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Caciagli V, Coloretti I, Talamonti M, Farinelli C, Gatto I, Biagioni E, Sarti M, Franceschini E, Meschiari M, Mussini C, Tonelli R, Clini E, Girardis M, Busani S. Association between Pulmonary Aspergillosis and Cytomegalovirus Reactivation in Critically Ill COVID-19 Patients: A Prospective Observational Cohort Study. Viruses 2023; 15:2260. [PMID: 38005936 PMCID: PMC10675747 DOI: 10.3390/v15112260] [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: 10/11/2023] [Revised: 11/09/2023] [Accepted: 11/14/2023] [Indexed: 11/26/2023] Open
Abstract
COVID-19-associated invasive pulmonary aspergillosis (CAPA) is common and is associated with poor outcomes in critically ill patients. This prospective observational study aimed to explore the association between CAPA development and the incidence and prognosis of cytomegalovirus (CMV) reactivation in critically ill COVID-19 patients. We included all consecutive critically ill adult patients with confirmed COVID-19 infection who were admitted to three COVID-19 intensive care units (ICUs) in an Italian hospital from 25 February 2020 to 8 May 2022. A standardized procedure was employed for early detection of CAPA. Risk factors associated with CAPA and CMV reactivation and the association between CMV recurrence and mortality were estimated using adjusted Cox proportional hazard regression models. CAPA occurred in 96 patients (16.6%) of the 579 patients analyzed. Among the CAPA population, 40 (41.7%) patients developed CMV blood reactivation with a median time of 18 days (IQR 7-27). The CAPA+CMV group did not exhibit a significantly higher 90-day mortality rate (62.5% vs. 48.2%) than the CAPA alone group (p = 0.166). The CAPA+CMV group had a longer ICU stay, fewer ventilation-free days, and a higher rate of secondary bacterial infections than the control group of CAPA alone. In the CAPA population, prior immunosuppression was the only independent risk factor for CMV reactivation (HR 2.33, 95% C.I. 1.21-4.48, p = 0.011). In critically ill COVID-19 patients, CMV reactivation is common in those with a previous CAPA diagnosis. Basal immunosuppression before COVID-19 appeared to be the primary independent variable affecting CMV reactivation in patients with CAPA. Furthermore, the association of CAPA+CMV versus CAPA alone appears to impact ICU length of stay and secondary bacterial infections but not mortality.
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Affiliation(s)
- Valeria Caciagli
- Anesthesia and Intensive Care Medicine, Policlinico di Modena, University of Modena and Reggio Emilia, 41124 Modena, Italy (E.B.)
| | - Irene Coloretti
- Anesthesia and Intensive Care Medicine, Policlinico di Modena, University of Modena and Reggio Emilia, 41124 Modena, Italy (E.B.)
| | - Marta Talamonti
- Anesthesia and Intensive Care Medicine, Policlinico di Modena, University of Modena and Reggio Emilia, 41124 Modena, Italy (E.B.)
| | - Carlotta Farinelli
- Anesthesia and Intensive Care Medicine, Policlinico di Modena, University of Modena and Reggio Emilia, 41124 Modena, Italy (E.B.)
| | - Ilenia Gatto
- Anesthesia and Intensive Care Medicine, Policlinico di Modena, University of Modena and Reggio Emilia, 41124 Modena, Italy (E.B.)
| | - Emanuela Biagioni
- Anesthesia and Intensive Care Medicine, Policlinico di Modena, University of Modena and Reggio Emilia, 41124 Modena, Italy (E.B.)
| | - Mario Sarti
- Microbiology and Virology Unit, Azienda Ospedaliero-Universitaria Policlinico, 41124 Modena, Italy
| | - Erica Franceschini
- Infectious Diseases Unit, Policlinico di Modena, University of Modena and Reggio Emilia, 41124 Modena, Italy (M.M.)
| | - Marianna Meschiari
- Infectious Diseases Unit, Policlinico di Modena, University of Modena and Reggio Emilia, 41124 Modena, Italy (M.M.)
| | - Cristina Mussini
- Infectious Diseases Unit, Policlinico di Modena, University of Modena and Reggio Emilia, 41124 Modena, Italy (M.M.)
| | - Roberto Tonelli
- Respiratory Diseases Unit, Policlinico di Modena, University of Modena and Reggio Emilia, 41124 Modena, Italy
| | - Enrico Clini
- Respiratory Diseases Unit, Policlinico di Modena, University of Modena and Reggio Emilia, 41124 Modena, Italy
| | - Massimo Girardis
- Anesthesia and Intensive Care Medicine, Policlinico di Modena, University of Modena and Reggio Emilia, 41124 Modena, Italy (E.B.)
| | - Stefano Busani
- Anesthesia and Intensive Care Medicine, Policlinico di Modena, University of Modena and Reggio Emilia, 41124 Modena, Italy (E.B.)
