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Torosian K, Lal E, Kavanaugh A, Loomba R, Ajmera V, Guma M. Psoriatic disease and non-alcoholic fatty liver disease shared pathogenesis review. Semin Arthritis Rheum 2023; 59:152165. [PMID: 36716599 PMCID: PMC9992353 DOI: 10.1016/j.semarthrit.2023.152165] [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: 09/30/2022] [Revised: 12/03/2022] [Accepted: 01/04/2023] [Indexed: 01/20/2023]
Abstract
Psoriatic disease (PD) and non-alcoholic fatty liver disease (NAFLD) potentially share disease pathways given the numerous inflammatory pathways involved in both diseases and a higher prevalence of NAFLD in PD patients. Metabolic syndrome and obesity are a key link between the two diseases, but even when controlling for this, associations between both diseases are still seen. Therapeutics that impact metabolic or inflammatory pathways may be impactful in both PD and NAFLD. In this review, we describe common inflammatory pathways contributing to both PD and NAFLD and critically review the potential impact of treatments for and on both diseases.
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Affiliation(s)
- Kelly Torosian
- Department of Medicine, School of Medicine, University of California, San Diego, 9500 Gilman Drive, San Diego, CA 92093, USA
| | - Esha Lal
- Department of Medicine, School of Medicine, University of California, San Diego, 9500 Gilman Drive, San Diego, CA 92093, USA
| | - Arthur Kavanaugh
- Department of Rheumatology, University of California, San Diego, 9500 Gilman Drive, San Diego, CA 92093, USA
| | - Rohit Loomba
- Division of Gastroenterology and Hepatology, University of California, San Diego, 9500 Gilman Drive, San Diego, CA 92093, USA; NAFLD Research Center, Department of Medicine, University of California at San Diego, La Jolla, USA; Division of Epidemiology, Department of Family and Preventative Medicine, University of California at San Diego, La Jolla, USA
| | - Veeral Ajmera
- Division of Gastroenterology and Hepatology, University of California, San Diego, 9500 Gilman Drive, San Diego, CA 92093, USA; NAFLD Research Center, Department of Medicine, University of California at San Diego, La Jolla, USA.
| | - Monica Guma
- Department of Rheumatology, University of California, San Diego, 9500 Gilman Drive, San Diego, CA 92093, USA; Department of Medicine, Autonomous University of Barcelona, Plaça Cívica, 08193 Bellaterra, Barcelona, Spain; San Diego VA Healthcare Service, San Diego, CA, 92161, USA.
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Gnesotto L, Mioso G, Bardazzi F, Filippi F, Di Lernia V, Motolese A, Di Nuzzo S, Conti A, Arginelli F, Corazza M, Odorici G, Borghi A, Gisondi P, Naldi L, Dapavo P, Parodi A, Burlando M, Piaserico S. Dimethyl Fumarate Treatment in Patients with Moderate-to-Severe Psoriasis: A 52-week Real-life Study. Acta Derm Venereol 2023; 103:adv4526. [PMID: 36987538 PMCID: PMC10077142 DOI: 10.2340/actadv.v103.4526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Accepted: 01/17/2023] [Indexed: 03/30/2023] Open
Abstract
Abstract is missing (Short communication)
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Affiliation(s)
- Laura Gnesotto
- Dermatology Unit, Department of Medicine, University of Padova, Via Cesare Battisti 206, IT-35128 Padua, Italy
| | - Guido Mioso
- Dermatology Unit, Department of Medicine, University of Padova, Via Cesare Battisti 206, IT-35128 Padua, Italy.
| | - Federico Bardazzi
- Department of Experimental, Diagnostic and Specialty Medicine- Division of Dermatology, University of Bologna, Bologna, Italy
| | - Federica Filippi
- Department of Experimental, Diagnostic and Specialty Medicine- Division of Dermatology, University of Bologna, Bologna, Italy
| | - Vito Di Lernia
- Dermatology Unit, Arcispedale S. Maria Nuova, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Alberico Motolese
- Dermatology Unit, Arcispedale S. Maria Nuova, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Sergio Di Nuzzo
- Dermatology, Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Andrea Conti
- Section of Dermatology, Department of Specialized Medicine, University of Modena and Reggio Emilia, Modena, Italy
| | - Federica Arginelli
- Section of Dermatology, Department of Specialized Medicine, University of Modena and Reggio Emilia, Modena, Italy
| | - Monica Corazza
- Section of Dermatology and Infectious Diseases, Department of Medical Sciences, University of Ferrara, Ferrara, Italy
| | - Giulia Odorici
- Section of Dermatology and Infectious Diseases, Department of Medical Sciences, University of Ferrara, Ferrara, Italy
| | - Alessandro Borghi
- Section of Dermatology and Infectious Diseases, Department of Medical Sciences, University of Ferrara, Ferrara, Italy
| | - Paolo Gisondi
- Section of Dermatology, Department of Medicine, University of Verona, Verona, Italy
| | - Luigi Naldi
- Dermatology Unit, San Bortolo Hospital, Vicenza, Italy
| | - Paolo Dapavo
- Section of Dermatology, Department of Medical Sciences, University of Turin, Turin, Italy
| | - Aurora Parodi
- University of Genova, DiSSal Section of Dermatology, San Martino Polyclinic Hospital IRCCS, Largo R. Benzi 10 16132 Genova, Italy
| | - Martina Burlando
- University of Genova, DiSSal Section of Dermatology, San Martino Polyclinic Hospital IRCCS, Largo R. Benzi 10 16132 Genova, Italy
| | - Stefano Piaserico
- Dermatology Unit, Department of Medicine, University of Padova, Padova, Italy
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Burlando M, Campione E, Cuccia A, Malara G, Naldi L, Prignano F, Zichichi L. Real-world use of dimehtyl fumarate in patients with plaque psoriasis: a Delphi-based expert consensus. Dermatol Reports 2022. [DOI: 10.4081/dr.2023.9613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Dimethyl fumarate (DMF) was recently approved by the European Medicines Agency for systemic treatment of moderate-to-severe chronic plaque psoriasis. Appropriate management of DMF treatment is required to achieve optimal clinical benefits. Seven dermatology experts gathered online for three meetings to identify consensus on use of DMF in patient selection, drug dosage/titration, side effects management, and follow-up, with the aim to provide guidance on use of DMF for psoriasis in clinical dermatological practice based on literature data and expert opinion. Twenty statements were discussed and voted on using a facilitator-mediated modified Delphi methodology. Strong consensus was reached for all statements (agreement level of 100%). DMF treatment is characterized by dosage flexibility, sustained efficacy, high rates of drug survival, and low potential for drug–drug interactions. It can be used in a broad range of patients, including the elderly or those with comorbidities. Side effects (mainly gastrointestinal disorders, flushing, and lymphopenia) are frequently reported but are generally mild and transient and can be minimized by dosage adjustments and slow titration schedule. Hematologic monitoring throughout treatment course is required to reduce the risk of lymphopenia. This consensus document provides clinical dermatologists with answers on optimal use of DMF to treat psoriasis.
