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Orsini D, Caldarola G, Dattola A, Campione E, Bernardini N, Frascione P, De Simone C, Richetta AG, Galluzzo M, Skroza N, Assorgi C, Amore E, Falco GM, Gaeta Shumak R, Artosi F, Maretti G, Potenza C, Bianchi L, Pellacani G, Peris K, Bonifati C, Graceffa D. Efficacy and safety of tildrakizumab in elderly patients: real-world multicenter study (ESTER - study). J DERMATOL TREAT 2024; 35:2319304. [PMID: 38413097 DOI: 10.1080/09546634.2024.2319304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/29/2024]
Abstract
Purpose of the article: Interleukin-23 inhibitors, such as tildrakizumab, have emerged as safe and effective options for the management of psoriasis. Yet their efficacy in elderly patients (aged 65 years or more), particularly in those with difficult-to-treat areas involvement, remains insufficiently explored. We conducted this real-life retrospective multicentric observational study to assess the effectiveness of tildrakizumab in elderly patients with moderate-to-severe psoriasis, with involvement of difficult-to-treat areas.Materials and methods: We enrolled forty-nine patients aged 65 years old or more (mean age 73.1 ± 6.0), all treated with tildrakizumab for at least 28 weeks. The effectiveness of tildrakizumab was assessed by Static Physician's Global Assessment of Genitalia (sPGA-G), fingernail-PGA (f-PGA), palmoplantar PGA (pp-PGA), scalp-specific PGA (sc-PGA), and Psoriasis Area and Severity Index (PASI) scores.Results: Significant improvements in PASI scores were observed within 28 weeks of treatment, with 77.5%, 60%, and 45.2% of patients achieving PASI75, PASI90, and PASI100, respectively. The mean PASI decreased significantly from baseline (13.6 ± 9.9) to 1.3 ± 1.7 at week 28. More than 90% of patients had clear sPGA-G and pp-PGA scores and over 70% had clear f-PGA and sc-PGA scores after 28 weeks.Conclusions: Our findings suggest that tildrakizumab could be a valuable option for the treatment of elderly patients, including those with difficult-to-treat areas involvement.
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Affiliation(s)
- Diego Orsini
- Clinical Dermatology Unit, IFO-San Gallicano Dermatological Institute-IRCCS, Rome, Italy
| | - Giacomo Caldarola
- UOC di Dermatologia, Dipartimento di Scienze Mediche e Chirurgiche, Fondazione Policlinico Universitario A. Gemelli - IRCCS, Rome, Italy
- Dermatologia, Dipartimento di Medicina e Chirurgia Traslazionale, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Annunziata Dattola
- Unit of Dermatology, Department of Internal Medicine and Medical Specialties, Sapienza University, Rome, Italy
| | - Elena Campione
- Dermatology Unit, Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Nicoletta Bernardini
- Dermatology Unit "Daniele Innocenzi" ASL LATINA, Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Polo Pontino, Italy
| | - Pasquale Frascione
- Oncologic and Preventive Dermatology Unit, IFO-San Gallicano Dermatological Institute-IRCCS, Rome, Italy
| | - Clara De Simone
- UOC di Dermatologia, Dipartimento di Scienze Mediche e Chirurgiche, Fondazione Policlinico Universitario A. Gemelli - IRCCS, Rome, Italy
- Dermatologia, Dipartimento di Medicina e Chirurgia Traslazionale, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Antonio G Richetta
- Unit of Dermatology, Department of Internal Medicine and Medical Specialties, Sapienza University, Rome, Italy
| | - Marco Galluzzo
- Dermatology Unit, Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Nevena Skroza
- Dermatology Unit "Daniele Innocenzi" ASL LATINA, Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Polo Pontino, Italy
| | - Chiara Assorgi
- Clinical Dermatology Unit, IFO-San Gallicano Dermatological Institute-IRCCS, Rome, Italy
- Section of Dermatology, Department of Clinical Medicine and Surgery, University of Naples Federico II Napoli Italy
| | - Emanuele Amore
- Unit of Dermatology, Department of Internal Medicine and Medical Specialties, Sapienza University, Rome, Italy
| | - Gennaro M Falco
- UOC di Dermatologia, Dipartimento di Scienze Mediche e Chirurgiche, Fondazione Policlinico Universitario A. Gemelli - IRCCS, Rome, Italy
- Dermatologia, Dipartimento di Medicina e Chirurgia Traslazionale, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Ruslana Gaeta Shumak
- Dermatology Unit, Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Fabio Artosi
- Dermatology Unit, Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Giulia Maretti
- Dermatology Unit "Daniele Innocenzi" ASL LATINA, Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Polo Pontino, Italy
- Department of Neurosciences, Mental Health and Sensory Organs, "Sapienza" University of Rome, Rome, Italy
| | - Concetta Potenza
- Dermatology Unit "Daniele Innocenzi" ASL LATINA, Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Polo Pontino, Italy
| | - Luca Bianchi
- Dermatology Unit, Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Giovanni Pellacani
- Unit of Dermatology, Department of Internal Medicine and Medical Specialties, Sapienza University, Rome, Italy
| | - Ketty Peris
- UOC di Dermatologia, Dipartimento di Scienze Mediche e Chirurgiche, Fondazione Policlinico Universitario A. Gemelli - IRCCS, Rome, Italy
- Dermatologia, Dipartimento di Medicina e Chirurgia Traslazionale, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Claudio Bonifati
- Clinical Dermatology Unit, IFO-San Gallicano Dermatological Institute-IRCCS, Rome, Italy
| | - Dario Graceffa
- Clinical Dermatology Unit, IFO-San Gallicano Dermatological Institute-IRCCS, Rome, Italy
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Graceffa D, Zangrilli A, Caldarola G, Lora V, Orsini D, Moretta G, Pagnanelli G, Provini A, Masini C, Bavetta M, Giordano D, Richetta A, Tolino E, Bianchi L, Peris K, Sperati F, Bonifati C. Effectiveness of risankizumab for the treatment of psoriatic arthritis: a multicenter, real-world study. Int J Dermatol 2024. [PMID: 38584311 DOI: 10.1111/ijd.17156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Revised: 03/08/2024] [Accepted: 03/19/2024] [Indexed: 04/09/2024]
Abstract
BACKGROUND IL-23 inhibitors were recently approved for the treatment of skin psoriasis and psoriatic arthritis (PsA). Risankizumab, a humanized monoclonal antibody that specifically binds the p19 subunit of IL-23, has proven effective on PsA in two randomized controlled trials. To date, only a few real-world data are available on this topic. METHODS Our study aimed to prospectively evaluate the effectiveness of risankizumab in patients with PsA in a real-world setting. For this purpose, both rheumatologic and dermatologic assessments were performed at baseline and after 28-40 weeks of continuous risankizumab administration. Moreover, joint and entheses ultrasound assessment was performed at the mentioned time points. The rheumatologic assessment was carried out by means of the following scores: (i) clinical Disease Activity Index for Psoriatic Arthritis (cDAPSA); (ii) Leeds Enthesitis Index (LEI); (iii) Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) and (iii) Bath Ankylosing Spondylitis Functional Index (BASFI). The degree of skin involvement was measured by both the Psoriasis Area and Severity Index (PASI) and Physician Global Assessment (PGA). Quality of life was assessed by the Health Assessment Questionnaire (HAQ) and Dermatology Life Quality Index (DLQI). Ultrasound assessment of joints and entheses was performed on the basis of the EULAR-OMERACT score. RESULTS After treatment, cDAPSA decreased from a mean value of 12.9 ± 7.6 to 7.0 ± 6.1 (P < 0.001), and the median PD score significantly decreased from baseline (3; range 1-8) to TP1 (1; range 0-7) (P < 0.001). PASI score also decreased from 8.4 ± 4.9 to 0.3 ± 0.5 (P < 0.001), and PGA from 3.1 ± 1.0 to 0.4 ± 0.5 (P < 0.001). CONCLUSION We can conclude that risankizumab led to substantial improvement in both skin and joint involvement.
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Affiliation(s)
- Dario Graceffa
- Department of Clinical Dermatology, San Gallicano Dermatological Institute, IRCCS, Rome, Italy
| | - Arianna Zangrilli
- Department of Dermatology, University of Rome Tor Vergata, Rome, Italy
| | - Giacomo Caldarola
- Dipartimento di Scienze Mediche e Chirurgiche, UOC di Dermatologia, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
| | - Viviana Lora
- Department of Clinical Dermatology, San Gallicano Dermatological Institute, IRCCS, Rome, Italy
| | - Diego Orsini
- Department of Clinical Dermatology, San Gallicano Dermatological Institute, IRCCS, Rome, Italy
| | - Gala Moretta
- Istituto Dermopatico dell'Immacolata, IRCCS, Rome, Italy
| | | | | | - Cinzia Masini
- UOC Dermatologia, Ospedale San Sebastiano, Frascati (RM), Italy
| | - Mauro Bavetta
- UOC Dermatologia, Ospedale San Sebastiano, Frascati (RM), Italy
| | - Domenico Giordano
- NESMOS Department, Dermatology Unit, Sant'Andrea Hospital, University of Rome Sapienza, Rome, Italy
| | - Antonio Richetta
- Unit of Dermatology, Department of Internal Medicine and Medical Specialties Sapienza, University of Rome, Rome, Italy
| | - Ersilla Tolino
- Department of Medical-Surgical Sciences and Biotechnologies, Dermatology Unit "Daniele Innocenzi", Sapienza University of Rome, Rome, Italy
| | - Luca Bianchi
- Department of Dermatology, University of Rome Tor Vergata, Rome, Italy
| | - Ketty Peris
- Dipartimento di Scienze Mediche e Chirurgiche, UOC di Dermatologia, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
| | - Francesca Sperati
- UOSD Clinical Trial Center, Biostatistics and Bioinformatics, IRCCS San Gallicano Dermatological Institute, Rome, Italy
| | - Claudio Bonifati
- Department of Clinical Dermatology, San Gallicano Dermatological Institute, IRCCS, Rome, Italy
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Galluzzo M, Talamonti M, Bernardini N, Chiricozzi A, De Simone C, Bonifati C, Bruni P, Diotallevi F, Esposito M, Graceffa D, Hansel K, Loconsole F, Moretta G, Mugheddu C, Papini M, Richetta A, Skroza N, Atzori L, Fargnoli MC, Persechino S, Offidani A, Stingeni L, Peris K, Potenza C, Bianchi L. Real-world outcomes in patients with moderate-to-severe plaque psoriasis treated with guselkumab for up to 1 year. Expert Opin Biol Ther 2022; 22:1585-1592. [PMID: 35708257 DOI: 10.1080/14712598.2022.2090835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
BACKGROUND Real-world data on guselkumab, especially at times >6 months, are limited. RESEARCH DESIGN AND METHODS We performed a longitudinal, retrospective analysis on 307 patients with moderate-severe chronic plaque psoriasis (Psoriasis Area Severity Index [PASI] >10) treated with guselkumab for up to 12 months. MAIN OUTCOME MEASURES PASI 75, PASI 90, and PASI 100 were assessed at baseline and at 4, 12, 20, 28, 36, 44, and 52 weeks. RESULTS At 12 weeks, PASI 75, PASI 90, and PASI 100 were achieved in 56.4%, 33.6%, and 24.1% of patients, respectively. At 52 weeks, PASI 75, PASI 90, and PASI 100 were achieved in 82.7%, 68.7%, and 51.1% of patients, respectively. Patients without comorbidities and those naïve to previous biological therapy had better responses. The mean Dermatology Life Quality Index score decreased from 14.0 at baseline to 3.1 at 12 weeks and 1.6 at 6 months, which was maintained at later times. Similar improvements were seen in pruritus visual analog scale. CONCLUSIONS Guselkumab maintains its efficacy for up to 12 months among responders in a real-world cohort of patients with moderate-severe plaque psoriasis, confirming data from prior real-world studies with smaller cohorts and shorter duration of follow-up.