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Campani S, Talamonti M, Dall’Ara L, Coloretti I, Gatto I, Biagioni E, Tosi M, Meschiari M, Tonelli R, Clini E, Cossarizza A, Guaraldi G, Mussini C, Sarti M, Trenti T, Girardis M. The Association of Procalcitonin and C-Reactive Protein with Bacterial Infections Acquired during Intensive Care Unit Stay in COVID-19 Critically Ill Patients. Antibiotics (Basel) 2023; 12:1536. [PMID: 37887237 PMCID: PMC10604665 DOI: 10.3390/antibiotics12101536] [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: 09/03/2023] [Revised: 09/22/2023] [Accepted: 10/09/2023] [Indexed: 10/28/2023] Open
Abstract
In COVID-19 patients, procalcitonin (PCT) and C-reactive protein (CRP) performance in identifying bacterial infections remains unclear. Our study aimed to evaluate the association of PCT and CRP with secondary infections acquired during ICU stay in critically ill COVID-19 patients. This observational study included adult patients admitted to three COVID-19 intensive care units (ICUs) from February 2020 to May 2022 with respiratory failure caused by SARS-CoV-2 infection and ICU stay ≥ 11 days. The values of PCT and CRP collected on the day of infection diagnosis were compared to those collected on day 11 after ICU admission, the median time for infection occurrence, in patients without secondary infection. The receiver operating characteristic curve (ROC) and multivariate logistic model were used to assess PCT and CRP association with secondary infections. Two hundred and seventy-nine patients were included, of whom 169 (60.6%) developed secondary infection after ICU admission. The PCT and CRP values observed on the day of the infection diagnosis were larger (p < 0.001) than those observed on day 11 after ICU admission in patients without secondary infections. The ROC analysis calculated an AUC of 0.744 (95%CI 0.685-0.803) and 0.754 (95%CI 0.695-0.812) for PCT and CRP, respectively. Multivariate logistic models showed that PCT ≥ 0.16 ng/mL and CRP ≥ 1.35 mg/dL were associated (p < 0.001) with infections acquired during ICU stay. Our results indicated that in COVID-19 patients, PCT and CRP values were associated with infections acquired during the ICU stay and can be used to support, together with clinical signs, rather than predict or rule out, the diagnosis of these infections.
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Affiliation(s)
- Simone Campani
- Intensive Care Unit, University Hospital of Modena, 41125 Modena, Italy; (S.C.); (M.T.); (L.D.); (I.C.); (I.G.); (E.B.); (M.T.)
| | - Marta Talamonti
- Intensive Care Unit, University Hospital of Modena, 41125 Modena, Italy; (S.C.); (M.T.); (L.D.); (I.C.); (I.G.); (E.B.); (M.T.)
| | - Lorenzo Dall’Ara
- Intensive Care Unit, University Hospital of Modena, 41125 Modena, Italy; (S.C.); (M.T.); (L.D.); (I.C.); (I.G.); (E.B.); (M.T.)
| | - Irene Coloretti
- Intensive Care Unit, University Hospital of Modena, 41125 Modena, Italy; (S.C.); (M.T.); (L.D.); (I.C.); (I.G.); (E.B.); (M.T.)
| | - Ilenia Gatto
- Intensive Care Unit, University Hospital of Modena, 41125 Modena, Italy; (S.C.); (M.T.); (L.D.); (I.C.); (I.G.); (E.B.); (M.T.)
| | - Emanuela Biagioni
- Intensive Care Unit, University Hospital of Modena, 41125 Modena, Italy; (S.C.); (M.T.); (L.D.); (I.C.); (I.G.); (E.B.); (M.T.)
| | - Martina Tosi
- Intensive Care Unit, University Hospital of Modena, 41125 Modena, Italy; (S.C.); (M.T.); (L.D.); (I.C.); (I.G.); (E.B.); (M.T.)
| | - Marianna Meschiari
- Infectious Disease Unit, University Hospital of Modena, 41125 Modena, Italy; (M.M.); (G.G.); (C.M.)
| | - Roberto Tonelli
- Respiratory Disease Unit, University Hospital of Modena, 41125 Modena, Italy; (R.T.); (E.C.)
| | - Enrico Clini
- Respiratory Disease Unit, University Hospital of Modena, 41125 Modena, Italy; (R.T.); (E.C.)
| | - Andrea Cossarizza
- Immunology Laboratory, University of Modena and Reggio Emilia, 41125 Modena, Italy;
| | - Giovanni Guaraldi
- Infectious Disease Unit, University Hospital of Modena, 41125 Modena, Italy; (M.M.); (G.G.); (C.M.)
| | - Cristina Mussini
- Infectious Disease Unit, University Hospital of Modena, 41125 Modena, Italy; (M.M.); (G.G.); (C.M.)
| | - Mario Sarti
- Clinical Microbiology Laboratory, University of Modena and Reggio Emilia, 41125 Modena, Italy;
| | - Tommaso Trenti
- Diagnostic Hematology and Clinical Genomics Laboratory, Department of Laboratory Medicine and Pathology, Local Health Service and University Hospital of Modena, 41124 Modena, Italy;
| | - Massimo Girardis
- Intensive Care Unit, University Hospital of Modena, 41125 Modena, Italy; (S.C.); (M.T.); (L.D.); (I.C.); (I.G.); (E.B.); (M.T.)