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Di Cesare A, Ricceri F, Rosi E, Fastame MT, Prignano F. Therapy of PsO in Special Subsets of Patients. Biomedicines 2022; 10:2879. [PMID: 36359399 PMCID: PMC9687729 DOI: 10.3390/biomedicines10112879] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Revised: 10/17/2022] [Accepted: 10/27/2022] [Indexed: 01/02/2024] Open
Abstract
Psoriasis is a chronic, inflammatory skin disease that may occur at any age, with a bimodal peak of incidence around the age of 16-20 years of age (early onset) and 57-60 years (late-onset). It is estimated that roughly 70% of patients develop the disease before the age of 40, which coincides with the reproductive years. Moreover, psoriasis is a chronic disease, meaning that, with increased life-duration expectancy, the number of patients affected with psoriasis aged over 65 years is going to increase and represent a big therapeutic challenge. Actually, no specific drug recommendation is available, based only on the age of the patients, while therapeutic prescription should take into account that elderly patients have more comorbidities than younger patients, with polypharmacy and an increased risk of drug interactions. Women with psoriasis are more likely to report a worse influence of the disease on their quality of life, and they are more susceptible to the development of depression. Furthermore, pregnancy and lactation represent a major contraindication to several systemic agents, and only a few studies exist providing the safety of certain drugs during these periods of life of a woman, such as certolizumab pegol. In this paper, we discuss systemic therapeutic strategies, including conventional and biological therapies, in a special subset of patients affected with moderate-to-severe psoriasis focusing on elderly patients and on female patients in fertile age, pregnancy, and lactation.
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Affiliation(s)
| | | | | | | | - Francesca Prignano
- Department of Health Sciences, Section of Dermatology, University of Florence, 50125 Florence, Italy
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5
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Pellacani G, Bigi L, Parodi A, Burlando M, Lanna C, Campione E, Rongioletti F, Mugheddu C, Malara G, Moretti G, Stingeni L, Hansel K, Micali G, Naldi L, Pirro F, Peris K. Efficacy and Safety of Dimethyl Fumarate in Patients with Moderate-to-Severe Plaque Psoriasis: DIMESKIN-2, a Multicentre Single-Arm Phase IIIb Study. J Clin Med 2022; 11:jcm11164778. [PMID: 36013015 PMCID: PMC9410272 DOI: 10.3390/jcm11164778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Revised: 08/12/2022] [Accepted: 08/12/2022] [Indexed: 11/25/2022] Open
Abstract
This open-label multicentre trial evaluated the efficacy and safety of oral dimethyl fumarate (DMF) in patients with moderate-to-severe plaque psoriasis in real-life clinical practice over 52 weeks. Disease severity and improvement were assessed using the psoriasis area severity index (PASI), body surface area (BSA) affected, and Physician Global Assessment (PGA). Quality of life (QoL) was assessed using the Dermatology Life Quality Index (DLQI) questionnaire. The visual analogue scale (VAS) was used to quantify pruritus and measure treatment satisfaction. A total of 141 patients were included, being 66.7% male, aged 49.1 ± 14.7 years and with disease duration of 16 ± 12.1 years. After 52 weeks, mean PASI decreased from 15.9 ± 6.8 to 1.5 ± 2 and 87.7%, 56.9% and 24.6% of patients achieved PASI 75/90/100 response, respectively. BSA decreased from 26.5 ± 14.8% to 2.7 ± 3.5% at 52 weeks, and 81.5% of patients had a PGA 0-1. DLQI scores decreased from 9.4 ± 6.4 to 2.1 ± 3.3, and VAS of pruritus decreased from 53 ± 28.4 to 19.1 ± 26.2 at Week 52. VAS for treatment satisfaction was 79.4 ± 29.4 at Week 52. A total of 34.2% of patients had an AE leading to permanent discontinuation. These findings show that DMF can significantly improve indices of disease severity, pruritus and QoL, with high levels of patient satisfaction and similar safety profile to other fumarates.
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Affiliation(s)
- Giovanni Pellacani
- Dermatology Unit, Department of Surgical, Medical, Dental and Morphological Sciences Related to Transplant, Oncology and Regenerative Medicine, University of Modena and Reggio Emilia, 41121 Modena, Italy
- Department of Clinical Internal, Anesthesiological and Cardiovascular Sciences, Dermatology Clinic, Sapienza University of Rome, 00185 Rome, Italy
| | - Laura Bigi
- Dermatology Unit, Department of Surgical, Medical, Dental and Morphological Sciences Related to Transplant, Oncology and Regenerative Medicine, University of Modena and Reggio Emilia, 41121 Modena, Italy
- Correspondence: ; Tel.: +39-059-422-4264
| | - Aurora Parodi
- Section of Dermatology (DiSSal), University of Genoa, Ospedale-Policlinico San Martino IRCCS, 16132 Genova, Italy
| | - Martina Burlando
- Section of Dermatology (DiSSal), University of Genoa, Ospedale-Policlinico San Martino IRCCS, 16132 Genova, Italy
| | - Caterina Lanna
- Dermatology Unit, University of Rome “Tor Vergata”, 00133 Rome, Italy
| | - Elena Campione
- Dermatology Unit, University of Rome “Tor Vergata”, 00133 Rome, Italy
| | - Franco Rongioletti
- Vita Salute University IRCSS San Raffaele Hospital, 20132 Milan, Italy
- Dermatology Clinic, University of Cagliari, 09124 Cagliari, Italy
| | | | - Giovanna Malara
- Grande Ospedale Metropolitano di Reggio Calabria, 89124 Reggio Calabria, Italy
| | | | - Luca Stingeni
- Dermatology Section, Head of Resident School of Dermatology and Venereology, Department of Medicine and Surgery, University of Perugia, 06132 Perugia, Italy
| | - Katharina Hansel
- Dermatology Section, Head of Resident School of Dermatology and Venereology, Department of Medicine and Surgery, University of Perugia, 06132 Perugia, Italy
| | - Giuseppe Micali
