A Real-World Study to Assess the Effectiveness of Itolizumab in Patients with Chronic Plaque Psoriasis

Long-term therapy with itolizumab is safe and effective for patients with moderate to severe psoriasis: Results from an expanded-access program

Itolizumab is a humanized monoclonal antibody that selectively targets the CD6-ALCAM pathway. This article reports on the safety and efficacy of itolizumab in the treatment of moderate-to-severe plaque psoriasis in a clinical study conducted in Cuba in the setting of an expanded-access program (EAP). The study included 84 patients who had previously received conventional anti-psoriatic systemic therapies but were either intolerant, had an inadequate response, or had contraindications to these therapies. It consisted of multiple phases, including a 12-week induction phase, a 40-week maintenance phase, and a 24-week off-treatment follow-up phase, using either a 0.4 or 1.6 mg/Kg dose. The results showed that itolizumab monotherapy was safe and effective during 52 weeks of continuous treatment and the subsequent 24 follow-up weeks. Itolizumab treatment resulted in a significant improvement (PASI 75) in 80 % of patients at the end of the induction phase, and this effect was sustained till week 52 during the maintenance phase. Moreover, 24 weeks after treatment stopped nearly two-thirds of patients still showed a PASI ≥ 75. The observed effects were dose-dependent, with 1.6 mg/kg being the most convenient dose. This study further supports the strategy of targeting the CD6-ALCAM signaling pathway for the treatment of psoriasis and the use of itolizumab as a valuable asset in the armamentarium of anti-psoriasis drugs.

Th1 and Th17 cells are resistant towards T cell activation-induced downregulation of CD6

BACKGROUND

The cell surface molecule CD6 is a modulator of T cell receptor (TCR) signaling. Recently, it has been reported that CD6 is downregulated on CD4+ T cells following T cell activation. This mechanism could limit the efficacy of anti-CD6 therapeutical antibodies.

METHODS

We analyzed CD6 expression on activated and non-activated Th1 cells and Th17 cells by flow cytometry.

RESULTS

Our experiments confirmed a significant downregulation of CD6 on IFNγ- and IL17-negative CD4+ T cells from healthy individuals and from patients with rheumatoid arthritis following T cell activation with anti-CD3 and anti-CD28 antibodies. In contrast, CD6 expression remained stable on activated Th17 cells and Th1 cells.

CONCLUSIONS

Th1 and Th17 cells are resistant towards T cell activation-induced downregulation of CD6. These findings are relevant for the future development of CD6 targeting therapies and show that CD6 expression is differentially regulated in CD4+ T cell subsets.

The effects of selected biologics and a small molecule on Health-Related Quality of Life in adult plaque psoriasis patients: A systematic review and meta-analysis

BACKGROUND

The Dermatology Life Quality Index (DLQI) is commonly used to assess the quality of life of patients with skin diseases. Clinical trials confirm the positive effect of the use of biologics and new molecules on the quality of life of patients with plaque psoriasis.

MAIN OBJECTIVES

Investigation of the effect of infliximab, adalimumab, ixekizumab, secukinumab and tofacitinib on Health-Related Quality of Life (HRQOL) measured by the DLQI in adult plaque psoriatic patients with respect to the patients' race, type of used agent/placebo, agent's dosage and treatment duration as well as the DLQI score prior to and after commencement of treatment.

MATERIAL AND METHODS

Systematic literature searching for referential papers written in English using four databases: PubMed, EMBASE, Scopus, ClinicalTrials.gov as well as and manual searching (Google) Cochran's (Q) and I2 tests were used for evaluation of heterogeneity or the degree of variation in the true effect size estimates between the analysed studies. The standardized mean difference (the SMD; Hedge's g score) was applied to measure the differences between the two means (i.e. two groups: treated vs non-treated or treated vs placebo). The data coding and Hedge's g values were calculated according to the guidance of MetaXL software version 5.3.

MAIN RESULTS

43 studies, in total 25,898 individuals, were evaluated by the DLQI and weighted mean scores were derived for the analysis. The mean DLQI scores ranged from 6.83 to 17.8 with the overall DLQI score of 12.12 (95%CI: 11.24 to 13.06). A random-effects model demonstrated significant considerable heterogeneity of the study results (I2 = 98%; p<0.001).

CONCLUSION

Infliximab, adalimumab, ixekizumab, secukinumab and tofacitinib in adult plaque psoriatic patients improved HRQOL measured by the DLQI. The patients with lower quality of life before treatment obtained better results.

Are We Jumping the Gun with Itolizumab in India? A Situational Analysis from the Pre-COVID Era

Itolizumab, an anti-CD6 monoclonal antibody, has been recently approved for the off-label indication of cytokine release syndrome in the background of COVID-19, by the Drug Controller General of India. However, this drug has not been included in the National Clinical Management Protocol for COVID-19 yet. The limited-to-no experience of the Indian health workforce with the drug urged us to conduct a situational analysis in the pre-COVID era to analyse the degree of use of the drug and the indications for which it has been employed.

Anti-CD6 mAbs for the treatment of psoriasis

INTRODUCTION

Psoriasis is a chronic inflammatory skin condition known to affect about 1%-3% of the global population. Psoriasis can be a serious burden to the patients, having deleterious effect on their physical, social and mental wellbeing. Systemic therapies consisting of methotrexate, cyclosporine, acitretin, PUVA, etc. used in moderate to severe psoriasis, are associated with end organ toxicity with long term use.

AREAS COVERED

Role of Itolizumab, an anti CD6 biologic in regulation of lymphocyte development, selection, activation and differentiation in the set-up of psoriasis. We performed a literature review by searching online databases including PubMed and Google Scholar.

EXPERT OPINION

There is emerging evidence to implicate CD6 and its ligands in the pathogenesis and potentially the treatment of inflammatory and autoimmune diseases, like psoriasis and multiple sclerosis. Its potential advantage over anti TNF biologics in predisposing to lesser risk of tuberculosis and other serious systemic infections or adverse effects makes it a potential valuable asset in the armamentarium of anti-psoriasis drugs.

Spotlight on itolizumab in the treatment of psoriasis - current perspectives from India

Psoriasis is a chronic, debilitating, immune-mediated, systemic inflammatory disease affecting mainly skin, nails, and joints. Several therapeutic modalities are available depending on the severity of the disease. Long-term use of these drugs results in unwanted effects and toxicities. Recently, itolizumab, a humanized monoclonal immunoglobulin G1 antibody to CD6, has shown appreciable clinical effects and safety profile in patients with moderate-to-severe chronic plaque psoriasis. A literature search was conducted using the keywords "anti-CD6", "psoriasis", "phase trials", "case series", and "case reports". The data from all studies conducted in India on efficacy of itolizumab in psoriasis and published before September 2017 were collected. This article provides an overview of the clinical data obtained in these published articles. Itolizumab has immunomodulatory and anti-inflammatory effects. It is efficacious and provides a good duration of remission, and hence represents a new biological agent that could be added to the therapeutic armamentarium of psoriasis.