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Chimenti MS, Galluzzo M, Talamonti M, Campanati A, Bonifati C, Bruni P, Caldarola G, Carpentieri A, Chiricozzi A, De Simone C, Diotallevi F, Esposito M, Fiorella C, Graceffa D, Loconsole F, Hansel K, Mugheddu C, Papini M, Richetta A, Bergamini A, Luchetti MM, Atzori L, Peris K, Offidani A, Stingeni L, Bianchi L. AB0915 GUSELKUMAB REAL WORD DATA: EFFICACY AND SAFETY IN A COHORT OF 69 PATIENTS WITH PSORIATIC ARTHRITIS. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.4327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BackgroundPsoriasis (PSO) is a systemic immune-mediated disorder, characterized by inflammation skin and joint manifestations: it is known that up to 30% of PsO patients develop PsA.PsO and PsA share common etiopathogenetic pathways, as IL-23/IL-17 axis. In Italy, Guselkumab (GUS), a selective IL-23 inhibitor, was approved in 2018 for the treatment of PsO, and recently it was also approved for PsA therapy. Today, there are few “real-world” studies regarding the use of GUS in PsA patients.ObjectivesA multicenter Italian study group of dermatologists and rheumatologists aimed at evaluate GUS efficacy and safety in patients with concomitant PsO and PsA in real word setting on both skin and joint domains.MethodsAn observational retrospective, multicentric study was performed in 69 PsO patients with a confirmed diagnosis of moderate to severe PsA. PASI and DLQI were used for the evaluation of skin response, and the number swollen/tender joints, presence or absence of dactylitis or enthesitis or axial involvement and painVAS were evaluated for the articular and periarticular efficacy. These analyses were performed at baseline T0 (beginning of the therapy), T1 (12 weeks) and T2 (24 weeks).Results38/69 patients (55,1%) presented oligoarthritis, 31/69 (44,9%) showed polyarthritis, none of the patients had enthesitis or axial involvement. Moreover, co-morbidities were diagnosed: hypertension (52,2%), hypercholesterolemia (34,8%), Hypertriglyceridemia (29%), diabetes (24,6%), obesity (23,2%), HIV-positive (20,3%), psychiatric disorders (17,4%), cardiopathies (15,9%), inflammatory bowel disease (7,3%), Latent Tubercolosis (4,4%), Chronic B-Hepatitis (2,9%), Chronic C-Hepatitis (1,5%). In all these patients, skin and joint responses were evaluated at week 12 and week 24.Concerning skin efficacy, PASI 90 was achieved at week 24. Concerning Joint response: painVAS progressively improved till T2, tender joint count decreased in patients with oligo and polyarthritis at T1 and maintained at T2, while swollen joint count decreased in polyarthritis patients at T1 and maintained at T2. In oligo-arthritis patients, this parameter was not improved. The number of dactylitis did not decrease during the period of study (see Table 1). No safety concerns were reported in this population.ConclusionEfficacy and safety of GUS was confirmed in this study group of PsO patients with concomitant PsA and several comorbidities in a real-life setting.Disclosure of InterestsNone declared
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Baroni S, Marudi A, Rinaldi S, Ghedini S, Magistri P, Piero Guerrini G, Olivieri T, Dallai C, Talamonti M, Maccieri J, Benedetto FD, Bertellini E. Cytokine mass balance levels in donation after circulatory death donors using hemoadsorption: Case series report. Int J Artif Organs 2022; 45:642-646. [PMID: 35426347 DOI: 10.1177/03913988221091288] [Citation(s) in RCA: 2] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
The use of hemadsorption has been purposed to reduce cytokine levels during the reperfusion phase during donation after circulatory death (DCD) programs. This paper aims to describe a cases series of the inflammatory cytokine levels before and after hemadsorption during normothermic reperfusion in DCD donors of liver and kidneys. In this observational pilot paper, we describe 8 DCD donors of liver or kidneys in our center from the year 2018 to 2019. All DCD donor subjects had similar age, were younger than 60 years, without evident critical conditions, no liver or kidney dysfunction known, and they presented with poor neurological outcomes instrumentally and clinically documented. We observed in our patients an interesting reduction of IL-10 and TNF-α levels during the normothermic reperfusion with hemadsorption. We transplanted all livers and kidneys from DCD donors without significant compliances.
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Affiliation(s)
- Stefano Baroni
- Department of Anaesthesia and Intensive Care, Azienda Ospedaliero Universitaria Policlinico, Modena, Italy
| | - Andrea Marudi
- Department of Anaesthesia and Intensive Care, Azienda Ospedaliero Universitaria Policlinico, Modena, Italy
| | - Simone Rinaldi
- Department of Anaesthesia and Intensive Care, Azienda Ospedaliero Universitaria Policlinico, Modena, Italy
| | - Silvia Ghedini
- Department of Anaesthesia and Intensive Care, Azienda Ospedaliero Universitaria Policlinico, Bologna, Italy
| | - Paolo Magistri
- Hepato-Pancreato-Biliary Surgery and Liver Transplantation Unit, University of Modena and Reggio Emilia, Modena, Italy
| | - Gian Piero Guerrini
- Hepato-Pancreato-Biliary Surgery and Liver Transplantation Unit, University of Modena and Reggio Emilia, Modena, Italy
| | - Tiziana Olivieri
- Hepato-Pancreato-Biliary Surgery and Liver Transplantation Unit, University of Modena and Reggio Emilia, Modena, Italy
| | - Chiara Dallai
- Department of Anaesthesia and Intensive Care, Azienda Ospedaliero Universitaria Policlinico, Modena, Italy
| | - Marta Talamonti
- Department of Anaesthesia and Intensive Care, Azienda Ospedaliero Universitaria Policlinico, Modena, Italy
| | - Jessica Maccieri
- Department of Anaesthesia and Intensive Care, Azienda Ospedaliero Universitaria Policlinico, Bologna, Italy
| | - Fabrizio Di Benedetto
- Hepato-Pancreato-Biliary Surgery and Liver Transplantation Unit, University of Modena and Reggio Emilia, Modena, Italy
| | - Elisabetta Bertellini
- Department of Anaesthesia and Intensive Care, Azienda Ospedaliero Universitaria Policlinico, Modena, Italy
