1
|
van Hal TW, van den Reek JMPA, Wenink MH, Otero ME, Ossenkoppele PM, Njoo MD, Oostveen A, Peters B, Tjioe M, Kop EN, Körver JEM, Dodemont SRP, Kleinpenning MM, Berends MAM, Veldkamp WR, van Doorn MBA, Mommers JM, Lindhout RJ, Kuijpers ALA, van Lümig PP, de Jonge CEJ, Tupker RA, Hendricksen J, Keijsers RR, van den Hoogen FHJ, Vriezekolk JE, de Jong EMGJ. Impairment in work and activities of daily life in patients with psoriasis: results of the prospective BioCAPTURE registry. J DERMATOL TREAT 2024; 35:2304025. [PMID: 38263716 DOI: 10.1080/09546634.2024.2304025] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Accepted: 01/05/2024] [Indexed: 01/25/2024]
Abstract
Background: Little is known about the extent of impairments in work and activities of daily life (ADL) in patients with psoriasis, and the influence of contextual factors such as disease-related characteristics and treatment. Therefore, this study aimed to assess these impairments in patients with psoriasis who started using biologicals/small molecule inhibitors.Methods: Using data from the prospective BioCAPTURE registry, we collected patient, disease, and treatment parameters, as well as work/ADL impairments at baseline, 6 and 12 months. Changes in impairment parameters and correlations between impairment and patient/disease characteristics were assessed using generalized estimating equations.Results: We included 194 patients in our analysis. After biological initiation, disease activity decreased significantly (PASI 11.2 at baseline versus 3.9 at 12 months, p < 0.001). Work-for-pay in this cohort was lower than in the Dutch general population (53% versus 67%, p = 0.01). In patients who had work-for-pay, presenteeism improved over time (5% at baseline versus 0% at 12 months, p = 0.04). Up to half of the patients reported impairments in ADL, which did not change over time. Associations between impairments and contextual factors varied, but all impairments were associated with worse mental/physical general functioning.Conclusion: Patients with psoriasis using biologicals are less likely to have work-for-pay. Treatment improves the work productivity of employed patients, but we were unable to detect changes in ADL performance.
Collapse
Affiliation(s)
- Tamara W van Hal
- Department of Rheumatology, Sint Maartenskliniek, Nijmegen, the Netherlands
- Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Juul M P A van den Reek
- Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, the Netherlands
- Department of Dermatology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Mark H Wenink
- Department of Rheumatology, Sint Maartenskliniek, Nijmegen, the Netherlands
| | - Marisol E Otero
- Department of Dermatology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Paul M Ossenkoppele
- Department of Dermatology, ZiekenhuisGroep Twente, Almelo/Hengelo, the Netherlands
| | - Marcellus D Njoo
- Department of Dermatology, ZiekenhuisGroep Twente, Almelo/Hengelo, the Netherlands
| | - Annet Oostveen
- Department of Dermatology, Gelre Ziekenhuizen, Apeldoorn, the Netherlands
| | - Bas Peters
- Department of Dermatology, Ziekenhuis Rijnstate, Arnhem, the Netherlands
| | - Milan Tjioe
- Department of Dermatology/DermaTeam, Bravis Ziekenhuis, Bergen op Zoom, the Netherlands
| | - Else N Kop
- Department of Dermatology, Bernhoven Ziekenhuis, Uden, the Netherlands
| | - John E M Körver
- Department of Dermatology, Amphia Ziekenhuis, Breda, the Netherlands
| | | | | | - Maartje A M Berends
- Department of Dermatology, Slingeland Ziekenhuis, Doetinchem, the Netherlands
| | | | | | - Johannes M Mommers
- Department of Dermatology, St. Anna Ziekenhuis, Geldrop, the Netherlands
| | - Robert-Jan Lindhout
- Department of Dermatology, Jeroen Bosch Ziekenhuis, 's Hertogenbosch, the Netherlands
| | - Astrid L A Kuijpers
- Department of Dermatology, Maxima Medisch Centrum, Eindhoven, the Netherlands
| | - Paula P van Lümig
- Department of Dermatology, Maastricht UMC+, Maastricht, the Netherlands
| | - C Els J de Jonge
- Department of Dermatology, UMC Utrecht, Utrecht, the Netherlands
| | - Ron A Tupker
- Department of Dermatology, Sint Antoniusziekenhuis, Nieuwegein, the Netherlands
| | - Judith Hendricksen
- Department of Dermatology, Streekziekenhuis Koningin Beatrix, Winterswijk, the Netherlands
| | - Romy R Keijsers
- Department of Dermatology, Zuyderland Medisch Centrum, Sittard-Geleen, the Netherlands
| | | | - Johanna E Vriezekolk
- Department of Rheumatology, Sint Maartenskliniek, Nijmegen, the Netherlands
- Department of Research & Innovation, Sint Maartenskliniek, Nijmegen, the Netherlands
| | - Elke M G J de Jong
- Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, the Netherlands
- Department of Dermatology, ZiekenhuisGroep Twente, Almelo/Hengelo, the Netherlands
| |
Collapse
|
2
|
van den Reek JMPA, van der Leest RJT, Thomas SE, Prevoo R, Plantenga ME, de Jong EMGJ. Improved Quality of Life in Patients with Psoriasis Receiving Apremilast: Real-World Data from the Netherlands. Adv Ther 2024; 41:1594-1605. [PMID: 38402373 DOI: 10.1007/s12325-023-02759-9] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Accepted: 12/05/2023] [Indexed: 02/26/2024]
Abstract
INTRODUCTION Psoriasis is a chronic inflammatory condition that can significantly impact the quality of life (QoL), regardless of the level of skin involvement. Apremilast is indicated for the treatment of moderate to severe psoriasis. Real-world data regarding the impact of apremilast on patient-reported outcomes in clinical practice in the Netherlands is lacking. METHODS The prospective, multicenter observational Apremilast in Real-Life Psoriasis Treatment (APRIL) study enrolled patients ≥ 18 years old with moderate to severe plaque psoriasis receiving apremilast in clinical practice in the Netherlands. Patients were followed-up for 12 months, with assessments scheduled at 6 and 12 months. The primary outcome was Dermatology Life Quality Index (DLQI) response (score ≤ 5 or ≥ 5-point improvement from baseline) at 6 months. Secondary patient-reported outcomes included EQ-5D and skin-specific parameters; exploratory outcomes were Patient Benefit Index (PBI) and Work Productivity and Activity Impairment (WPAI). RESULTS Of the 155 patients enrolled (February 2016-June 2019), 153 received apremilast; 69 (45%) and 39 (26%) continued treatment at 6 and 12 months, respectively. Psoriasis in special areas was common (scalp, 65%; nail, 51%; palmoplantar, 27%). Most patients (92%) had received prior systemic antipsoriatic therapies. Of the 151 patients with a baseline DLQI value, 56 (37%) achieved DLQI response at 6 months. Mean (standard deviation) PBI scores were 3.5 (1.2) and 3.8 (1.1) at 6 and 12 months, respectively. Improvements in DLQI, EQ-5D, and WPAI scores and disease signs and symptoms, including itch and special areas, were observed at 6 and 12 months. Adverse events were consistent with the known safety profile. CONCLUSIONS In the Netherlands, patients with moderate to severe psoriasis receiving apremilast for up to 12 months reported improved disease-related QoL, skin involvement, and patient-reported outcomes. These data add to the growing body of evidence demonstrating apremilast is an effective treatment for psoriasis, itch, and special areas (scalp and palms). TRIAL REGISTRATION ClinicalTrials.gov, NCT02652494.
Collapse
Affiliation(s)
| | | | - Sarah E Thomas
- Radboud University Medical Center, Nijmegen, The Netherlands
| | - Ruud Prevoo
- Zuyderland Medisch Centrum, Limburg, The Netherlands
| | | | | |
Collapse
|
3
|
Rousel J, Bergmans ME, van der Meulen LWJ, Pagan L, de Bruin DT, de Kam ML, Klarenbeek NB, Bouwstra JA, Seyger MMB, van den Reek JMPA, Niemeyer-van der Kolk T, Rissmann R, van Doorn MBA. Guselkumab induction therapy demonstrates long-lasting efficacy in patients with mild psoriasis, results from a randomized, placebo-controlled exploratory clinical trial. J Am Acad Dermatol 2024; 90:395-397. [PMID: 37804933 DOI: 10.1016/j.jaad.2023.09.071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Revised: 09/15/2023] [Accepted: 09/20/2023] [Indexed: 10/09/2023]
Affiliation(s)
- Jannik Rousel
- Centre for Human Drug Research, Leiden, The Netherlands; Leiden Academic Centre for Drug Research, Leiden University, Leiden, The Netherlands
| | - Menthe E Bergmans
- Centre for Human Drug Research, Leiden, The Netherlands; Leiden University Medical Center, Leiden, The Netherlands
| | - Laura W J van der Meulen
- Centre for Human Drug Research, Leiden, The Netherlands; Department of Dermatology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Lisa Pagan
- Centre for Human Drug Research, Leiden, The Netherlands; Leiden University Medical Center, Leiden, The Netherlands
| | - Digna T de Bruin
- Centre for Human Drug Research, Leiden, The Netherlands; Leiden University Medical Center, Leiden, The Netherlands
| | | | | | - Joke A Bouwstra
- Leiden Academic Centre for Drug Research, Leiden University, Leiden, The Netherlands
| | - Marieke M B Seyger
- Department of Dermatology, Radboud University Medical Center, Nijmegen, The Netherlands
| | | | | | - Robert Rissmann
- Centre for Human Drug Research, Leiden, The Netherlands; Leiden Academic Centre for Drug Research, Leiden University, Leiden, The Netherlands; Leiden University Medical Center, Leiden, The Netherlands.
| | - Martijn B A van Doorn
- Centre for Human Drug Research, Leiden, The Netherlands; Department of Dermatology, Erasmus University Medical Center, Rotterdam, The Netherlands
| |
Collapse
|
4
|
Soegiharto R, Westmeijer M, Boekema-Bakker N, Groenewegen IAM, Knulst AC, van den Reek JMPA, Röckmann H. Prevalence of chronic urticaria and healthcare usage of patients with the condition in primary care: a population-based study in the Netherlands. Br J Dermatol 2024; 190:287-289. [PMID: 37897501 DOI: 10.1093/bjd/ljad426] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Revised: 10/18/2023] [Accepted: 10/29/2023] [Indexed: 10/30/2023]
Abstract
We present a large population-based study on the prevalence and healthcare usage of patients with chronic urticaria (CU) in primary care. The observed annual point prevalence of 0.48–0.30% and a median follow-up duration of 1.5 years provides new and reliable insight into the vastness, relatively modest healthcare usage and estimated disease duration of CU in the general population, which is useful knowledge when counselling new patients with CU in both primary and specialist care settings.
Collapse
Affiliation(s)
| | | | - Nicole Boekema-Bakker
- Julius Center for Health Sciences and Primary Health Care, University Medical Centre Utrecht, Utrecht
| | - Irene A M Groenewegen
- Julius Center for Health Sciences and Primary Health Care, University Medical Centre Utrecht, Utrecht
| | | | - Juul M P A van den Reek
- Department of Dermatology, Radboud University Nijmegen Medical Centre, Nijmegen, the Netherlands
| | | |
Collapse
|
5
|
Kwee KV, Murk JL, Yin Q, Visch MB, Davidson L, de Jong EMGJ, van den Reek JMPA, Tjioe M. Prevalence, risk and severity of SARS-CoV-2 infections in psoriasis patients receiving conventional systemic, biologic or topical treatment during the COVID-19 pandemic: a cross-sectional cohort study (PsoCOVID). J DERMATOL TREAT 2023; 34:2161297. [PMID: 36545844 DOI: 10.1080/09546634.2022.2161297] [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: 12/24/2022]
Abstract
BACKGROUND The risk of SARS-CoV-2 infection does not appear to be increased for psoriasis patients using biologics compared to those on other treatments, but evidence is still limited. OBJECTIVES (1) to estimate the prevalence of SARS-CoV-2 infection in patients with psoriasis, (2) to compare SARS-CoV-2 infection rates for different psoriasis treatments groups (biologic vs. systemic conventional vs. topical therapy) corrected for confounders and (3) to describe patients with severe COVID-19 for all treatment groups. METHODS In this cross-sectional cohort study all patients received a questionnaire to gather data on psoriasis treatment, SARS-CoV-2 infections and related risk factors. Simultaneously, they underwent a blood test to screen for antibodies to SARS-CoV-2 N-antigen. Prevalence of SARS-CoV-2 infections was calculated and logistic regression and Cox proportional-hazards models were performed to determine the association between treatment group and SARS-CoV-2 infection risk, corrected for confounders. Patients with severe COVID-19 disease were described and the mortality rate per treatment group was calculated for the target population. RESULTS Patients were included between April 12 2021 and October 31 2021. Of 551 patients, 59 (10.7% (CI95% 8.3-13.6)) had experienced a SARS-CoV-2 infection, based on questionnaire data combined with serological data. In our study cohort, corrected for confounders, biologic or non-biologic systemic therapy users did not appear to have increased SARS-CoV-2 infection risk compared to patients using other treatment. Only 4 hospitalizations (0.7% (CI95% 0.2-1.0) were reported in our study population and no ICU admissions were reported. The rough mortality rate in the target cohort was 0.32% (CI95% 0.13-0.66) in all treatment groups. CONCLUSIONS Corrected for risk-mitigating behavior and vaccination status, a higher SARS-CoV-2 incidence for biologics or non-biologics systemics compared to other treatments could not be proven. Severe cases were infrequent in all treatment groups. This finding further strengthens treatment recommendations that systemic therapies for patients with psoriasis do not require preventive cessation for reduction of SARS-CoV-2 infection risk.
