline and at 16, 24, and 48 weeks of treatment. RESULTS A total of 69 patients were included. Most (84.10%) had severe HS (Hurley III) and had been diagnosed for over ten years (58.80%). The patients had been subjected to multiple non-biological (mean 3.56) or biological (mean 1.78) therapies, and almost 90% of those treated with biologics had received adalimumab. A significant decrease in IHS4, HS-PGA, NPRS, and DLQI scores was observed from baseline to 48 weeks of guselkumab treatment (all p<0.01). HiSCR was achieved in 58.33% and 56.52% of the patients at 16 and 24 weeks, respectively. Overall, 16 patients discontinued treatment, mostly due to inefficacy (n=7) or loss of efficacy (n=3). No serious adverse events were observed. CONCLUSIONS Our results indicate that guselkumab may be a safe and effective therapeutic alternative for patients with severe HS that fail to respond to other biologics.
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Affiliation(s)
- R Rivera-Díaz
- Department of Dermatology, Hospital Universitario 12 de Octubre, Universidad Complutense, Madrid, Spain.
| | - T Pozo
- Department of Dermatology, Hospital Rio Hortega, Valladolid, Spain
| | - F Alfageme
- Department of Dermatology, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain
| | - B Díaz Ley
- Department of Dermatology, Hospital Universitario del Sureste, Arganda, Madrid, Spain
| | - G F Osorio
- Department of Dermatology, Hospital Universitario Virgen del Rocío, Universidad de Sevilla, Sevilla, Spain
| | - R Chico
- Department of Dermatology, Hospital Infanta Sofía, Alcobendas, Madrid, Spain
| | - E Vilarrasa
- Department of Dermatology, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - C Silvente
- Department of Dermatology, Hospital Universitario Infanta Leonor, Madrid, Spain
| | - C Ciudad Blanco
- Department of Dermatology, Hospital Universitario Gregorio Marañón, Universidad Complutense Madrid, Madrid, Spain
| | - J Romaní
- Department of Dermatology, Hospital General de Granollers, Barcelona, Spain
| | - A Martorell
- Department of Dermatology, Hospital de Manises, Valencia, Spain
| | - P Fernández
- Department of Dermatology, Hospital Universitario Ramon y Cajal, Madrid, Spain
| | - C Romero Ferreiro
- Scientific Support Unit, Instituto de Investigación Sanitaria Hospital Universitario, 12 de Octubre (imas12), 28041 Madrid, Spain; Faculty of Health Sciences, Universidad Francisco de Vitoria, Pozuelo de Alarcón, 28223 Madrid, Spain
| | - A Molina Leyva
- Department of Dermatology, Hospital Universitario Virgen de las Nieves, Granada, Spain; European Hidradenitis Suppurativa Foundation (EHSF), Dessau-Roßlau, Germany
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Autoreactive T-Cells in Psoriasis: Are They Spoiled Tregs and Can Therapies Restore Their Functions? Int J Mol Sci 2023; 24:ijms24054348. [PMID: 36901778 PMCID: PMC10002349 DOI: 10.3390/ijms24054348] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2023] [Revised: 02/10/2023] [Accepted: 02/13/2023] [Indexed: 02/25/2023] Open
Abstract
Psoriasis is a chronic inflammatory skin disease, which affects 2-4% of the population worldwide. T-cell derived factors such as Th17 and Th1 cytokines or cytokines such as IL-23, which favors Th17-expansion/differentiation, dominate in the disease. Therapies targeting these factors have been developed over the years. An autoimmune component is present, as autoreactive T-cells specific for keratins, the antimicrobial peptide LL37 and ADAMTSL5 have been described. Both autoreactive CD4 and CD8 T-cells exist, produce pathogenic cytokines, and correlate with disease activity. Along with the assumption that psoriasis is a T-cell-driven disease, Tregs have been studied extensively over the years, both in the skin and in circulation. This narrative review resumes the main findings about Tregs in psoriasis. We discuss how Tregs increase in psoriasis but are impaired in their regulatory/suppressive function. We debate the possibility that Tregs convert into T-effector cells under inflammatory conditions; for instance, they may turn into Th17-cells. We put particular emphasis on therapies that seem to counteract this conversion. We have enriched this review with an experimental section analyzing T-cells specific for the autoantigen LL37 in a healthy subject, suggesting that a shared specificity may exist between Tregs and autoreactive responder T-cells. This suggests that successful psoriasis treatments may, among other effects, restore Tregs numbers and functions.