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Peluso L, Ferlini L, Talamonti M, Ndieugnou Djangang N, Gouvea Bogossian E, Menozzi M, Annoni F, Macchini E, Legros B, Severgnini P, Creteur J, Oddo M, Vincent JL, Gaspard N, Taccone FS. Automated Pupillometry for Prediction of Electroencephalographic Reactivity in Critically Ill Patients: A Prospective Cohort Study. Front Neurol 2022; 13:867603. [PMID: 35386412 PMCID: PMC8977520 DOI: 10.3389/fneur.2022.867603] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Accepted: 02/28/2022] [Indexed: 12/27/2022] Open
Abstract
Background Electroencephalography (EEG) is widely used to monitor critically ill patients. However, EEG interpretation requires the presence of an experienced neurophysiologist and is time-consuming. Aim of this study was to evaluate whether parameters derived from an automated pupillometer (AP) might help to assess the degree of cerebral dysfunction in critically ill patients. Methods Prospective study conducted in the Department of Intensive Care of Erasme University Hospital in Brussels, Belgium. Pupillary assessments were performed using the AP in three subgroups of patients, concomitantly monitored with continuous EEG: "anoxic brain injury", "Non-anoxic brain injury" and "other diseases". An independent neurologist blinded to patient's history and AP results scored the degree of encephalopathy and reactivity on EEG using a standardized scale. The mean value of Neurologic Pupil Index (NPi), pupillary size, constriction rate, constriction and dilation velocity (CV and DV) and latency for both eyes, obtained using the NPi®-200 (Neuroptics, Laguna Hills, CA, USA), were reported. Results We included 214 patients (mean age 60 years, 55% male). EEG tracings were categorized as: mild (n = 111, 52%), moderate (n = 65, 30%) or severe (n = 16, 8%) encephalopathy; burst-suppression (n = 19, 9%) or suppression background (n = 3, 1%); a total of 38 (18%) EEG were classified as "unreactive". We found a significant difference in all pupillometry variables among different EEG categories. Moreover, an unreactive EEG was associated with lower NPi, pupil size, pupillary reactivity, CV and DV and a higher latency than reactive recordings. Low DV (Odds ratio 0.020 [95% confidence intervals 0.002-0.163]; p < 0.01) was independently associated with an unreactive EEG, together with the use of analgesic/sedative drugs and high lactate concentrations. In particular, DV values had an area under the curve (AUC) of 0.86 [0.79-0.92; p < 0.01] to predict the presence of unreactive EEG. In subgroups analyses, AUC of DV to predict unreactive EEG was lower (0.72 [0.56-0.87]; p < 0.01) in anoxic brain injury than Non-anoxic brain injury (0.92 [0.85-1.00]; p < 0.01) and other diseases (0.96 [0.90-1.00]; p < 0.01). Conclusions This study suggests that low DV measured by the AP might effectively identify an unreactive EEG background, in particular in critically ill patients without anoxic brain injury.
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Affiliation(s)
- Lorenzo Peluso
- Department of Intensive Care, Erasme University Hospital, Brussels, Belgium
| | - Lorenzo Ferlini
- Department of Neurology, Erasme University Hospital, Brussels, Belgium
| | - Marta Talamonti
- Department of Intensive Care, Erasme University Hospital, Brussels, Belgium
| | | | | | - Marco Menozzi
- Department of Intensive Care, Erasme University Hospital, Brussels, Belgium
| | - Filippo Annoni
- Department of Intensive Care, Erasme University Hospital, Brussels, Belgium
| | | | - Benjamin Legros
- Department of Neurology, Erasme University Hospital, Brussels, Belgium
| | - Paolo Severgnini
- Department of Biotechnology and Life Sciences, Insubria University, Cardiac Anesthesiology and Intensive Care - ASST Sette Laghi, Varese, Italy
| | - Jacques Creteur
- Department of Intensive Care, Erasme University Hospital, Brussels, Belgium
| | - Mauro Oddo
- Critical Care Clinical Research Unit, Department of Intensive Care Medicine, CHUV-Lausanne University Hospital, Lausanne, Switzerland
| | - Jean-Louis Vincent
- Department of Intensive Care, Erasme University Hospital, Brussels, Belgium
| | - Nicolas Gaspard
- Department of Neurology, Erasme University Hospital, Brussels, Belgium.,Department of Neurology, Yale University Medical School, New Haven, CT, United States
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Gouvea Bogossian E, Diaferia D, Ndieugnou Djangang N, Menozzi M, Vincent JL, Talamonti M, Dewitte O, Peluso L, Barrit S, Al Barajraji M, Andre J, Schuind S, Creteur J, Taccone FS. Brain tissue oxygenation guided therapy and outcome in non-traumatic subarachnoid hemorrhage. Sci Rep 2021; 11:16235. [PMID: 34376735 PMCID: PMC8355344 DOI: 10.1038/s41598-021-95602-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Accepted: 07/27/2021] [Indexed: 02/08/2023] Open
Abstract
Brain hypoxia can occur after non-traumatic subarachnoid hemorrhage (SAH), even when levels of intracranial pressure (ICP) remain normal. Brain tissue oxygenation (PbtO2) can be measured as a part of a neurological multimodal neuromonitoring. Low PbtO2 has been associated with poor neurologic recovery. There is scarce data on the impact of PbtO2 guided-therapy on patients’ outcome. This single-center cohort study (June 2014–March 2020) included all patients admitted to the ICU after SAH who required multimodal monitoring. Patients with imminent brain death were excluded. Our primary goal was to assess the impact of PbtO2-guided therapy on neurological outcome. Secondary outcome included the association of brain hypoxia with outcome. Of the 163 patients that underwent ICP monitoring, 62 were monitored with PbtO2 and 54 (87%) had at least one episode of brain hypoxia. In patients that required treatment based on neuromonitoring strategies, PbtO2-guided therapy (OR 0.33 [CI 95% 0.12–0.89]) compared to ICP-guided therapy had a protective effect on neurological outcome at 6 months. In this cohort of SAH patients, PbtO2-guided therapy might be associated with improved long-term neurological outcome, only when compared to ICP-guided therapy.