Collapse
Affiliation(s)
- Kevin V Kwee
- Department of Dermatology/DermaTeam Research, Bravis Hospital, Roosendaal, The Netherlands
| | - Jean-Luc Murk
- Elisabeth Tweesteden Hospital, Microvida, Tilburg, The Netherlands
| | - Qiqi Yin
- Department of Dermatology/DermaTeam Research, Bravis Hospital, Roosendaal, The Netherlands
| | - M Birgitte Visch
- Department of Dermatology, Rijnstate Hospital, Arnhem, The Netherlands
| | - Linda Davidson
- Independent Infectious Disease specialist, Nijmegen, The Netherlands
| | - Elke M G J de Jong
- Department of Dermatology, Radboud University Medical Center, Nijmegen, The Netherlands
| | | | - Milan Tjioe
- Department of Dermatology/DermaTeam Research, Bravis Hospital, Roosendaal, The Netherlands
| |
Collapse
|
6
|
Thomas SE, van den Reek JMPA, Seyger MMB, de Jong EMGJ. How to define a 'super-responder' to biologics in psoriasis studies. Br J Dermatol 2023; 189:621-622. [PMID: 37595133 DOI: 10.1093/bjd/ljad280] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Revised: 07/28/2023] [Accepted: 08/03/2023] [Indexed: 08/20/2023]
Abstract
Recently, there has been an increase of publications on super-responders to biologic therapy for psoriasis.In this study, we aimed to contribute to this growing area of research by (i) synthesizing the different definitions of super-responders currently being used in psoriasis literature; and (ii) evaluating the impact of these different definitions on the composition of the super-responder group.
Collapse
Affiliation(s)
- Sarah E Thomas
- Department of Dermatology, Radboud University Medical Centre (Radboudumc), Nijmegen
| | | | - Marieke M B Seyger
- Department of Dermatology, Radboud University Medical Centre (Radboudumc), Nijmegen
| | - Elke M G J de Jong
- Department of Dermatology, Radboud University Medical Centre (Radboudumc), Nijmegen
- Radboud University, Nijmegen, the Netherlands
| |
Collapse
|
7
|
van Huizen AM, van der Kraaij GE, Busard CI, Ouwerkerk W, van den Reek JMPA, Menting SP, Prens EP, Rispens T, de Vries A, de Jong EMGJ, Lambert J, van Doorn MBA, Spuls PI. Adalimumab combined with methotrexate versus adalimumab monotherapy in psoriasis: Three-year follow-up data of a single-blind randomized controlled trial. J Eur Acad Dermatol Venereol 2023; 37:1815-1824. [PMID: 37014287 DOI: 10.1111/jdv.19089] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Accepted: 03/08/2023] [Indexed: 04/05/2023]
Abstract
BACKGROUND Anti-drug antibodies (ADA) are formed in patients treated with adalimumab (ADL). This might increase clearance of ADL, potentially causing a (secondary) non-response. Combination therapy of ADL and methotrexate (MTX) reduces ADA levels and has a clinical benefit in rheumatologic diseases. In psoriasis however, the long-term effectiveness and safety have not been studied. OBJECTIVES To investigate the three-year follow-up data of ADL combined with MTX compared to ADL monotherapy in ADL-naive patients with moderate to severe plaque type psoriasis. METHODS We conducted a multicentre RCT in the Netherlands and Belgium. Randomization was performed by a centralized online randomization service. Patients were seen every 12 weeks until week 145. Outcome assessors were blinded. We collected data on drug survival, effectiveness, safety, pharmacokinetics and immunogenicity of patients that started ADL combined with MTX compared to ADL monotherapy. We present descriptive analysis and patients were analysed according to the group initially randomized to. Patients becoming non-adherent to the biologic were excluded from analyses. RESULTS Sixty-one patients were included and 37 patients (ADL group n = 17, ADL + MTX group n = 20) continued in the follow-up study after 1 year. After 109 weeks and 145 weeks, there was a trend towards longer drug survival in the ADL + MTX group compared to the ADL group (week 109: 54.8% vs. 41.4%; p = 0.326, week 145: 51.6% vs. 41.4%; p = 0.464). At week 145, 7/13 patients were treated with MTX. In the ADL group, 4/12 patients that completed the study developed ADA, and 3/13 in the ADL + MTX group. CONCLUSIONS In this small study, there was no significant difference in ADL overall drug survival when it was initially combined with MTX, compared to ADL alone. Discontinuation due to adverse events was common in the combination group. To secure accessible healthcare, combination treatment of ADL and MTX can be considered in individual patients.
Collapse
Affiliation(s)
- Astrid M van Huizen
- Department of Dermatology, Amsterdam UMC, Location University of Amsterdam, Amsterdam, The Netherlands
| | - Gayle E van der Kraaij
- Department of Dermatology, Amsterdam UMC, Location University of Amsterdam, Amsterdam, The Netherlands
| | - Celine I Busard
- Department of Dermatology, Amsterdam UMC, Location University of Amsterdam, Amsterdam, The Netherlands
| | - Wouter Ouwerkerk
- Department of Clinical Epidemiology and Data Science, Biostatistics and Bioinformatics, Amsterdam UMC, Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands
- National Heart Centre Singapore, Singapore City, Singapore
| | | | - Stef P Menting
- Department of Dermatology, OLVG, Amsterdam, The Netherlands
| | - Errol P Prens
- Department of Dermatology, Erasmus MC, Rotterdam, The Netherlands
| | - Theo Rispens
- Sanquin Research and Landsteiner Laboratory, Department of Blood Cell Research, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - Annick de Vries
- Sanquin Pharma&Biotech Services, Sanquin, Amsterdam, The Netherlands
| | - Elke M G J de Jong
- Radboud UMC, Radboud University, Department of Dermatology, Nijmegen, The Netherlands
| | - Jo Lambert
- Department of Dermatology, Ghent University Hospital, Ghent, Belgium
| | - Martijn B A van Doorn
- Department of Dermatology, Erasmus MC, Rotterdam, The Netherlands
- Centre for Human Drug Research, Leiden, The Netherlands
| | - Phyllis I Spuls
- Department of Dermatology, Amsterdam UMC, Location University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam UMC, University of Amsterdam, Amsterdam Public Health, Infection and Immunity, Amsterdam, The Netherlands
| |
Collapse
|
8
|
Thomas SE, van den Reek JMPA. Should we prefer biologics over nonbiological agents in psoriasis? Br J Dermatol 2023; 189:258-259. [PMID: 37421659 DOI: 10.1093/bjd/ljad231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Revised: 06/26/2023] [Accepted: 07/06/2023] [Indexed: 07/10/2023]
Affiliation(s)
- Sarah E Thomas
- Department of Dermatology, Radboudumc, Nijmegen, the Netherlands
| | | |
Collapse
|
9
|
van Niekerk CC, Otten JHDM, van Rossum MM, van den Reek JMPA, Brummelkamp E, Mol M, Groenewoud JHMM, Verbeek ALM. Trends in three major histological subtypes of cutaneous melanoma in the Netherlands between 1989 and 2016. Int J Dermatol 2023; 62:508-513. [PMID: 36539393 DOI: 10.1111/ijd.16559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 07/03/2022] [Revised: 11/17/2022] [Accepted: 11/30/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND Time trend analysis of cutaneous melanoma (CM) mortality in fair skin populations shows both a gradual decrease and/or an increase. To explain these differences, we analyzed long-term time trends in the incidence of the most common histological subtypes of CM: superficial spreading melanoma (SSM), lentigo maligna melanoma (LMM), and nodular melanoma (NM). METHODS Using data from the Netherlands Cancer Registry and Statistics Netherlands, the number and rates of cases diagnosed with SSM, LLM, and NM from 1989 to 2016 were analyzed by age, calendar period, and birth cohort of people born in successive periods from 1925 to 1973. RESULTS Primary CM was diagnosed in 52,000 men and 66,588 women in the study period. The annual age-standardized incidence rate increased three-fold from 14 to 42 per 100,000 person-years. The most common subtype was SSM (50%), followed by LMM (23%) and NM (14%). Age-specific subtype rates showed an upward trend over time for both men and women. Younger birth cohorts had higher rates of SSM and LMM diagnosis than older birth cohorts. This birth cohort pattern was not observed for NM. CONCLUSIONS We observed a strong increase in the melanoma epidemic curves in the light-skinned Dutch population over the last three decades. This increase is explained by younger generations having higher rates of SSM and LMM than older generations.
Collapse
Affiliation(s)
- Catharina C van Niekerk
- Department for Health Evidence, Radboud Institute for Health Sciences, Radboud University Medical Center Nijmegen, Nijmegen, the Netherlands
| | - J Hans D M Otten
- Department for Health Evidence, Radboud Institute for Health Sciences, Radboud University Medical Center Nijmegen, Nijmegen, the Netherlands
| | - Michelle M van Rossum
- Department of Dermatology, Radboud University Medical Center, Nijmegen, the Netherlands
| | | | - Erik Brummelkamp
- Department for Health Evidence, Radboud Institute for Health Sciences, Radboud University Medical Center Nijmegen, Nijmegen, the Netherlands
| | - Martijn Mol
- Department for Health Evidence, Radboud Institute for Health Sciences, Radboud University Medical Center Nijmegen, Nijmegen, the Netherlands
| | - J Hans M M Groenewoud
- Department for Health Evidence, Radboud Institute for Health Sciences, Radboud University Medical Center Nijmegen, Nijmegen, the Netherlands
| | - André L M Verbeek
- Department for Health Evidence, Radboud Institute for Health Sciences, Radboud University Medical Center Nijmegen, Nijmegen, the Netherlands
| |
Collapse
|
10
|
van der Schoot LS, Atalay S, Otero ME, Kievit W, van den Reek JMPA, de Jong EMGJ. Regaining adequate treatment responses in patients with psoriasis who discontinued dose reduction of adalimumab, etanercept or ustekinumab. Br J Dermatol 2022; 187:1028-1030. [PMID: 35895852 PMCID: PMC10087531 DOI: 10.1111/bjd.21797] [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: 06/16/2022] [Revised: 07/26/2022] [Accepted: 07/26/2022] [Indexed: 12/24/2022]
Affiliation(s)
- Lara S van der Schoot
- Department of Dermatology, Radboud University Medical Center, Nijmegen, the Netherlands.,Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Selma Atalay
- Department of Dermatology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Marisol E Otero
- Department of Dermatology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Wietske Kievit
- Department for Health Evidence, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Juul M P A van den Reek
- Department of Dermatology, Radboud University Medical Center, Nijmegen, the Netherlands.,Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Elke M G J de Jong
- Department of Dermatology, Radboud University Medical Center, Nijmegen, the Netherlands.,Radboud University, Nijmegen, the Netherlands
| |
Collapse
|
11
|
Spekhorst LS, de Graaf M, Zuithoff NPA, van den Reek JMPA, Kamsteeg M, Boesjes CM, Romeijn GLE, Loman L, Haeck I, Oosting AJ, de Boer-Brand A, Touwslager WRH, Flinterman A, van Lynden-van Nes AMT, Gostynski AH, de Bruin-Weller MS, Schuttelaar ML. Dupilumab Drug Survival and Associated Predictors in Patients With Moderate to Severe Atopic Dermatitis: Long-term Results From the Daily Practice BioDay Registry. JAMA Dermatol 2022; 158:1048-1056. [PMID: 35947364 PMCID: PMC9366658 DOI: 10.1001/jamadermatol.2022.3014] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Accepted: 06/03/2022] [Indexed: 11/14/2022]
Abstract
Importance Long-term data on dupilumab drug survival in patients with atopic dermatitis (AD) are scarce. Furthermore, little is known about the factors associated with drug survival of dupilumab in AD. Objective To describe the drug survival of dupilumab in patients with AD and to identify associated predictors. Design, Setting, and Participants This cohort study was based on data from the multicenter prospective daily practice BioDay registry, in which 4 university and 10 nonuniversity hospitals in the Netherlands participated. Analysis included patients (age ≥18 years) participating in the BioDay registry with a follow-up of at least 4 weeks. The first patient treated with dupilumab was recorded in the BioDay registry in October 2017; data lock took place in December 2020, and data analysis was performed from October 2017 to December 2020. Main Outcomes and Measures Drug survival was analyzed by Kaplan-Meier survival curves and associated characteristics by using univariate and multivariate Cox regression analysis. Results A total of 715 adult patients with AD (mean [SD] age, 41.8 [16.0] years; 418 [58.5%] were male) were included with a 1-year, 2-year, and 3-year overall dupilumab drug survival of 90.3%, 85.9%, and 78.6%, respectively. Characteristics associated with shorter drug survival owing to ineffectiveness were the use of immunosuppressant drugs at baseline (hazard ratio [HR], 2.64; 95% CI, 1.10-6.37) and being a nonresponder at 4 weeks (HR, 8.68; 95% CI, 2.97-25.35). Characteristics associated with shorter drug survival owing to adverse effects were the use of immunosuppressant drugs at baseline (HR, 2.69; 95% CI, 1.32-5.48), age 65 years or older (HR, 2.94; 95% CI, 1.10-7.87), and Investigator Global Assessment score of very severe AD (HR, 3.51; 95% CI, 1.20-10.28). Conclusions and Relevance This cohort study demonstrated a good overall 1-year, 2-year, and 3-year dupilumab drug survival. Patients using immunosuppressive therapy at baseline and those with an absence of treatment effect at week 4 tended to discontinue treatment owing to ineffectiveness more frequently. Using immunosuppressant drugs at baseline, older age, and Investigator Global Assessment score of very severe AD were characteristics associated with an increased risk for discontinuation owing to adverse effects. These data provide more insight and new perspectives regarding dupilumab treatment in AD and can contribute to the optimization of patient outcomes.