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Affiliation(s)
- Marco Galluzzo
- Department of Systems Medicine, University of Rome "Tor Vergata", Rome, Italy.,Dermatology Unit, Fondazione Policlinico "Tor Vergata", Rome, Italy
| | - Marina Talamonti
- Department of Systems Medicine, University of Rome "Tor Vergata", Rome, Italy.,Dermatology Unit, Fondazione Policlinico "Tor Vergata", Rome, Italy
| | | | - Andrea Chiricozzi
- UOC di Dermatologia, Dipartimento di Scienze Mediche e Chirurgiche, Fondazione Policlinico Universitario A. Gemelli - IRCCS, Rome, Italy; Dermatologia, Dipartimento di Medicina e Chirurgia Traslazionale, Università Cattolica del Sacro Cuore, Roma, Italy
| | - Clara De Simone
- UOC di Dermatologia, Dipartimento di Scienze Mediche e Chirurgiche, Fondazione Policlinico Universitario A. Gemelli - IRCCS, Rome, Italy; Dermatologia, Dipartimento di Medicina e Chirurgia Traslazionale, Università Cattolica del Sacro Cuore, Roma, Italy
| | - Claudio Bonifati
- Dermatology Unit, San Gallicano Dermatological Institute - IRCCS, Roma, Italy
| | - Pierluigi Bruni
- Dermatology University of Perugia, Terni Hospital, Terni Italy
| | - Federico Diotallevi
- Dermatology Unit, Dept. of Clinical and Molecular Sciences, Polytechnic Marche University, Ancona, Italy
| | - Maria Esposito
- Dermatology, Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Dario Graceffa
- Dermatology Unit, San Gallicano Dermatological Institute - IRCCS, Roma, Italy
| | - Katharina Hansel
- Dermatology Section, Department of Dermatology and Venereology, University of Perugia, Perugia, Italy
| | - Francesco Loconsole
- Dermatology clinic, University hospital "Policlinico universitario di Bari", Bari, Italy
| | | | | | - Manuela Papini
- Dermatology University of Perugia, Terni Hospital, Terni Italy
| | - Antonio Richetta
- Dermatology, Sapienza University of Rome - Umberto I Hospital, Rome, Italy
| | - Nevena Skroza
- Dermatology, Sapienza University of Rome - Polo Pontino, Rome, Italy
| | - Laura Atzori
- Dermatology, University of Cagliari, Cagliari, Italy
| | - Maria Concetta Fargnoli
- Dermatology, Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Severino Persechino
- Department of Neuroscienze Salute Mentale e Organi di Senso (NESMOS), Sapienza University of Rome, Rome, Italy
| | - Annamaria Offidani
- Dermatology Unit, Dept. of Clinical and Molecular Sciences, Polytechnic Marche University, Ancona, Italy
| | - Luca Stingeni
- Dermatology Section, Department of Dermatology and Venereology, University of Perugia, Perugia, Italy
| | - Ketty Peris
- UOC di Dermatologia, Dipartimento di Scienze Mediche e Chirurgiche, Fondazione Policlinico Universitario A. Gemelli - IRCCS, Rome, Italy; Dermatologia, Dipartimento di Medicina e Chirurgia Traslazionale, Università Cattolica del Sacro Cuore, Roma, Italy
| | - Concetta Potenza
- Dermatology, Sapienza University of Rome - Polo Pontino, Rome, Italy
| | - Luca Bianchi
- Department of Systems Medicine, University of Rome "Tor Vergata", Rome, Italy.,Dermatology Unit, Fondazione Policlinico "Tor Vergata", Rome, Italy
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Cusano F, Sampogna F, Brunasso Vernetti AMG, Stisi S, Sandri G, Malara G, Naldi L, Pellegrino M, Tripepi GL, Di Luzio Paparatti U, Agnusdei CP, Bonifati C, Celano A, Corazza V, D'Agostino F, De Pasquale R, Filippucci E, Foti R, Galdo G, Gai F, Ganzetti G, Graceffa D, Maccarone M, Mazzotta A, Melchionda G, Molinaro F, Paoletti F, Tonolo S, Vercellone A, Vitetta R, Massone C, Sebastiani GD. A consensus-based approach on the management of patients with both psoriasis and psoriatic arthritis in the dermatological and rheumatological settings in Italy: The ADOI PSO-Amore Project. Dermatol Reports 2022; 14:9541. [PMID: 36199897 PMCID: PMC9527681 DOI: 10.4081/dr.2022.9541] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2022] [Accepted: 07/20/2022] [Indexed: 11/23/2022] Open
Abstract
Psoriasis is a complex disease often needing a multidisciplinary approach. In particular, the collaboration between dermatologist and rheumatologist is crucial for the management of patients suffering from both psoriasis (PSO) and psoriatic arthritis (PsA). Here we report a series of recommendations from a group of experts, as a result of a Consensus Conference, defining the circumstances in which it is preferable or even mandatory, depending on the available settings, to rely on the opinion of the two specialists, jointly or in a deferred manner. Indications are given on how to organize a 3rd level joint Dermatology- Rheumatology care unit, in connection with 1st and 2nd level clinicians of both specialties, GPs, and other specialists involved in the management of psoriasis. A potential patient journey is suggested, that can be used as a basis for future design and validation of national and/or local diagnostic therapeutic and assistance pathways.
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Graceffa D, Sperati F, Bonifati C, Spoletini G, Lora V, Pimpinelli F, Pontone M, Pellini R, Di Bella O, Morrone A, Cristaudo A. Immunogenicity of three doses of anti-SARS-CoV-2 BNT162b2 vaccine in psoriasis patients treated with biologics. Front Med (Lausanne) 2022; 9:961904. [PMID: 36148445 PMCID: PMC9485492 DOI: 10.3389/fmed.2022.961904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2022] [Accepted: 08/15/2022] [Indexed: 11/16/2022] Open
Abstract
Introduction Psoriasis has not been directly linked to a poor prognosis for COVID-19, yet immunomodulatory agents used for its management may lead to increased vulnerability to the dangerous complications of SARS-CoV-2 infection, as well as impair the effectiveness of the recently introduced vaccines. The three-dose antibody response trend and the safety of BNT162b2 mRNA vaccine in psoriasis patients treated with biologic drugs have remained under-researched. Materials and methods Forty-five psoriatic patients on biologic treatment were enrolled to evaluate their humoral response to three doses of BNT162b2. IgG titers anti-SARS-CoV-2 spike protein were evaluated at baseline (day 0, first dose), after 3 weeks (second dose), four weeks post-second dose, at the time of the third dose administration and 4 weeks post-third dose. Seropositivity was defined as IgG ≥15 antibody-binding units (BAU)/mL. Data on vaccine safety were also collected by interview at each visit. Results A statistically significant increase in antibody titers was observed after each dose of vaccine compared with baseline, with no significant differences between patients and controls. Methotrexate used in combination with biologics has been shown to negatively influence the antibody response to the vaccine. On the contrary, increasing body mass index (BMI) positively influenced the antibody response. No adverse effects were reported, and no relapses of psoriasis were observed in the weeks following vaccine administration in our study population. Conclusions Our data are largely consistent with the recent literature on this topic confirming the substantial efficacy and safety of BNT162b2 mRNA vaccine on psoriatic patients treated with biologics of different types and support the recommendation to perform additional doses in this specific subgroup of patients.