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Ruiz-Villaverde R, Rodriguez-Fernandez-Freire L, Armario-Hita JC, Pérez-Gil A, Vasquez Chinchay F, Galán-Gutiérrez M. Effectiveness, survival and safety of guselkumab attending to basal characteristics in moderate-to-severe psoriatic patients: a cohort study. F1000Res 2022; 11:1178. [PMID: 36567685 PMCID: PMC9755754 DOI: 10.12688/f1000research.122945.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/02/2022] [Indexed: 11/09/2022] Open
Abstract
Background: Psoriasis is a chronic inflammatory disease which can impact quality of life. In the past decade multiple biologic treatments have been released with encouraging results. Guselkumab is a monoclonal antibody targeting IL-23p19. Multiple randomized clinical trials have demonstrated its efficacy in psoriasis, but response differences among patient subpopulations have not been extensively reported. Furthermore, patients in real life are often non-eligible for clinical trials and their responses may differ from pivotal studies. Methods: This is a retrospective, observational study of real clinical practice of patients receiving guselkumab treatment in Spain. Patients treated with guselkumab were included between February 2019 to December 2021. This study evaluates the potential differential effect of baseline demographic and disease characteristics on therapeutic responses to guselkumab. We measured effectiveness and survival by the psoriasis area and severity index, the dermatology life quality index as well as Kaplan meier curves, respectively. Categorical and quantitative variables are reported with frequencies, and with mean and standard deviation, respectively. Differences between groups in psoriasis area and severity index and dermatology life quality index, were calculated using a mixed-effects analysis. Survival was calculated using Kaplan meier curves and log-rank tests. Results: A total of 87 patients were included. In this study, our objective was to evaluate the effectiveness, safety and survival of guselkumab attending to demographic characteristics. No differences in psoriasis area and severity index or dermatology life quality index baseline values or therapeutic responses were noted at 52 weeks of follow-up among all the subgroups analysed (age, sex, psoriasis duration, body mass index, and comorbidities). A difference in drug survival was only seen between gender groups. Conclusions: Our research has demonstrated the consistency of guselkumab effectiveness across patient subgroups. No baseline features affected the effectiveness or drug survival of guselkumab, except for lower drug survival in female patients.
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Affiliation(s)
| | | | | | - Amalia Pérez-Gil
- Dermatology Department, Hospital Universitario Virgen de Valme, Sevilla, 41014, Spain
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Torres T, Puig L, Vender R, Yeung J, Carrascosa JM, Piaserico S, Gisondi P, Lynde C, Ferreira P, Bastos PM, Dauden E, Leite L, Valerio J, Del Alcázar-Viladomiu E, Rull EV, Llamas-Velasco M, Pirro F, Messina F, Bruni M, Licata G, Ricceri F, Nidegger A, Hugo J, Mufti A, Daponte AI, Teixeira L, Balato A, Romanelli M, Prignano F, Gkalpakiotis S, Conrad C, Lazaridou E, Rompoti N, Papoutsaki M, Nogueira M, Chiricozzi A. Drug Survival of Interleukin (IL)‑17 and IL‑23 Inhibitors for the Treatment of Psoriasis: A Retrospective Multi‑country, Multicentric Cohort Study. Am J Clin Dermatol 2022; 23:891-904. [PMID: 35976568 DOI: 