Collapse
Affiliation(s)
- Lotte S. Spekhorst
- National Expertise Center for Atopic Dermatitis, Department of Dermatology and Allergology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Marlies de Graaf
- National Expertise Center for Atopic Dermatitis, Department of Dermatology and Allergology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Nicolaas P. A. Zuithoff
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands
| | | | - Marijke Kamsteeg
- Department of Dermatology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Celeste M. Boesjes
- National Expertise Center for Atopic Dermatitis, Department of Dermatology and Allergology, University Medical Center Utrecht, Utrecht, the Netherlands
| | | | - Laura Loman
- Department of Dermatology, University Medical Center Groningen, Groningen, the Netherlands
| | - Inge Haeck
- Department of Dermatology, Reinier de Graaf Gasthuis, Delft, the Netherlands
| | - Albert J. Oosting
- Department of Dermatology, Spaarnegasthuis, Haarlem, the Netherlands
| | | | | | | | | | - Antoni H. Gostynski
- Department of Dermatology, University Medical Center Maastricht, Maastricht, the Netherlands
| | - Marjolein S. de Bruin-Weller
- National Expertise Center for Atopic Dermatitis, Department of Dermatology and Allergology, University Medical Center Utrecht, Utrecht, the Netherlands
| | | |
Collapse
|
12
|
Bruno M, Davidson L, Koenen HJPM, van den Reek JMPA, van Cranenbroek B, de Jong EMGJ, van de Veerdonk FL, Kullberg BJ, Netea MG. Immunological effects of anti-IL-17/12/23 therapy in patients with psoriasis complicated by Candida infections. J Invest Dermatol 2022; 142:2929-2939.e8. [PMID: 35662644 DOI: 10.1016/j.jid.2022.05.1083] [Citation(s) in RCA: 3] [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] [Received: 02/08/2022] [Revised: 05/08/2022] [Accepted: 05/24/2022] [Indexed: 12/12/2022]
Abstract
Biologics that block the T-helper-17 pathway are very effective in the treatment of psoriasis and other inflammatory diseases. However, interleukin-17 is also crucial for antifungal host defense, and clinical trial data suggest an increase in the incidence of Candida infections during IL-17 inhibitor (IL-17i) therapy. We investigated the innate and adaptive immune responses of psoriasis patients with a history of skin and/or mucosal candidiasis during IL-17i or IL-12/23i therapy, comparing those responses to healthy controls. Psoriasis patients with IL-17i showed significantly lower CD4+Th1-like (CCR6-CXCR3+CCR4-) and Th1Th17-like (CD4+CCR6+CXCR3+CCR4-) cell percentages. Patient cells stimulated with Candida albicans produced significantly lower IL-6 in the IL-12/23i group and IL-1β production in the IL-17i group, while the release of TNF-α and ROS was similar between patients and controls. IFN-γ and IL-10 production in response to several stimuli after 7 days was particularly decreased in patients receiving IL-17i therapy. Finally, after stimulation with the polarizing cytokines IL-1β and IL-23, the Th17 cytokine response was significantly lower in the IL-17i patient group. These innate and adaptive immune response defects can diminish antifungal host immune response and thereby increase susceptibility to candidiasis in patients treated with IL-17i or IL-12/23i.
Collapse
Affiliation(s)
- Mariolina Bruno
- Radboud University Medical Center Center for Infectious Diseases (RCI), Department of Internal Medicine, Radboud University Medical Center, Nijmegen, the Netherlands; Department of Internal Medicine, Radboud University Medical Center, Nijmegen, the Netherlands.
| | - Linda Davidson
- Radboud University Medical Center Center for Infectious Diseases (RCI), Department of Internal Medicine, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Hans J P M Koenen
- Laboratory Medical Immunology, Radboud University Medical Center, the Netherlands
| | | | - Bram van Cranenbroek
- Laboratory Medical Immunology, Radboud University Medical Center, the Netherlands
| | - Elke M G J de Jong
- Department of Dermatology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Frank L van de Veerdonk
- Radboud University Medical Center Center for Infectious Diseases (RCI), Department of Internal Medicine, Radboud University Medical Center, Nijmegen, the Netherlands; Department of Internal Medicine, Radboud University Medical Center, Nijmegen, the Netherlands; Radboud Center for Infectious Disease (RCI), Radboud University Medical Center, Nijmegen, the Netherlands
| | - Bart-Jan Kullberg
- Radboud University Medical Center Center for Infectious Diseases (RCI), Department of Internal Medicine, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Mihai G Netea
- Department of Internal Medicine, Radboud University Medical Center, Nijmegen, the Netherlands; Radboud Center for Infectious Disease (RCI), Radboud University Medical Center, Nijmegen, the Netherlands; Department of Immunology and Metabolism, Life and Medical Sciences Institute (LIMES), University of Bonn, Bonn, Germany
| |
Collapse
|
13
|
van Huizen AM, Menting SP, Gyulai R, Iversen L, van der Kraaij GE, Middelkamp-Hup MA, Warren RB, Spuls PI, Schejtman AA, Egeberg A, Firooz A, Kumar AS, Oakley A, Foulkes A, Ramos AMC, Fougerousse AC, Carija A, Akman-Karakas A, Horváth B, Fábos B, Matlock BH, Claréus BW, Castro C, Ferrándiz C, Correa CC, Marchesi C, Goujon C, Gonzalez C, Maldonado-García C, Hong CH, Griffiths CEM, Vestergaard C, Echeverría CM, de la Cruz C, Conrad C, Törocsik D, Drvar DL, Balak D, Jullien D, Appelen D, Kim DH, de Jong EMGJ, El Gamal E, Laffitte E, Mahé E, Sonkoly E, Colombo EP, Vilarrasa E, Willaert F, Novoa FD, Handjani F, Valenzuela F, Vílchez-Márquez F, Gonzalez GO, Krisztián G, Damiani G, Krnjevic-Pezic G, Pellerano G, Carretero G, Hunter HJA, Riad H, Oon HH, Boonen HPJ, Moussa IO, García-Doval I, Csányi I, Brajac I, Turchin I, Grozdev I, Weinberg JM, Nicolopoulos J, Wells J, Lambert JLW, Ingram JR, Prinz JC, de Souza Sittart JA, Sanchez JL, Hsiao JPF, Castro-Ayarza JR, Maul JT, van den Reek JMPA, Trcko K, Barber K, Reich K, Gebauer KA, Khobzei K, Maul LV, Massari LP, Fardet L, le Cleach L, Misery L, Chandrashekar L, Muresanu LI, Lecluse L, Skov L, Frez ML, Babic LT, Puig L, Gomez LC, Ramam M, Dutil M, El-Sayed MH, Olszewska M, Schram ME, Franco MD, Llamas-Velasco M, Gonçalo M, Velásquez-Lopera MM, Abad ME, de Oliveira MDFSP, Seyger MMB, Kaštelan M, Rademaker M, Sikora M, Lebwohl M, Wiseman MC, Ferran M, van Doorn M, Danespazhooh M, Bylaite-Bucinskiene M, Gooderham MJ, Polic MV, de Rie MA, Zheng M, Gómez-Flores M, Salleras I Redonnet M, Silverberg NB, Doss N, Yawalkar N, Chosidow O, Zargari O, de la Cueva P, Fernandez-Peñas P, Cárdenas Rojas PJ, Gisondi P, Grewal P, Sator P, Luna PC, Félix PAO, Varela P, Holló P, Cetkovska P, Calzavara-Pinton P, Ghislain PD, Araujo RR, Romiti R, Kui R, Ceovic R, Vender R, Lafuente-Urrez RF, Del-Río R, Gulin SJ, Handa S, Mahil SK, Kolalapudi SA, Marrón SE, Azimi SZ, Janmohamed SR, da Cruz Costa SA, Choon SE, Urbancek S, Ayanlowo O, Margasin SM, Wong TW, Mälkönen T, Hurtová T, Reciné TR, Huldt-Nystrøm T, Torres T, Liu TY, Leonidze T, Sharma VK, Weightman W, Gulliver W, Veldkamp W. International eDelphi Study to Reach Consensus on the Methotrexate Dosing Regimen in Patients With Psoriasis. JAMA Dermatol 2022; 158:561-572. [PMID: 35353175 DOI: 10.1001/jamadermatol.2022.0434] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Importance A clear dosing regimen for methotrexate in psoriasis is lacking, and this might lead to a suboptimal treatment. Because methotrexate is affordable and globally available, a uniform dosing regimen could potentially optimize the treatment of patients with psoriasis worldwide. Objective To reach international consensus among psoriasis experts on a uniform dosing regimen for treatment with methotrexate in adult and pediatric patients with psoriasis and identify potential future research topics. Design, Setting, and Participants Between September 2020 and March 2021, a survey study with a modified eDelphi procedure that was developed and distributed by the Amsterdam University Medical Center and completed by 180 participants worldwide (55 [30.6%] resided in non-Western countries) was conducted in 3 rounds. The proposals on which no consensus was reached were discussed in a conference meeting (June 2021). Participants voted on 21 proposals with a 9-point scale (1-3 disagree, 4-6 neither agree nor disagree, 7-9 agree) and were recruited through the Skin Inflammation and Psoriasis International Network and European Academy of Dermatology and Venereology in June 2020. Apart from being a dermatologist/dermatology resident, there were no specific criteria for participation in the survey. The participants worked mainly at a university hospital (97 [53.9%]) and were experienced in treating patients with psoriasis with methotrexate (163 [91.6%] had more than 10 years of experience). Main Outcomes and Measures In a survey with eDelphi procedure, we tried to reach consensus on 21 proposals. Consensus was defined as less than 15% voting disagree (1-3). For the consensus meeting, consensus was defined as less than 30% voting disagree. Results Of 251 participants, 180 (71.7%) completed all 3 survey rounds, and 58 participants (23.1%) joined the conference meeting. Consensus was achieved on 11 proposals in round 1, 3 proposals in round 2, and 2 proposals in round 3. In the consensus meeting, consensus was achieved on 4 proposals. More research is needed, especially for the proposals on folic acid and the dosing of methotrexate for treating subpopulations such as children and vulnerable patients. Conclusions and Relevance In this eDelphi consensus study, consensus was reached on 20 of 21 proposals involving methotrexate dosing in patients with psoriasis. This consensus may potentially be used to harmonize the treatment with methotrexate in patients with psoriasis.
