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Yamanaka-Takaichi M, Demer AM, Baum CL, Theoharides TC, Alavi A. The role of mast cells and related molecules in itch of hidradenitis suppurativa. Exp Dermatol 2024; 33:e15061. [PMID: 38532563 PMCID: PMC11099845 DOI: 10.1111/exd.15061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Revised: 03/06/2024] [Accepted: 03/10/2024] [Indexed: 03/28/2024]
Affiliation(s)
- Mika Yamanaka-Takaichi
- Visiting Research Fellow in the Department of Dermatology (Yamanaka-Takaichi, limited tenure) and Department of Dermatology (Demer, Baum, Alavi), Mayo Clinic, Rochester, Minnesota; Institute of Neuro-Immune Medicine (Theoharides), Nova Southeastern University, Clearwater, Florida; and Department of Immunology (Theoharides), Tufts University School of Medicine, Boston, Massachusetts
| | - Addison M. Demer
- Visiting Research Fellow in the Department of Dermatology (Yamanaka-Takaichi, limited tenure) and Department of Dermatology (Demer, Baum, Alavi), Mayo Clinic, Rochester, Minnesota; Institute of Neuro-Immune Medicine (Theoharides), Nova Southeastern University, Clearwater, Florida; and Department of Immunology (Theoharides), Tufts University School of Medicine, Boston, Massachusetts
| | - Christian L. Baum
- Visiting Research Fellow in the Department of Dermatology (Yamanaka-Takaichi, limited tenure) and Department of Dermatology (Demer, Baum, Alavi), Mayo Clinic, Rochester, Minnesota; Institute of Neuro-Immune Medicine (Theoharides), Nova Southeastern University, Clearwater, Florida; and Department of Immunology (Theoharides), Tufts University School of Medicine, Boston, Massachusetts
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Ackerman L, Acloque G, Bacchelli S, Schwartz H, Feinstein BJ, La Stella P, Alavi A, Gollerkeri A, Davis J, Campbell V, McDonald A, Agarwal S, Karnik R, Shi K, Mishkin A, Culbertson J, Klaus C, Enerson B, Massa V, Kuhn E, Sharma K, Keaney E, Barnes R, Chen D, Zheng X, Rong H, Sabesan V, Ho C, Mainolfi N, Slavin A, Gollob JA. IRAK4 degrader in hidradenitis suppurativa and atopic dermatitis: a phase 1 trial. Nat Med 2023; 29:3127-3136. [PMID: 37957373 PMCID: PMC10719089 DOI: 10.1038/s41591-023-02635-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Accepted: 10/06/2023] [Indexed: 11/15/2023]
Abstract
Toll-like receptor-driven and interleukin-1 (IL-1) receptor-driven inflammation mediated by IL-1 receptor-associated kinase 4 (IRAK4) is involved in the pathophysiology of hidradenitis suppurativa (HS) and atopic dermatitis (AD). KT-474 (SAR444656), an IRAK4 degrader, was studied in a randomized, double-blind, placebo-controlled phase 1 trial where the primary objective was safety and tolerability. Secondary objectives included pharmacokinetics, pharmacodynamics and clinical activity in patients with moderate to severe HS and in patients with moderate to severe AD. KT-474 was administered as a single dose and then daily for 14 d in 105 healthy volunteers (HVs), followed by dosing for 28 d in an open-label cohort of 21 patients. Degradation of IRAK4 was observed in HV blood, with mean reductions after a single dose of ≥93% at 600-1,600 mg and after 14 daily doses of ≥95% at 50-200 mg. In patients, similar IRAK4 degradation was achieved in blood, and IRAK4 was normalized in skin lesions where it was overexpressed relative to HVs. Reduction of disease-relevant inflammatory biomarkers was demonstrated in the blood and skin of patients with HS and patients with AD and was associated with improvement in skin lesions and symptoms. There were no drug-related infections. These results, from what, to our knowledge, is the first published clinical trial using a heterobifunctional degrader, provide initial proof of concept for KT-474 in HS and AD to be further confirmed in larger trials. ClinicalTrials.gov identifier: NCT04772885 .