- Azienda Ospedaliero—Universitaria “Policlinico—Vittorio Emanuele” P.O. Gaspare Rodolico U.O.C. di Dermatologia Catania, 95123 Catania, Italy
| | - Luigi Naldi
- Azienda ULSS 8 Berica-Ospedale San Bortolo U.O. di Dermatologia, 36100 Vicenza, Italy
| | - Federico Pirro
- Dermatology Unit, Catholic University of Rome, Fondazione Policlinico A. Gemelli, 00168 Rome, Italy
| | - Ketty Peris
- Dermatology Unit, Catholic University of Rome, Fondazione Policlinico A. Gemelli, 00168 Rome, Italy
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Campione E, Mazzilli S, Di Prete M, Dattola A, Cosio T, Lettieri Barbato D, Costanza G, Lanna C, Manfreda V, Gaeta Schumak R, Prignano F, Coniglione F, Ciprani F, Aquilano K, Bianchi L. The Role of Glutathione-S Transferase in Psoriasis and Associated Comorbidities and the Effect of Dimethyl Fumarate in This Pathway. Front Med (Lausanne) 2022; 9:760852. [PMID: 35211489 PMCID: PMC8863102 DOI: 10.3389/fmed.2022.760852] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Accepted: 01/05/2022] [Indexed: 12/12/2022] Open
Abstract
Psoriasis vulgaris is a chronic inflammatory skin disease characterized by well-demarcated scaly plaques. Oxidative stress plays a crucial role in the psoriasis pathogenesis and is associated with the disease severity. Dimethyl fumarate modulates the activity of the pro-inflammatory transcription factors. This is responsible for the downregulation of inflammatory cytokines and an overall shift from a pro-inflammatory to an anti-inflammatory/regulatory response. Both steps are necessary for the amelioration of psoriatic inflammation, although additional mechanisms have been proposed. Several studies reported a long-term effectiveness and safety of dimethyl fumarate monotherapy in patients with moderate-to-severe psoriasis. Furthermore, psoriasis is a chronic disease often associated to metabolic comorbidities, as obesity, diabetes, and cardiovascular diseases, in which glutathione-S transferase deregulation is present. Glutathione-S transferase is involved in the antioxidant system. An increase of its activity in psoriatic epidermis in comparison with the uninvolved and normal epidermal biopsies has been reported. Dimethyl fumarate depletes glutathione-S transferase by formation of covalently linked conjugates. This review investigates the anti-inflammatory role of dimethyl fumarate in oxidative stress and its effect by reducing oxidative stress. The glutathione-S transferase regulation is helpful in treating psoriasis, with an anti-inflammatory effect on the keratinocytes hyperproliferation, and in modulation of metabolic comorbidities.
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Affiliation(s)
- Elena Campione
- Dermatology Unit, University of Rome Tor Vergata, Rome, Italy
| | - Sara Mazzilli
- Italy State Police Health Service Department, Ministry of Interior, Rome, Italy
| | - Monia Di Prete
- Anatomic Pathology Unit, University of Rome Tor Vergata, Rome, Italy.,Anatomic Pathology, Santa Maria di Ca' Foncello Hospital, Treviso, Italy
| | | | - Terenzio Cosio
- Dermatology Unit, University of Rome Tor Vergata, Rome, Italy
| | - Daniele Lettieri Barbato
- Department of Biology, University of Rome Tor Vergata, Rome, Italy.,Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Fondazione Santa Lucia, Rome, Italy
| | | | - Caterina Lanna
- Dermatology Unit, University of Rome Tor Vergata, Rome, Italy
| | | | | | - Francesca Prignano
- Unit of Dermatology, Department of Surgery and Translational Medicine, University of Florence, Florence, Italy
| | - Filadelfo Coniglione
- Department of Surgical Sciences, University Nostra Signora del Buon Consiglio, Tirana, Albania
| | - Fabrizio Ciprani
- Italy State Police Health Service Department, Ministry of Interior, Rome, Italy
| | - Katia Aquilano
- Department of Biology, University of Rome Tor Vergata, Rome, Italy
| | - Luca Bianchi
- Dermatology Unit, University of Rome Tor Vergata, Rome, Italy
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Dimethyl Fumarate's Effectiveness and Safety in Psoriasis: A Real-Life Experience During the COVID-19 Pandemic. Dermatol Ther (Heidelb) 2022; 12:671-681. [PMID: 35103934 PMCID: PMC8805130 DOI: 10.1007/s13555-022-00684-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Accepted: 01/17/2022] [Indexed: 12/13/2022] Open
Abstract
Introduction Dimethyl fumarate (DMF) is approved as oral systemic treatment for moderate-to-severe psoriasis. Scarce evidence is available for DMF treatment in psoriatic patients at the time of COVID-19 pandemic. The objective of this study was to assess the long-term effectiveness and safety of DMF monotherapy in moderate-to-severe psoriasis during the COVID-19 pandemic period. Methods This multicenter, retrospective study included patients with moderate-to-severe psoriasis who had received a 48-week DMF treatment during the COVID-19 pandemic. Selected outcomes were: variation of mean PASI, proportion of patients achieving PASI50 and PASI75, variation of mean PGA and face PGA, genital PGA, scalp PGA, mean itch VAS and mean DLQI. Results Forty-four patients were enrolled, and four patients became COVID-19 positive during the observation period but did not discontinue DMF therapy. DMF produced a significant improvement of signs and symptoms of psoriasis as expressed by mean PASI variation from 13.07 at baseline to 6.11 at week 48 (p < 0.0001), itch VAS from 3.22 at baseline to 1.18 at week 48 (p < 0.001), PGA from 2.84 at baseline to 1.30 at week 48 (p < 0.0001) and DLQI from 13.09 at baseline to 6.07 at week 48 (p < 0.0001). The percentage of patients who achieved PASI50 and PASI75 was 4.55% at week 4 and 59.09% at week 48 and 0% at week 4 and 22.73% at week 48, respectively. A clinical important decrease of mean PGA score was observed in all subgroups, face psoriasis, genital psoriasis and scalp psoriasis. Adverse events were predictable and manageable. Conclusions DMF monotherapy is an effective and safe treatment option in moderate-to-severe psoriasis also in patients who develop SARS-CoV-2 infection.