Collapse
Affiliation(s)
- Astrid M van Huizen
- Department of Dermatology, Amsterdam UMC, University of Amsterdam, Amsterdam Public Health, Infection and Immunity, Amsterdam, the Netherlands
| | - Stef P Menting
- Department of Dermatology, OLVG, Amsterdam, the Netherlands
| | - Rolland Gyulai
- Department of Dermatology, University of Pécs, Medical School, Venerology and Oncodermatology, Pécs, Hungary
| | - Lars Iversen
- Department of Dermatology, Aarhus University Hospital, Aarhus, Denmark
| | - Gayle E van der Kraaij
- Department of Dermatology, Amsterdam UMC, University of Amsterdam, Amsterdam Public Health, Infection and Immunity, Amsterdam, the Netherlands
| | - Maritza A Middelkamp-Hup
- Department of Dermatology, Amsterdam UMC, University of Amsterdam, Amsterdam Public Health, Infection and Immunity, Amsterdam, the Netherlands
| | - Richard B Warren
- The Dermatology Centre, Salford Royal NHS Foundation Trust, The Manchester NIHR Biomedical Research Centre, United Kingdom
| | - Phyllis I Spuls
- Department of Dermatology, Amsterdam UMC, University of Amsterdam, Amsterdam Public Health, Infection and Immunity, Amsterdam, the Netherlands
| | | | | | - Alireza Firooz
- Center for Research and Training in Skin Diseases and Leprosy, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Amanda Oakley
- Waikato District Health Board, University of Auckland, Auckland, New Zealand
| | - Amy Foulkes
- The Dermatology Centre, Salford Royal NHS Foundation Trust, The Manchester NIHR Biomedical Research Centre, United Kingdom
| | | | | | - Antoanela Carija
- School of Medicine, University of Split, University Hospital Centre Split, Croatia
| | - Ayse Akman-Karakas
- Department of Dermatology and Venerology, Akdeniz University School of Medicine, Antalya, Turkey
| | - Barbara Horváth
- Department of Dermatology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Béata Fábos
- Department of Dermatology, Teaching Hospital Kaposvar, Kaposvar, Hungary
| | - Benjamin Hidalgo Matlock
- University of Costa Rica/Hospital Nacional de Niños, San Pedro Montes de Oca, San Jose Province, Costa Rica
| | | | - Carla Castro
- Dermatologist Hospital Universitario Austral, Buenos Aires, Argentina
| | - Carlos Ferrándiz
- Department of Dermatology, Hospital universitario Germans Trias i Pujol, Universidad Autónoma de Barcelona, Barcelona, Spain
| | - Carolina Cortés Correa
- Dermatology Service of La Samaritana University Hospital, Bogotá, Colombia
- Pontificia Universidad Javeriana/National University of Colombia, Bogotá, Colombia
| | | | - Catherine Goujon
- Department of Immunology and Clinical Allergology, Lyon sud Hospital, Saint-Genis-Laval, France
| | | | | | - Chih-Ho Hong
- Department of Dermatology and Skin Science, University of British Columbia, Vancouver, British Columbia, Canada
| | - Christopher E M Griffiths
- The Dermatology Centre, Salford Royal NHS Foundation Trust, The Manchester NIHR Biomedical Research Centre, United Kingdom
| | | | | | | | - Curdin Conrad
- Department of Dermatology, Lausanne University Hospital CHUV, Lausanne, Switzerland
| | - Dániel Törocsik
- Department of Dermatology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Daniela Ledic Drvar
- Department of Dermatology and Venereology, University Hospital Centre Zagreb, School of Medicine University of Zagreb, Croatia
| | - Deepak Balak
- Department of Dermatology, Ghent University Hospital, Ghent, Belgium
| | - Denis Jullien
- Hospices Civils de Lyon, Hôpital E. Herriot, Service de Dermatologie, Lyon, France
| | | | - Dong Hyun Kim
- Department of Dermatology, CHA Bundang Medical Center, CHA University College of Medicine, Seongnam, Republic of Korea
| | | | - Emad El Gamal
- Damietta Faculty of Medicine, Al-Azhar University, Cairo, Egypt
| | - Emmanuel Laffitte
- Department of Dermatology, University Hospital of Geneva, Geneva, Switzerland
| | - Emmanuel Mahé
- Service de Dermatologie, Hôpital Victor Dupouy, Argenteuil, France
| | - Enikö Sonkoly
- Department of Medical Sciences, Uppsala University, Uppsala, Sweden
| | | | - Eva Vilarrasa
- Dermatology Department, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
| | | | | | - Farhad Handjani
- Molecular Dermatology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Fernando Valenzuela
- Department of Dermatology University of Chile and Centro Internacional de Estudios Clinicos, Probity Medical Research, Santiago, Chile
| | | | | | - Gáspár Krisztián
- Department of Dermatology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Giovanni Damiani
- Department of Clinical Dermatology, IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy
| | | | | | - Gregorio Carretero
- Servicio de Dermatología, Hospital Universitario de Gran Canaria Doctor Negrín, Las Palmas de Gran Canaria, Spain
| | - Hamish J A Hunter
- The Dermatology Centre, Salford Royal NHS Foundation Trust, The Manchester NIHR Biomedical Research Centre, United Kingdom
| | | | | | | | | | - Ignacio García-Doval
- Dermatology Department, Complexo Hospitalario Universitario de Vigo, Vigo, Spain
| | - Ildíko Csányi
- Department of Dermatology and Allergology, Albert Szent-Györgyi Health Center, Department of Dermatology and Allergology, Szeged, Hungary
| | - Ines Brajac
- Department of Dermatovenerology, University Hospital Clinic Rijeka, Croatia
| | - Irina Turchin
- Brunswick Dermatology Center, Fredericton, New Brunswick, Canada
- Dalhousie University, Halifax, Nova Scotia, Canada
- Probity Medical Research, Waterloo, Ontario, Canada
| | - Ivan Grozdev
- Department of Dermatology, Brugmann University Hospital, Brussels, Belgium
| | | | - Jenny Nicolopoulos
- Department of Dermatology, Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Jillian Wells
- University of Sydney, Westmead Hospital, Sydney, New South Wales, Australia
| | - Jo L W Lambert
- Department of Dermatology, Ghent University Hospital, Ghent, Belgium
| | - John R Ingram
- Department of Dermatology, Division of Infection & Immunity, Cardiff University, Cardiff, Wales
| | - Jörg Christoph Prinz
- Department of Dermatology and Allergy, University Hospital, LMU Munich, Munich, Germany
| | | | - Jose Luis Sanchez
- Department of Dermatology, General Hospital Valencia, Valencia, Spain
| | | | | | - Julia-Tatjana Maul
- Department of Dermatology, University Hospital of Zürich, Zürich, Switzerland
| | | | - Katarina Trcko
- Department of Dermatology and Venereal Diseases, University Medical Centre Maribor, Maribor, Slovenia
| | - Kirk Barber
- University of Calgary, Calgary, Alberta, Canada
| | - Kristian Reich
- Translational Research in Inflammatory Skin Diseases, Institute for Health Services Research in Dermatology and Nursing, University Medical Center Hamburg-Eppendorf, Germany
| | | | - Kuzma Khobzei
- Kyiv Medical University, Medical Centre Khobzei Clinic, Kyiv, Ukraine
| | - Lara V Maul
- Department of Dermatology, University Hospital of Basel, Basel, Switzerland
| | - Larisa Prpic Massari
- Department of Dermatovenerology, Clinical Hospital Center Rijeka, Medical Faculty University of Rijeka, Rijeka, Croatia
| | - Laurence Fardet
- Department of dermatology, Hôpital Henri Mondor, Creteil, France
| | - Laurence le Cleach
- University Paris Est Créteil, Créteil, France
- Department of Dermatology, Hôpitaux universitaires Henri Mondor, UPEC, Créteil, France
| | - Laurent Misery
- Department of Dermatology, University Hospital of Brest, Department of Dermatology, Brest, France
| | | | | | | | - Lone Skov
- Department of Dermatology and Allergy, Copenhagen University Hospital-Herlev and Gentofte, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Ma Lorna Frez
- University of the Philippines College of Medicine, Philippine General Hospital, Manila, Philippines
| | | | - Lluís Puig
- Department of Dermatology, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona School of Medicine, Barcelona, Spain
| | - Luis Castro Gomez
- Hospital Militar Central Universidad Militar Nueva Granada, Bogota, Colombia
| | - M Ramam
- All India Institute of Medical Sciences, New Delhi, India
| | - Maha Dutil
- University of Toronto, Toronto, Ontario, Canada
| | | | | | | | | | - Mar Llamas-Velasco
- Dermatology Department, Hospital Universitario de la Princesa, Madrid, Spain
| | - Margarida Gonçalo
- Department of Dermatology, Coimbra University Hospital and Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | | | | | | | - Marieke M B Seyger
- Department of Dermatology, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - Marija Kaštelan
- Department of Dermatovenergology, Referral Center for Psoriasis, CHC Rijeka, University of Rijeka, Rijeka, Croatia
| | - Marius Rademaker
- Waikato Clinical School, School of Medicine, University of Auckland, Auckland, New Zealand
| | - Mariusz Sikora
- National Institute of Geriatrics, Rheumatology and Rehabilitation, Warsaw, Poland
| | - Mark Lebwohl
- Icahn School of Medicine at Mount Sinai, New York, New York
| | - Marni C Wiseman
- Department of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Marta Ferran
- Department of Dermatology, Hospital del Mar, Barcelona, Spain
| | - Martijn van Doorn
- Department of Dermatology, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Maryam Danespazhooh
- Department of Dermatology, Tehran University of Medical Sciences, Tehran, Iran
| | - Matilda Bylaite-Bucinskiene
- Clinic of Infectious Diseases and Dermatovenereology, Centre of Dermatovenereology, Vilnius University, Vilnius, Lithuania
| | - Melinda J Gooderham
- SKiN Centre for Dermatology and Probity Medical Research, Queen's University, Peterborough, Ontario, Canada
| | | | - Menno A de Rie
- Department of Dermatology, Amsterdam UMC, University of Amsterdam, Amsterdam Public Health, Infection and Immunity, Amsterdam, the Netherlands
| | - Min Zheng
- School of Medicine, the Second Affiliated Hospital of Zhejiang University, Hangzhou, China
| | | | | | | | - Nejib Doss
- Golden Towers Médical Centre, Tunis, Tunisia
| | - Nikhil Yawalkar
- Department of Dermatology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | | | | | - Pablo de la Cueva
- Dermatology Department, Hospital Unuversitario Infanta Leonor, Madrid, Spain
| | - Pablo Fernandez-Peñas
- Department of Dermatology, University of Sydney, Westmead Hospital, Westmead, New South Wales, Australia
| | | | - Paolo Gisondi
- Section of Dermatology and Venereology, University of Verona, Verona, Italy
| | | | - Paul Sator
- Department of Dermatology, Clinic Hietzing, Vienna, Austria
| | | | | | - Paulo Varela
- Dermatology Department, Centro Hospitalar VN Gaia, Portugal
| | - Péter Holló
- Department of Dermatology, Venereology, and Dermatooncology, Semmelweis University, Budapest, Hungary
| | - Petra Cetkovska
- Department of Dermatovenereology, Faculty of Medicine, Charles University, Prague, Czech Republic
| | | | | | - Raquel Ruiz Araujo
- University of Sydney, Westmead Hospital, Sydney, New South Wales, Australia
| | - Ricardo Romiti
- Department of Dermatology, Hospital das Clínicas, University of São Paulo, São Paulo, Brazil
| | - Róbert Kui
- Department of Dermatology and AllergologyAlbert Szent-Györgyi Medical School, University of Szeged, Szeged, Hungary
| | - Romana Ceovic
- Department of Dermatology and Venereology, University Hospital Center Zagreb, School of Medicine, University of Zagreb, Zagreb, Croatia
| | | | | | - Rubén Del-Río
- Hospital L´Esperit Sant, Santa Coloma de Gramenet, Spain
| | - Sandra J Gulin
- Department of Dermatology, Ryhov County Hospital, Jonkoping, Sweden
| | - Sanjeev Handa
- Department of Dermatology, Venereology & Leprology, Chandigarh, India
| | - Satveer K Mahil
- St John's Institute of Dermatology, Guy's and St Thomas' NHS Foundation Trust and King's College London, London, England
| | | | - Servando E Marrón
- Dermatology Department, University Hospital Miguel Servet, Zaragoza, Spain
- Aragon Psychodermatology Research Group, Zaragoza, Spain
| | | | - Sherief R Janmohamed
- Department of Dermatology, Unit Pediatric Dermatology, SKIN Research Group, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Brussels, Belgium
| | | | - Siew Eng Choon
- Clinical School Johor Bahru, Monash University Malaysia, Subang Jaya, Malaysia
| | - Slavomir Urbancek
- Department of Dermatology, F.D. Roosevelt Hospital, Banska Bystrica, Slovakia
| | - Olusola Ayanlowo
- Dermatology Unit, Department of Medicine, Faculty of Clinical Sciences, University of Lagos, Lagos, Nigeria
| | - Susana M Margasin
- Consultorios Integrados Rosio, Hospital I Carrasco Rosario, Argentina
| | - Tak-Wah Wong
- Departments of Dermatology, Biochemistry & Molecular Biology, Center of Applied Nanomedicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Tarja Mälkönen
- Helsinki University Hospital, Skin and Allergy Hospital, Helsinki, Finland
| | - Tatiana Hurtová
- Jessenius Faculty of Medicine, Martin, Comenius University, Bratislava, Slovakia
| | | | | | - Tiago Torres
- Department of Dermatology, Centro Hospitalar Universitário do Porto, Porto, Portugal
| | - Tong-Yun Liu
- First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Tsira Leonidze
- Akad.N.Kipshidze Central University Clinic, Tbilisi, Georgia
| | - Vinod Kumar Sharma
- School of Medical Sciences and Research, Sharda University, Uttar Pradesh, India
| | | | - Wayne Gulliver
- Faculty of Medicine, Memorial University of Newfoundland and Labrador, St. John's, Newfoundland and Labrador, Canada
| | - Wendelien Veldkamp
- Department of Dermatology, Radboudumc Nijmegen, Nijmegen, the Netherlands
| |
Collapse
|
14
|
van Acht MR, van den Reek JMPA, de Jong EMGJ, Seyger MMB. The Effect of Lifestyle Changes on Disease Severity and Quality of Life in Patients with Plaque Psoriasis: A Narrative Review. Psoriasis (Auckl) 2022; 12:35-51. [PMID: 35433402 PMCID: PMC9007593 DOI: 10.2147/ptt.s294189] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Accepted: 03/31/2022] [Indexed: 01/24/2023]
Abstract
Objective To evaluate the effect of lifestyle changes on the severity of psoriasis and the quality of life in patients with psoriasis. Methods For this narrative review, PubMed, Embase and ClinicalTrials.gov were searched for lifestyle intervention studies with an intervention duration of at least 12 weeks. Results Thirty-four intervention studies were included. Most studies performed interventions in the diet of patients with psoriasis (n=9), or added supplements to the diet (n=18). Three studies comprised relaxation techniques and four studies combined relaxation or stress-reducing techniques with an educational program or exercise. No interventional studies were carried out regarding smoking, alcohol and sleep. Especially dietary and relaxation interventions showed promising results with respect to psoriasis severity and dermatology-related QoL, respectively. Regarding dietary supplements, the three largest studies investigating fish oil or vitamin D did not show significant effects. Conclusion There is some evidence that dietary and relaxation interventions could be promising with respect to psoriasis severity and dermatology-related QoL, respectively. Furthermore, our review identified important gaps in psoriasis lifestyle research regarding study design and reporting of outcomes.