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Affiliation(s)
- Dario Graceffa
- Department of Clinical Dermatology, San Gallicano Dermatological Institute, IRCCS, Rome, Italy
| | - Francesca Sperati
- Biostatistics Unit, San Gallicano Dermatological Institute IRCCS, Rome, Italy
| | - Claudio Bonifati
- Department of Clinical Dermatology, San Gallicano Dermatological Institute, IRCCS, Rome, Italy
| | - Gabriele Spoletini
- General Surgery and Liver Transplantation, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Viviana Lora
- Department of Clinical Dermatology, San Gallicano Dermatological Institute, IRCCS, Rome, Italy
| | - Fulvia Pimpinelli
- Microbiology and Virology Unit, Dermatological Clinical and Research Department, San Gallicano Dermatological Institute, IRCCS, Rome, Italy
| | - Martina Pontone
- Microbiology and Virology Unit, Dermatological Clinical and Research Department, San Gallicano Dermatological Institute, IRCCS, Rome, Italy
| | - Raul Pellini
- Department Otolaryngology Head and Neck Surgery, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Ornella Di Bella
- Medical Direction, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Aldo Morrone
- Scientific Direction, San Gallicano Dermatological Institute, IRCCS, Rome, Italy
| | - Antonio Cristaudo
- Department of Clinical Dermatology, San Gallicano Dermatological Institute, IRCCS, Rome, Italy
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Lamberti A, Lora V, Graceffa D, Bonifati C, Cota C. Nail psoriasis: a rare mRNA COVID-19 vaccine reaction. J Eur Acad Dermatol Venereol 2022; 36:e745-e746. [PMID: 35604041 PMCID: PMC9348061 DOI: 10.1111/jdv.18255] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Accepted: 05/18/2022] [Indexed: 12/16/2022]
Affiliation(s)
- A. Lamberti
- Dermatopathology UnitSan Gallicano Dermatological Institute, IRCCSRomeItaly,Dermatology Unit, Department of Medical, Surgical and neurological SciencesUniversity of SienaSienaItaly
| | - V. Lora
- Dermatology UnitSan Gallicano Dermatological Institute, IRCCSRomeItaly
| | - D. Graceffa
- Dermatology UnitSan Gallicano Dermatological Institute, IRCCSRomeItaly
| | - C. Bonifati
- Dermatology UnitSan Gallicano Dermatological Institute, IRCCSRomeItaly
| | - C. Cota
- Dermatopathology UnitSan Gallicano Dermatological Institute, IRCCSRomeItaly
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7
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Chimenti MS, Galluzzo M, Talamonti M, Campanati A, Bonifati C, Bruni P, Caldarola G, Carpentieri A, Chiricozzi A, De Simone C, Diotallevi F, Esposito M, Fiorella C, Graceffa D, Loconsole F, Hansel K, Mugheddu C, Papini M, Richetta A, Bergamini A, Luchetti MM, Atzori L, Peris K, Offidani A, Stingeni L, Bianchi L. AB0915 GUSELKUMAB REAL WORD DATA: EFFICACY AND SAFETY IN A COHORT OF 69 PATIENTS WITH PSORIATIC ARTHRITIS. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.4327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BackgroundPsoriasis (PSO) is a systemic immune-mediated disorder, characterized by inflammation skin and joint manifestations: it is known that up to 30% of PsO patients develop PsA.PsO and PsA share common etiopathogenetic pathways, as IL-23/IL-17 axis. In Italy, Guselkumab (GUS), a selective IL-23 inhibitor, was approved in 2018 for the treatment of PsO, and recently it was also approved for PsA therapy. Today, there are few “real-world” studies regarding the use of GUS in PsA patients.ObjectivesA multicenter Italian study group of dermatologists and rheumatologists aimed at evaluate GUS efficacy and safety in patients with concomitant PsO and PsA in real word setting on both skin and joint domains.MethodsAn observational retrospective, multicentric study was performed in 69 PsO patients with a confirmed diagnosis of moderate to severe PsA. PASI and DLQI were used for the evaluation of skin response, and the number swollen/tender joints, presence or absence of dactylitis or enthesitis or axial involvement and painVAS were evaluated for the articular and periarticular efficacy. These analyses were performed at baseline T0 (beginning of the therapy), T1 (12 weeks) and T2 (24 weeks).Results38/69 patients (55,1%) presented oligoarthritis, 31/69 (44,9%) showed polyarthritis, none of the patients had enthesitis or axial involvement. Moreover, co-morbidities were diagnosed: hypertension (52,2%), hypercholesterolemia (34,8%), Hypertriglyceridemia (29%), diabetes (24,6%), obesity (23,2%), HIV-positive (20,3%), psychiatric disorders (17,4%), cardiopathies (15,9%), inflammatory bowel disease (7,3%), Latent Tubercolosis (4,4%), Chronic B-Hepatitis (2,9%), Chronic C-Hepatitis (1,5%). In all these patients, skin and joint responses were evaluated at week 12 and week 24.Concerning skin efficacy, PASI 90 was achieved at week 24. Concerning Joint response: painVAS progressively improved till T2, tender joint count decreased in patients with oligo and polyarthritis at T1 and maintained at T2, while swollen joint count decreased in polyarthritis patients at T1 and maintained at T2. In oligo-arthritis patients, this parameter was not improved. The number of dactylitis did not decrease during the period of study (see Table 1). No safety concerns were reported in this population.ConclusionEfficacy and safety of GUS was confirmed in this study group of PsO patients with concomitant PsA and several comorbidities in a real-life setting.Disclosure of InterestsNone declared
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Caldarola G, Zangrilli A, Bernardini N, Bavetta M, De Simone C, Graceffa D, Bonifati C, Faleri S, Giordano D, Mariani M, Micheli A, Moretta G, Pagnanelli G, Panasiti V, Provini A, Richetta A, Peris K, Bianchi L. Risankizumab for the treatment of moderate-to-severe psoriasis: a multi-center, retrospective, 1 year real-life study. Dermatol Ther 2022; 35:e15489. [PMID: 35385202 PMCID: PMC9287038 DOI: 10.1111/dth.15489] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2021] [Revised: 02/11/2022] [Accepted: 04/01/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Several new biologic agents targeting IL23/Th17 axis, such as risankizumab, have been developed for the treatment of psoriasis. OBJECTIVE To analyze the efficacy and safety of risankizumab in patients with moderate-to-severe psoriasis over a 52-week period. MATERIALS AND METHODS A multicentric retrospective study was conducted in patients who initiated risankizumab between July 2019-December 2020. Psoriasis Area and Severity Index - PASI was measured at baseline and after 4, 16, 28 and 52 weeks. Clinical responses were evaluated by PASI75, PASI90 and PASI100 at the same timepoints. Potential safety issues and adverse events (AEs) were collected. Univariable and multivariable logistic regressions were performed for variables predicting clinical response. RESULTS 112 patients with psoriasis were included. PASI90 response was achieved by 17.86% of patients at week 4, 72.22% at week 16, 91.0% at week 28 and 95.24% at week 52 (as observed analysis). No associations between the considered variables and the efficacy endpoints were retrieved, influence of variables such as Body Mass Index (BMI), baseline PASI or previous biologics were not shown. No serious safety issues or discontinuations related to adverse events were reported. CONCLUSIONS Risankizumab showed high efficacy and a favorable safety profile, regardless of patient- and disease-related factors.
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Affiliation(s)
- Giacomo Caldarola
- Dermatologia, Dipartimento di Medicina e Chirurgia Traslazionale, Università Cattolica del Sacro Cuore, Rome, Italy.,UOC di Dermatologia, Dipartimento di Scienze Mediche e Chirurgiche, Fondazione Policlinico Universitario A. Gemelli - IRCCS, Rome, Italy
| | - Arianna Zangrilli
- Department of Dermatology, University of Rome Tor Vergata, Rome, Italy
| | - Nicoletta Bernardini
- Department of Medical-Surgical Sciences and Biotechnologies, Dermatology Unit "Daniele Innocenzi", Sapienza University of Rome, Rome, Italy
| | - Mauro Bavetta
- Department of Dermatology, University of Rome Tor Vergata, Rome, Italy
| | - Clara De Simone
- Dermatologia, Dipartimento di Medicina e Chirurgia Traslazionale, Università Cattolica del Sacro Cuore, Rome, Italy.,UOC di Dermatologia, Dipartimento di Scienze Mediche e Chirurgiche, Fondazione Policlinico Universitario A. Gemelli - IRCCS, Rome, Italy
| | - Dario Graceffa
- Istituto Dermatologico San Gallicano - IRCCS, Rome, Italy
| | | | - Sara Faleri
- UOC DERMATOLOGIA dell'Ospedale di Belcolle, Viterbo, Italy
| | - Domenico Giordano
- NESMOS department, dermatology unit, Sant'Andrea hospital, university of Rome Sapienza, Italy
| | - Marco Mariani
- Section of Hygiene, University Department of Health Sciences and Public Health, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Adriana Micheli
- Unità di Dermatologia, Ospedale Nuovo Regina Margherita, Rome, Italy
| | - Gaia Moretta
- Istituto Dermopatico dell'Immacolata - IRCCS, Rome, Italy
| | | | - Vincenzo Panasiti
- Plastic and Reconstructive Surgery Unit, Campus Bio-Medico University, Rome, Italy
| | | | - Antonio Richetta
- Unit of Dermatology, Department of Internal Medicine and Medical Specialties, Sapienza University of Rome, Rome, Italy
| | - Ketty Peris
- Dermatologia, Dipartimento di Medicina e Chirurgia Traslazionale, Università Cattolica del Sacro Cuore, Rome, Italy.,UOC di Dermatologia, Dipartimento di Scienze Mediche e Chirurgiche, Fondazione Policlinico Universitario A. Gemelli - IRCCS, Rome, Italy
| | - Luca Bianchi
- Department of Dermatology, University of Rome Tor Vergata, Rome, Italy
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9
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Cristaudo A, Graceffa D, Pimpinelli F, Sperati F, Spoletini G, Bonifati C, Pellini R, Lora V, Pontone M, Di Bella O, Bracco D, Morrone A. Immunogenicity and safety of anti-SARS-CoV-2 BNT162b2 vaccine in psoriasis patients treated with biologic drugs. J Eur Acad Dermatol Venereol 2021; 36:e266-e268. [PMID: 34897821 DOI: 10.1111/jdv.17861] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Revised: 11/12/2021] [Accepted: 12/03/2021] [Indexed: 02/02/2023]
Affiliation(s)
- A Cristaudo
- Department of Clinical Dermatology, San Gallicano Dermatological Institute, IRCCS, Rome, Italy
| | - D Graceffa
- Department of Clinical Dermatology, San Gallicano Dermatological Institute, IRCCS, Rome, Italy
| | - F Pimpinelli
- Microbiology and Virology Unit, Dermatological Clinical and Research Department, San Gallicano Dermatological Institute, IRCCS, Rome, Italy
| | - F Sperati
- Biostatistics Unit, San Gallicano Dermatological Institute IRCCS, Rome, Italy
| | - G Spoletini
- General Surgery and Liver Transplantation, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - C Bonifati
- Department of Clinical Dermatology, San Gallicano Dermatological Institute, IRCCS, Rome, Italy
| | - R Pellini
- Department Otolaryngology Head and Neck Surgery, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - V Lora
- Department of Clinical Dermatology, San Gallicano Dermatological Institute, IRCCS, Rome, Italy
| | - M Pontone
- Microbiology and Virology Unit, Dermatological Clinical and Research Department, San Gallicano Dermatological Institute, IRCCS, Rome, Italy
| | - O Di Bella
- Medical Direction, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - D Bracco
- Medical Direction, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - A Morrone
- Scientific Direction, San Gallicano Dermatological Institute, IRCCS, Rome, Italy
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10
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Zangrilli A, Caldarola G, Bernardini N, Bavetta M, Graceffa D, Bonifati C, Cantoresi F, Faleri S, Giordano D, Mariani M, Micheli A, Moretta G, Pirro F, Pagnanelli G, Panasiti V, Provini A, Richetta A, Sacchelli L, Bianchi L, Peris K. Predictive factors of lack of response to adalimumab among bio-naive patients suffering from moderate-to severe psoriasis: analysis of a multicenter data collection in Italy. Expert Opin Biol Ther 2021; 21:1291-1298. [PMID: 34278889 DOI: 10.1080/14712598.2021.1948530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Efficacy of anti-TNF-a agents seems inferior to IL-17 and IL-23 inhibitors. Nevertheless, after biosimilars approval, anti TNF-a agents are recommended as first-line for psoriatic patients, for economic reasons. METHODS Predictive factors of response or non-response to adalimumab in bionaive patients who started adalimumab (originator or biosimilar) over 12 years in 9 dermatologic centers in Italy. Effectiveness was assessed with Psoriasis Area and Severity Index (PASI75 and PASI90) at weeks 12, 24 and 48. Multiple logistic regressions were used for variables predicting clinical response; Kaplan-Meier survival curves and Cox regression for drug survival. RESULTS The drug survival analysis showed reduced hazard ratio of overall discontinuation with male gender and scalp localization. In contrast, baseline PASI and genital psoriasis were significantly associated with increased risk of overall discontinuation. Predictive factors of non-response seemed elevated in patients with baseline PASI, older age groups, previously treated patients with phototherapy, females or patients with palmo-plantar while scalp psoriasis, previous cyclosporine and acitretin appeared as a positive predictive factor. CONCLUSIONS This real-life analysis might be useful for clinicians in case of bio-naive patients with moderate-to-severe psoriasis and various comorbidities.
