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Boswell ND, Singla S, Gordon KB. Sequencing of Targeted Therapy in Psoriasis: Does it Matter? Am J Clin Dermatol 2024:10.1007/s40257-024-00874-z. [PMID: 39003351 DOI: 10.1007/s40257-024-00874-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/06/2024] [Indexed: 07/15/2024]
Abstract
With the continued development of biologics for the treatment of psoriasis, some patients have achieved optimal control, but a recommended biologic sequence if a biologic fails to initially improve the skin, termed primary nonresponse, or loses efficacy after initial improvement, termed secondary nonresponse, is still lacking. Primary and secondary nonresponse can occur with any class of biologics, and the type of nonresponse can drive the choice of whether to switch within a biologic class or to a different biologic class. The choice of biologic can also be challenging when managing psoriasis and concomitant psoriatic arthritis, as treatment differs on the basis of the severity of both diseases and further classification of axial and peripheral joint involvement. When choosing a biologic, each patient's comorbidities and preferences are also taken into account to provide the optimal therapy. With this lack of an established biologic sequence after biologic failure, the objective of our review is to define a therapy sequence for the tumor necrosis factor (TNF), interleukin-17 (IL-17), and interleukin-23 (IL-23) inhibitor classes in the treatment of psoriasis and psoriatic arthritis. Our proposed biologic sequence was derived through an analysis of the efficacy of each biologic class, primary and secondary nonresponse rates from clinical trials, and clinical experience with expert opinion.
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Affiliation(s)
- Nicole D Boswell
- Department of Dermatology, Medical College of Wisconsin, Milwaukee, WI, 53226, USA.
| | - Shikha Singla
- Department of Rheumatology, Medical College of Wisconsin, Milwaukee, WI, 53226, USA
| | - Kenneth B Gordon
- Department of Dermatology, Medical College of Wisconsin, Milwaukee, WI, 53226, USA
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Jin JQ, Cronin A, Roberts-Toler C, Yeroushalmi S, Hadeler E, Spencer RK, Elhage KG, Gondo G, Wallace EB, Reddy SM, Han G, Kaffenberger J, Davis MS, Hakimi M, Scher JU, Armstrong AW, Bhutani T, McLean RR, Liao W. Sociodemographic and clinical characteristics associated with multiple biologic failure in psoriasis: A 2015-2022 prospective cohort analysis of the CorEvitas psoriasis registry. J Am Acad Dermatol 2023; 89:974-983. [PMID: 37495173 DOI: 10.1016/j.jaad.2023.06.058] [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: 03/07/2023] [Revised: 06/16/2023] [Accepted: 06/20/2023] [Indexed: 07/28/2023]
Abstract
BACKGROUND Psoriasis patients with poor therapeutic response to multiple biologic agents are not well-characterized. OBJECTIVE To describe the characteristics associated with development of multiple biologic failure (MBF) versus good clinical response (GR) to the first biologic. METHODS This prospective cohort analysis evaluated patients in the multicenter CorEvitas Psoriasis Registry who initiated their first biologic between 2015 and 2020 and were followed for ≥24 months. Multivariable logistic regression identified sociodemographic, clinical, and patient-reported outcomes that differed between MBF (discontinued ≥2 biologics of different classes, each used for ≥90 days, due to inadequate efficacy) and GR (continued use of first biologic for ≥2 years) patients. RESULTS One thousand thirty-nine patients were analyzed (490 GR [47.2%], 65 MBF [6.3%]). Female sex, shorter psoriasis duration, earlier year of biologic initiation, prior nonbiologic systemic therapy use, history of hyperlipidemia, and Medicaid insurance were significantly associated with MBF, though the latter 2 variables exhibited wider confidence intervals, indicating a lower level of support. The first-to-second biologic sequence most observed with MBF was Tumor necrosis factor-α inhibitor to IL-17 inhibitor use. LIMITATIONS Biologic adherence between visits was not evaluated. CONCLUSION Approximately 6% of psoriasis patients met MBF criteria. The results identify characteristics associated with MBF that may distinguish patients warranting more frequent follow-up.