Collapse
Affiliation(s)
- Maartje R van Acht
- Department of Dermatology, Radboud University Medical Center (Radboudumc), Nijmegen, the Netherlands
| | - Juul M P A van den Reek
- Department of Dermatology, Radboud University Medical Center (Radboudumc), Nijmegen, the Netherlands
| | - Elke M G J de Jong
- Department of Dermatology, Radboud University Medical Center (Radboudumc), Nijmegen, the Netherlands
| | - Marieke M B Seyger
- Department of Dermatology, Radboud University Medical Center (Radboudumc), Nijmegen, the Netherlands
| |
Collapse
|
15
|
Atalay S, Berends SE, Groenewoud HMM, Mathot RAA, Njoo DM, Mommers JM, Ossenkoppele PM, Koetsier MIA, Berends MA, de Vries A, van de Kerkhof PCM, den Broeder AA, de Jong EMGJ, van den Reek JMPA. Serum drug levels and anti-drug antibodies in the context of dose tapering by interval prolongation of adalimumab, etanercept and ustekinumab in psoriasis patients: results of the CONDOR trial. J DERMATOL TREAT 2022; 33:2680-2684. [PMID: 35193441 DOI: 10.1080/09546634.2022.2043546] [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: 10/19/2022]
Abstract
BACKGROUND Biologics for psoriasis are registered in standard dosages. In patients with low disease activity, reduction of the dose by interval prolongation can prevent overtreatment, and lower risks and costs. However, fear for increased anti-drug antibody (ADA) formation due to interval prolongation of biologics is an important barrier. OBJECTIVE To investigate the course of serum drug concentrations, ADA levels, and predictors for successful dose reduction of adalimumab, ustekinumab, and etanercept for psoriasis. METHODS Patients were randomized to dose reduction (DR) or usual care (UC) and followed for one year. The course and extent of detectable ADA levels were expressed as proportions/relative risks for DR vs. UC. Association of baseline characteristics with successful tapering was investigated with log-binomial regression analysis. RESULTS In total, 118 patients were included. In adalimumab-treated patients, no significant difference in the proportion of patients with relevant ADA levels in DR vs. UC was seen. For ustekinumab, relevant ADA development was absent in both groups. Baseline trough levels were not predictive for successful DR. CONCLUSIONS Immunogenicity may not increase by interval prolongation in psoriasis patients with low disease activity. This pilot provides important and reassuring insight into the pharmacological changes after dose tapering of adalimumab, etanercept, and ustekinumab.
Collapse
Affiliation(s)
- Selma Atalay
- Department of Dermatology, Radboudumc, Nijmegen René Descartesdreef 1, Nijmegen, Netherlands
| | - Sophie E Berends
- Department of Hospital Pharmacy, Academic Medical Center, Amsterdam, Netherlands
| | - Hans M M Groenewoud
- Department for Health Evidence, Radboud Institute for Health Sciences, Radboudumc, Nijmegen, Netherlands
| | - Ron A A Mathot
- Department of Hospital Pharmacy, Academic Medical Center, Amsterdam, Netherlands
| | - David M Njoo
- Department of Dermatology, Ziekenhuis Groep Twente, Hengelo, Netherlands
| | | | | | | | - Maartje A Berends
- Department of Dermatology, Slingelandziekenhuis, Doetinchem, Netherlands
| | - Annick de Vries
- Biologics Lab, Bioanalysis, Sanquin Diagnostic Services, Amsterdam, Netherlands
| | | | | | - Elke M G J de Jong
- Department of Dermatology, Radboudumc, Nijmegen René Descartesdreef 1, Nijmegen, Netherlands.,Radboud University, Nijmegen, Netherlands
| | - Juul M P A van den Reek
- Department of Dermatology, Radboudumc, Nijmegen René Descartesdreef 1, Nijmegen, Netherlands
| |
Collapse
|
16
|
van der Schoot LS, van den Reek JMPA, Grine L, Schots L, Kievit W, Lambert JLW, de Jong EMGJ. Dose reduction of the new generation biologics (IL-17 and IL-23 inhibitors) in psoriasis: study protocol for an international, pragmatic, multicenter, randomized, controlled, non-inferiority study-the BeNeBio study. Trials 2021; 22:707. [PMID: 34656148 PMCID: PMC8520290 DOI: 10.1186/s13063-021-05681-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 02/04/2021] [Accepted: 10/04/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Psoriasis is a chronic immune-mediated inflammatory skin disease for which biologics are effective treatments. Dose reduction (DR) of the first generation biologics seems a promising way for more efficient use of expensive biologics. A substantial part of patients on tumor necrosis factor (TNF)-alfa inhibitors and ustekinumab could successfully lower their dose, after following a tightly controlled DR strategy. The objective of this study is to assess whether controlled DR of interleukin (IL)-17 and IL-23 inhibitors in psoriasis patients with low disease activity is non-inferior (NI) to usual care (UC). METHODS This is an international, prospective, multicenter, pragmatic, randomized, non-inferiority trial. A total of 244 patients with stable low disease activity (Psoriasis Area and Severity Index (PASI) ≤ 5) for at least 6 months and using secukinumab, ixekizumab, brodalumab, guselkumab, risankizumab, or tildrakizumab in the standard dose, together with stable low disease activity, defined as a PASI ≤ 5 and Dermatology Life Quality Index (DLQI) ≤ 5 at the moment of inclusion, will be randomized 2:1 to DR or UC. In the DR group, dosing intervals will be prolonged stepwise to achieve 66% and 50% of the original dose. Disease activity is monitored every 3 months by PASI and DLQI. In case of disease flare (i.e., PASI and/or DLQI increase), treatment is adjusted to the previous effective dose. The primary outcome is the incidence proportion of persistent flares (PASI > 5 for ≥ 3 months), which will be compared between arms. Secondary outcomes include proportion of patients with successful DR, (course of) PASI and DLQI, serious adverse events (SAEs), health-related quality of life, costs, and pharmacokinetic profile. Outcomes of DR will be compared to UC. DISCUSSION With this study, we aim to assess whether DR of IL-17 and IL-23 inhibiting biologics can be achieved for psoriasis patients with low disease activity, without losing disease control. Reducing the dose may lead to more efficient use of biologics. TRIAL REGISTRATION ClinicalTrials.gov NCT04340076 . Registered on April 9 2020.
Collapse
Affiliation(s)
- Lara S van der Schoot
- Radboud University Medical Center, Department of Dermatology, Rene Descartesdreef 1, 6525GL, Nijmegen, The Netherlands.,Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, The Netherlands
| | - Juul M P A van den Reek
- Radboud University Medical Center, Department of Dermatology, Rene Descartesdreef 1, 6525GL, Nijmegen, The Netherlands.,Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, The Netherlands
| | - Lynda Grine
- Department of Dermatology, Ghent University Hospital, C. Heymanslaan 10, 9000, Ghent, Belgium
| | - Lisa Schots
- Department of Dermatology, Ghent University Hospital, C. Heymanslaan 10, 9000, Ghent, Belgium
| | - Wietske Kievit
- Radboud University Medical Center, Department for Health Evidence, Geert Grooteplein 21, 6525EZ, Nijmegen, The Netherlands
| | - Jo L W Lambert
- Department of Dermatology, Ghent University Hospital, C. Heymanslaan 10, 9000, Ghent, Belgium
| | - Elke M G J de Jong
- Radboud University Medical Center, Department of Dermatology, Rene Descartesdreef 1, 6525GL, Nijmegen, The Netherlands. .,Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, The Netherlands. .,Radboud University, Comeniuslaan 4, 6525HP, Nijmegen, The Netherlands.
| |
Collapse
|
17
|
Mulder MLM, He X, van den Reek JMPA, Urbano PCM, Kaffa C, Wang X, van Cranenbroek B, van Rijssen E, van den Hoogen FHJ, Joosten I, Alkema W, de Jong EMGJ, Smeets RL, Wenink MH, Koenen HJPM. Blood-Based Immune Profiling Combined with Machine Learning Discriminates Psoriatic Arthritis from Psoriasis Patients. Int J Mol Sci 2021; 22:ijms222010990. [PMID: 34681660 PMCID: PMC8538368 DOI: 10.3390/ijms222010990] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Revised: 10/04/2021] [Accepted: 10/08/2021] [Indexed: 12/22/2022] Open
Abstract
Psoriasis (Pso) is a chronic inflammatory skin disease, and up to 30% of Pso patients develop psoriatic arthritis (PsA), which can lead to irreversible joint damage. Early detection of PsA in Pso patients is crucial for timely treatment but difficult for dermatologists to implement. We, therefore, aimed to find disease-specific immune profiles, discriminating Pso from PsA patients, possibly facilitating the correct identification of Pso patients in need of referral to a rheumatology clinic. The phenotypes of peripheral blood immune cells of consecutive Pso and PsA patients were analyzed, and disease-specific immune profiles were identified via a machine learning approach. This approach resulted in a random forest classification model capable of distinguishing PsA from Pso (mean AUC = 0.95). Key PsA-classifying cell subsets selected included increased proportions of differentiated CD4+CD196+CD183-CD194+ and CD4+CD196-CD183-CD194+ T-cells and reduced proportions of CD196+ and CD197+ monocytes, memory CD4+ and CD8+ T-cell subsets and CD4+ regulatory T-cells. Within PsA, joint scores showed an association with memory CD8+CD45RA-CD197- effector T-cells and CD197+ monocytes. To conclude, through the integration of in-depth flow cytometry and machine learning, we identified an immune cell profile discriminating PsA from Pso. This immune profile may aid in timely diagnosing PsA in Pso.
Collapse
Affiliation(s)
- Michelle L. M. Mulder
- Department of Rheumatology, Sint Maartenskliniek, 6524 Nijmegen, The Netherlands; (M.L.M.M.); (F.H.J.v.d.H.); (M.H.W.)
- Department of Dermatology, Radboud University Medical Center, 6524 Nijmegen, The Netherlands; (J.M.P.A.v.d.R.); (E.M.G.J.d.J.)
| | - Xuehui He
- Department of Laboratory Medicine—Medical Immunology, Department of Dermatology, Radboud University Medical Center, 6524 Nijmegen, The Netherlands; (X.H.); (P.C.M.U.); (B.v.C.); (E.v.R.); (I.J.); (R.L.S.)
| | - Juul M. P. A. van den Reek
- Department of Dermatology, Radboud University Medical Center, 6524 Nijmegen, The Netherlands; (J.M.P.A.v.d.R.); (E.M.G.J.d.J.)
| | - Paulo C. M. Urbano
- Department of Laboratory Medicine—Medical Immunology, Department of Dermatology, Radboud University Medical Center, 6524 Nijmegen, The Netherlands; (X.H.); (P.C.M.U.); (B.v.C.); (E.v.R.); (I.J.); (R.L.S.)
| | - Charlotte Kaffa
- Center for Molecular and Biomolecular Informatics, Radboud University Medical Center, 6524 Nijmegen, The Netherlands;
| | - Xinhui Wang
- Luxembourg Centre for Systems Biomedicine, University of Luxembourg, L-4475 Belvaux, Luxembourg;
- College of Computer Science, Qinghai Normal University, Xining 810000, China
| | - Bram van Cranenbroek
- Department of Laboratory Medicine—Medical Immunology, Department of Dermatology, Radboud University Medical Center, 6524 Nijmegen, The Netherlands; (X.H.); (P.C.M.U.); (B.v.C.); (E.v.R.); (I.J.); (R.L.S.)
| | - Esther van Rijssen
- Department of Laboratory Medicine—Medical Immunology, Department of Dermatology, Radboud University Medical Center, 6524 Nijmegen, The Netherlands; (X.H.); (P.C.M.U.); (B.v.C.); (E.v.R.); (I.J.); (R.L.S.)
| | - Frank H. J. van den Hoogen
- Department of Rheumatology, Sint Maartenskliniek, 6524 Nijmegen, The Netherlands; (M.L.M.M.); (F.H.J.v.d.H.); (M.H.W.)
| | - Irma Joosten
- Department of Laboratory Medicine—Medical Immunology, Department of Dermatology, Radboud University Medical Center, 6524 Nijmegen, The Netherlands; (X.H.); (P.C.M.U.); (B.v.C.); (E.v.R.); (I.J.); (R.L.S.)
| | - Wynand Alkema
- Institute for Life Science and Technology, Hanze University of Applied Sciences, 9727 Groningen, The Netherlands;
- TenWise BV, 5344 KX Oss, The Netherlands
| | - Elke M. G. J. de Jong
- Department of Dermatology, Radboud University Medical Center, 6524 Nijmegen, The Netherlands; (J.M.P.A.v.d.R.); (E.M.G.J.d.J.)
| | - Ruben L. Smeets
- Department of Laboratory Medicine—Medical Immunology, Department of Dermatology, Radboud University Medical Center, 6524 Nijmegen, The Netherlands; (X.H.); (P.C.M.U.); (B.v.C.); (E.v.R.); (I.J.); (R.L.S.)
- Department of Laboratory Medicine, Laboratory for Diagnostics, Radboud University Medical Center, 6524 Nijmegen, The Netherlands
| | - Mark H. Wenink
- Department of Rheumatology, Sint Maartenskliniek, 6524 Nijmegen, The Netherlands; (M.L.M.M.); (F.H.J.v.d.H.); (M.H.W.)
| | - Hans J. P. M. Koenen
- Department of Laboratory Medicine—Medical Immunology, Department of Dermatology, Radboud University Medical Center, 6524 Nijmegen, The Netherlands; (X.H.); (P.C.M.U.); (B.v.C.); (E.v.R.); (I.J.); (R.L.S.)