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Affiliation(s)
- Elisa Gouvea Bogossian
- Department of Intensive Care, Erasme Hospital, Université Libre de Bruxelles, Route de Lennik, 808, 1070, Brussels, Belgium.
| | - Daniela Diaferia
- Department of Intensive Care, Erasme Hospital, Université Libre de Bruxelles, Route de Lennik, 808, 1070, Brussels, Belgium
| | - Narcisse Ndieugnou Djangang
- Department of Intensive Care, Erasme Hospital, Université Libre de Bruxelles, Route de Lennik, 808, 1070, Brussels, Belgium
| | - Marco Menozzi
- Department of Intensive Care, Erasme Hospital, Université Libre de Bruxelles, Route de Lennik, 808, 1070, Brussels, Belgium
| | - Jean-Louis Vincent
- Department of Intensive Care, Erasme Hospital, Université Libre de Bruxelles, Route de Lennik, 808, 1070, Brussels, Belgium
| | - Marta Talamonti
- Department of Intensive Care, Erasme Hospital, Université Libre de Bruxelles, Route de Lennik, 808, 1070, Brussels, Belgium
| | - Olivier Dewitte
- Department of Neurosurgery, Erasme Hospital, Université Libre de Bruxelles, Route de Lennik, 808, 1070, Brussels, Belgium
| | - Lorenzo Peluso
- Department of Intensive Care, Erasme Hospital, Université Libre de Bruxelles, Route de Lennik, 808, 1070, Brussels, Belgium
| | - Sami Barrit
- Department of Neurosurgery, Erasme Hospital, Université Libre de Bruxelles, Route de Lennik, 808, 1070, Brussels, Belgium
| | - Mejdeddine Al Barajraji
- Department of Neurosurgery, Erasme Hospital, Université Libre de Bruxelles, Route de Lennik, 808, 1070, Brussels, Belgium
| | - Joachim Andre
- Department of Radiology, Erasme Hospital, Université Libre de Bruxelles, Route de Lennik, 808, 1070, Brussels, Belgium
| | - Sophie Schuind
- Department of Neurosurgery, Erasme Hospital, Université Libre de Bruxelles, Route de Lennik, 808, 1070, Brussels, Belgium
| | - Jacques Creteur
- Department of Intensive Care, Erasme Hospital, Université Libre de Bruxelles, Route de Lennik, 808, 1070, Brussels, Belgium
| | - Fabio Silvio Taccone
- Department of Intensive Care, Erasme Hospital, Université Libre de Bruxelles, Route de Lennik, 808, 1070, Brussels, Belgium
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7
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Patruno C, Napolitano M, Argenziano G, Peris K, Ortoncelli M, Girolomoni G, Offidani A, Ferrucci SM, Amoruso GF, Rossi M, Stingeni L, Malara G, Grieco T, Foti C, Gattoni M, Loi C, Iannone M, Talamonti M, Stinco G, Rongioletti F, Pigatto PD, Cristaudo A, Nettis E, Corazza M, Guarneri F, Amerio P, Esposito M, Belloni Fortina A, Potenza C, Fabbrocini G. Dupilumab therapy of atopic dermatitis of the elderly: a multicentre, real-life study. J Eur Acad Dermatol Venereol 2021; 35:958-964. [PMID: 33332697 DOI: 10.1111/jdv.17094] [Citation(s) in RCA: 55] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Accepted: 11/20/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND Treatment of moderate-to-severe atopic dermatitis (AD) in the elderly may be challenging, due to side-effects of traditional anti-inflammatory drugs and to comorbidities often found in this age group. Furthermore, efficacy and safety of innovative drugs such as dupilumab are not yet well known. OBJECTIVES A multicentre retrospective, observational, real-life study on the efficacy and safety of dupilumab was conducted in a group of patients aged ≥65 years and affected by severe AD. Their main clinical features were also examined. METHODS Data of elderly patients with severe (EASI ≥24) AD treated with dupilumab at label dosage for 16 weeks were retrospectively collected. Treatment outcome was assessed by comparing objective (EASI) and subjective (P-NRS, S-NRS and DLQI) scores at baseline and after 16 weeks of treatment. RESULTS Two hundred and seventy-six patients were enrolled in the study. They represented 11.37% of all patients with severe AD. Flexural eczema was the most frequent clinical phenotype, followed by prurigo nodularis. The coexistence of more than one phenotype was found in 63/276 (22.82%) subjects. Data on the 16-week treatment with dupilumab were available for 253 (91.67%) patients. Efficacy of dupilumab was demonstrated by a significant reduction of all the scores. No statistically significant difference regarding efficacy was found in elderly patients when compared to the group of our AD patients aged 18-64 years, treated with dupilumab over the same period. Furthermore, only 18 (6.52%) patients discontinued the drug due to inefficacy. Sixty-one (22.51%) patients reported adverse events, conjunctivitis and flushing being the most frequent. One (0.36%) patient only discontinued dupilumab due to an adverse event. CONCLUSIONS Therapy with dupilumab led to a significant improvement of AD over a 16-week treatment period, with a good safety profile. Therefore, dupilumab could be considered as an efficacious and safe treatment for AD also in the elderly.