10.1007/s40257-022-00722-y] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/02/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND Drug survival, defined as the length of time from initiation to discontinuation of a given therapy, allows comparisons between drugs, helps to predict patient's likelihood of remaining on a specific treatment, and achieving the best decision for each patient in daily clinical practice. OBJECTIVE The aim of this study was to provide data on drug survival of secukinumab, ixekizumab, brodalumab, guselkumab, tildrakizumab, and risankizumab in a large international cohort, and to identify clinical predictors that might have an impact on the drug survival of these drugs. METHODS This was a retrospective, multicentric, multi-country study that provides data of adult patients with moderate to severe psoriasis who started treatment with an interleukin (IL)-17 or IL-23 inhibitor between 1 February 2015 and 31 October 2021. Data were collected from 19 distinct hospital and non-hospital-based dermatology centers from Canada, Czech Republic, Italy, Greece, Portugal, Spain, and Switzerland. Kaplan-Meier estimator and proportional hazard Cox regression models were used for drug survival analysis. RESULTS A total of 4866 treatment courses (4178 patients)-overall time of exposure of 9500 patient-years-were included in this study, with 3164 corresponding to an IL-17 inhibitor (secukinumab, ixekizumab, brodalumab) and 1702 corresponding to an IL-23 inhibitor (guselkumab, risankizumab, tildrakizumab). IL-23 inhibitors had the highest drug survival rates during the entire study period. After 24 months of treatment, the cumulative probabilities of drug survival were 0.92 (95% confidence interval [CI] 0.89-0.95) for risankizumab, 0.90 (95% CI 0.88-0.92) for guselkumab, 0.80 (95% CI 0.76-0.84) for brodalumab, 0.79 (95% CI 0.76-0.82) for ixekizumab, and 0.75 (95% CI 0.73-0.77) for secukinumab. At 36 months, only guselkumab [0.88 (95% CI 0.85-0.91)], ixekizumab [0.73 (95% CI 0.70-0.76)], and secukinumab [0.67 (95% CI 0.65-0.70)] had more than 40 patients at risk of drug discontinuation. Only two drugs had more than 40 patients at risk of drug discontinuation at 48 months, with ixekizumab demonstrating to have a higher cumulative probability of drug survival [0.71 (95% CI 0.68-0.75)] when compared with secukinumab [0.63 (95% CI 0.60-0.66)]. Secondary failure was the main cause for drug discontinuation. According to the final multivariable model, patients receiving risankizumab, guselkumab, and ixekizumab were significantly less likely to discontinue treatment than those receiving secukinumab. Previous exposure to biologic agents, absent family history of psoriasis, higher baseline body mass index (BMI), and higher baseline Psoriasis Area and Severity Index (PASI) were identified as predictors of drug discontinuation. CONCLUSION The cumulative probability of drug survival of both IL-17 and IL-23 inhibitors was higher than 75% at 24 months, with risankizumab and guselkumab demonstrating to have overall cumulative probabilities ≥ 90%. Biological agent chosen, prior exposure to biologic agents, higher baseline BMI and PASI values, and absence of family history of psoriasis were identified as predictors for drug discontinuation. Risankizumab, guselkumab, and ixekizumab were less likely to be discontinued than secukinumab.
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Affiliation(s)
- Tiago Torres
- Department of Dermatology, Centro Hospitalar Universitário do Porto, Porto, Portugal. .,Instituto de Ciências Biomédicas Abel Salazar, University of Porto, Porto, Portugal.