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Ricceri F, Bardazzi F, Buggiani G, Burlando M, Campione E, Corazza M, Cuccia A, Dapavo P, Filippi F, Zichichi L, Parodi A, Prignano F. Efficacy and safety of dimethylfumarate in elderly psoriasis patients: a multicentric Italian study. J DERMATOL TREAT 2021; 33:2000-2003. [PMID: 34315343 DOI: 10.1080/09546634.2021.1962000] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
The number of psoriatic elderly patients is steadily increasing in the Western world, nevertheless they are frequently excluded from clinical trials and described as a high-risk group for adverse events.We conducted a retrospective multicentric study of DMF use in elderly (>65 years) psoriatic patients. DMF efficacy was evaluated up to 24 weeks by Psoriasis Area and Severity Index (PASI) score. We also evaluated drug maintenance and safety.Our study population included 81 elderly psoriatic patients treated with DMF up to 24 weeks. The PASI score at the baseline (week 0) ranged from 3,7-24 (mean ± SD, 9,8 ± 4,1), which changed after DMF administration to 4,3 ± 3,2 at week 16 and 2,7 ± 3,2 at week 24. Among 81 elderly psoriatic patients 59 (72,8%) adverse events were reported during the observation period. The most common were gastrointestinal complaints (n = 24, 29,6%) and flushes (n = 10, 12,3%). Lymphocytopenia (n = 10, 12,35%) was frequently observed.In daily practice, DMF seems to be efficacy and well tolerated in elderly psoriatic patients. DMF may be a first-line systemic treatment option to manage elderly psoriasis, provided that also the long-term safety data are closely monitored, in particular lymphocytopenia.
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Affiliation(s)
- Federica Ricceri
- Department of Health Sciences, Section of Dermatology, University of Florence, Florence, Italy
| | - Federico Bardazzi
- Dermatology Unit -IRCCS Policlinico di Sant'Orsola, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy
| | | | - Martina Burlando
- DISSAL, Dermatologic Clinic, San Martino Policlinic Hospital, Genoa, Italy
| | - Elena Campione
- Department of Systems Medicine, Dermatologic Unit, University of Rome Tor Vergata, Rome, Italy
| | - Monica Corazza
- Department of Medical Sciences, Section of Dermatology and Infectious Diseases, University of Ferrara, Ferrara, Italy
| | - Aldo Cuccia
- Unit of Dermatology, San Donato Hospital, Arezzo, Italy
| | - Paolo Dapavo
- Department of Biomedical Science and Human Oncology, Second Dermatologic Clinic, University of Turin, Turin, Italy
| | - Federica Filippi
- Dermatology Unit -IRCCS Policlinico di Sant'Orsola, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy
| | | | - Aurora Parodi
- DISSAL, Dermatologic Clinic, San Martino Policlinic Hospital, Genoa, Italy
| | - Francesca Prignano
- Department of Health Sciences, Section of Dermatology, University of Florence, Florence, Italy
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Dello Russo C, Scott KA, Pirmohamed M. Dimethyl fumarate induced lymphopenia in multiple sclerosis: A review of the literature. Pharmacol Ther 2020; 219:107710. [PMID: 33091427 DOI: 10.1016/j.pharmthera.2020.107710] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/15/2020] [Indexed: 12/13/2022]
Abstract
Dimethyl fumarate (DMF) is a first line medication for multiple sclerosis. It has a favourable safety profile, however, there is concern regarding the occurrence of moderate-severe and sustained lymphopenia and the associated risk of progressive multifocal leukoencephalopathy. We carried out an extensive literature review to understand the molecular mechanisms underlying this adverse reaction. Dynamic changes in certain components of the immune system are likely to be important for the therapeutic effects of DMF, including depletion of memory T cells and decrease in activated T cells together with expansion of naïve T cells. Similar modifications were reported for the B cell components. CD8+ T cells are particularly susceptible to DMF-induced cell death, with marked reductions observed in lymphopenic subjects. The reasons underlying such increased sensitivity are not known, nor it is known how expansion of other lymphocyte subsets occurs. Understanding the molecular mechanisms underlying DMF action is challenging: in vivo DMF is rapidly metabolized to monomethyl fumarate (MMF), a less potent immunomodulator in vitro. Pharmacokinetics indicate that MMF is the main active species in vivo. However, the relative importance of DMF and MMF in toxicity remains unclear, with evidence presented in favour of either of the compounds as toxic species. Pharmacogenetic studies to identify genetic predictors of DMF-induced lymphopenia are limited, with inconclusive results. A role of the gut microbiome in the pharmacological effects of DMF is emerging. It is clear that further investigations are necessary to understand the mechanisms of DMF-induced lymphopenia and devise preventive strategies. Periodic monitoring of absolute lymphocyte counts, currently performed in clinical practise, allows for the early detection of lymphopenia as a risk-minimization strategy.
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Affiliation(s)
- Cinzia Dello Russo
- MRC Centre for Drug Safety Science and Wolfson Centre for Personalised Medicine, Institute of Systems, Molecular and Integrative Biology (ISMIB), University of Liverpool, Liverpool, UK; Dept. of Healthcare Surveillance and Bioethics, Section of Pharmacology, Fondazione Policlinico Universitario A. Gemelli IRCCS - Università Cattolica del Sacro Cuore, Rome, Italy
| | - Kathryn Anne Scott
- MRC Centre for Drug Safety Science and Wolfson Centre for Personalised Medicine, Institute of Systems, Molecular and Integrative Biology (ISMIB), University of Liverpool, Liverpool, UK
| | - Munir Pirmohamed
- MRC Centre for Drug Safety Science and Wolfson Centre for Personalised Medicine, Institute of Systems, Molecular and Integrative Biology (ISMIB), University of Liverpool, Liverpool, UK.
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Yagishita Y, Gatbonton-Schwager TN, McCallum ML, Kensler TW. Current Landscape of NRF2 Biomarkers in Clinical Trials. Antioxidants (Basel) 2020; 9:antiox9080716. [PMID: 32784785 PMCID: PMC7464243 DOI: 10.3390/antiox9080716] [Citation(s) in RCA: 48] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Revised: 08/02/2020] [Accepted: 08/05/2020] [Indexed: 12/12/2022] Open
Abstract
The transcription factor NF-E2 p45-related factor 2 (NRF2; encoded by NFE2L2) plays a critical role in the maintenance of cellular redox and metabolic homeostasis, as well as the regulation of inflammation and cellular detoxication pathways. The contribution of the NRF2 pathway to organismal homeostasis is seen in many studies using cell lines and animal models, raising intense attention towards targeting its clinical promise. Over the last three decades, an expanding number of clinical studies have examined NRF2 inducers targeting an ever-widening range of diseases. Full understanding of the pharmacokinetic and pharmacodynamic properties of drug candidates rely partly on the identification, validation, and use of biomarkers to optimize clinical applications. This review focuses on results from clinical trials with four agents known to target NRF2 signaling in preclinical studies (dimethyl fumarate, bardoxolone methyl, oltipraz, and sulforaphane), and evaluates the successes and limitations of biomarkers focused on expression of NRF2 target genes and others, inflammation and oxidative stress biomarkers, carcinogen metabolism and adduct biomarkers in unavoidably exposed populations, and targeted and untargeted metabolomics. While no biomarkers excel at defining pharmacodynamic actions in this setting, it is clear that these four lead clinical compounds do touch the NRF2 pathway in humans.