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Affiliation(s)
- C Patruno
- Department of Health Sciences, University Magna Graecia of Catanzaro, Catanzaro, Italy
| | - M Napolitano
- Department of Medicine and Health Sciences Vincenzo Tiberio, University of Molise, Campobasso, Italy
| | - G Argenziano
- Dermatology Unit, University of Campania, Naples, Italy
| | - K Peris
- Dermatology, University of the Sacred Heart, Rome, Italy.,Fondazione Policlinico Universitario A.Gemelli, IRCCS, Rome, Italy
| | - M Ortoncelli
- Dermatology Clinic, University of Turin, Turin, Italy
| | - G Girolomoni
- Section of Dermatology, Department of Medicine, University of Verona, Verona, Italy
| | - A Offidani
- Dermatology Unit, Department of Clinical and Molecular Sciences, Polytechnic Marche University, Ancona, Italy
| | - S M Ferrucci
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy
| | - G F Amoruso
- AO Cosenza, UOC Dermatologia, Cosenza, Italy
| | - M Rossi
- UO Dermatologia, ASST Spedali Civili di Brescia, Brescia, Italy
| | - L Stingeni
- Dermatology Section, Department of Medicine, University of Perugia, Perugia, Italy
| | - G Malara
- Struttura Complessa di Dermatologia, Grande Ospedale Metropolitano 'Bianchi Melacrino Morelli', Reggio Calabria, Italy
| | - T Grieco
- Dermatology Unit, Sapienza University of Rome, Rome, Italy
| | - C Foti
- Department of Biomedical Sciences and Human Oncology, University of Bari, Bari, Italy
| | - M Gattoni
- Dermatologic Department, S. Andrea Hospital Vercelli, Vercelli, Italy
| | - C Loi
- Dermatology, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy
| | - M Iannone
- Department of Dermatology, University of Pisa, Pisa, Italy
| | - M Talamonti
- Dermatology Unit, Policlinico Tor Vergata, Department of Systemic Medicine, Tor Vergata University of Rome, Rome, Italy
| | - G Stinco
- Department of Medicine, Institute of Dermatology, University of Udine, Udine, Italy
| | - F Rongioletti
- Unit of Dermatology, Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - P D Pigatto
- Department of Medical, Surgical and Odontoiatric Science, IRCCS Ospedale Ortopedico Galeazzi, Milano, Italy
| | - A Cristaudo
- San Gallicano Dermatologic Institute IRCCS, Rome, Italy
| | - E Nettis
- Department of Emergency and Organ Transplantation, School and Chair of Allergology and Clinical Immunology, University of Bari - Aldo Moro, Bari, Italy
| | - M Corazza
- Section of Dermatology and Infectious Diseases, Department of Medical Sciences, University of Ferrara, Ferrara, Italy
| | - F Guarneri
- Department of Clinical and Experimental Medicine, Dermatology, University of Messina, Messina, Italy
| | - P Amerio
- Dermatologic Clinic, SS. Annunziata Hospital, Chieti, Italy
| | - M Esposito
- Dermatology, Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - A Belloni Fortina
- Unit of Dermatology, Department of Medicine DIMED, University of Padua, Padua, Italy
| | - C Potenza
- Dermatology Unit 'Daniele Innocenzi', Department of MEDICO-Surgical Sciences and Bio-Technologies, Sapienza University of Rome, Fiorini Hospital, Polo Pontino, Terracina, Italy
| | - G Fabbrocini
- Section of Dermatology, Department of Clinical Medicine and Surgery, University of Naples Federico II, Napoli, Italy
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Fratino S, Peluso L, Talamonti M, Menozzi M, Costa Hirai LA, Lobo FA, Prezioso C, Creteur J, Payen JF, Taccone FS. Evaluation of Nociception Using Quantitative Pupillometry and Skin Conductance in Critically Ill Unconscious Patients: A Pilot Study. Brain Sci 2021; 11:brainsci11010109. [PMID: 33467451 PMCID: PMC7829933 DOI: 10.3390/brainsci11010109] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Revised: 01/09/2021] [Accepted: 01/13/2021] [Indexed: 11/25/2022] Open
Abstract
Background: Pain assessment is a challenge in critically ill patients, in particular those who are unable to express movements in reaction to noxious stimuli. The purpose of the study was to compare the pupillary response and skin conductance to pain stimulation in critically ill unconscious patients. Methods: This observational study included adult patients admitted to the intensive care unit (ICU) with acute brain injury (Glasgow Coma Scale < 9 with a motor response < 5) and/or requirements for deep level of sedation. Automated pupillometry (Algiscan, ID-MED, Marseille, France) was used to determine pupillary reflex dilation during tetanic stimulation. The maximum intensity of the stimulation value allowed the determination of a pupillary pain index score ranging from 1 (no nociception) to 9 (high nociception): a pupillary pain index (PPI) score of ≤4 was used to reflect adequate pain control. For skin conductance (SC), the number of SC peaks per second (NSCF) was collected concomitantly to tetanic stimulation. An NSCF of ≤0.07 peak/second was used to reflect adequate pain control. Results: Of the 51 included patients, there were 32 with brain injury and 19 receiving deep sedation. Mean PPI score was 5 (Interquartile Range= 2–7); a total of 28 (55%) patients showed inadequate control of the nociceptive stimulation according to the PPI assessment. Only 15 (29%) patients showed a detectable skin conductance, with NSCF values from 0.07 to 0.47/s. No correlation was found between skin conductance algesimeter (SCA)-derived variables and PPI score or pupillary dilation to pain. Conclusions: Detection of inadequate pain control might vary according to the method used to assess nociception in ICU patients. A poor agreement between quantitative pupillometry and skin conductance was observed.
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Affiliation(s)
- Sara Fratino
- Department of Intensive Care, Erasme Hospital, Université Libre de Bruxelles, Route de Lennik 808, 1070 Brussels, Belgium; (S.F.); (M.T.); (M.M.); (L.A.C.H.); (C.P.); (J.C.); (F.S.T.)
| | - Lorenzo Peluso
- Department of Intensive Care, Erasme Hospital, Université Libre de Bruxelles, Route de Lennik 808, 1070 Brussels, Belgium; (S.F.); (M.T.); (M.M.); (L.A.C.H.); (C.P.); (J.C.); (F.S.T.)