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Affiliation(s)
- Joy Q Jin
- School of Medicine, University of California San Francisco, San Francisco, California; Department of Dermatology, University of California San Francisco, San Francisco, California
| | | | | | - Samuel Yeroushalmi
- Department of Dermatology, University of California San Francisco, San Francisco, California
| | - Edward Hadeler
- Department of Dermatology, University of California San Francisco, San Francisco, California
| | - Riley K Spencer
- Department of Dermatology, University of California San Francisco, San Francisco, California
| | - Kareem G Elhage
- Department of Dermatology, University of California San Francisco, San Francisco, California
| | | | | | - Soumya M Reddy
- Division of Rheumatology, Department of Medicine, New York University Grossman School of Medicine, NYU Langone Medical Center, New York, New York
| | - George Han
- Department of Dermatology, Zucker School of Medicine at Hofstra/Northwell, New Hyde Park, New York
| | - Jessica Kaffenberger
- Division of Dermatology, Department of Internal Medicine, The Ohio State University, Columbus, Ohio
| | - Mitchell S Davis
- Department of Dermatology, University of California San Francisco, San Francisco, California
| | - Marwa Hakimi
- Department of Dermatology, University of California San Francisco, San Francisco, California
| | - Jose U Scher
- Division of Rheumatology, Department of Medicine, New York University Grossman School of Medicine, NYU Langone Medical Center, New York, New York
| | - April W Armstrong
- Department of Dermatology, University of Southern California, Los Angeles, California
| | - Tina Bhutani
- Department of Dermatology, University of California San Francisco, San Francisco, California
| | | | - Wilson Liao
- Department of Dermatology, University of California San Francisco, San Francisco, California.
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Soenen R, Stove C, Capobianco A, De Schutter H, Dobbelaere M, Mahjor T, Follens M, Lambert J, Grine L. Promising Tools to Facilitate the Implementation of TDM of Biologics in Clinical Practice. J Clin Med 2022; 11:jcm11113011. [PMID: 35683398 PMCID: PMC9181069 DOI: 10.3390/jcm11113011] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Revised: 05/23/2022] [Accepted: 05/25/2022] [Indexed: 02/04/2023] Open
Abstract
Therapeutic drug monitoring (TDM) of biologics—encompassing the measurement of (trough) concentrations and anti-drug antibodies—is emerging as a valuable tool for clinical decision making. While this strategy needs further validation, attention on its implementation into the clinic is warranted. Rapid testing and easy sampling are key to its implementation. Here, we aimed to evaluate the feasibility and volunteers’ perception of home microsampling for quantification of adalimumab (ADM) concentrations in psoriasis patients. In addition, we compared lateral flow testing (LFT) with enzyme-linked immunosorbent assay (ELISA). Patients participating in the SUPRA-A study (clinicaltrials.gov NCT04028713) were asked to participate in a substudy where volumetric absorptive microsampling (VAMS) was performed at home. At three time points, whole blood and corresponding serum samples were collected for ADM measurement using an in-house ELISA. In addition, the patients’ perspective on microsampling was evaluated via a questionnaire. LFT-obtained ADM concentrations agreed very well with ELISA results (Pearson’s correlation = 0.95 and R2 = 0.89). ADM concentrations determined in both capillary (via finger prick) and corresponding venous blood VAMS samples correlated strongly with serum concentrations (Pearson’s correlation = 0.87). Our preliminary data (n = 7) on rapid testing and home-based microsampling are considered promising with regard to TDM implementation for adalimumab, warranting further research.
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Affiliation(s)
- Rani Soenen
- Department of Dermatology, Ghent University Hospital, 9000 Ghent, Belgium; (R.S.); (L.G.)
- Dermatology Research Unit, University Ghent, 9000 Ghent, Belgium; (A.C.); (H.D.S.); (M.D.); (T.M.); (M.F.)
- Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, 3000 Leuven, Belgium
| | - Christophe Stove
- Department of Bioanalysis, Ghent University Hospital, 9000 Ghent, Belgium;
| | - Alessio Capobianco
- Dermatology Research Unit, University Ghent, 9000 Ghent, Belgium; (A.C.); (H.D.S.); (M.D.); (T.M.); (M.F.)
| | - Hanne De Schutter
- Dermatology Research Unit, University Ghent, 9000 Ghent, Belgium; (A.C.); (H.D.S.); (M.D.); (T.M.); (M.F.)
| | - Marie Dobbelaere
- Dermatology Research Unit, University Ghent, 9000 Ghent, Belgium; (A.C.); (H.D.S.); (M.D.); (T.M.); (M.F.)
| | - Tahmina Mahjor
- Dermatology Research Unit, University Ghent, 9000 Ghent, Belgium; (A.C.); (H.D.S.); (M.D.); (T.M.); (M.F.)
| | - Merel Follens
- Dermatology Research Unit, University Ghent, 9000 Ghent, Belgium; (A.C.); (H.D.S.); (M.D.); (T.M.); (M.F.)
| | - Jo Lambert
- Department of Dermatology, Ghent University Hospital, 9000 Ghent, Belgium; (R.S.); (L.G.)
- Dermatology Research Unit, University Ghent, 9000 Ghent, Belgium; (A.C.); (H.D.S.); (M.D.); (T.M.); (M.F.)
- Correspondence:
| | - Lynda Grine
- Department of Dermatology, Ghent University Hospital, 9000 Ghent, Belgium; (R.S.); (L.G.)
- Dermatology Research Unit, University Ghent, 9000 Ghent, Belgium; (A.C.); (H.D.S.); (M.D.); (T.M.); (M.F.)