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Balak DMW, Gerdes S, Parodi A, Salgado-Boquete L. Long-term Safety of Oral Systemic Therapies for Psoriasis: A Comprehensive Review of the Literature. Dermatol Ther (Heidelb) 2020; 10:589-613. [PMID: 32529393 PMCID: PMC7367959 DOI: 10.1007/s13555-020-00409-4] [Citation(s) in RCA: 48] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Indexed: 01/10/2023] Open
Abstract
Oral systemic therapies are important treatment options for patients with moderate-to-severe psoriasis, either as monotherapy or in therapy-recalcitrant cases as combination therapy with phototherapy, other oral systemics or biologics. Long-term treatment is needed to maintain sufficient disease control in psoriasis, but continuous use of systemic treatments is limited by adverse events (AEs) and cumulative toxicity risks. The primary aim of this comprehensive literature review was to examine the long-term safety profiles of oral agents commonly used in the treatment of adults with psoriasis. Searches were conducted in EMBASE and PubMed up to November 2018, and 157 relevant publications were included. Long-term treatment with acitretin could be associated with skeletal toxicity and hepatotoxicity, although evidence for skeletal toxicity is mixed and hepatotoxicity is rare, particularly at low doses. Other safety issues include hyperlipidaemia and potential for teratogenicity up to 2-3 years after discontinuation of treatment. There is a paucity of data on long-term treatment with apremilast. Continued exposure to apremilast does not seem to increase the incidence of common AEs, such as gastrointestinal (GI) AEs, upper respiratory tract infections and headache, while the long-term risks for depression, suicidal thoughts and weight loss are unknown. Long-term ciclosporin treatment is associated with renal toxicity, hypertension, non-melanoma skin cancer, neurological AEs and GI AEs. Long-term methotrexate treatment is associated with hepatotoxicity, GI AEs, haematological toxicity, renal toxicity and alopecia. Finally, long-term treatment with fumaric acid esters (FAE) is associated with GI AEs, flushing, lymphocytopenia, proteinuria and elevated liver enzymes. Median drug survival estimates varied considerably: ~ 2.9-9.7 months for apremilast; ~ 5.4 months for ciclosporin; ~ 8.6 months for acitretin; ~ 12.1-21.6 months for methotrexate; and ~ 54.8 months for FAE. These long-term safety profiles may help to guide clinicians to select the optimal oral systemic treatment for the long-term treatment of psoriasis in adults.
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Affiliation(s)
- Deepak M W Balak
- Department of Dermatology, LangeLand Ziekenhuis, Zoetermeer, the Netherlands.
| | - Sascha Gerdes
- Department of Dermatology, Psoriasis-Center, University Medical Center Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Aurora Parodi
- DiSSal Section of Dermatology, University of Genoa-Ospedale-Policlinico San Martino IRCCS, Genoa, Italy
| | - Laura Salgado-Boquete
- Department of Dermatology, Complejo Hospitalario Universitario de Pontevedra, Pontevedra, Spain
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12
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Reszke R, Szepietowski JC. A safety evaluation of dimethyl fumarate in moderate-to-severe psoriasis. Expert Opin Drug Saf 2020; 19:373-380. [PMID: 32129112 DOI: 10.1080/14740338.2020.1736553] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Introduction: Psoriasis is a chronic inflammatory disorder affecting skin, nails and joints. Systemic therapy of psoriasis is based upon several drugs which include fumaric acid esters (FAEs), initially introduced in 1959. Since 2017, one of the key substances among FAE spectrum (dimethyl fumarate; DMF) was registered by the European Medicines Agency (EMA) for the treatment of moderate-to-severe psoriasis vulgaris.Areas covered: This article covers the basic concepts underlying usefulness of DMF in psoriasis and extensively reviews the studies, which included its use in monotherapy of this dermatosis, with a particular emphasis on safety aspects and adverse events (AEs).Expert opinion: DMF monotherapy is a valuable systemic modality in the management of moderate-to-severe psoriasis as proved by a recent phase III study. AEs associated with DMF therapy are frequent, usually of mild severity, with a dose-independent manner. Occasionally they are burdensome and require drug discontinuation. The most common AEs comprise gastrointestinal symptoms, flushing and white blood cell count abnormalities. The latter require strict monitoring to prevent serious complications. Acknowledging the possibility of AEs, the use of DMF in moderate-to-severe psoriasis is encouraged while the need of further studies still remains.
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Affiliation(s)
- Radomir Reszke
- Department of Dermatology, Venereology and Allergology, Wroclaw Medical University, Wroclaw, Poland
| | - Jacek C Szepietowski
- Department of Dermatology, Venereology and Allergology, Wroclaw Medical University, Wroclaw, Poland
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13
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van der Kraaij GE, Balak DMW, Busard CI, van Cranenburgh OD, Chung Y, Driessen RJB, de Groot M, de Jong EMGJ, Kemperman PMJH, de Kort WJA, Karsch SA, Lamberts A, Lecluse LLA, van Lümig PPM, Menting SP, Prens EP, van den Reek JMPA, Seyger MMB, Thio HB, Veldkamp WR, Wakkee M, Nast A, Jacobs A, Rosumeck S, Spuls Chair PI. Highlights of the updated Dutch evidence- and consensus-based guideline on psoriasis 2017. Br J Dermatol 2019; 180:31-42. [PMID: 30604536 PMCID: PMC6849803 DOI: 10.1111/bjd.17198] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/02/2018] [Indexed: 12/31/2022]
Abstract
Linked Comment: https://doi.org/10.1111/bjd.17390.