- Correspondence:
| | - Marta Talamonti
- Department of Intensive Care, Erasme Hospital, Université Libre de Bruxelles, Route de Lennik 808, 1070 Brussels, Belgium; (S.F.); (M.T.); (M.M.); (L.A.C.H.); (C.P.); (J.C.); (F.S.T.)
| | - Marco Menozzi
- Department of Intensive Care, Erasme Hospital, Université Libre de Bruxelles, Route de Lennik 808, 1070 Brussels, Belgium; (S.F.); (M.T.); (M.M.); (L.A.C.H.); (C.P.); (J.C.); (F.S.T.)
| | - Lucas Akira Costa Hirai
- Department of Intensive Care, Erasme Hospital, Université Libre de Bruxelles, Route de Lennik 808, 1070 Brussels, Belgium; (S.F.); (M.T.); (M.M.); (L.A.C.H.); (C.P.); (J.C.); (F.S.T.)
| | - Francisco A Lobo
- Department of Anesthesiology, CHTMAD-Hospital de S. Pedro, 5000 Vila Real, Portugal;
| | - Chiara Prezioso
- Department of Intensive Care, Erasme Hospital, Université Libre de Bruxelles, Route de Lennik 808, 1070 Brussels, Belgium; (S.F.); (M.T.); (M.M.); (L.A.C.H.); (C.P.); (J.C.); (F.S.T.)
| | - Jacques Creteur
- Department of Intensive Care, Erasme Hospital, Université Libre de Bruxelles, Route de Lennik 808, 1070 Brussels, Belgium; (S.F.); (M.T.); (M.M.); (L.A.C.H.); (C.P.); (J.C.); (F.S.T.)
| | - Jean-François Payen
- Department of Anesthesia and Critical Care CHU Grenoble Alpes, University Grenoble Alpes, 38000 Grenoble, France;
| | - Fabio Silvio Taccone
- Department of Intensive Care, Erasme Hospital, Université Libre de Bruxelles, Route de Lennik 808, 1070 Brussels, Belgium; (S.F.); (M.T.); (M.M.); (L.A.C.H.); (C.P.); (J.C.); (F.S.T.)
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Menozzi M, Gosse J, Talamonti M, Di Bernardini E, Quispe Cornejo A, Gustot T, Creteur J, Peluso L, Taccone FS. The use of automated pupillometry in critically ill cirrhotic patients with hepatic encephalopathy. J Crit Care 2020; 62:176-182. [PMID: 33388562 DOI: 10.1016/j.jcrc.2020.12.013] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 12/09/2020] [Accepted: 12/17/2020] [Indexed: 01/04/2023]
Abstract
PURPOSE To evaluate whether pupillary abnormalities would correlate with the severity of encephalopathy in critically ill cirrhotic patients. METHODS In this retrospective study, we enrolled adult cirrhotic patients admitted to the Intensive Care Unit undergoing automated pupillometry assessment within the first 72 h since ICU admission. Encephalopathy was assessed with West-Haven classification and Glasgow Coma Scale. Pupillometry-derived variables were also correlated with biological variables, including ammonium, renal function or inflammatory parameters, measured on the day of pupillary assessment. RESULTS A total of 62 critically ill cirrhotic patients (Age 61 [52-68] years; 69% male) were included. Median GCS and West-Haven classification were 14 [11-15] and 1 [0-3], respectively. There was a significant although weak correlation between GCS and constriction velocity (CV; R2 = 0.1; p = 0.017). We observed significant differences in CV and DV values among different levels of West-Haven classification. When only patients with encephalopathy (n = 42) or severe HE (n = 18) were considered, a weak correlation between GCS and worst CV was observed. When patients receiving sedatives or opioids were excluded, no significant correlation between pupillometry and clinical variables was observed. CONCLUSIONS Pupillary function assessed by the automated pupillometry was poorly associated with encephalopathy scales in cirrhotic patients.
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Affiliation(s)
- Marco Menozzi
- Department of Intensive Care, Erasme Hospital, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Juliette Gosse
- Department of Intensive Care, Erasme Hospital, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Marta Talamonti
- Department of Intensive Care, Erasme Hospital, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Eugenio Di Bernardini
- Department of Intensive Care, Erasme Hospital, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Armin Quispe Cornejo
- Department of Intensive Care, Erasme Hospital, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Thierry Gustot
- Liver Transplant Unit, Department of Gastroenterology, Erasme Hospital, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Jacques Creteur
- Department of Intensive Care, Erasme Hospital, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Lorenzo Peluso
- Department of Intensive Care, Erasme Hospital, Université Libre de Bruxelles (ULB), Brussels, Belgium.
| | - Fabio Silvio Taccone
- Department of Intensive Care, Erasme Hospital, Université Libre de Bruxelles (ULB), Brussels, Belgium
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Gorham J, Moreau A, Corazza F, Peluso L, Ponthieux F, Talamonti M, Izzi A, Nagant C, Ndieugnou Djangang N, Garufi A, Creteur J, Taccone FS. Interleukine-6 in critically ill COVID-19 patients: A retrospective analysis. PLoS One 2020; 15:e0244628. [PMID: 33382773 PMCID: PMC7774924 DOI: 10.1371/journal.pone.0244628] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Accepted: 12/15/2020] [Indexed: 01/08/2023] Open
Abstract
INTRODUCTION Coronavirus disease 2019 (COVID-19) appeared in China in December 2019 and has spread around the world. High Interleukin-6 (IL-6) levels in COVID-19 patients suggest that a cytokine storm may play a major role in the pathophysiology and are considered as a relevant parameter in predicting most severe course of disease. The aim of this study was to assess repeated IL-6 levels in critically ill COVID-19 patients admitted to our Intensive Care Unit (ICU) and to evaluate their relationship with patient's severity and outcome. METHODS We conducted a retrospective study on patients admitted to the ICU with a diagnosis of COVID-19 between March 10 (i.e. the date of the first admitted patients) and April 30, 2020. Demographic, clinical and laboratory data were collected at admission. On the day of IL-6 blood concentration measurement, we also collected results of D-Dimers, C-Reactive Protein, white blood cells and lymphocytes count, lactate dehydrogenase (LDH) and ferritin as well as microbiological samples, whenever present. RESULTS Of a total of 65 patients with COVID-19 admitted to our ICU we included 41 patients with repeated measure of IL-6. There was a significant difference in IL-6 levels between survivors and non-survivors over time (p = 0.001); moreover, non survivors had a significantly higher IL-6 maximal value when compared to survivors (720 [349-2116] vs. 336 [195-646] pg/mL, p = 0.01). The IL-6 maximal value had a significant predictive value of ICU mortality (AUROC 0.73 [95% CI 0.57-0.89]; p = 0.01). CONCLUSIONS Repeated measurements of IL-6 can help clinicians in identifying critically ill COVID-19 patients with the highest risk of poor prognosis.