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Affiliation(s)
- Arianna Zangrilli
- Department of Dermatology, University of Rome Tor Vergata, Rome, Italy
| | - Giacomo Caldarola
- Department of Dermatology, Università Cattolica Del Sacro Cuore, Rome, Italy.,Department of Dermatology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Nicoletta Bernardini
- Department of Medical-Surgical Sciences and Biotechnologies, Dermatology Unit "Daniele Innocenzi," Sapienza University of Rome, Rome, Italy
| | - Mauro Bavetta
- Department of Dermatology, University of Rome Tor Vergata, Rome, Italy
| | - Dario Graceffa
- Department of Dermatology, Istituto Dermatologico San Gallicano - IRCCS, Roma, Italy
| | - Claudio Bonifati
- Department of Dermatology, Istituto Dermatologico San Gallicano - IRCCS, Roma, Italy
| | - Franca Cantoresi
- Unit of Dermatology, Department of Internal Medicine and Medical Specialties, Sapienza University of Rome, Rome, Italy
| | - Sara Faleri
- Department of Dermatology, UOC DERMATOLOGIA dell'Ospedale Di Belcolle, Viterbo, Italy
| | - Domenico Giordano
- NESMOS Department, Dermatology Unit, Sant'Andrea Hospital, University of Rome Sapienza, Italy
| | - Marco Mariani
- Section of Hygiene, University Department of Health Sciences and Public Health, Università Cattolica Del Sacro Cuore, Rome, Italy
| | - Adriana Micheli
- Unità Di Dermatologia, Ospedale Nuovo Regina Magherita, Roma, Italy
| | - Gaia Moretta
- Department of Dermatology, Istituto Dermopatico dell'Immacolata - IRCCS, Roma, Italy
| | - Federico Pirro
- Department of Dermatology, Università Cattolica Del Sacro Cuore, Rome, Italy.,Department of Dermatology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Gianluca Pagnanelli
- Department of Dermatology, Istituto Dermopatico dell'Immacolata - IRCCS, Roma, Italy
| | - Vincenzo Panasiti
- Plastic and Reconstructive Surgery Unit, Campus Bio-Medico University, Rome, Italy
| | - Alessia Provini
- Department of Dermatology, Istituto Dermopatico dell'Immacolata - IRCCS, Roma, Italy
| | - Antonio Richetta
- Unit of Dermatology, Department of Internal Medicine and Medical Specialties, Sapienza University of Rome, Rome, Italy
| | - Lidia Sacchelli
- Department of Experimental, Diagnostic and Specialty Medicine, Dermatology Unit, University of Bologna, Bologna, Italy.,Dermatology, IRCCS Policlinico Di Sant'Orsola, University of Bologna, Bologna, Italy
| | - Luca Bianchi
- Department of Dermatology, University of Rome Tor Vergata, Rome, Italy
| | - Ketty Peris
- Department of Dermatology, Università Cattolica Del Sacro Cuore, Rome, Italy.,Department of Dermatology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
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11
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Bonifati C, Capoccia R, Graceffa D, Morrone A. Effectiveness of Systemic Therapies in Patients with Obesity and Psoriasis: A Single-center Retrospective Study. Acta Dermatovenerol Croat 2021; 29:88-93. [PMID: 34477074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
This retrospective study included 63 patients with obesity (Body Mass Index; BMI ≥ 30) and psoriasis. Our aim was to verify the effectiveness of different systemic therapies administered to the above cohort of subjects over a period of 1 year. Improvements of 75%, 90%. and 100% compared with the baseline Psoriasis Area Severity Index (PASI 75, PASI 90, and PASI 100, respectively) were used as clinical outcome measures. In a median time of 16 weeks, 85.7%, 68.2%, and 38.0% of patients achieved PASI 75, PASI 90, and PASI 100, respectively. In parallel, the Dermatology Life Quality Index (DLQI) and the visual analog score for measuring itch intensity (VAS itch) decreased significantly (P<0.0001 for both parameters). At the achievement of PASI 75, BMI increased as compared to baseline (P=0.02) and did not significantly vary at the attainment of PASI 90 and PASI 100 (P= 0.07 for both outcomes). Logistic multivariate regression analysis showed that treatment with biologic drugs was a positive predictor for achieving PASI 75, PASI 90, and PASI 100. BMI >31.7 and the presence of psoriatic arthritis were negative predictors for the achievement of PASI 90, while having a DLQI >6 was a positive predictor.
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12
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Graceffa D, Lora V, Cristaudo A, Elia F, Morrone A, Bonifati C. AB0563 DISCONTINUATION OF ANTI-TNFα IN PATIENTS WITH PSORIATIC ARTHRITIS: A SINGLE-CENTER EXPERIENCE. Ann Rheum Dis 2021. [DOI: 10.1136/annrheumdis-2021-eular.3002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background:TNF inhibitors have been largely demonstrated to be effective and reasonably safe for the treatment of psoriatic arthritis (PsA). Current EULAR guidelines recommend the use of an anti-TNF as first choice treatment in patients with PsA for whom a synthetic DMARD (usually methotrexate or leflunomide) is not efficacious or not well tolerated [1]. In a scenario where biologic treatments are easily available, and the treat to target strategy is widely accepted, a complete disease remission or at least a minimal disease activity are considered realistic goals to be achieved in a growing proportion of patients [2]. However, there remains very little research regarding anti-TNF discontinuation in patients who achieved a complete remission [3-5].Objectives:The primary aim of this study was to measure the disease-free interval after anti-TNF discontinuation, secondary it was investigated whether the use of Power Doppler Ultrasound (PDUS) and Contrast Enhanced Ultrasound (CEUS) could improve the diagnostic accuracy in the recognition of the relapse. Finally, we wanted to characterize the clinical features of the disease recurrence.Methods:From June 2018, 35 patients with PsA (27 males and 8 female) treated with anti-TNF, in stable remission were prospectively monitored for 1 year after treatment discontinuation. Remission was defined as documented absence of clinical and ultrasonographic signs of arthritis or enthesitis. Complete rheumatological and dermatological examinations were performed in all participants, at baseline and every 8-12 weeks: American College of Rheumatology (ACR) 66-68 joint count; Psoriasis Area Severity Index (PASI); patient pain visual analog score (VAS); patient global disease activity VAS; Health Assessment Questionnaire (HAQ); Leeds Enthesitis Index (LEI); Bath Ankylosing Spondylitis Disease Activity Index (BASDAI); Bath Ankylosing Spondylitis Functional Index (BASFI); Power Doppler Ultrasound (PDUS) of the involved joints and entheses, Contrast Enhanced Ultrasound (CEUS) of a selected joint or enthesis and laboratory inflammation tests.Results:31 out of the 35 enrolled patients, experienced a disease recurrence with an average disease-free interval of 27.9±21.1 weeks (Figure 1). In 3 patients the treatment was restored for a relapse of the skin psoriasis, 8 patients reported only axial symptoms of disease relapse and 20 patients had both axial and peripheral joints involvement (average DAPSA score of 23.6±11.1; average BASDAI score of 4.7±2.6; average BASFI score 4.5±2.9). In all cases the disease flare was moderate and all patients promptly regained remission after restarting the treatment. Both PDUS and CEUS were safe and reliable showing a good percentage of accordance (95,4%) in detecting synovitis and enthesitis.Conclusion:The rate of disease relapse of PsA after anti-TNF discontinuation is relevant. However the disease-free interval was not short. Retreatment with the same anti-TNF was effective and safe.References:[1]Gossec L, Baraliakos X, Kerschbaumer A, et al. EULAR recommendations for the management of psoriatic arthritis with pharmacological therapies: 2019 update. Ann Rheum Dis. 2020 Jun;79(6):700-712.[2]Dures E, Shepperd S, Mukherjee S, et al. Treat-to-target in PsA: methods and necessity. RMD Open. 2020 Feb;6(1):e001083.[3]Stober C, Ye W, Guruparan T, et al. Prevalence and predictors of tumour necrosis factor inhibitor persistence in psoriatic arthritis. Rheumatology (Oxford). 2018 Jan 1;57(1):158-163.[4]Huynh DH, Boyd TA, Etzel CJ, et al. Persistence of low disease activity after tumour necrosis factor inhibitor (TNFi) discontinuation in patients with psoriatic arthritis. RMD Open. 2017 Jan 16;3(1):e000395.[5]Ye W, Tucker LJ, Coates LC. Tapering and Discontinuation of Biologics in Patients with Psoriatic Arthritis with Low Disease Activity. Drugs. 2018 Nov;78(16):1705-1715.Disclosure of Interests:None declared.
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13
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Bonifati C, Morrone A, Cristaudo A, Graceffa D. Effectiveness of anti-interleukin 23 biologic drugs in psoriasis patients who failed anti-interleukin 17 regimens. A real-life experience. Dermatol Ther 2020; 34:e14584. [PMID: 33236471 DOI: 10.1111/dth.14584] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Revised: 11/16/2020] [Accepted: 11/21/2020] [Indexed: 12/29/2022]
Abstract
Among the most recent biologic drugs available for psoriasis therapy, those targeting interleukin-17 (secukinumab and ixekizumab) or its receptor (brodalumab) have been shown to be quickly effective. However, in those patients who failed one or more of the above-cited drugs, real-life data on the effectiveness of switching to one anti-interleukin-23 biologic (guselkumab, risankizumab, or tildrakizumab) are very scarce. Here, we report our experience in treating 12 multi-failure psoriatic patients, prospectively followed-up over 6 months, who showed a significant improvement in their psoriasis after switching from an anti-interleukn-17 to an anti-interleukin-23 drug.
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Affiliation(s)
- Claudio Bonifati
- Department of Clinical Dermatology; Center for the Study and Treatment of Psoriasis, San Gallicano Dermatological Institute, IRCCS, Rome, Italy
| | - Aldo Morrone
- Scientific Direction, San Gallicano Dermatological Institute IRCCS, Rome, Italy
| | - Antonio Cristaudo
- Department of Clinical Dermatology; Center for the Study and Treatment of Psoriasis, San Gallicano Dermatological Institute, IRCCS, Rome, Italy
| | - Dario Graceffa
- Department of Clinical Dermatology; Center for the Study and Treatment of Psoriasis, San Gallicano Dermatological Institute, IRCCS, Rome, Italy
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14
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Spoletini G, Bianco G, Graceffa D, Lai Q. Transplantation during the COVID-19 pandemic: nothing noble is accomplished without danger. BMC Gastroenterol 2020; 20:259. [PMID: 32762651 PMCID: PMC7407436 DOI: 10.1186/s12876-020-01401-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Accepted: 07/27/2020] [Indexed: 02/06/2023] Open
Abstract
The global health crisis due to the fast spread of coronavirus disease (COVID-19) has caused major disruption in all aspects of healthcare. Transplantation is one of the most affected sectors, as it relies on a variety of services that have been drastically occupied to treat patients affected by COVID-19. With this report from two transplant centers in Italy, we aim to reflect on resource organization, organ allocation, virus testing and transplant service provision during the course of the pandemic and to provide actionable information highlighting advantages and drawbacks.To what extent can we preserve the noble purpose of transplantation in times of increased danger? Strategies to minimize risk exposure to the transplant population and health- workers include systematic virus screening, protection devices, social distancing and reduction of patients visits to the transplant center. While resources for the transplant activity are inevitably reduced, new dilemmas arise to the transplant community: further optimization of time constraints during organ retrievals and implantation, less organs and blood products donated, limited space in the intensive care unit and the duty to maintain safety and outcomes.