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Rajagopalan M, Chatterjee M, De A, Dogra S, Ganguly S, Kar BR, Madnani N, Neema S, Parasramani SG, Patel K, Tahiliani S. Systemic Management of Psoriasis Patients in Indian Scenario: An Expert Consensus. Indian Dermatol Online J 2021; 12:674-682. [PMID: 34667752 PMCID: PMC8456263 DOI: 10.4103/idoj.idoj_113_21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Revised: 07/07/2021] [Accepted: 08/19/2021] [Indexed: 01/14/2023] Open
Abstract
Background: Psoriasis is a common inflammatory disease with significant comorbidities, and regardless of its extent, it affects the patients' quality of life. The various modalities of treating psoriasis comprise topical or systemic medications, phototherapy, and an array of biologic agents. There is a lack of Indian recommendations on the management of psoriasis with these different modalities and challenges faced by the clinicians in day-to-day practice. Aim: To develop India-specific consensus for systemic management of patients with moderate-to-severe psoriasis. Method and Results: A panel of dermatology experts, based on the evidence and international recommendations, coupled with their own clinical experience, developed recommendations for systemic management of patients with moderate-to-severe psoriasis. Conclusion: These recommendations are meant to provide guidance in terms of choice of systemic therapies, dosing, effectiveness, and safety. It also addresses clinical challenges that may be experienced during psoriasis management.
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Affiliation(s)
| | - Manas Chatterjee
- Department of Dermatology, Command Hospital, Kolkata, West Bengal, India
| | - Abhishek De
- Department of Dermatology, Calcutta National Medical College, Kolkata, West Bengal, India
| | - Sunil Dogra
- Department of Dermatology, Venereology and Leprology, Postgraduate Institute of Medical Education and Research, Raipur, Chhattisgarh, India
| | - Satyaki Ganguly
- Department of Dermatology, All India Institute of Medical Sciences, Raipur, Chhattisgarh, India
| | - Bikash Ranjan Kar
- Department of Dermatology, Institute of Medical Sciences and Sum Hospital, Siksha 'O' Anusandhan, Bhubaneshwar, Odisha, India
| | - Nina Madnani
- Visiting Dermatology Consultant, P. D. Hinduja National Hospital and Medical Research Centre, Mumbai, Maharashtra, India
| | - Shekhar Neema
- Department of Dermatology, Armed Forces Medical College, Pune, Maharashtra, India
| | - S G Parasramani
- Department of Dermacosmetology, Lilavati Hospital, Mumbai, Maharashtra, India
| | - Krina Patel
- Department of Dermatology, Gujarat Medical Education and Research Society Medical College, Sola, Gujarat, India
| | - Sushil Tahiliani
- Consultant Skin and S.T.D. Specialist, Dermatosurgeon, Dr. Tahiliani's Clinic, Bandra West, Mumbai, Maharashtra, India
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Clinical Consequences of Antibody Formation, Serum Concentrations, and HLA-Cw6 Status in Psoriasis Patients on Ustekinumab. Ther Drug Monit 2020; 41:634-639. [PMID: 31107404 PMCID: PMC6752798 DOI: 10.1097/ftd.0000000000000646] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
BACKGROUND Ustekinumab for the treatment of psoriasis is currently administered in a standard dosing regimen. However, some patients tend to benefit from alternative dosing regimens, a step toward personalized medicine. METHODS To investigate the role of ustekinumab serum concentrations, anti-ustekinumab antibodies [AUA] and HLA-Cw6 status as tools for optimizing ustekinumab treatment, a multicenter prospective cohort study was conducted at an academic hospital with affiliated nonacademic hospitals in Belgium (cohort 1) and 2 academic hospitals in the Netherlands (cohort 2 and 3). Patients with plaque-type psoriasis were eligible if treated with ustekinumab for ≥16 weeks. Serum samples and Psoriasis Area and Severity Index scores were obtained at baseline, week 16, 28, 40, 52, and/or ≥64 of ustekinumab treatment. RESULTS A total of 137 patients with 229 observations for serum concentrations and AUA and 61 observations for HLA-Cw6 status were included. Presence of AUA (prevalence of 8.7%) was significantly associated with a diminished clinical response (P = 0.032). The median ustekinumab trough concentration was 0.3 mcg/mL (<0.02-3.80). No differences in serum concentrations were observed between moderate to good responders and nonresponders (P = 0.948). Serum trough concentrations were not affected by methotrexate comedication. Prevalence of HLA-Cw6 positivity was 41% with no statistically significant difference in clinical response between HLA-Cw6-positive and HLA-Cw6-negative patients (P = 0.164). CONCLUSIONS The presence of AUA was associated with treatment failure in this patient population; measurement of AUA may therefore be a candidate marker for personalized pharmacotherapy. The clinical utility of ustekinumab serum trough concentrations or HLA-Cw6 status determination remains less clear. Further exploration on the potential of measuring ustekinumab serum concentrations and other biomarkers in predicting therapy outcomes should be encouraged.
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