- Correspondence: ; Tel.: +31-243-693-478
| |
Collapse
|
18
|
Mulder MLM, van Hal TW, Wenink MH, Koenen HJPM, van den Hoogen FHJ, de Jong EMGJ, van den Reek JMPA, Vriezekolk JE. Clinical, laboratory, and genetic markers for the development or presence of psoriatic arthritis in psoriasis patients: a systematic review. Arthritis Res Ther 2021; 23:168. [PMID: 34127053 PMCID: PMC8201808 DOI: 10.1186/s13075-021-02545-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [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: 01/28/2021] [Accepted: 05/21/2021] [Indexed: 12/11/2022] Open
Abstract
Twenty to thirty percent of psoriasis (Pso) patients will develop psoriatic arthritis (PsA). Detection of Pso patients that are (at risk for) developing PsA is essential to prevent structural damage. We conducted a systematic search of five bibliographic databases, up to May 2020. We searched for studies assessing markers (clinical, laboratory, genetic) associated with the development or presence of PsA in Pso patients. Study selection and quality assessment of the included studies was performed, followed by a qualitative best evidence synthesis to determine the level of evidence for a marker and its association with concomitant/developing PsA in Pso. Overall, 259 possible markers were identified in 119 studies that met the inclusion criteria. Laboratory markers related to inflammation and bone metabolism reached a strong level of evidence for the association (not prediction) of PsA in Pso. Only CXCL10 showed strong evidence for a positive predictive value for PsA in Pso. The importance of timely detecting PsA in a Pso population, and finding more (bio)markers contributing to early detection, remains high.
Collapse
Affiliation(s)
- Michelle L M Mulder
- Department of Rheumatology, Sint Maartenskliniek, PO box 9011, 6500 GM, Nijmegen, The Netherlands. .,Radboud Institute for Health Sciences (RIHS), Radboud University Medical Center, Nijmegen, The Netherlands.
| | - Tamara W van Hal
- Department of Rheumatology, Sint Maartenskliniek, PO box 9011, 6500 GM, Nijmegen, The Netherlands.,Radboud Institute for Health Sciences (RIHS), Radboud University Medical Center, Nijmegen, The Netherlands
| | - Mark H Wenink
- Department of Rheumatology, Sint Maartenskliniek, PO box 9011, 6500 GM, Nijmegen, The Netherlands
| | - Hans J P M Koenen
- Laboratory of Medical Immunology, Department of Laboratory Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
| | | | - Elke M G J de Jong
- Radboud Institute for Health Sciences (RIHS), Radboud University Medical Center, Nijmegen, The Netherlands.,Radboud University, Nijmegen, The Netherlands.,Department of Dermatology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Juul M P A van den Reek
- Radboud Institute for Health Sciences (RIHS), Radboud University Medical Center, Nijmegen, The Netherlands.,Department of Dermatology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Johanna E Vriezekolk
- Department of Rheumatology, Sint Maartenskliniek, PO box 9011, 6500 GM, Nijmegen, The Netherlands
| |
Collapse
|
19
|
Barenbrug L, Groen MT, Hoentjen F, van Drongelen J, Reek JMPAVD, Joosten I, de Jong EMGJ, van der Molen RG. Pregnancy and neonatal outcomes in women with immune mediated inflammatory diseases exposed to anti-tumor necrosis factor-α during pregnancy: A systemic review and meta-analysis. J Autoimmun 2021; 122:102676. [PMID: 34126302 DOI: 10.1016/j.jaut.2021.102676] [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] [Received: 03/23/2021] [Revised: 05/27/2021] [Accepted: 05/29/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Anti-TNFα is increasingly used as treatment for immune mediated inflammatory diseases (IMID), such as inflammatory bowel disease (IBD), rheumatoid arthritis (RA) and psoriasis (PS). However, the impact of anti-TNFα during pregnancy on mother and newborn is under debate. This requires a sound knowledge of the effects of this treatment on pregnancy and neonatal outcomes. OBJECTIVES To assess pregnancy and neonatal outcomes after anti-TNFα therapy during pregnancy in women with IMID, specifically IBD, RA and PS. METHODS We performed a systematic review and meta-analysis of 39 studies assessing pregnancy and neonatal outcomes of women with IMID exposed to anti-TNFα agents during pregnancy. We used a random-effects model to determine pooled outcome measures. RESULTS An increased risk of preterm births (OR 1.45, 95% CI = 1.16 to 1.82, p = 0.001) and infections in newborns (OR 1.12, 95% CI = 1.00 to 1.27, p = 0.05)) was seen for women in the combined group of IMID exposed to anti-TNFα compared to diseased controls. Specifically for IBD patients exposed to anti-TNFα, the risk was increased for preterm birth (OR 1.66, 95% CI = 1.14 to 2.42, p = 0.009), and low birth weight (OR 1.49, 95% CI = 1.01 to 2.20, p = 0.047) compared to diseased controls. Combined data from studies of women with RA and PS, showed no increased risk for adverse pregnancy outcome after exposure to anti-TNFα. Most children of mothers with IMID received vaccination according to national vaccination schemes and only minor adverse events were reported. CONCLUSION Exposure to anti-TNFα agents during pregnancy is associated with increased risk of preterm birth and infections in newborns of women with IMID compared to diseased controls. The risk of preterm birth and low birth weight was increased in women with IBD specifically. The increased risk of infections in newborns underlines the importance of vaccination, which seems to be safe in children exposed to anti-TNFα. Delay of vaccination is therefore unnecessary in these children. These data may aid in balancing the continuing anti-TNFα therapy versus the risk of adverse pregnancy outcomes.
Collapse
Affiliation(s)
- Liana Barenbrug
- Laboratory of Medical Immunology, Department of Laboratory Medicine, Radboud Institute for Molecular Life Sciences, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Maarten Te Groen
- Inflammatory Bowel Disease Centre, Department of Gastroenterology and Hepatology, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - Frank Hoentjen
- Inflammatory Bowel Disease Centre, Department of Gastroenterology and Hepatology, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - Joris van Drongelen
- Department of Obstetrics and Gynaecology, Radboud University Medical Center, Nijmegen, the Netherlands
| | | | - Irma Joosten
- Laboratory of Medical Immunology, Department of Laboratory Medicine, Radboud Institute for Molecular Life Sciences, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Elke M G J de Jong
- Department of Dermatology, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - Renate G van der Molen
- Laboratory of Medical Immunology, Department of Laboratory Medicine, Radboud Institute for Molecular Life Sciences, Radboud University Medical Center, Nijmegen, the Netherlands.
| |
Collapse
|
20
|
Atalay S, van der Schoot LS, Vandermaesen L, van Vugt LJ, Eilander M, van den Reek JMPA, de Jong EMGJ. Evaluation of a One-step Dose Reduction Strategy of Adalimumab, Etanercept and Ustekinumab in Patients with Psoriasis in Daily Practice. Acta Derm Venereol 2021; 101:adv00463. [PMID: 33903920 PMCID: PMC9367038 DOI: 10.2340/00015555-3815] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Dose reduction of biologics for psoriasis could contribute to lower drug exposure. This study evaluated a one-step, tightly controlled, biologic dose reduction strategy in a prospective daily practice cohort. In patients with psoriasis with low disease activity using adalimumab, etanercept or ustekinumab for at least 6 months, the dosing interval was prolonged with 33%. Patients could return to their normal dosing interval in case of disease flare. Of 108 eligible patients, 80 started dose reduction and were analysed. In total, 36/80 patients (45.0%) discontinued dose reduction after 19 months (95% confidence interval 14.9–23.1 months). Of 67 patients with 1-year follow-up, 45 (67.2%) still used the lower dose after 1 year. No serious adverse events related to dose reduction occurred. Cumulative dose and costs decreased by 22.7% during 1 year. In conclusion, a one-step tightly controlled dose reduction strategy for adalimumab, etanercept and ustekinumab has considerable potential to safely decrease biologic dosages in patients with psoriasis in daily practice.
Collapse
Affiliation(s)
- Selma Atalay
- Department of Dermatology, Radboud University Medical Center, 6500HB Nijmegen, The Netherlands
| | | | | | | | | | | | | |
Collapse
|
21
|
Dekkers C, Alizadeh Aghdam M, de Graaf M, Knulst AC, Meijer Y, van den Reek JMPA, Stadermann MB, Röckmann H. Safety and effectiveness of omalizumab for the treatment of chronic urticaria in pediatric patients. Pediatr Allergy Immunol 2021; 32:720-726. [PMID: 33305439 PMCID: PMC8248194 DOI: 10.1111/pai.13426] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Revised: 09/24/2020] [Accepted: 11/23/2020] [Indexed: 01/10/2023]
Abstract
BACKGROUND Evidence on safety and effectiveness of omalizumab for treatment of chronic urticaria in pediatric patients is scarce and limited to case reports. In particular, drug survival of omalizumab has not yet been investigated, which is a key element in the evaluation of its clinical performance. The aim of this study was to investigate safety, effectiveness, and drug survival rates of omalizumab in a daily practice cohort of pediatric patients with chronic urticaria (CU). METHODS This is a multicenter study including all pediatric patients from an academic center (Wilhelmina Children's Hospital) and a general center (Diakonessenhuis Hospital) in the Netherlands, who started omalizumab treatment before the age of 18 years. Data on safety, effectiveness, time to discontinuation, and reasons for discontinuation of treatment were assessed. Drug survival of omalizumab was estimated using the Kaplan-Meier survival analysis. RESULTS A total of 38 patients, who started treatment between January 2014 and January 2020, were included. Most patients (68.4%) used omalizumab without reporting any side effects and a complete or good response to treatment was achieved in 76.3% of patients. The 1- and 2-year drug survival rates were 62% and 50%, respectively, with well-controlled disease activity as the most frequent reason for discontinuation in 69.2% of patients, followed by ineffectiveness in 23.1% and side effects in 7.7% of patients. CONCLUSIONS This study demonstrates high safety and effectiveness of omalizumab treatment in pediatric patients with CU, which will aid clinical decision making and management of expectations when choosing omalizumab treatment for pediatric patients with CU.
Collapse
Affiliation(s)
- Coco Dekkers
- Department of Dermatology/Allergology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Mehran Alizadeh Aghdam
- Department of Dermatology/Allergology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Marlies de Graaf
- Department of Dermatology/Allergology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - André C Knulst
- Department of Dermatology/Allergology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Yolanda Meijer
- Department of Pediatric Pulmonology/Allergology, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | | | - Marike B Stadermann
- Department of Pediatrics, Diakonessenhuis Hospital, Utrecht, The Netherlands
| | - Heike Röckmann
- Department of Dermatology/Allergology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| |
Collapse
|
22
|
Atalay S, van den Reek JMPA, den Broeder AA, van Vugt LJ, Otero ME, Njoo MD, Mommers JM, Ossenkoppele PM, Koetsier MI, Berends MA, van de Kerkhof PCM, Groenewoud HMM, Kievit W, de Jong EMGJ. Comparison of Tightly Controlled Dose Reduction of Biologics With Usual Care for Patients With Psoriasis: A Randomized Clinical Trial. JAMA Dermatol 2020; 156:393-400. [PMID: 32049319 DOI: 10.1001/jamadermatol.2019.4897] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Importance Biologics revolutionized the treatment of psoriasis. Biologics are given in a fixed dose, but lower doses might be possible. Objective To investigate whether dose reduction (DR) of biologics in patients with stable psoriasis is noninferior to usual care (UC). Design, Setting, and Participants This pragmatic, open-label, prospective, controlled, noninferiority randomized clinical trial was conducted from March 1, 2016, to July 22, 2018, at 6 dermatology departments in the Netherlands. A total of 120 patients with plaque psoriasis and stable low disease activity who were receiving treatment with adalimumab, etanercept, or ustekinumab were studied. Interventions Patients were randomized 1:1 to DR (n = 60) or UC (n = 60). In the DR group, injection intervals were prolonged stepwise, leading to 67% and 50% of the original dose. Main Outcomes and Measures The primary outcome was between-group difference in disease activity corrected for baseline at 12 months compared with the predefined noninferiority margin of 0.5. Secondary outcomes were Psoriasis Area and Severity Index (PASI) score and health-related quality of life (including Dermatology Life Quality Index [DLQI] and Medical Outcomes Study 36-Item Short Form Health Survey scores), proportion of patients with short and persistent flares (defined as PASI and/or DLQI scores >5 for ≥3 months), and proportion of patients with successful dose tapering. Results Of 120 patients (mean [SD] age, 54.0 [13.2] years; 82 [68%] male), 2 patients were lost to follow-up, 2 patients had a protocol violation, and 5 patients had a protocol deviation, leaving 111 patients for the per-protocol analysis (53 in the DR group and 58 in the UC group). The median PASI scores at month 12 were 3.4 (interquartile range [IQR], 2.2-4.5) in the DR group and 2.1 (IQR, 0.6-3.6) in the UC group (mean difference, 1.2; 95% CI, 0.7-1.8). This indicates that noninferiority was not demonstrated for DR compared to UC. The median DLQI score at month 12 was 1.0 (IQR, 0.0-2.0) in the DR group and 0.0 (IQR, 0.0-2.0) in the UC group (mean difference, 0.8; 95% CI, 0.3-1.3), indicating noninferiority for DR compared with UC. No significant difference was found regarding persistent flares between groups (n = 5 in both groups). Twenty-eight patients (53%; 95% CI, 39%-67%) in the DR group tapered their dose successfully at 12 months. No severe adverse events related to the intervention occurred. Conclusions and Relevance In this trial, noninferiority was not demonstrated for DR of adalimumab, etanercept, and ustekinumab based on the PASI in patients with psoriasis compared with UC with the chosen noninferiority margin. However, the strategy was noninferior based on the DLQI. Dose tapering did not lead to persistent flares or safety issues. Trial Registration ClinicalTrials.gov Identifier: NCT02602925.