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Affiliation(s)
- Gabriele Spoletini
- General Surgery and Liver Transplantation, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo Agostino Gemelli 8, 00168, Rome, Italy.
| | - Giuseppe Bianco
- General Surgery and Liver Transplantation, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo Agostino Gemelli 8, 00168, Rome, Italy
| | - Dario Graceffa
- Centre for the Study and Treatment of Psoriasis, Department of Clinical Dermatology, San Gallicano Dermatological Institute, IRCCS, Rome, Italy
| | - Quirino Lai
- Hepatobiliary and Organ Transplantation Unit, Sapienza University of Rome, Umberto I Polyclinic of Rome, Rome, Italy
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15
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Lai Q, Spoletini G, Bianco G, Graceffa D, Agnes S, Rossi M, Lerut J. SARS-CoV2 and immunosuppression: A double-edged sword. Transpl Infect Dis 2020; 22:e13404. [PMID: 32639598 PMCID: PMC7361075 DOI: 10.1111/tid.13404] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2020] [Accepted: 06/29/2020] [Indexed: 12/15/2022]
Abstract
Severe acute respiratory syndrome Coronavirus 2 (SARS‐Cov2) outbreak has caused a pandemic rapidly impacting on the way of life of the entire world. This impact in the specific setting of transplantation and immunosuppression has been poorly explored to date. Discordant data exist on the impact of previous coronavirus outbreaks on immunosuppressed patients. Overall, only a very limited number of cases have been reported in literature, suggesting that transplanted patients not necessarily present an increased risk of severe SARS‐Cov2‐related disease compared to the general population. We conducted a literature review related to the impact of immunosuppression on coronavirus infections including case reports and series describing immunosuppression management in transplant recipients. The role of steroids, calcineurin inhibitors, and mycophenolic acid has been explored more in detail. A point‐in‐time snapshot of the yet released literature and some considerations in relation to the use of immunosuppression in SARS‐Cov2 infected transplant recipients are provided here for the physicians dealing with immunocompromised patients.
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Affiliation(s)
- Quirino Lai
- Hepatobiliary and Organ Transplantation Unit, Sapienza University of Rome, Umberto I Polyclinic of Rome, Rome, Italy
| | - Gabriele Spoletini
- General Surgery and Liver Transplantation, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Giuseppe Bianco
- General Surgery and Liver Transplantation, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Dario Graceffa
- Centre for the Study and Treatment of Psoriasis, Department of Clinical Dermatology, San Gallicano Dermatological Institute, IRCCS, Rome, Italy
| | - Salvatore Agnes
- General Surgery and Liver Transplantation, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Massimo Rossi
- General Surgery and Liver Transplantation, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Jan Lerut
- Institute for Experimental and Clinical Research *IREC - Université catholique de Louvain - UCL, Brussels, Belgium
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16
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Graceffa D, Bonifati C, Pacifico A, Morrone A. When the old works better than the new: A case of severe nail psoriasis successfully treated with acitretin after failure of two biologic regimens. Dermatol Ther 2020; 33:e13615. [DOI: 10.1111/dth.13615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Revised: 05/08/2020] [Accepted: 05/14/2020] [Indexed: 11/30/2022]
Affiliation(s)
- Dario Graceffa
- Centre for the Study and Treatment of Psoriasis at the Department of Clinical Dermatology San Gallicano Dermatological Institute IRCCS Rome Italy
| | - Claudio Bonifati
- Centre for the Study and Treatment of Psoriasis at the Department of Clinical Dermatology San Gallicano Dermatological Institute IRCCS Rome Italy
| | - Alessia Pacifico
- Centre for the Study and Treatment of Psoriasis at the Department of Clinical Dermatology San Gallicano Dermatological Institute IRCCS Rome Italy
| | - Aldo Morrone
- Scientific Direction, San Gallicano Dermatological Institute IRCCS Rome Italy
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17
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De Felice C, Graceffa D, Morrone A, Bonifati C. Familial pityriasis rubra pilaris successfully treated with brodalumab. Int J Dermatol 2020; 59:885-887. [DOI: 10.1111/ijd.14857] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Revised: 02/24/2020] [Accepted: 02/28/2020] [Indexed: 12/29/2022]
Affiliation(s)
- Catia De Felice
- Centre for the Study and Treatment of Psoriasis at the Department of Clinical Dermatology San Gallicano Dermatological Institute IRCCS Rome Italy
| | - Dario Graceffa
- Centre for the Study and Treatment of Psoriasis at the Department of Clinical Dermatology San Gallicano Dermatological Institute IRCCS Rome Italy
| | - Aldo Morrone
- Scientific Direction San Gallicano Dermatological Institute IRCCS Rome Italy
| | - Claudio Bonifati
- Centre for the Study and Treatment of Psoriasis at the Department of Clinical Dermatology San Gallicano Dermatological Institute IRCCS Rome Italy
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18
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Graceffa D, Bonifati C, Lora V, Saraceni PL, De Felice C, Chimenti MS, Perricone R, Morrone A. Ultrasound assessment of enthesis thickness in psoriasis and psoriatic arthritis: A cross-sectional study. Indian J Dermatol Venereol Leprol 2019; 85:175-181. [PMID: 29547136 DOI: 10.4103/ijdvl.ijdvl_205_17] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background The inflammatory involvement of the enthesis in the course of psoriasis is accompanied by structural abnormalities detectable by ultrasound. The most common of these abnormalities is the thickening of the tendon at the insertion site. Aims The aim of the present study was to compare the thickness of entheses of patients with psoriatic arthritis, only skin psoriasis, and healthy controls. Methods A cross-sectional study was conducted in a cohort of patients affected with either only skin psoriasis or psoriatic arthritis as well as in a control group. Eight entheses sites were scanned by ultrasound bilaterally. The following entheseal characteristics were collected and recorded in a predefined database: entheseal thickness, bone erosions, enthesis calcifications (enthesophytes), presence of blood flow, and presence of bursitis. All the detected entheseal changes were scored, and the data was statistically analyzed. Results The major differences in enthesis thickness between only skin psoriasis and psoriatic arthritis patients were found at the following sites: (i) olecranon tuberosity, (ii) superior pole of the patella, and (iii) medial epicondyle of femur. The thickness of the medial collateral ligament at the site of the femoral origin was increased in psoriatic arthritis, but not in both only skin psoriasis and healthy controls. The score obtained by adding the thickness of all the 8 examined entheses for each patient showed significant differences among the three groups (psoriatic arthritis: 81.3; only skin psoriasis 74.4; Controls: 67.6; P < 0.0001). Interestingly, we found that in psoriatic arthritis patients, the highest enthesis thickening was seen in entheses affected by bone erosions. Limitations The small sample of patients studied is a limiting factor in this study. Conclusions Our data demonstrated that the ultrasound measurement of the enthesis thickness enables a distinction between patients with psoriatic arthritis from those with only skin psoriasis. It is a useful method to improve diagnostic accuracy, especially in patients without clear clinical signs of enthesitis.
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Affiliation(s)
- Dario Graceffa
- Department of Clinical Dermatology, San Gallicano Dermatological Institute, Via Elio Chianesi 53, 00144, Rome, Italy
| | - Claudio Bonifati
- Department of Clinical Dermatology, San Gallicano Dermatological Institute, Via Elio Chianesi 53, 00144, Rome, Italy
| | - Viviana Lora
- Department of Clinical Dermatology, San Gallicano Dermatological Institute, Via Elio Chianesi 53, 00144, Rome, Italy
| | - Pier Luigi Saraceni
- Department of Clinical Dermatology, San Gallicano Dermatological Institute, Via Elio Chianesi 53, 00144, Rome, Italy
| | - Catia De Felice
- Department of Clinical Dermatology, San Gallicano Dermatological Institute, Via Elio Chianesi 53, 00144, Rome, Italy
| | - Maria Sole Chimenti
- Department of "Medicina dei Sistemi", Rheumatology, Allergology and Clinical Immunology, University of Rome Tor Vergata, Viale Oxford, 81, 00100 Rome, Italy
| | - Roberto Perricone
- Department of "Medicina dei Sistemi", Rheumatology, Allergology and Clinical Immunology, University of Rome Tor Vergata, Viale Oxford, 81, 00100 Rome, Italy
| | - Aldo Morrone
- Department of Clinical Dermatology, San Gallicano Dermatological Institute, Via Elio Chianesi 53, 00144, Rome, Italy
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19
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Chimenti MS, Esposito M, Graceffa D, Teoli M, Peluso G, Birra D, Moretta G, Galossi A, Carboni V, Sensi F, Mazzotta A, Caccavale R, Bernardini N, Sessa P, Richetta A, Del Duca E, Urbani S, Persechino S, De Simone C, Bonifati C, Gremese E, Peris K, Perricone R. PsA-Disk, a novel visual instrument to evaluate psoriatic arthritis in psoriatic patients: an Italian derma-rheuma multicentre study. Ther Adv Chronic Dis 2019; 10:2040622319847056. [PMID: 31205645 PMCID: PMC6535736 DOI: 10.1177/2040622319847056] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Accepted: 03/04/2019] [Indexed: 11/15/2022] Open
Abstract
Background: Consensus among dermatologists and rheumatologists in the diagnosis and
assessment of musculoskeletal diseases in psoriasis (PsO) patients is
needed. This study assesses characteristics of musculoskeletal pain in
patients with PsO for the presence of psoriatic arthritis (PsA) and
evaluation of a novel 16-item visual instrument (PsA-Disk). Methods: Data were collected from eight dermatological/rheumatological centres across
Italy. Patients with PsO completed PEST (Psoriasis Epidemiology Screening
Tool) and PsA-Disk questionnaires during the first visit. A rheumatological
visit was performed to confirm the presence of PsA. Both validity and
reliability of PsA-Disk were assessed. Results: A total of 573 patients with PsO were examined at the first visit, and 120
(21%) were diagnosed with PsA. Patients with PsA compared with patients with
PsO (n = 119) presented statistically significant
differences for: nail involvement, PEST score ⩾3, higher erythrocyte
sedimentation rate (ESR), Nail Psoriasis Severity Index (NAPSI)-feet,
NAPSI-(hands + feet) and PsA-Disk scores (73.9 ± 32.1
versus 58.1 ± 39.8, p < 0.001).