| | - Luis Puig
- Department of Dermatology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Ron Vender
- McMaster University, Hamilton, ON, Canada
| | - Jensen Yeung
- Division of Dermatology, Department of Medicine, University of Toronto, Probity Medical Research, Waterloo, ON, Canada
| | - José-Manuel Carrascosa
- Department of Dermatology, Germans Trias i Pujol University Hospital (HUGTP), Autonomous University of Barcelona (UAB), Badalona, Spain
| | - Stefano Piaserico
- Dermatology Unit, Department of Medicine, University of Padua, 35128, Padua, Italy
| | - Paolo Gisondi
- Department of Medicine, Section of Dermatology and Venereology, University of Verona, Verona, Italy
| | - Charles Lynde
- The Lynde Institute for Dermatology, Department of Medicine, University of Toronto, Toronto, Canada
| | | | | | - Esteban Dauden
- Dermatology Department, Hospital Universitario de la Princesa, Instituto de Investigación Sanitaria La Princesa (IIS-IP), Madrid, Spain
| | | | | | - Elena Del Alcázar-Viladomiu
- Department of Dermatology, Germans Trias i Pujol University Hospital (HUGTP), Autonomous University of Barcelona (UAB), Badalona, Spain
| | - Eva Vilarrasa Rull
- Department of Dermatology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Mar Llamas-Velasco
- Dermatology Department, Hospital Universitario de la Princesa, Instituto de Investigación Sanitaria La Princesa (IIS-IP), Madrid, Spain
| | - Federico Pirro
- Dermatologia, Dipartimento di Medicina e Chirurgia Traslazionale, Università Cattolica Del Sacro Cuore, Rome, Italy.,UOC di Dermatologia, Dipartimento di Scienze Mediche e Chirurgiche, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Francesco Messina
- Dermatology Unit, Department of Medicine, University of Padua, 35128, Padua, Italy
| | - Manfredo Bruni
- Department of Medicine, Section of Dermatology and Venereology, University of Verona, Verona, Italy
| | - Gaetano Licata
- Dermatology Department, University of Brescia, ASST Spedali Civili of Brescia, Brescia, Italy
| | - Federica Ricceri
- Department of Dermatological Science, Section of Dermatology, University of Florence, Florence, Italy
| | - Alessia Nidegger
- Department of Dermatology, Lausanne University Hospital CHUV and University of Lausanne, Lausanne, Switzerland
| | - Jan Hugo
- Department of Dermatovenereology, Third Faculty of Medicine, Charles University and Kralovske Vinohrady University Hospital, Prague, Czech Republic
| | - Asfandyar Mufti
- Division of Dermatology, Department of Medicine, University of Toronto, Probity Medical Research, Waterloo, ON, Canada
| | - Athina-Ioanna Daponte
- Second Department of Dermatology-Venereology, Aristotle University School of Medicine, Thessaloniki, Greece
| | - Laetitia Teixeira
- Center for Health Technology and Services Research (CINTESIS), Institute of Biomedical Sciences Abel Salazar, University of Porto (ICBAS.UP), Porto, Portugal
| | - Anna Balato
- Unit of Dermatology, University of Campania Luigi Vanvitelli, Naples, Italy
| | | | - Francesca Prignano
- Department of Dermatological Science, Section of Dermatology, University of Florence, Florence, Italy
| | - Spyridon Gkalpakiotis
- Department of Dermatovenereology, Third Faculty of Medicine, Charles University and Kralovske Vinohrady University Hospital, Prague, Czech Republic
| | - Curdin Conrad
- Department of Dermatology, Lausanne University Hospital CHUV and University of Lausanne, Lausanne, Switzerland
| | - Elizabeth Lazaridou
- Second Department of Dermatology-Venereology, Aristotle University School of Medicine, Thessaloniki, Greece
| | - Natalia Rompoti
- 1st Departament of Dermatology-Venereology, Faculty of Medicine, National and Kapodistrian University of Athens, "A. Sygros" Hospital for Skin and Venereal Diseases, Athens, Greece
| | - Marina Papoutsaki
- 1st Departament of Dermatology-Venereology, Faculty of Medicine, National and Kapodistrian University of Athens, "A. Sygros" Hospital for Skin and Venereal Diseases, Athens, Greece