Collapse
Affiliation(s)
- Selma Atalay
- Department of Dermatology, Radboud University Medical Center, Nijmegen, the Netherlands
| | | | | | - Lieke J van Vugt
- Department of Dermatology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Marisol E Otero
- Department of Dermatology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Marcellus D Njoo
- Department of Dermatology, Ziekenhuis Groep Twente, Hengelo, the Netherlands
| | - Johannes M Mommers
- Department of Dermatology, Sint Anna Ziekenhuis, Geldrop, the Netherlands
| | | | | | - Maartje A Berends
- Department of Dermatology, Slingelandziekenhuis, Doetinchem, the Netherlands
| | | | | | - Wietske Kievit
- Department for Health Evidence, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Elke M G J de Jong
- Department of Dermatology, Radboud University Medical Center, Nijmegen, the Netherlands
| |
Collapse
|
23
|
Atalay S, van den Reek JMPA, Otero ME, Njoo MD, Mommers JM, Ossenkoppele PM, Koetsier MI, Berends MM, van de Kerkhof PCM, Groenewoud HMM, den Broeder AA, de Jong EMGJ, Kievit W. Health Economic Consequences of a Tightly Controlled Dose Reduction Strategy for Adalimumab, Etanercept and Ustekinumab Compared with Standard Psoriasis Care: A Cost-utility Analysis of the CONDOR Study. Acta Derm Venereol 2020; 100:adv00340. [PMID: 33196101 PMCID: PMC9309701 DOI: 10.2340/00015555-3692] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
A dose reduction strategy for adalimumab, etanercept and ustekinumab in patients with psoriasis who have stable and low disease activity has recently been compared with usual care in the CONDOR study (CONtrolled DOse Reduction) of biologics in patients with psoriasis with low disease activity. The aim of the current study was to perform a cost-utility analysis with a 12-month time horizon alongside this trial, using prospectively measured healthcare costs and quality-adjusted life years, based on Short-Form Six-Dimension utilities. Bootstrap analyses were used to calculate the decremental cost-utility ratio and the incremental net monetary benefit. The dose reduction strategy resulted in a mean cost saving of €3,820 (95th percentile –€3,099 to –€4,509) per patient over a period of 12 months. There was an 83% chance that dose reduction would result in a reduction in quality adjusted life years (mean –0.02 (95th percentile –0.06 to 0.02). In conclusion, dose reduction of biologics resulted in substantial cost savings with an acceptable reduction in quality of life.
Collapse
Affiliation(s)
- Selma Atalay
- Department of Dermatology, Radboud university medical center, 6525 Nijmegen, The Netherlands. E-mail:
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
24
|
van Winden MEC, van der Schoot LS, van de L’Isle Arias M, van Vugt LJ, van den Reek JMPA, van de Kerkhof PCM, de Jong EMGJ, Lubeek SFK. Effectiveness and Safety of Systemic Therapy for Psoriasis in Older Adults. JAMA Dermatol 2020; 156:1229-1239. [DOI: 10.1001/jamadermatol.2020.2311] [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] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Affiliation(s)
| | | | | | - Lieke J. van Vugt
- Department of Dermatology, Maastricht University Medical Center, Maastricht, the Netherlands
| | | | | | - Elke M. G. J. de Jong
- Department of Dermatology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Satish F. K. Lubeek
- Department of Dermatology, Radboud University Medical Center, Nijmegen, the Netherlands
| |
Collapse
|
25
|
van Muijen ME, van Hal TW, Groenewoud HMM, van den Reek JMPA, de Jong EMGJ. The Skin May Clear But the Arthritis Won't Disappear: Focusing on Concomitant and New-Onset Psoriatic Arthritis in a Daily Practice Cohort of Psoriasis Patients on Biologic Therapy. Psoriasis (Auckl) 2020; 10:29-37. [PMID: 33117661 PMCID: PMC7547182 DOI: 10.2147/ptt.s270619] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Accepted: 08/14/2020] [Indexed: 11/23/2022]
Abstract
Background Previously identified risk factors for psoriatic arthritis (PsA); nail dystrophy and scalp lesions are highly prevalent in patients with moderate-to-severe psoriasis. Therefore, these variables may not be useful as predictors for PsA in this population. Objective We assessed the predictive value of demographic and clinical characteristics for development of PsA in a cohort of patients with moderate-to-severe psoriasis, currently treated with biologics. Furthermore, we reported the incidence of new-onset PsA in this population and described the characteristics of patients that developed PsA during biologic treatment. Methods Demographics and treatment characteristics of psoriasis patients currently using biologic therapy were extracted from the BioCAPTURE database (n=427). Poisson regression was used to calculate incidence rates. Multivariable logistic regression was performed to identify factors independently associated with PsA onset. Patient and treatment characteristics of patients that developed PsA during biologic treatment were described. Results The incidence of PsA was 1.0 (95% CI 0.8–1.2) per 100 psoriasis-years. Except for a lower risk for PsA in male gender (OR 0.58, 95% CI 0.34–0.98, p-value 0.04), no clinical factors were significantly associated with an altered risk of developing PsA. During biologic therapy, 32 patients (9.4%) newly developed PsA. In this group, 53.8% had PASI<5 at PsA diagnosis. The incidence rate of PsA was 1.6 (95% CI 1.1–2.2) per 100 years on biologic therapy. Conclusion Clinical risk factors might be inaccurate to predict PsA onset in patients with moderate-to-severe psoriasis on biologics. Even with low disease activity, psoriasis patients on biologics are still prone to develop PsA.
Collapse
Affiliation(s)
- Marloes E van Muijen
- Department of Dermatology, Radboud University Medical Center (Radboudumc), Nijmegen, the Netherlands.,Radboud Institute for Health Sciences (RIHS), Radboud University Medical Center (Radboudumc), Nijmegen, the Netherlands
| | - Tamara W van Hal
- Department of Dermatology, Radboud University Medical Center (Radboudumc), Nijmegen, the Netherlands.,Radboud Institute for Health Sciences (RIHS), Radboud University Medical Center (Radboudumc), Nijmegen, the Netherlands.,Department of Rheumatology, Sint Maartenskliniek, Nijmegen, the Netherlands
| | - Hans M M Groenewoud
- Radboud Institute for Health Sciences (RIHS), Radboud University Medical Center (Radboudumc), Nijmegen, the Netherlands
| | - Juul M P A van den Reek
- Department of Dermatology, Radboud University Medical Center (Radboudumc), Nijmegen, the Netherlands.,Radboud Institute for Health Sciences (RIHS), Radboud University Medical Center (Radboudumc), Nijmegen, the Netherlands
| | - Elke M G J de Jong
- Department of Dermatology, Radboud University Medical Center (Radboudumc), Nijmegen, the Netherlands.,Radboud Institute for Health Sciences (RIHS), Radboud University Medical Center (Radboudumc), Nijmegen, the Netherlands.,Radboud University, Nijmegen, the Netherlands
| |
Collapse
|
26
|
van Vugt LJ, van den Reek JMPA, Hannink G, Coenen MJH, de Jong EMGJ. Association of HLA-C*06:02 Status With Differential Response to Ustekinumab in Patients With Psoriasis: A Systematic Review and Meta-analysis. JAMA Dermatol 2020; 155:708-715. [PMID: 30994858 DOI: 10.1001/jamadermatol.2019.0098] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Importance Previous research showed a differential response to ustekinumab therapy based on HLA-C*06:02 status in patients with psoriasis but consisted mostly of small (and sometimes inconclusive) cohort studies. Objective To assess whether HLA-C*06:02 status is associated with a differential response to ustekinumab therapy in patients with psoriasis through a systematic review and a meta-analysis of available data. Data Sources A comprehensive search was conducted using MEDLINE, Embase, the Cochrane Library, Web of Science, and gray literature sources. Databases were searched from January 1, 2000, to May 14, 2018. Search strategies included terms and synonyms for psoriasis, HLA-C, and ustekinumab. Languages were restricted to English, French, German, and Dutch. Study Selection Studies were included if they reported the association between HLA-C*06:02 status and 75% improvement in Psoriasis Area and Severity Index (PASI75) response to ustekinumab therapy in patients with plaque psoriasis after 6 and/or 3 months of treatment. Randomized clinical trials and observational studies were included. Screening and selection were performed independently by 2 reviewers. Data Extraction and Synthesis HLA-C*06:02 genotype status and PASI75 response rates were extracted by 2 reviewers. Data were pooled using random-effects models. Heterogeneity was assessed using the τ2 and I2 statistic. Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) and Meta-Analysis of Observational Studies in Epidemiology (MOOSE) reporting guidelines were followed. Main Outcome and Measure The primary outcome was the risk difference of achieving PASI75 after 6 months of ustekinumab therapy between HLA-C*06:02-positive and HLA-C*06:02-negative patients. Results A total of 8 studies were reviewed; 1048 patients were included for meta-analyses, and 937 patients were included for the primary analysis of PASI75 response after 6 months of treatment. Random-effects meta-analysis showed a risk difference of 0.24 (95% CI, 0.14-0.35; P < .001) in favor of HLA-C*06:02-positive patients. The median PASI75 response rate in the HLA-C*06:02-positive group was 92% (pooled, 89%; range, 62%-98%). For HLA-C*06:02-negative patients, the median response rate was 67% (pooled, 62%; range, 40%-84%). Substantial heterogeneity may have been present, with an I2 of 82%. Conclusions and Relevance The meta-analysis showed a differential response to ustekinumab therapy based on HLA-C*06:02 status in patients with psoriasis. Although HLA-C*06:02-positive patients had high PASI75 response rates after 6 months, the PASI75 response rate was also high in the HLA-C*06:02-negative group. There appears to be no rationale for excluding patients from ustekinumab treatment based on a negative HLA-C*06:02 status.
Collapse
Affiliation(s)
- Lieke J van Vugt
- Department of Dermatology, Radboud University Medical Centre, Radboud Institute of Health Sciences, Nijmegen, the Netherlands
| | - Juul M P A van den Reek
- Department of Dermatology, Radboud University Medical Centre, Radboud Institute of Health Sciences, Nijmegen, the Netherlands
| | - Gerjon Hannink
- Department of Operating Rooms, Radboud University Medical Centre, Radboud Institute of Health Sciences, Nijmegen, the Netherlands
| | - Marieke J H Coenen
- Department of Human Genetics, Radboud University Medical Centre, Radboud Institute of Health Sciences, Nijmegen, the Netherlands
| | - Elke M G J de Jong
- Department of Dermatology, Radboud University Medical Centre, Radboud Institute of Health Sciences, Nijmegen, the Netherlands.,Radboud University, Nijmegen, the Netherlands
| |
Collapse
|
27
|
Otero ME, van den Reek JMPA, van de Kerkhof PCM, Mertens JS, Seyger MMB, Kievit W, de Jong EMGJ. Beliefs About Medicines in Patients with Psoriasis Treated with Methotrexate or Biologics: A Cross-sectional Survey Study. Acta Derm Venereol 2019; 99:386-392. [PMID: 30543381 DOI: 10.2340/00015555-3108] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Methotrexate (MTX) and biologics are frequently used treatments for psoriasis. Exploring patients' beliefs about their treatment may help to elucidate patients' attitudes towards these therapies. A cross-sectional survey was conducted using the Beliefs about Medicines Questionnaire-Specific (BMQ-Specific) in patients treated with methotrexate or biologics. BMQ-Specific scores (Necessity and Concerns scales) were calculated and patients were classified as "accepting", "indifferent", "ambivalent" or "sceptical" towards their treat-ment. Biologics users scored higher on the Necessity scale than did methotrexate users. Both groups had lower Concerns scores than Necessity scores. A high Necessity scale was associated with a low Psoriasis Area and Severity Index score in both groups and long treatment duration in the methotrexate group. Although this study cannot make a direct comparison, it was observed that most patients on biologics could be classified as "accepting" (59%), and most patients on MTX could be classified as "indifferent" (47%). In conclusion, the BMQ-Specific is useful to identify patients with a sceptical, ambivalent or indifferent profile. These profiles may negatively influence patient's attitude towards their medication.
Collapse
Affiliation(s)
- Marisol E Otero
- Department of Dermatology, Radboud university medical center, 6500 HB Nijmegen, The Netherlands.
| | | | | | | | | | | | | |
Collapse
|
28
|
van den Reek JMPA, van Vugt LJ, van Doorn MBA, van der Kraaij GE, de Kort WJA, Lucker GPH, Horvath B, Njoo MD, Bovenschen HJ, Ossenkoppele PM, De Bruin-Weller MS, de Groot M, Mommers R, Prevoo RLMA, van de Kerkhof PCM, Spuls PI, Kievit W, de Jong EMGJ. Initial Results of Secukinumab Drug Survival in Patients with Psoriasis: A Multicentre Daily Practice Cohort Study. Acta Derm Venereol 2018; 98:648-654. [PMID: 29405245 DOI: 10.2340/00015555-2900] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Interleukin 17-antagonist secukinumab demonstrated high efficacy for treatment of psoriasis in randomized controlled trials. However, performance in daily practice may differ from trials. Drug survival is a comprehensive outcome covering effectiveness and safety, suitable for analyses of daily practice. The aim of this study was to evaluate drug survival of secukinumab in a daily practice psoriasis cohort. Data were collected from 13 hospitals. Drug survival was analysed using Kaplan-Meier survival curves, split for reason of discontinuation. In total, 196 patients were included (83% biologic experienced). Overall, 12 and 18 months drug survival of secukinumab was 76% and 67%, respectively, and was mostly determined by ineffectiveness. There was a trend towards shorter drug survival in women and in biologic experienced patients. Thirteen percent of patients experienced at least one episode of fungal infection. This is one of the first studies of drug survival of secukinumab in patients with psoriasis treated in daily practice.