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | - Kelvin Shi
- Kymera Therapeutics, Inc., Watertown, MA, USA
| | | | | | | | | | | | - Eric Kuhn
- Kymera Therapeutics, Inc., Watertown, MA, USA
| | | | - Erin Keaney
- Kymera Therapeutics, Inc., Watertown, MA, USA
| | | | - Dapeng Chen
- Kymera Therapeutics, Inc., Watertown, MA, USA
| | | | | | | | - Chris Ho
- Kymera Therapeutics, Inc., Watertown, MA, USA
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Li Y, Speck P, Viera E, Siira M, Orenstein LAV. The Influence of Pain on Reduced Quality of Life in Patients with Hidradenitis Suppurativa: A Single-Center Retrospective Study. Dermatology 2023; 239:1007-1012. [PMID: 37717562 DOI: 10.1159/000533740] [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: 04/25/2023] [Accepted: 08/20/2023] [Indexed: 09/19/2023] Open
Abstract
BACKGROUND Pain and itch are impactful and burdensome symptoms of hidradenitis suppurativa (HS). Elucidating factors associated with pain and itch severity may identify groups disproportionally affected by HS-related pain and itch and further our understanding of how pain and itch impact quality of life (QoL) in patients with HS. OBJECTIVE The objective of the study was to determine factors associated with pain severity, itch severity, and reduced QoL in patients with HS. METHODS This is a retrospective cross-sectional study of 257 adults with HS who received care in an HS Specialty Clinic from January 2019 to August 2021. Multivariable mixed-effects linear regression was used to determine the relationships between clinical and demographic patient factors and the outcomes of pain severity, itch severity, and skin-specific QoL. RESULTS Factors associated with reduced QoL were Hurley stage II (β = 19.66, 95% CI: 1.40-37.93) and III (β = 21.98, 95% CI: 1.57-42.39) disease as well as severity of pain (β = 13.74, 95% CI: 11.93-15.55), itch (β = 4.57, 95% CI: 2.59-6.55), anxiety (β = 2.55 95% CI: 1.29-3.81), and depression (β = 1.43, 95% CI: 0.30-2.56). Increasing HS pain severity was associated with Hurley stage III disease (β = 2.04, 95% Cl: 0.99-3.09), black race (β = 1.23, 95% Cl: 0.40, 2.06), depression severity (β = 0.08, 95% Cl: 0.02, 0.14), and anxiety severity (β = 0.10 95% Cl: 0.04, 0.17). Factors associated with HS itch severity were Hurley stage III disease (β = 2.23, 95% Cl: 1.19, 3.27), black race (β = 0.92, 95% Cl: 0.07, 1.78), depression severity (β = 0.09, 95% Cl: 0.04, 0.14), and anxiety severity (β = 0.07, 95% Cl: 0.01, 0.13). CONCLUSION Pain is one of the largest contributors to QoL in patients with HS; on a 0-10 numeric rating scale, a 2-point increase in HS pain had a similar independent effect on QoL as having Hurley stage III disease compared to Hurley stage I.
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Affiliation(s)
- Yiwen Li
- Department of Dermatology, Emory University School of Medicine, Atlanta, USA,
| | - Patrick Speck
- Department of Dermatology, Emory University School of Medicine, Atlanta, USA
| | - Eric Viera
- Department of Dermatology, Emory University School of Medicine, Atlanta, USA
| | - Meron Siira
- Department of Dermatology, Emory University School of Medicine, Atlanta, USA
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Johnston L, Dupuis E, Lam L, Poelman S. Understanding Hurley Stage III Hidradenitis Suppurativa Patients' Experiences With Pain: A Cross-Sectional Analysis. J Cutan Med Surg 2023; 27:487-492. [PMID: 37489915 PMCID: PMC10616983 DOI: 10.1177/12034754231188452] [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: 04/08/2023] [Revised: 05/20/2023] [Accepted: 07/01/2023] [Indexed: 07/26/2023]
Abstract
BACKGROUND More than 90% of patients with hidradenitis suppurativa (HS) report that pain interferes with their quality of life (QoL) and pain may have a larger impact on QoL than disease severity alone. OBJECTIVES The purpose of this study was to understand the impact of pain on the daily lives of patients with Hurley stage III HS. METHODS This was a single-center, prospective cross-sectional study that was conducted at Beacon Dermatology in Calgary, AB. Patients ≥ 18 years old with Hurley stage III HS in at least one area of the body were prospectively invited to participate in this study. The study consisted of survey questions on patients' demographic information, past medical histories, HS-related pain histories, and previous therapies for pain management. Additionally, patients completed a series of standardized rating scales on their pain and overall QoL. RESULTS Of the 10 patients that participated in the study, 90% (9/10) expressed a desire for more counselling on pain management options. Many patients (8/10, 80%) reported routine use of over-the-counter pain medications and 70% (7/10) used complementary and alternative medicines (CAMs) to manage their pain. Patients' efficacy ratings of HS treatments in controlling their pain revealed that topical treatments provided minimal or no relief, while surgical interventions had the highest efficacy for reducing pain. Patients' average worst pain over the preceding 24 hrs was 6.3 +/- 2.5 (2-9) on the Numerical Rating Scale for pain and the mean Dermatology Life Quality Index score was 19.5 +/- 8.2 (5-29). CONCLUSIONS Patients with Hurley stage III HS report high levels of daily pain and QoL impairment and many individuals use over-the-counter treatments and CAMs to manage their pain. Physicians involved in the care of HS patients should consider implementing routine counselling on pain management into their clinical practices, especially for patients with severe HS.