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Affiliation(s)
- G E van der Kraaij
- Department of Dermatology, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands.,Public Health, Infection and Immunity, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands.,Dutch Society of Dermatology and Venereology, Utrecht, the Netherlands
| | - D M W Balak
- University Medical Centre Utrecht, Utrecht, the Netherlands
| | - C I Busard
- Department of Dermatology, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands.,Public Health, Infection and Immunity, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - O D van Cranenburgh
- Department of Dermatology, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands.,Dutch Skin Foundation, Nieuwegein, the Netherlands
| | - Y Chung
- Dutch Society of Dermatology and Venereology, Utrecht, the Netherlands
| | - R J B Driessen
- Radboud University Medical Centre, Nijmegen, the Netherlands
| | - M de Groot
- Antonius Hospital, Sneek/Emmeloord, the Netherlands
| | - E M G J de Jong
- Radboud University Medical Centre, Nijmegen, the Netherlands.,Radboud University Nijmegen, the Netherlands
| | - P M J H Kemperman
- Department of Dermatology, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands.,Waterlandziekenhuis, Purmerend, the Netherlands
| | | | - S A Karsch
- Dutch Society of Dermatology and Venereology, Utrecht, the Netherlands
| | - A Lamberts
- Dutch Society of Dermatology and Venereology, Utrecht, the Netherlands.,University Medical Center Groningen, Groningen, the Netherlands
| | - L L A Lecluse
- Bergman Clinics and U-clinic, Amsterdam, the Netherlands
| | - P P M van Lümig
- Radboud University Medical Centre, Nijmegen, the Netherlands
| | - S P Menting
- Department of Dermatology, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - E P Prens
- Erasmus Medical Centre, Rotterdam, the Netherlands
| | | | - M M B Seyger
- Radboud University Medical Centre, Nijmegen, the Netherlands
| | - H B Thio
- Erasmus Medical Centre, Rotterdam, the Netherlands
| | - W R Veldkamp
- Dutch Society of Dermatology and Venereology, Utrecht, the Netherlands.,Radboud University Nijmegen, the Netherlands
| | - M Wakkee
- Erasmus Medical Centre, Rotterdam, the Netherlands
| | - A Nast
- Department of Dermatology, Venereology und Allergy, Division of Evidence-Based Medicine (dEBM), Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - A Jacobs
- Department of Dermatology, Venereology und Allergy, Division of Evidence-Based Medicine (dEBM), Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - S Rosumeck
- Department of Dermatology, Venereology und Allergy, Division of Evidence-Based Medicine (dEBM), Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - P I Spuls Chair
- Department of Dermatology, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands.,Public Health, Infection and Immunity, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
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14
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van Hezik D, Bovenschen HJ. Association of lymphopenia and eosinophilia with dimethylfumarate treatment efficacy and tolerability in psoriasis: a retrospective study. J DERMATOL TREAT 2019; 31:378-381. [DOI: 10.1080/09546634.2019.1605135] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- D.F.C van Hezik
- Department of Dermatology, Máxima Medical Center Veldhoven, Veldhoven, The Netherlands
| | - H. J. Bovenschen
- Department of Dermatology, Máxima Medical Center Veldhoven, Veldhoven, The Netherlands
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15
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Rosa AC, Benetti E, Gallicchio M, Boscaro V, Cangemi L, Dianzani C, Miglio G. Analyzing Cysteine Site Neighbors in Proteins to Reveal Dimethyl Fumarate Targets. Proteomics 2019; 19:e1800301. [DOI: 10.1002/pmic.201800301] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Revised: 12/10/2018] [Indexed: 12/24/2022]
Affiliation(s)
- Arianna Carolina Rosa
- Dipartimento di Scienza e Tecnologia del Farmaco; Università degli Studi di Torino; Turin 10125 Italy
| | - Elisa Benetti
- Dipartimento di Scienza e Tecnologia del Farmaco; Università degli Studi di Torino; Turin 10125 Italy
| | - Margherita Gallicchio
- Dipartimento di Scienza e Tecnologia del Farmaco; Università degli Studi di Torino; Turin 10125 Italy
| | - Valentina Boscaro
- Dipartimento di Scienza e Tecnologia del Farmaco; Università degli Studi di Torino; Turin 10125 Italy
| | - Luigi Cangemi
- Dipartimento di Scienza e Tecnologia del Farmaco; Università degli Studi di Torino; Turin 10125 Italy
| | - Chiara Dianzani
- Dipartimento di Scienza e Tecnologia del Farmaco; Università degli Studi di Torino; Turin 10125 Italy
| | - Gianluca Miglio
- Dipartimento di Scienza e Tecnologia del Farmaco; Università degli Studi di Torino; Turin 10125 Italy
- Centro di Competenza sul Calcolo Scientifico C S; Università degli Studi di Torino; Turin 10125 Italy
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16
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Lee SS, Choe YJ, Lee H, Lee SY, Kim HS. PGA2-induced expression of HO-1 is mediated by transcriptional upregulation of Nrf2. Mol Cell Toxicol 2018. [DOI: 10.1007/s13273-018-0043-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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17
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Mrowietz U, Barker J, Boehncke WH, Iversen L, Kirby B, Naldi L, Reich K, Tanew A, van de Kerkhof P, Warren R. Clinical use of dimethyl fumarate in moderate-to-severe plaque-type psoriasis: a European expert consensus. J Eur Acad Dermatol Venereol 2018; 32 Suppl 3:3-14. [DOI: 10.1111/jdv.15218] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2018] [Accepted: 08/24/2018] [Indexed: 02/06/2023]
Affiliation(s)
- U. Mrowietz
- Psoriasis-Centre at the Department of Dermatology; University Medical Centre Schleswig-Holstein; Kiel Germany
| | - J. Barker
- St John's Institute of Dermatology; King's College London; London UK
| | - W.-H. Boehncke
- Division of Dermatology and Venereology; Geneva University Hospitals; Geneva Switzerland
- Department of Pathology and Immunology; Faculty of Medicine; University of Geneva; Geneva Switzerland
| | - L. Iversen
- Department of Dermatology; Aarhus University Hospital; Aarhus Denmark
| | - B. Kirby
- Department of Dermatology; St. Vincent's University Hospital; Dublin Ireland
| | - L. Naldi
- Centro Studi GISED; Bergamo Italy
- Department of Dermatology; Ospedale san Bortolo di Vicenza; Vicenza Italy
| | - K. Reich
- Dermatologikum Berlin and SCIderm Research Institute; Hamburg Germany
| | - A. Tanew
- Department of Dermatology; Medical University of Vienna; Vienna Austria
| | - P.C.M. van de Kerkhof
- Department of Dermatology; Radboud University Nijmegen Medical Centre; Nijmegen The Netherlands
| | - R.B. Warren
- Dermatology Centre; Salford Royal NHS Foundation Trust; Salford UK
- Manchester Academic Health Science Centre; Manchester NIHR Biomedical Research Centre; The University of Manchester; Manchester UK
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18
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Bouwes Bavinck J, van Zuuren E. Light on fumaric acid esters therapy for psoriasis. Br J Dermatol 2018; 178:586-587. [DOI: 10.1111/bjd.16272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- J.N. Bouwes Bavinck
- Department of Dermatology; Leiden University Medical Centre; Albinusdreef 2 2333 ZA Leiden the Netherlands
| | - E.J. van Zuuren
- Department of Dermatology; Leiden University Medical Centre; Albinusdreef 2 2333 ZA Leiden the Netherlands
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19