Collapse
Affiliation(s)
- Juul M P A van den Reek
- Department of Dermatology, Radboud University Medical Centre, PO Box 9101, NL-6500 HB Nijmegen, The Netherlands.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
29
|
Atalay S, van den Reek JMPA, van Vugt LJ, Otero ME, van de Kerkhof PCM, den Broeder AA, Kievit W, de Jong EMGJ. Tight controlled dose reduction of biologics in psoriasis patients with low disease activity: a randomized pragmatic non-inferiority trial. BMC Dermatol 2017; 17:6. [PMID: 28482858 PMCID: PMC5422943 DOI: 10.1186/s12895-017-0057-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/23/2016] [Accepted: 04/25/2017] [Indexed: 11/19/2022]
Abstract
BACKGROUND Psoriasis is an immune-mediated chronic inflammatory skin disorder for which several targeted biologic therapies became available in the last 10 years. Data from patients with rheumatoid arthritis revealed that dose tapering combined with tight control of disease activity is successful. For psoriasis patients the lowest effective dose of biologics needs to be determined. The objective was to assess whether dose tapering of biologics guided by Psoriasis Area and Severity Index (PASI) and Dermatology Quality of Life Index (DLQI) scores in psoriasis patients with controlled disease activity is non-inferior (NI) to usual care. METHODS/DESIGN This is a multicenter, pragmatic, randomized, non-inferiority trial with cost- effectiveness analysis. One hundred and twenty patients with stable low disease activity (PASI ≤ 5 and DLQI ≤ 5) for at least 6 months with a stable use of adalimumab, etanercept or ustekinumab will be randomized 1:1 to the dose reduction group or usual care. In the dose reduction group, the treatment intervals will be prolonged stepwise, resulting in a 33% and 50% dose reduction, respectively. Disease activity is monitored every three months with PASI and DLQI. In case of flare the treatment is adjusted to the previous effective dose. The primary outcome (PASI) at 12 months will be analyzed with ANCOVA in which the baseline PASI will be included as covariate to gain efficiency. The secondary outcomes include number of and time to disease flares, health-related quality of life, serious adverse events, and costs. DISCUSSION With this study we want to assess whether disease activity guided dose reduction of biologics can be achieved for psoriasis patients with low stable disease activity, without losing disease control. By using the lowest effective dose of biologics, we expect to minimize side effects and save costs. TRIAL REGISTRATION This trial was registered at ClinicalTrials.gov ( NCT 02602925 ). Trial registration date October 9 2015.
Collapse
Affiliation(s)
- Selma Atalay
- Department of Dermatology, Radboud University Medical Center, Rene Descartesdreef 1, 6525 GL Nijmegen, The Netherlands
| | - Juul M. P. A. van den Reek
- Department of Dermatology, Radboud University Medical Center, Rene Descartesdreef 1, 6525 GL Nijmegen, The Netherlands
| | - Lieke J. van Vugt
- Department of Dermatology, Radboud University Medical Center, Rene Descartesdreef 1, 6525 GL Nijmegen, The Netherlands
| | - Marisol E. Otero
- Department of Dermatology, Radboud University Medical Center, Rene Descartesdreef 1, 6525 GL Nijmegen, The Netherlands
| | - Peter C. M. van de Kerkhof
- Department of Dermatology, Radboud University Medical Center, Rene Descartesdreef 1, 6525 GL Nijmegen, The Netherlands
| | - Alfons A. den Broeder
- Department of Rheumatology, Sint Maartenskliniek, Hengstdal 3, 6574 NA Ubbergen, Nijmegen, The Netherlands
| | - Wietske Kievit
- Department for Health Evidence, Radboud University, Geert Grooteplein 21, 6525 EZ Nijmegen, The Netherlands
| | - Elke M. G. J. de Jong
- Department of Dermatology, Radboud University Medical Center, Rene Descartesdreef 1, 6525 GL Nijmegen, The Netherlands
- Radboud University, Comeniuslaan 4, 6525 HP Nijmegen, The Netherlands
| |
Collapse
|
30
|
Zweegers J, Bronckers IM, van den Reek JMPA, van Geel MJ, van de Kerkhof PCM, Seyger MMB, de Jong EMGJ. Comment on "Review of patient registries in dermatology". J Am Acad Dermatol 2016; 75:e241. [PMID: 27846976 DOI: 10.1016/j.jaad.2016.05.051] [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: 04/26/2016] [Revised: 05/09/2016] [Accepted: 05/12/2016] [Indexed: 10/20/2022]
Affiliation(s)
- Jeffrey Zweegers
- Department of Dermatology, Radboud University Medical Center, Nijmegen, The Netherlands.
| | - Inge M Bronckers
- Department of Dermatology, Radboud University Medical Center, Nijmegen, The Netherlands
| | | | - Maartje J van Geel
- Department of Dermatology, Radboud University Medical Center, Nijmegen, The Netherlands
| | | | - Marieke M B Seyger
- Department of Dermatology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Elke M G J de Jong
- Department of Dermatology, Radboud University Medical Center, Nijmegen, The Netherlands
| |
Collapse
|
31
|
Zweegers J, Otero ME, van den Reek JMPA, van Lümig PP, Driessen RJ, Kievit W, Seyger MMB, van de Kerkhof PCM, de Jong EMGJ. Effectiveness of Biologic and Conventional Systemic Therapies in Adults with Chronic Plaque Psoriasis in Daily Practice: A Systematic Review. Acta Derm Venereol 2016; 96:453-8. [PMID: 26537336 DOI: 10.2340/00015555-2276] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
The efficacy of biologic or conventional systemic therapies for psoriasis has been shown in randomized controlled trials. Effectiveness, however, has been studied in daily practice cohorts, and no aggregation of effectiveness data is available. This systematic review searched PubMed and EMBASE and summarized the real-world evidence on effectiveness of biologics (adalimumab, etanercept, infliximab and ustekinumab) and conventional systemic therapies (acitretin, cyclosporine, fumarates and methotrexate) for the treatment of plaque psoriasis in adults. Thirty-two studies were included. Few data were available on infliximab, ustekinumab and conventional systemics. Results show that biologics and conventional systemics were effective in real-life treatment of psoriasis, with large ranges in the percentage of patients reaching 75% improvement in psoriasis area and severity index score compared with baseline, especially for etanercept and adalimumab treatment. Combination therapies of biologics with conventional systemics, and dose adjustments of biologics were frequently applied strategies and may explain the large range in improvements between cohorts.
Collapse
Affiliation(s)
- Jeffrey Zweegers
- Department of Dermatology 370, Radboud University Medical Centre, René Descartesdreef 1, PO Box 9101, 6500 HB Nijmegen, The Netherlands.
| | | | | | | | | | | | | | | | | |
Collapse
|
32
|
Menting SP, Coussens E, Pouw MF, van den Reek JMPA, Temmerman L, Boonen H, de Jong EMGJ, Spuls PI, Lambert J. Developing a Therapeutic Range of Adalimumab Serum Concentrations in Management of Psoriasis: A Step Toward Personalized Treatment. JAMA Dermatol 2015; 151:616-22. [PMID: 25807311 DOI: 10.1001/jamadermatol.2014.5479] [Citation(s) in RCA: 66] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Adalimumab has proven to be effective in suppressing psoriasis disease activity and is administered in a standard dose. OBJECTIVE To establish a therapeutic range for adalimumab trough levels in the treatment of plaque-type psoriasis, leading to a more personalized treatment. DESIGN, SETTING, AND PARTICIPANTS A multicenter, prospective, observational, daily practice cohort study conducted at an academic hospital with affiliated secondary care hospitals in Belgium (cohort 1) and 2 academic hospitals in the Netherlands (cohort 2). Both cohorts included adult patients treated with adalimumab for plaque-type psoriasis. Cohort 1 comprised 73 patients who were being treated with adalimumab for more than 24 weeks until 401 weeks. In cohort 2 (n = 62), serum samples were obtained between weeks 24 and 52 of treatment. INTERVENTIONS Before the start of adalimumab therapy and at time of serum sampling, Psoriasis Area and Severity Index (PASI) scores were determined. MAIN OUTCOMES AND MEASURES Adalimumab trough level and PASI score at the time of serum sampling to determine the receiver-operator characteristics analyses and concentration effect curve. RESULTS By means of receiver-operator characteristics analyses with an area under the curve of 0.756 (SD, 0.046; 95% CI, 0.666-0.847) and a sensitivity of 78% and a specificity of 70%, 3.51 mg/L was established as the lower margin for the therapeutic range. By means of a concentration effect curve, 7 mg/L was established as the upper margin. One-third of patients had an adalimumab trough concentration exceeding 7 mg/L. CONCLUSIONS AND RELEVANCE A therapeutic range of adalimumab trough levels of 3.51 mg/L to 7.00 mg/L, which corresponds to an optimal clinical effect, was identified. In one-third of patients, it was observed that trough concentrations exceeded the therapeutic window. Based on the established range, a therapeutic algorithm for adalimumab treatment for patients with psoriasis can be developed and validated in a prospective patient cohort. By identifying this range, a step has been taken toward a more rational use of biological therapy in psoriasis. Developing a therapeutic algorithm may lead to less overtreatment of patients and cost savings.
Collapse
Affiliation(s)
- Stef P Menting
- Department of Dermatology, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Emma Coussens
- Department of Dermatology, Ghent University Hospital, Gent, Belgium
| | - Mieke F Pouw
- Jan van Breemen Research Institute/Reade, Amsterdam, the Netherlands4Sanquin Research and Landsteiner Laboratory, Department of Immunopathology, Academic Medical Centre, University of Amsterdam, Amsterdam, the Netherlands
| | | | - Linda Temmerman
- Department of Dermatology, Maria Middelares Hospital, Gent, Belgium
| | - Hugo Boonen
- Department of Dermatology, H Hart Ziekenhuis, Mol, Belgium
| | - Elke M G J de Jong
- Department of Dermatology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Phyllis I Spuls
- Department of Dermatology, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Jo Lambert
- Department of Dermatology, Ghent University Hospital, Gent, Belgium
| |
Collapse
|
33
|
Menting SP, van Lümig PPM, de Vries ACQ, van den Reek JMPA, van der Kleij D, de Jong EMGJ, Spuls PI, Lecluse LLA. Extent and Consequences of Antibody Formation Against Adalimumab in Patients With Psoriasis. JAMA Dermatol 2014; 150:130-6. [DOI: 10.1001/jamadermatol.2013.8347] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Stef P. Menting
- Department of Dermatology, Academic Medical Center, Amsterdam, the Netherlands
| | - Paula P. M. van Lümig
- Department of Dermatology, Radboud University Nijmegen Medical Centre, Nijmegen, the Netherlands
| | | | | | - Desiree van der Kleij
- Laboratory for Monoclonal Therapeutics, Sanquin Diagnostic Services, Amsterdam, the Netherlands
| | - Elke M. G. J. de Jong
- Department of Dermatology, Radboud University Nijmegen Medical Centre, Nijmegen, the Netherlands
| | - Phyllis I. Spuls
- Department of Dermatology, Academic Medical Center, Amsterdam, the Netherlands
| | | |
Collapse
|
34
|
van den Reek JMPA, van Lümig PPM, Kievit W, Zweegers J, van de Kerkhof PCM, Seyger MMB, de Jong EMGJ. Effectiveness of adalimumab dose escalation, combination therapy of adalimumab with methotrexate, or both in patients with psoriasis in daily practice. J DERMATOL TREAT 2013. [PMID: 23194389 DOI: 10.3109/09546634.2012.751483] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND To increase effectiveness of standard adalimumab treatment 40 mg every other week (EOW) for patients with psoriasis, dose escalation to 40 mg every week or addition of methotrexate (MTX) are possible strategies. METHODS Daily practice data about adalimumab treatment were extracted from a prospective observational cohort. We analyzed all patients with insufficient efficacy of adalimumab EOW who received 1) adalimumab dose escalation, 2) addition of MTX to adalimumab EOW, or 3) both. Effectiveness was analyzed after 12 and 24 weeks using PASI50, PASI75, and mean differences in PASI. RESULTS Forty-seven treatment episodes (TE) of adalimumab dose escalations, 11 of MTX addition and six combinations were analyzed. After a first episode of adalimumab dose escalation, 25% and 35% achieved PASI50 after 12 and 24 weeks, respectively. After MTX introduction to adalimumab EOW, 9% and 18% achieved PASI50 after 12 and 24 weeks, respectively. No related serious adverse events were reported. CONCLUSIONS Twenty-five percent of first TE with adalimumab dose escalation induced a PASI50 response after 12 weeks and 35% after 24 weeks. Addition of MTX to adalimumab EOW resulted in PASI50 in 9% after 12 weeks and 18% after 24 weeks. Defining patient-groups that will benefit from these interventions is important.
Collapse
Affiliation(s)
- Juul M P A van den Reek
- Department of Dermatology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands.
| | | | | | | | | | | | | |
Collapse
|