Patients with PsA with knee arthritis had higher PsA-Disk scores (98.4 ± 26
versus 71.5 ± 31.9, p = 0.006) that
were also correlated with number of swollen (r = 0.2,
p < 0.05) and tender joints (r =
0.24, p = 0.021), patient (r = 0.4,
p < 0.001) and physician-pain-visual analogue scale
(VAS; r = 0.33, p < 0.001), patient
global assessment (PGA)-VAS (r = 0.23, p =
0.025), physician-health assessment questionnaire (HAQ; r =
0.38, p = 0.011), Disease Activity Score (DAS)-44
(r = 0.25, p = 0.023) and Disease
Activity in Psoriatic Arthritis (DAPSA; r = 0.31,
p = 0.005). The instrument had excellent reliability in
terms of internal consistency (Cronbach’s alpha = 0.90) and stability
(intraclass correlation = 0.98). Moderate agreement between PsA-Disk and
PEST (Cohen’s kappa = 0.46) was observed, while construct validity appeared
appropriate [PsA + patients: PsA-Disk score (interquartile range; IQR) =71
(50–96); PsA-patients: PsA-Disk score (IQR)=50 (20–90); p
< 0.001]. Conclusion: PsA-Disk may be considered a valid novel instrument aiding both
dermatologists and rheumatologists in the rapid detection and assessment of
musculoskeletal disease characteristics.
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Affiliation(s)
- Maria Sole Chimenti
- Department of Systems Medicine, Rheumatology, Allergology and Clinical Immunology, University of Rome 'Tor Vergata', Viale Oxford 81, Rome, 00133, Italy
| | - Maria Esposito
- Department of Dermatology, University of Rome, 'Tor Vergata', Rome, Italy
| | - Dario Graceffa
- Istituto Dermatologico San Gallicano, IRCCS, Rome, Italy
| | - Miriam Teoli
- Department of Dermatology, University of Rome, 'Tor Vergata', Rome, Italy
| | - Giusy Peluso
- Institute of Rheumatology and Affine Sciences, Division of Rheumatology, Catholic University of the Sacred Heart, Rome, Italy
| | - Domenico Birra
- Institute of Rheumatology and Affine Sciences, Division of Rheumatology, Catholic University of the Sacred Heart, Rome, Italy
| | - Gaia Moretta
- Institute of Dermatology, Catholic University of the Sacred Heart, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | | | | | - Felice Sensi
- Reumatologia, Ospedale San Camillo-Forlanini, Rome, Italy
| | | | - Rosalba Caccavale
- Dipartimento di Scienze e Biotecnologie Medico-Chirurgiche, Sapienza Università di Roma, Polo Pontino, Latina, Italy
| | - Nicoletta Bernardini
- Dermatology Unit "Daniele Innocenzi", Department of Medical-Surgical Sciences and Bio-Technologies, Sapienza University of Rome, Fiorini Hospital, Polo Pontino, Terracina, Italy
| | - Paola Sessa
- Reumatologia, Dipartimento di Medicina Interna e Specialità Mediche, Sapienza Università di Roma, Italy
| | - Antonio Richetta
- Dermatologia, Dipartimento di Medicina Interna e Specialità Mediche Policlinico Umberto I, Rome, Italy
| | - Ester Del Duca
- Department of Dermatology, University of Rome, 'Tor Vergata', Rome, Italy
| | - Sara Urbani
- Department of Systems Medicine, Rheumatology, Allergology and Clinical Immunology, University of Rome 'Tor Vergata', Rome, Italy
| | - Severino Persechino
- Dermatology Unit, NESMOS Department, S. Andrea Hospital, Sapienza Università di Roma, Rome Italy
| | - Clara De Simone
- Institute of Dermatology, Catholic University of the Sacred Heart, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | | | - Elisa Gremese
- Institute of Rheumatology and Affine Sciences, Division of Rheumatology, Catholic University of the Sacred Heart, Rome, Italy
| | - Ketty Peris
- Institute of Dermatology, Catholic University of the Sacred Heart, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Roberto Perricone
- Department of Systems Medicine, Rheumatology, Allergology and Clinical Immunology, University of Rome 'Tor Vergata', Rome, Italy
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Bonifati C, De Felice C, Lora V, Morrone A, Graceffa D. Effectiveness of etanercept biosimilar SB4 in maintaining low disease activity in patients with psoriatic arthritis switched from etanercept originator: an open-label one year study. J DERMATOL TREAT 2019; 31:687-691. [DOI: 10.1080/09546634.2019.1606886] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Affiliation(s)
- C. Bonifati
- Department of Clinical Dermatology, Centre for the Study and Treatment of Psoriasis, San Gallicano Dermatological Institute, IRCCS, Rome, Italy
| | - C. De Felice
- Department of Clinical Dermatology, Centre for the Study and Treatment of Psoriasis, San Gallicano Dermatological Institute, IRCCS, Rome, Italy
| | - V. Lora
- Department of Clinical Dermatology, Centre for the Study and Treatment of Psoriasis, San Gallicano Dermatological Institute, IRCCS, Rome, Italy
| | - A. Morrone
- Scientific Direction, San Gallicano Dermatological Institute, IRCCS, Rome, Italy
| | - D. Graceffa
- Department of Clinical Dermatology, Centre for the Study and Treatment of Psoriasis, San Gallicano Dermatological Institute, IRCCS, Rome, Italy
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Lora V, Graceffa D, De Felice C, Morrone A, Bonifati C. Treatment of severe psoriasis with ixekizumab in a liver transplant recipient with concomitant hepatitis B virus infection. Dermatol Ther 2019; 32:e12909. [PMID: 30964590 DOI: 10.1111/dth.12909] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Revised: 04/01/2019] [Accepted: 04/05/2019] [Indexed: 12/16/2022]
Abstract
Treatment of severe psoriasis (PsO) in organ transplant (OT) patients is difficult. In fact, systemic drugs used for PsO therapy can be detrimental to transplanted organs and/or can increase the risk of serious infections in subjects already taking antireject medicines. Current guidelines fail to give indications on how to manage PsO OT subjects. Moreover, only a few cases of patients with the above-cited characteristics treated with systemic therapies have been published so far. Here, we report our experience concerning a liver transplant patient successfully treated with ixekizumab for his psoriasis throughout 1 year.
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Affiliation(s)
- Viviana Lora
- Department of Clinical Dermatology, Centre for the Study and Treatment of Psoriasis, San Gallicano Dermatological Institute, IRCCS, Rome, Italy
| | - Dario Graceffa
- Department of Clinical Dermatology, Centre for the Study and Treatment of Psoriasis, San Gallicano Dermatological Institute, IRCCS, Rome, Italy
| | - Catia De Felice
- Department of Clinical Dermatology, Centre for the Study and Treatment of Psoriasis, San Gallicano Dermatological Institute, IRCCS, Rome, Italy
| | - Aldo Morrone
- Scientific Direction, San Gallicano Dermatological Institute, IRCCS, Rome, Italy
| | - Claudio Bonifati
- Department of Clinical Dermatology, Centre for the Study and Treatment of Psoriasis, San Gallicano Dermatological Institute, IRCCS, Rome, Italy
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22
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Graceffa D, De Felice C, Lora V, Morrone A, Bonifati C. Successful treatment of psoriatic arthritis with apremilast in a mixed connective tissue disease patient. GIORN ITAL DERMAT V 2019; 155:373-375. [PMID: 30636395 DOI: 10.23736/s0392-0488.18.06042-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Dario Graceffa
- Department of Clinical Dermatology, San Gallicano Dermatologic IRCCS Institute, Rome, Italy -
| | - Catia De Felice
- Department of Clinical Dermatology, San Gallicano Dermatologic IRCCS Institute, Rome, Italy
| | - Viviana Lora
- Department of Clinical Dermatology, San Gallicano Dermatologic IRCCS Institute, Rome, Italy
| | - Aldo Morrone
- Department of Clinical Dermatology, San Gallicano Dermatologic IRCCS Institute, Rome, Italy
| | - Claudio Bonifati
- Department of Clinical Dermatology, San Gallicano Dermatologic IRCCS Institute, Rome, Italy
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Innamorati M, Quinto RM, Lester D, Iani L, Graceffa D, Bonifati C. Cognitive impairment in patients with psoriasis: A matched case-control study. J Psychosom Res 2018; 105:99-105. [PMID: 29332640 DOI: 10.1016/j.jpsychores.2017.12.011] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2017] [Revised: 12/06/2017] [Accepted: 12/22/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND In the past decade, a few studies have suggested that psoriasis could be associated with the presence of mild cognitive deficits. OBJECTIVES The aim of the present matched case-control study was to investigate several cognitive domains (executive functions, verbal memory, attention, and language) in a sample of outpatients with psoriasis. We also investigated whether cognitive impairment was associated with poor health-related quality of life (HRQoL) in patients with psoriasis. METHODS Fifty adult outpatients and 50 age- and sex-matched healthy controls were administered a battery of neuropsychological tests investigating major cognitive domains, psychopathology (anxiety and depression), alexithymia, and HRQoL. RESULTS At the bivariate level, psoriasis patients (compared to healthy controls) performed worse on most of the neuropsychological tests, and they also reported more anxiety and depressive symptoms, higher scores for alexithymia, and worse physical and mental health. At the multivariate level, cognitive performance was independently associated with psoriasis even when controlling for psychopathology and alexithymia. CONCLUSIONS Patients with psoriasis show impaired cognitive performance, high levels of anxiety and depression, and impaired quality of life. Based on the current results, clinicians should assess the presence of psychological symptoms in their patients and evaluate whether the presence of cognitive deficits is limiting the patients' ability to cope with the disease.