| | - Miguel Nogueira
- Department of Dermatology, Centro Hospitalar Universitário do Porto, Porto, Portugal
| | - Andrea Chiricozzi
- Dermatologia, Dipartimento di Medicina e Chirurgia Traslazionale, Università Cattolica Del Sacro Cuore, Rome, Italy.,UOC di Dermatologia, Dipartimento di Scienze Mediche e Chirurgiche, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
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8
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Torres T, Puig L, Vender R, Lynde C, Piaserico S, Carrascosa JM, Gisondi P, Daudén E, Conrad C, Mendes-Bastos P, Ferreira P, Leite L, Lu JD, Valerio J, Bruni M, Messina F, Nidegger A, Llamas-Velasco M, Del Alcazar E, Mufti A, White K, Caldarola G, Teixeira L, Romanelli P, Desai K, Gkalpakiotis S, Romanelli M, Yeung J, Nogueira M, Chiricozzi A. Drug Survival of IL-12/23, IL-17 and IL-23 Inhibitors for Psoriasis Treatment: A Retrospective Multi-Country, Multicentric Cohort Study. Am J Clin Dermatol 2021; 22:567-579. [PMID: 33786754 DOI: 10.1007/s40257-021-00598-4] [Citation(s) in RCA: 65] [Impact Index Per Article: 21.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/06/2021] [Indexed: 01/05/2023]
Abstract
BACKGROUND Drug survival analysis of biologic agents in psoriasis is of extreme importance, as it allows not only the evaluation of objective clinical outcomes (such as effectiveness and safety) but also of factors that are associated with patients' adherence to treatment. The aim of this study was to evaluate and compare the drug survival of the most recent biologic agents approved for the treatment of moderate-to-severe psoriasis-ustekinumab, secukinumab, ixekizumab, brodalumab, guselkumab, and risankizumab-and to identify clinical predictors that can influence the drug survival of these drugs. METHODS This retrospective multicentric cohort study from 16 dermatology centers in Portugal, Spain, Italy, Switzerland, Czech Republic, Canada, and the United States included patients that started IL-12/23, IL-17 (IL-17A and IL-17R) and IL-23 inhibitors for the treatment of psoriasis between January 1, 2012 and December 31, 2019. Survival analysis was performed using a Kaplan-Meier estimator, to obtain descriptive survival curves, and proportional hazard Cox regression models. RESULTS A total of 3312 treatment courses (total patients: 3145) were included in the study; 1118 (33.8%) with an IL-12/23 inhibitor (ustekinumab), 1678 (50.7%) with an IL-17 inhibitor [911 (27.5%) on secukinumab, 651 (19.7%) on ixekizumab, 116 (3.5%) on brodalumab], and 516 (15.5%) with an IL-23 inhibitor [398 (12.0%) on guselkumab, 118 (3.5%) on risankizumab]. At 18 months, the cumulative probability of survival was 96.4% for risankizumab, 91.1% for guselkumab, 86.3% for brodalumab, 86.1% for ustekinumab, 82.0% for ixekizumab, and 79.9% for secukinumab. Using ustekinumab as reference, drug survival of guselkumab was higher (HR 0.609; 95% CI 0.418-0.887) and that of secukinumab was lower (HR 1.490; 95% CI 1.257-1.766). In the final multivariable model, secukinumab, female sex, higher BMI, and prior exposure to biologic agents significantly increased the risk of drug discontinuation, whereas risankizumab was protective. CONCLUSION In this multinational cohort with 8439 patient-years of follow-up, the cumulative probability of drug survival for all drugs was >79% at 18 months. Prescribed biologic, female sex, higher BMI, and previous exposure to biologic agents were predictors of drug discontinuation. Drug survival of guselkumab and risankizumab was higher than that of ustekinumab, and secukinumab was lower.
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Affiliation(s)
- Tiago Torres
- Department of Dermatology, Centro Hospitalar Universitário do Porto, Porto, Portugal.
- Instituto de Ciências Biomédicas Abel Salazar, University of Porto, Porto, Portugal.