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Arnold T, Schaarschmidt ML, Herr R, Fischer JE, Goerdt S, Peitsch WK. Drug survival rates and reasons for drug discontinuation in psoriasis. J Dtsch Dermatol Ges 2018; 14:1089-1099. [PMID: 27879076 DOI: 10.1111/ddg.13152] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2016] [Accepted: 06/04/2016] [Indexed: 01/22/2023]
Abstract
BACKGROUND AND OBJECTIVES Moderate-to-severe psoriasis frequently requires long-term systemic therapy. Reflecting efficacy, safety, and treatment satisfaction, drug survival is an indicator of therapeutic success. The objective of the present study was to assess drug survival rates and reasons for discontinuation of fumaric acid esters (FAE), methotrexate (MTX), acitretin (ACI), cyclosporine A (CyA), adalimumab (ADA), etanercept (ETA), infliximab (INF), and ustekinumab (UST) in patients with moderate-to-severe psoriasis. PATIENTS AND METHODS We performed a retrospective analysis of 373 patients who had received a total of 696 treatment courses at a German university hospital in the period 1/2003-5/2014. RESULTS The crude probability of survival was highest for UST, followed by ADA, ETA, INF, FAE, MTX, ACI, and CyA. In multivariate regression analysis using FAE as reference, hazard ratios (HR) for discontinuation were 0.14 (95 % confidence interval: 0.06-0.35) for UST, 0.43 (0.26-0.73) for ADA, 2.11 (1.14-3.91) for ACI, and 3.26 (1.44-7.39) for CyA. INF showed longer survival when combined with MTX (HR 2.87, 1.21-6.81). Traditional systemic antipsoriatic agents as well as INF were most frequently discontinued due to adverse events; all other biologics, due to inefficacy with respect to cutaneous lesions. CONCLUSIONS Drug survival rates should be integrated into therapeutic decisions in order to provide patients with an optimal long-term strategy.
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Affiliation(s)
- Tobias Arnold
- Department of Dermatology, Venereology and Allergology, University Medical Center and Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Marthe-Lisa Schaarschmidt
- Department of Dermatology, Venereology and Allergology, University Medical Center and Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Raphael Herr
- Mannheim Institute of Public Health, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Joachim E Fischer
- Mannheim Institute of Public Health, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Sergij Goerdt
- Department of Dermatology, Venereology and Allergology, University Medical Center and Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Wiebke K Peitsch
- Department of Dermatology, Venereology and Allergology, University Medical Center and Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany.,Department of Dermatology and Phlebology, Vivantes Klinikum im Friedrichshain, Berlin, Germany
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20
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21
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Bauer B, Göderz AL, Braumüller H, Neudörfl JM, Röcken M, Wieder T, Schmalz HG. Methyl Fumarate-Derived Iron Carbonyl Complexes (FumET-CORMs) as Powerful Anti-inflammatory Agents. ChemMedChem 2017; 12:1927-1930. [DOI: 10.1002/cmdc.201700488] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2017] [Revised: 09/28/2017] [Indexed: 11/06/2022]
Affiliation(s)
- Britta Bauer
- University Medical Center Tübingen; Department of Dermatology; Liebermeisterstr. 25 72076 Tübingen Germany
| | - Anna-Lena Göderz
- Department of Chemistry; University of Cologne; Greinstrasse 4 50939 Köln Germany
| | - Heidi Braumüller
- University Medical Center Tübingen; Department of Dermatology; Liebermeisterstr. 25 72076 Tübingen Germany
| | - Jörg Martin Neudörfl
- Department of Chemistry; University of Cologne; Greinstrasse 4 50939 Köln Germany
| | - Martin Röcken
- University Medical Center Tübingen; Department of Dermatology; Liebermeisterstr. 25 72076 Tübingen Germany
| | - Thomas Wieder
- University Medical Center Tübingen; Department of Dermatology; Liebermeisterstr. 25 72076 Tübingen Germany
| | - Hans-Günther Schmalz
- Department of Chemistry; University of Cologne; Greinstrasse 4 50939 Köln Germany
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22
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Affiliation(s)
- D M W Balak
- Department of Dermatology, Erasmus MC, University Medical Center, Burg. s'Jacobplein 51, 3015 CA, Rotterdam, the Netherlands
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23
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Arnold T, Schaarschmidt M, Herr R, Fischer JE, Goerdt S, Peitsch WK. „Drug‐Survival“‐Raten und Gründe für den Abbruch von Systemtherapien bei Psoriasis. J Dtsch Dermatol Ges 2016; 14:1090-1101. [DOI: 10.1111/ddg.13152_g] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2016] [Accepted: 06/04/2016] [Indexed: 12/29/2022]
Affiliation(s)
- Tobias Arnold
- Klinik für Dermatologie Venerologie und Allergologie Universitätsmedizin Mannheim, Medizinische Fakultät Mannheim, Universität Heidelberg Mannheim
| | - Marthe‐Lisa Schaarschmidt
- Klinik für Dermatologie Venerologie und Allergologie Universitätsmedizin Mannheim, Medizinische Fakultät Mannheim, Universität Heidelberg Mannheim
| | - Raphael Herr
- Mannheimer Institut für Public Health, Sozial‐ und Präventivmedizin Medizinische Fakultät Mannheim, Universität Heidelberg Mannheim
| | - Joachim E. Fischer
- Mannheimer Institut für Public Health, Sozial‐ und Präventivmedizin Medizinische Fakultät Mannheim, Universität Heidelberg Mannheim
| | - Sergij Goerdt
- Klinik für Dermatologie Venerologie und Allergologie Universitätsmedizin Mannheim, Medizinische Fakultät Mannheim, Universität Heidelberg Mannheim
| | - Wiebke K. Peitsch
- Klinik für Dermatologie Venerologie und Allergologie Universitätsmedizin Mannheim, Medizinische Fakultät Mannheim, Universität Heidelberg Mannheim
- Klinik für Dermatologie und Phlebologie Vivantes Klinikum im Friedrichshain Berlin
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24
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Loboda A, Damulewicz M, Pyza E, Jozkowicz A, Dulak J. Role of Nrf2/HO-1 system in development, oxidative stress response and diseases: an evolutionarily conserved mechanism. Cell Mol Life Sci 2016; 73:3221-47. [PMID: 27100828 PMCID: PMC4967105 DOI: 10.1007/s00018-016-2223-0] [Citation(s) in RCA: 1636] [Impact Index Per Article: 204.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2016] [Revised: 04/07/2016] [Accepted: 04/08/2016] [Indexed: 12/12/2022]
Abstract
The multifunctional regulator nuclear factor erythroid 2-related factor (Nrf2) is considered not only as a cytoprotective factor regulating the expression of genes coding for anti-oxidant, anti-inflammatory and detoxifying proteins, but it is also a powerful modulator of species longevity. The vertebrate Nrf2 belongs to Cap 'n' Collar (Cnc) bZIP family of transcription factors and shares a high homology with SKN-1 from Caenorhabditis elegans or CncC found in Drosophila melanogaster. The major characteristics of Nrf2 are to some extent mimicked by Nrf2-dependent genes and their proteins including heme oxygenase-1 (HO-1), which besides removing toxic heme, produces biliverdin, iron ions and carbon monoxide. HO-1 and their products exert beneficial effects through the protection against oxidative injury, regulation of apoptosis, modulation of inflammation as well as contribution to angiogenesis. On the other hand, the disturbances in the proper HO-1 level are associated with the pathogenesis of some age-dependent disorders, including neurodegeneration, cancer or macular degeneration. This review summarizes our knowledge about Nrf2 and HO-1 across different phyla suggesting their conservative role as stress-protective and anti-aging factors.