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Affiliation(s)
- Marco Innamorati
- Department of Human Sciences, European University of Rome, Rome, Italy.
| | - Rossella M Quinto
- Department of Human Sciences, European University of Rome, Rome, Italy
| | | | - Luca Iani
- Department of Human Sciences, European University of Rome, Rome, Italy
| | - Dario Graceffa
- Center for the Study and Treatment of Psoriasis, San Gallicano Dermatologic Institute, IRCCS, Rome, Italy
| | - Claudio Bonifati
- Center for the Study and Treatment of Psoriasis, San Gallicano Dermatologic Institute, IRCCS, Rome, Italy
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24
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Lora V, De Felice C, Cota C, Graceffa D, Morrone A, Bonifati C. A case of juvenile pityriasis rubra pilaris type III successfully treated with etanercept. Dermatol Ther 2017; 31. [PMID: 29193567 DOI: 10.1111/dth.12577] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2017] [Revised: 09/11/2017] [Accepted: 11/01/2017] [Indexed: 12/01/2022]
Affiliation(s)
- Viviana Lora
- Department of Clinical Dermatology, San Gallicano Dermatologic Institute, IRCCS, Rome, Italy
| | - Catia De Felice
- Center for the Study and Treatment of Psoriasis, San Gallicano Dermatologic Institute, IRCCS, Rome, Italy
| | - Carlo Cota
- Dermatopathological Laboratory, San Gallicano Dermatologic Institute, IRCCS, Rome, Italy
| | - Dario Graceffa
- Center for the Study and Treatment of Psoriasis, San Gallicano Dermatologic Institute, IRCCS, Rome, Italy
| | - Aldo Morrone
- Department of Clinical Dermatology, San Gallicano Dermatologic Institute, IRCCS, Rome, Italy
| | - Claudio Bonifati
- Center for the Study and Treatment of Psoriasis, San Gallicano Dermatologic Institute, IRCCS, Rome, Italy
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Bonifati C, Lora V, Graceffa D. Doubling golimumab doses did not improve skin disease in two obese patients with psoriatic arthritis. Ital J Dermatol Venerol 2017; 152:670-672. [PMID: 29050449 DOI: 10.23736/s0392-0488.16.05338-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Claudio Bonifati
- Center for the Study and Treatment of Psoriasis, San Gallicano Dermatologic Institute for Research and Care, Rome, Italy -
| | - Viviana Lora
- Center for the Study and Treatment of Psoriasis, San Gallicano Dermatologic Institute for Research and Care, Rome, Italy
| | - Dario Graceffa
- Center for the Study and Treatment of Psoriasis, San Gallicano Dermatologic Institute for Research and Care, Rome, Italy
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26
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Bonifati C, Graceffa D, Lora V, Maiani E. Clinical characteristics and systemic therapies administered to first-time patients at a tertiary psoriasis outpatient clinic. GIORN ITAL DERMAT V 2016; 151:596-602. [PMID: 26505567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
BACKGROUND The aim of this study was to describe the clinical characteristics and the systemic therapies given to a cohort of patients attending for the first time our tertiary psoriasis outpatient clinic. METHODS Data were extracted from an electronic database where the patients, mostly eligible for systemic therapies, are consecutively recorded. Based on skin disease severity the subjects were classified into three groups: group 1, mild psoriasis (MP; Psoriasis Area Severity Index [PASI]≤5); group 2, mild-to-moderate psoriasis (MMP; 5<PASI<10); group 3, moderate-to-severe psoriasis (MSP; PASI>10). RESULTS Of the 289 patients studied, 88 (30.4%) presented with MP, 91 (31.5%) with MMP, and 110 (38%) with MSP, 89 (30.8%) of whom were affected by psoriatic arthritis. Of the 289 patients, 267 (92.3%) were deemed eligible for a systemic treatment, and 228 (85.4%) of them started a systemic treatment as monotherapy. The therapies administered were as follows: cyclosporine to 65 (28.5%); methotrexate to 59 (25.8%); etanercept to 33 (44%); adalimumab to 25 (33.3%); ustekinumab to 17 (22.6%); acitretin to 29 (12.7%); golimumab to one (1.3%). CONCLUSIONS Our data show a composite distribution of patients eligible for a systemic therapy and attending for the first time our center. The traditional drugs were more frequently administered (67.1%) as compared to biological ones (32.9%).
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Affiliation(s)
- Claudio Bonifati
- Center for the Study and Treatment of Psoriasis, Department of Clinical Dermatology, San Gallicano Dermatologic Institute for Scientific Research, Rome, Italy -
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27
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Innamorati M, Quinto RM, Imperatori C, Lora V, Graceffa D, Fabbricatore M, Lester D, Contardi A, Bonifati C. Health-related quality of life and its association with alexithymia and difficulties in emotion regulation in patients with psoriasis. Compr Psychiatry 2016; 70:200-8. [PMID: 27565774 DOI: 10.1016/j.comppsych.2016.08.001] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2016] [Revised: 07/27/2016] [Accepted: 08/01/2016] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND Health-related quality of life (HRQoL) in psoriasis patients could be negatively affected by medical (e.g., obesity) and psychological (e.g., depression, anxiety, and alexithymia) conditions the presence of which suggests difficulties in understanding and regulating inner states and emotions. Thus, the aim of this study was to investigate HRQoL and its association with obesity and difficulties in understanding and regulating inner states and emotions in patients with psoriasis. A second objective was to examine whether the presence of difficulties in understanding and regulating inner states and emotions may mediate the association between psoriasis and poor HRQoL. METHOD One hundred adult outpatients and 97 healthy controls were administered a checklist assessing major socio-demographic variables, and measures of HRQoL, difficulties in emotion regulation, alexithymia, anxiety, depression, and food craving. RESULTS Psoriasis patients (compared to controls) reported more frequently obesity, alexithymia, anxiety, depression and food craving, and reported lower scores on the mental and physical components of HRQoL. A mediation model, with mental health as the dependent variable, indicated significant direct and indirect (through BMI, difficulties in emotion regulation, anxiety, depression, and food craving) effects of psoriasis on the quality of life, so that psoriasis was associated with worse mental health. A second mediation model with physical health as dependent variable indicated only a significant indirect effect (through BMI and depression) of psoriasis on the quality of life. CONCLUSIONS Psoriasis is characterized by poor HRQoL and the presence of difficulties in understanding and regulating inner states and emotions. In patients with psoriasis the possible influence of food craving on abnormal eating habits should be carefully assessed.
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Affiliation(s)
- Marco Innamorati
- Department of Human Sciences, European University of Rome, Via degli Aldobrandeschi 190, 00163 Rome, Italy.
| | - Rossella M Quinto
- Department of Human Sciences, European University of Rome, Via degli Aldobrandeschi 190, 00163 Rome, Italy
| | - Claudio Imperatori
- Department of Human Sciences, European University of Rome, Via degli Aldobrandeschi 190, 00163 Rome, Italy
| | - Viviana Lora
- Center for the Study and Treatment of Psoriasis, San Gallicano Dermatologic Institute, IRCCS, Via Elio Chianesi 53, 00144 Rome, Italy
| | - Dario Graceffa
- Center for the Study and Treatment of Psoriasis, San Gallicano Dermatologic Institute, IRCCS, Via Elio Chianesi 53, 00144 Rome, Italy
| | | | | | - Anna Contardi
- Department of Human Sciences, European University of Rome, Via degli Aldobrandeschi 190, 00163 Rome, Italy
| | - Claudio Bonifati
- Center for the Study and Treatment of Psoriasis, San Gallicano Dermatologic Institute, IRCCS, Via Elio Chianesi 53, 00144 Rome, Italy
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Bonifati C, Lora V, Graceffa D, Nosotti L. Management of psoriasis patients with hepatitis B or hepatitis C virus infection. World J Gastroenterol 2016; 22:6444-6455. [PMID: 27605880 PMCID: PMC5006156 DOI: 10.3748/wjg.v22.i28.6444] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2016] [Revised: 05/25/2016] [Accepted: 06/15/2016] [Indexed: 02/06/2023] Open
Abstract
The systemic therapies available for the management of Psoriasis (PsO) patients who cannot be treated with more conservative options, such as topical agents and/or phototherapy, with the exception of acitretin, can worsen or reactivate a chronic infection. Therefore, before administering immunosuppressive therapies with either conventional disease-modifying drugs (cDMARDs) or biological ones (bDMARDs) it is mandatory to screen patients for some infections, including hepatitis B virus (HBV) and hepatitis C virus (HCV). In particular, the patients eligible to receive an immunosuppressive drug must be screened for the following markers: antibody to hepatitis B core, antibody to hepatitis B surface antigen (anti-HBsAg), HBsAg, and antibody to HCV (anti-HCV). In case HBV or HCV infection is diagnosed, a close collaboration with a consultant hepatologist is needed before and during an immunosuppressive therapy. Concerning therapy with immunosuppressive drugs in PsO patients with HBV or HCV infection, data exist mainly for cyclosporine a (CyA) or bDMARDs (etanercept, adalimumab, infliximab, ustekinumab). The natural history of HBV and HCV infection differs significantly as well as the effect of immunosuppression on the aforementioned infectious diseases. As a rule, in the case of active HBV infection, systemic immunosuppressive antipsoriatic therapies must be deferred until the infection is controlled with an adequate antiviral treatment. Inactive carriers need to receive antiviral prophylaxis 2-4 wk before starting immunosuppressive therapy, to be continued after 6-12 mo from its suspension. Due to the risk of HBV reactivation, these patients should be monitored monthly for the first 3 mo and then every 3 mo for HBV DNA load together with transaminases levels. Concerning the patients who are occult HBV carriers, the risk of HBV reactivation is very low. Therefore, these patients generally do not need antiviral prophylaxis and the sera HBsAg and transaminases dosing can be monitored every 3 mo. Concerning PsO patients with chronic HCV infection their management with immunosuppressive drugs is less problematic as compared to those infected by HBV. In fact, HCV reactivation is an extremely rare event after administration of drugs such as CyA or tumor necrosis factor-α inhibitors. As a rule, these patients can be monitored measuring HCV RNA load, and ALT, aspartate transaminase, gamma-glutamyl-transferase, bilirubin, alkaline phosphatase, albumin and platelet every 3-6 mo. The present article provides an updated overview based on more recently reported data on monitoring and managing PsO patients who need systemic antipsoriatic treatment and have HBV or HCV infection as comorbidity.