| | - Luis Puig
- Department of Dermatology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Ron Vender
- McMaster University, Hamilton, Ontario, Canada
| | - Charles Lynde
- Lynde Institute for Dermatology, Markham, Ontario, Canada
| | - Stefano Piaserico
- Dermatology Unit, Department of Medicine, University of Padua, 35128, Padua, Italy
| | - Jose M Carrascosa
- Department of Dermatology, Germans Trias i Pujol University Hospital (HUGTP), Autonomous University of Barcelona (UAB), Badalona, Spain
| | - Paolo Gisondi
- Section of Dermatology and Venereology, Department of Medicine, University of Verona, 37126, Verona, Italy
| | - Esteban Daudén
- Dermatology Department, Hospital Universitario de la Princesa, Instituto de Investigación Sanitaria La Princesa (IIS-IP), Madrid, Spain
| | - Curdin Conrad
- Department of Dermatology, Lausanne University Hospital CHUV, University of Lausanne, Lausanne, Switzerland
| | | | | | | | - Justin D Lu
- Michael G. DeGroote School of Medicine, Faculty of Medicine, Hamilton, Ontario, Canada
| | - J Valerio
- Clínica Médica Belém, Lisbon, Portugal
| | - M Bruni
- Section of Dermatology and Venereology, Department of Medicine, University of Verona, 37126, Verona, Italy
| | - F Messina
- Dermatology Unit, Department of Medicine, University of Padua, 35128, Padua, Italy
| | - A Nidegger
- Department of Dermatology, Lausanne University Hospital CHUV, University of Lausanne, Lausanne, Switzerland
| | - M Llamas-Velasco
- Dermatology Department, Hospital Universitario de la Princesa, Instituto de Investigación Sanitaria La Princesa (IIS-IP), Madrid, Spain
| | - E Del Alcazar
- Department of Dermatology, Germans Trias i Pujol University Hospital (HUGTP), Autonomous University of Barcelona (UAB), Badalona, Spain
| | - A Mufti
- Division of Dermatology, Department of Medicine, University of Toronto, Probity Medical Research, Waterloo, Ontario, Canada
| | - Kyra White
- Lynde Institute for Dermatology, Markham, Ontario, Canada
| | - G Caldarola
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Università Cattolica del Sacro Cuore, Largo Agostino Gemelli, 8, 00168, Rome, Italy
| | - Laetitia Teixeira
- Center for Health Technology and Services Research (CINTESIS), Institute of Biomedical Sciences Abel Salazar, University of Porto (ICBAS.UP), Porto, Portugal
| | - Paolo Romanelli
- Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, University of Miami, Miller School of Medicine, Miami, Florida, USA
| | - K Desai
- Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, University of Miami, Miller School of Medicine, Miami, Florida, USA
| | - Spyridon Gkalpakiotis
- Department of Dermatovenereology, Third Faculty of Medicine, Charles University and Kralovske Vinohrady University Hospital, Prague, Czech Republic
| | | | - Jensen Yeung
- Division of Dermatology, Department of Medicine, University of Toronto, Probity Medical Research, Waterloo, Ontario, Canada
| | - Miguel Nogueira
- Department of Dermatology, Centro Hospitalar Universitário do Porto, Porto, Portugal
| | - Andrea Chiricozzi
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Università Cattolica del Sacro Cuore, Largo Agostino Gemelli, 8, 00168, Rome, Italy
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Meitei HT, Jadhav N, Lal G. CCR6-CCL20 axis as a therapeutic target for autoimmune diseases. Autoimmun Rev 2021; 20:102846. [PMID: 33971346 DOI: 10.1016/j.autrev.2021.102846] [Citation(s) in RCA: 87] [Impact Index Per Article: 29.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 03/15/2021] [Accepted: 03/23/2021] [Indexed: 12/11/2022]
Abstract
Chemokine receptor CCR6 is expressed on various cells such as B cells, immature dendritic cells, innate lymphoid cells (ILCs), regulatory CD4 T cells, and Th17 cells. CCL20 is the only known high-affinity ligand that binds to CCR6 and drives CCR6+ cells' migration in tissues. CCL20 is mainly produced by epithelial cells, and its expression is increased by several folds under inflammatory conditions. Genome-wide association studies (GWAS) in patients with inflammatory bowel disease (IBD), psoriasis (PS), rheumatoid arthritis (RA), and multiple sclerosis (MS) showed a very strong correlation between the expression of CCR6 and disease severity. It has been shown that disruption of CCR6-CCL20 interaction by using antibodies or antagonists prevents the migration of CCR6 expressing immune cells at the site of inflammation and reduces the severity of the disease. This review discussed the importance of the CCR6-CCL20 axis in IBD, PS, RA, and MS, and recent advances in targeting the CCR6-CCL20 in controlling these autoimmune diseases.
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Affiliation(s)
| | - Nandadeep Jadhav
- National Centre for Cell Science, Ganeshkhind, Pune MH-411007, India
| | - Girdhari Lal
- National Centre for Cell Science, Ganeshkhind, Pune MH-411007, India.
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