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Affiliation(s)
- Agnieszka Loboda
- Department of Medical Biotechnology, Faculty of Biochemistry, Biophysics and Biotechnology, Jagiellonian University, Gronostajowa 7, 30-387, Krakow, Poland.
- Malopolska Centre of Biotechnology, Jagiellonian University, Krakow, Poland.
| | - Milena Damulewicz
- Department of Cell Biology and Imaging, Faculty of Biology and Earth Sciences, Jagiellonian University, Krakow, Poland
| | - Elzbieta Pyza
- Department of Cell Biology and Imaging, Faculty of Biology and Earth Sciences, Jagiellonian University, Krakow, Poland
| | - Alicja Jozkowicz
- Department of Medical Biotechnology, Faculty of Biochemistry, Biophysics and Biotechnology, Jagiellonian University, Gronostajowa 7, 30-387, Krakow, Poland
| | - Jozef Dulak
- Department of Medical Biotechnology, Faculty of Biochemistry, Biophysics and Biotechnology, Jagiellonian University, Gronostajowa 7, 30-387, Krakow, Poland
- Malopolska Centre of Biotechnology, Jagiellonian University, Krakow, Poland
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25
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Balak D, Fallah Arani S, Hajdarbegovic E, Hagemans C, Bramer W, Thio H, Neumann H. Efficacy, effectiveness and safety of fumaric acid esters in the treatment of psoriasis: a systematic review of randomized and observational studies. Br J Dermatol 2016; 175:250-62. [DOI: 10.1111/bjd.14500] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/15/2016] [Indexed: 12/11/2022]
Affiliation(s)
- D.M.W. Balak
- Department of Dermatology; Erasmus MC; University Medical Center; Rotterdam the Netherlands
| | - S. Fallah Arani
- Department of Dermatology; Erasmus MC; University Medical Center; Rotterdam the Netherlands
| | - E. Hajdarbegovic
- Department of Dermatology; Erasmus MC; University Medical Center; Rotterdam the Netherlands
| | - C.A.F. Hagemans
- Department of Dermatology; Erasmus MC; University Medical Center; Rotterdam the Netherlands
| | - W.M. Bramer
- Medical Library; Erasmus MC; University Medical Center; Rotterdam the Netherlands
| | - H.B. Thio
- Department of Dermatology; Erasmus MC; University Medical Center; Rotterdam the Netherlands
| | - H.A.M. Neumann
- Department of Dermatology; Erasmus MC; University Medical Center; Rotterdam the Netherlands
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26
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van Geel MJ, van de Kerkhof PCM, Oostveen AM, de Jong EMGJ, Seyger MMB. Fumaric acid esters in recalcitrant pediatric psoriasis: A prospective, daily clinical practice case series. J DERMATOL TREAT 2015; 27:214-20. [PMID: 26452994 DOI: 10.3109/09546634.2015.1088131] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Evidence on fumaric acid esters (FAE) in the treatment of pediatric psoriasis is scarce. OBJECTIVE Describe the effectiveness, influence on the quality of life (QoL) and safety of FAE in children with recalcitrant psoriasis in daily clinical practice. METHODS A prospective case series. RESULTS Fourteen patients with recalcitrant plaque-type psoriasis were described (mean age 13.7, range 8-17 years). Mean treatment duration was 48.6 weeks (range 12-124). Maximum daily dose varied between 180 and 1200 mg with a mean of 564 mg per day. Mean Psoriasis Area and Severity Index (PASI) (±SEM) at baseline was 10.5 (1.0) compared to 8.6 (1.1), 6.2 (1.6) and 4.9 (1.5) at week 12, 24 and 36, respectively. An improvement in PASI was observed in nine patients (64.3%). Mean CDLQI (±SEM) at week 0, 12, 24 and 36 was 8.9 (1.4), 6.8 (1.2), 3.7 (1.4) and 3.1 (2.0), respectively. Most common adverse events (AEs) were gastrointestinal complaints (n = 13, 92.9%) and flushes (n = 10, 71.4%). Lymphocytopenia (n = 5, 45.5%) and eosinophilia (n = 4, 36.4%) were frequently observed laboratory abnormalities. AEs were usually mild and transient. One serious adverse event, unrelated to FAE, was reported. CONCLUSIONS FAE showed improvement of disease severity and QoL in the majority of children. Side-effects occurred frequently, but were usually mild and transient. FAE may be an alternative systemic treatment option for pediatric psoriasis, provided that also the long-term safety data are closely monitored, in particular lymphocytopenia.
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Affiliation(s)
- M J van Geel
- a Department of Dermatology , Radboud university medical center , Nijmegen , The Netherlands
| | - P C M van de Kerkhof
- a Department of Dermatology , Radboud university medical center , Nijmegen , The Netherlands
| | - A M Oostveen
- a Department of Dermatology , Radboud university medical center , Nijmegen , The Netherlands
| | - E M G J de Jong
- a Department of Dermatology , Radboud university medical center , Nijmegen , The Netherlands
| | - M M B Seyger
- a Department of Dermatology , Radboud university medical center , Nijmegen , The Netherlands
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