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Affiliation(s)
- Leah Johnston
- Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Elaine Dupuis
- Cumming School of Medicine, University of Calgary, Calgary, Canada
- Beacon Dermatology, Calgary, Canada
| | - Lauren Lam
- Beacon Dermatology, Calgary, Canada
- Department of Dermatology, University of Alberta, Edmonton, Canada
| | - Susan Poelman
- Cumming School of Medicine, University of Calgary, Calgary, Canada
- Beacon Dermatology, Calgary, Canada
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Zalewski A, Krajewski PK, Szepietowski JC. Prevalence and Characteristics of Itch and Pain in Patients Suffering from Chronic Hand Eczema. J Clin Med 2023; 12:4198. [PMID: 37445233 DOI: 10.3390/jcm12134198] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Revised: 06/16/2023] [Accepted: 06/20/2023] [Indexed: 07/15/2023] Open
Abstract
BACKGROUND Hand eczema (HE) is a frequent chronic inflammatory dermatosis. Itch and pain are considered two of the most common and burdensome symptoms of the disease. Yet, the data related to these symptoms are still limited. The aim of this study was to evaluate characteristics of itch and pain in adults suffering from HE. METHODS The study group comprised 100 adult HE patients. An original questionnaire designed by the authors was used to survey the patients. It included questions regarding demographic characteristics such as the duration of the disease, exacerbation count, past diagnostics and treatment, as well as atopic predispositions. Additionally, the itch and pain intensity (numerical rating scale-NRS) during '3 days prior to the study' and the 'entire disease' period was implemented. The clinical assessment of the disease severity was performed according to two specific measurement instruments: Investigator Global Assessment for Chronic Hand Eczema (IGA-CHE) scale and Hand Eczema Severity Index (HECSI). To assess patient quality of life (QoL), the DLQI tool was used and to determine the level of stigmatization and for its impact on patients' life the 6-Item Stigmatization Scale (6-ISS) was employed. RESULTS Within the period of 3 days prior to the examination, itch was reported by 81.0% of patients (n = 81), whereas 53.0% (n = 53) of them experienced pain. Both symptoms were reported more frequently in females (itch: p = 0.022; pain: p = 0.033). When sexes were compared, females reached higher scores in both IGA-CHE and HECSI. Itch and pain intensity correlated positively with disease severity. The intensity of itch and pain significantly influences HE patients' QoL. A positive correlation between the 6-ISS score and the intensity of itch in the 'last 3 days' period was revealed (r = 0.221; p = 0.027). CONCLUSIONS Itch and pain are common symptoms in HE patients, significantly contributing to the feeling of stigmatization. Providing characteristics of itch and pain may improve HE management. Symptom-decreasing treatment would definitely have a positive influence on patients' well-being.
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Affiliation(s)
- Adam Zalewski
- Department of Dermatology, Venereology and Allergology, Wroclaw Medical University, 50-368 Wroclaw, Poland
| | - Piotr K Krajewski
- Department of Dermatology, Venereology and Allergology, Wroclaw Medical University, 50-368 Wroclaw, Poland
| | - Jacek C Szepietowski
- Department of Dermatology, Venereology and Allergology, Wroclaw Medical University, 50-368 Wroclaw, Poland
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