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Solivetti FM, Guerrisi A, Salducca N, Desiderio F, Graceffa D, Capodieci G, Romeo P, Sperduti I, Canitano S. Appropriateness of knee MRI prescriptions: clinical, economic and technical issues. Radiol Med 2015; 121:315-22. [DOI: 10.1007/s11547-015-0606-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2015] [Accepted: 11/09/2015] [Indexed: 10/22/2022]
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30
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Affiliation(s)
- Claudio Bonifati
- Department of Clinical Dermatology; Center for the Study and Treatment of Psoriasis, San Gallicano Dermatologic Institute, IRCCS; Via Elio Chianesi 53 Rome 00144 Italy
| | - Dario Graceffa
- Department of Clinical Dermatology; Center for the Study and Treatment of Psoriasis, San Gallicano Dermatologic Institute, IRCCS; Via Elio Chianesi 53 Rome 00144 Italy
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Graceffa D, Maiani E, Sperduti I, Ceralli F, Bonifati C. Clinical remission of psoriatic arthritis in patients receiving continuous biological therapies for 1 year: the experience of an outpatient dermatological clinic for psoriasis. Clin Exp Dermatol 2014; 40:136-41. [DOI: 10.1111/ced.12504] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/24/2014] [Indexed: 01/14/2023]
Affiliation(s)
- D. Graceffa
- Centre for the Study and Treatment of Psoriasis at the Department of Clinical Dermatology; San Gallicano Dermatologic Institute; IRCCS; 00144 Rome Italy
| | - E. Maiani
- Centre for the Study and Treatment of Psoriasis at the Department of Clinical Dermatology; San Gallicano Dermatologic Institute; IRCCS; 00144 Rome Italy
| | - I. Sperduti
- Biostatistic Division; Scientific Direction; San Gallicano Dermatologic Institute; IRCCS; 00144 Rome Italy
| | - F. Ceralli
- Department of Rheumatology; San Camillo-Forlanini Hospital; Rome Italy
| | - C. Bonifati
- Centre for the Study and Treatment of Psoriasis at the Department of Clinical Dermatology; San Gallicano Dermatologic Institute; IRCCS; 00144 Rome Italy
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Chimenti M, Esposito M, Giunta A, Graceffa D, Babino G, Teoli M, Mazzotta A, Perricone R, Chimenti S. Remission of Psoriatic Arthritis after Etanercept Discontinuation: Analysis of Patients' Clinical Characteristics Leading to Disease Relapse. Int J Immunopathol Pharmacol 2013; 26:833-8. [DOI: 10.1177/039463201302600333] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Psoriatic arthritis is a chronic, inflammatory, disabling arthritis affecting up to 30% of psoriatic patients. Recently, it has been demonstrated that tumor necrosis factor alpha (TNF-α) plays a pivotal role in inducing and maintaining joint damage and that molecules that block this cytokine are effective in the treatment of psoriatic arthritis. Etanercept is a recombinant fusion protein acting as a competitive inhibitor of TNF-α, and numerous clinical trials have demonstrated its efficacy in determining psoriatic arthritis remission. However, specific criteria defining psoriatic arthritis remission have not been delineated and few data describing the length of the remission after etanercept discontinuation are available. The aim of this observational, retrospective study was to assess post-remission efficacy maintenance and relapse characteristics after etanercept interruption in patients with moderate-to-severe peripheral psoriatic arthritis (PsA) and cutaneous involvement.
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Affiliation(s)
- M.S. Chimenti
- Rheumatology, Allergology and Clinical Immunology, Department of Internal Medicine, Unit of Rheumatology, University of Rome Tor Vergata, Rome Italy
| | - M. Esposito
- Department of Dermatology, University of Rome Tor Vergata, Rome, Italy
| | - A. Giunta
- Department of Dermatology, University of Rome Tor Vergata, Rome, Italy
| | - D. Graceffa
- Rheumatology, Allergology and Clinical Immunology, Department of Internal Medicine, Unit of Rheumatology, University of Rome Tor Vergata, Rome Italy
| | - G. Babino
- Department of Dermatology, University of Rome Tor Vergata, Rome, Italy
| | - M. Teoli
- Department of Dermatology, University of Rome Tor Vergata, Rome, Italy
| | - A. Mazzotta
- Department of Dermatology, University of Rome Tor Vergata, Rome, Italy
| | - R. Perricone
- Rheumatology, Allergology and Clinical Immunology, Department of Internal Medicine, Unit of Rheumatology, University of Rome Tor Vergata, Rome Italy
| | - S. Chimenti
- Department of Dermatology, University of Rome Tor Vergata, Rome, Italy
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Solivetti FM, Elia F, Graceffa D, Di Carlo A. Ultrasound morphology of inguinal lymph nodes may not herald an associated pathology. J Exp Clin Cancer Res 2012; 31:88. [PMID: 23078807 PMCID: PMC3551661 DOI: 10.1186/1756-9966-31-88] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/13/2012] [Accepted: 09/28/2012] [Indexed: 11/17/2022]
Abstract
Background Among patients undergoing follow-up after surgery for melanoma, ultrasound (US) very often reveals lymph nodes in groin area, that do not show clear characters of a metastatic lesion yet that have atypical US features, which could result in diagnostic uncertainty. We evaluated such lesions among a cohort of patients. Methods The study population consisted of patients who presented consecutively to our facility for a control between 1 January 2009 and 30 July 2010 and who had undergone surgery for a melanoma, at least 6 months earlier, in areas draining to lymph nodes of the groin but choosing – for this study - the opposite side to the natural drainage. The following parameters of the US performed on the lymph nodes were evaluated: number and size, aspects of the outline, including any extroflexion of the outline and contours morphology, homogeneity and thickness of the cortex and aspects of the hilus, characteristics of the vascularisation of the lymph node at color-power Doppler. A second US examination was performed on the same area after at least 12 months. Results and conclusions We found a very high number of patients (42/124) with lymph nodes that did not appear to be fully normal at US examination, particularly those with structural alterations in the hilus and slight loss of physiologic curvature of the outlines, with moderate thickening of the cortex. Of the 124 patients, who were followed for at least one year, 42 showed these characteristics, and none of these showed any progression to malignancy at follow-up. Based on these results, we can conclude that focusing excessively on such US findings could lead to the inappropriate performance of additional diagnostic tests, with a consequent increase in management costs and a worsening of the quality of life for these patients.
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Chimenti MS, Perricone C, Graceffa D, Di Muzio G, Ballanti E, Guarino MD, Conigliaro P, Greco E, Kroegler B, Perricone R. Complement system in psoriatic arthritis: a useful marker in response prediction and monitoring of anti-TNF treatment. Clin Exp Rheumatol 2012; 30:23-30. [PMID: 22260811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2011] [Accepted: 07/08/2011] [Indexed: 05/31/2023]
Abstract
OBJECTIVES Treatment with anti-TNF agents is well established in psoriatic arthritis (PsA). Anti-TNF agents are capable of modulating complement activity in vitro but there are no data on the in vivo effect. Anti-TNF have high costs and potential risks, thus, there is an urgent need for accurate predictors of response. We aimed at studying the usefulness of erythrocyte-sedimentation-rate (ESR), C-reactive protein (CRP), and complement for response prediction and monitoring of anti-TNF treatment in PsA patients. METHODS Fifty-five patients were included consecutively before starting etanercept or adalimumab. ESR, CRP, plasma complement C3, C4, and C3 and B cleavage fragments were evaluated at baseline and after 22 weeks of anti-TNF treatment. Disease activity was measured with DAS28 and response to therapy with EULAR criteria. Complement was evaluated at baseline in 30 healthy subjects as well. RESULTS At baseline, C3 and C4 levels were significantly higher than in controls (C3 126.9±22 vs. 110±25 mg/dl, p=0.000002; C4 31.2±9.2 vs. 22.7±8.3 mg/dl, p=0.0003). After anti-TNF therapy, C3 and C4 levels were significantly reduced to normalization (p=0.0009 and 0.0005, respectively) and ESR, CRP and DAS28 showed a significant reduction (p=0.002, 0.004 and 0.0001, respectively). Split products of C3 and B were not observed at baseline and after 22 weeks. Higher baseline C3 levels were associated with EULAR non-response (p=0.011). CONCLUSIONS PsA patients with moderate to severe disease show elevated C3 and C4 levels, reverted by anti-TNF treatment. High C3 may be considered a hallmark of inflammation and C3 revealed the highest predictive value for response to anti-TNF.
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Affiliation(s)
- M S Chimenti
- Allergology, Clinical Immunology and Rheumatology, Department of Internal Medicine, University of Rome Tor Vergata, Rome, Italy
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Valeriani M, Galli F, Tarantino S, Graceffa D, Pignata E, Miliucci R, Biondi G, Tozzi A, Vigevano F, Guidetti V. Correlation Between Abnormal Brain Excitability and Emotional Symptomatology in Paediatric Migraine. Cephalalgia 2009; 29:204-13. [DOI: 10.1111/j.1468-2982.2008.01708.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
We investigated a possible correlation between brain excitability in children with migraine and tension-type headache (TTH) and their behavioural symptomatology, assessed by using the Child Behaviour Checklist (CBCL). The mismatch negativity (MMN) and P300 response were recorded in three successive blocks to test the amplitude reduction of each response from the first to the third block (habituation). MMN and P300 habituation was significantly lower in migraineurs and TTH children than in control subjects (two-way ANOVA: P < 0.05). In migraineurs, but not in TTH patients, significant positive correlations between the P300 habituation deficit and the CBCL scores were found ( P < 0.05), meaning that the migraineurs with the most reduced habituation showed also the worst behavioural symptomatology. To the best of our knowledge, this is the first study showing a correlation between neurophysiological abnormality and emotional symptomatology in migraine, suggesting a role of the latter in producing the migrainous phenotype.
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Affiliation(s)
- M Valeriani
- Headache Centre, Division of Neurology, Ospedale Pediatrico Bambino Gesù IRCCS
| | - F Galli
- Faculty of Psychology 1, University of Rome ‘La Sapienza’, Rome, Italy
| | - S Tarantino
- Division of Paediatric Psychology, Ospedale Pediatrico Bambino Gesù IRCCS
| | - D Graceffa
- Faculty of Psychology 1, University of Rome ‘La Sapienza’, Rome, Italy
| | - E Pignata
- Faculty of Psychology 1, University of Rome ‘La Sapienza’, Rome, Italy
| | - R Miliucci
- Headache Centre, Division of Neurology, Ospedale Pediatrico Bambino Gesù IRCCS
| | - G Biondi
- Division of Paediatric Psychology, Ospedale Pediatrico Bambino Gesù IRCCS
| | - A Tozzi
- Epidemiology Unit, Ospedale Pediatrico Bambino Gesù IRCCS
| | - F Vigevano
- Headache Centre, Division of Neurology, Ospedale Pediatrico Bambino Gesù IRCCS
| | - V Guidetti
- Department of Child and Adolescent Neurology and Psychiatry, University of Rome ‘La Sapienza’, Rome, Italy
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Graceffa C, Giorgianni C, Raimondi M, Graceffa D, D'Arrigo G, Abbate C. [Carpal tunnel syndrome among cashiers in commercial businesses]. G Ital Med Lav Ergon 2006; 28:187-8. [PMID: 16805458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
The Check-out assistants represent a working sector at risk of Work Related Musculo Skeletal Disorders (WMSDs). The aim of our study is to evaluate carpal tunnel syndrome's incidence in check out assistants. Our search was carried out on a sample of 695 female check-out assistants,after a specific risk's valutazion witch "chec-list application", during health surveillance. Subjects with an pand's painful symptoms or paraesthesias along territory of median were submitted to tests thath revial compression of median at wrist: Phalen and Tinel tests. Who were positive to painful symptoms or paraesthesias in both tests, were subjected to electromyographia (E.M.G.), gold standard for carpal tunnel Syndrome diagnosis. This sample was compared with a control group no-exposed to specific risk (all teachers) of equal number, age, sex and working age of our sample. Our results point out that: our study sample show more symptoms and carpal tunnel Syndrome than the control group; tere aren't statistically meaningful differences between test's positive subjects amd EMG positive subjects. We demonstrated that a careful anamnesis and objective exam can replace EMG.
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Affiliation(s)
- C Graceffa
- Dip di Medicina Sociale e del Territorio Università di Messina, Sez Medicina del Lavoro, Italy
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