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Affiliation(s)
- Julie Gorham
- Department of Intensive Care, Erasme Hospital, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Anthony Moreau
- Department of Intensive Care, Erasme Hospital, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Francis Corazza
- Department of Immunology, Laboratoire Hospitalier Universitaire de Bruxelles (LHUB-ULB), Translational Research, Campus Horta, ULB, Brussels, Belgium
| | - Lorenzo Peluso
- Department of Intensive Care, Erasme Hospital, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Fanny Ponthieux
- Department of Immunology, Laboratoire Hospitalier Universitaire de Bruxelles (LHUB-ULB), Translational Research, Campus Horta, ULB, Brussels, Belgium
| | - Marta Talamonti
- Department of Intensive Care, Erasme Hospital, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Antonio Izzi
- Department of Intensive Care, Erasme Hospital, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Carole Nagant
- Department of Immunology, Laboratoire Hospitalier Universitaire de Bruxelles (LHUB-ULB), Translational Research, Campus Horta, ULB, Brussels, Belgium
| | | | - Alessandra Garufi
- Department of Intensive Care, Erasme Hospital, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Jacques Creteur
- Department of Intensive Care, Erasme Hospital, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Fabio Silvio Taccone
- Department of Intensive Care, Erasme Hospital, Université Libre de Bruxelles (ULB), Brussels, Belgium
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Ndieugnou Djangang N, Ramunno P, Izzi A, Garufi A, Menozzi M, Diaferia D, Peluso L, Prezioso C, Talamonti M, Njimi H, Schuind S, Vincent JL, Creteur J, Taccone FS, Gouvea Bogossian E. The Prognostic Role of Lactate Concentrations after Aneurysmal Subarachnoid Hemorrhage. Brain Sci 2020; 10:brainsci10121004. [PMID: 33348866 PMCID: PMC7766816 DOI: 10.3390/brainsci10121004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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: 11/10/2020] [Revised: 12/04/2020] [Accepted: 12/16/2020] [Indexed: 12/14/2022] Open
Abstract
Blood lactate concentrations are often used to assess global tissue perfusion in critically ill patients; however, there are scarce data on lactate concentrations after subarachnoid hemorrhage (SAH). We aimed to assess the prognostic role of serial blood lactate measurements on hospital mortality and neurological outcomes at 3 months after SAH. We reviewed all SAH patients admitted to the intensive care unit from 2007 to 2019 and recorded the highest daily arterial lactate concentration for the first 6 days. Patients with no lactate concentration were excluded. Hyperlactatemia was defined as a blood lactate concentration >2.0 mmol/L. A total of 456 patients were included: 158 (35%) patients died in hospital and 209 (46%) had an unfavorable outcome (UO) at 3 months. The median highest lactate concentration was 2.7 (1.8–3.9) mmol/L. Non-survivors and patients with UO had significantly higher lactate concentrations compared to other patients. Hyperlactatemia increased the chance of dying (OR 4.19 (95% CI 2.38–7.39)) and of having UO in 3 months (OR 4.16 (95% CI 2.52–6.88)) after adjusting for confounding factors. Therefore, initial blood lactate concentrations have prognostic implications in patients with SAH; their role in conjunction with other prognostic indicators should be evaluated in prospective studies.
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Affiliation(s)
- Narcisse Ndieugnou Djangang
- Department of Intensive Care, Erasme Hospital, Université Libre de Bruxelles, Route de Lennik, 808 1070 Brussels, Belgium; (N.N.D.); (P.R.); (A.I.); (A.G.); (M.M.); (D.D.); (L.P.); (C.P.); (M.T.); (H.N.); (J.-L.V.); (J.C.); (F.S.T.)
| | - Pamela Ramunno
- Department of Intensive Care, Erasme Hospital, Université Libre de Bruxelles, Route de Lennik, 808 1070 Brussels, Belgium; (N.N.D.); (P.R.); (A.I.); (A.G.); (M.M.); (D.D.); (L.P.); (C.P.); (M.T.); (H.N.); (J.-L.V.); (J.C.); (F.S.T.)
| | - Antonio Izzi
- Department of Intensive Care, Erasme Hospital, Université Libre de Bruxelles, Route de Lennik, 808 1070 Brussels, Belgium; (N.N.D.); (P.R.); (A.I.); (A.G.); (M.M.); (D.D.); (L.P.); (C.P.); (M.T.); (H.N.); (J.-L.V.); (J.C.); (F.S.T.)
| | - Alessandra Garufi
- Department of Intensive Care, Erasme Hospital, Université Libre de Bruxelles, Route de Lennik, 808 1070 Brussels, Belgium; (N.N.D.); (P.R.); (A.I.); (A.G.); (M.M.); (D.D.); (L.P.); (C.P.); (M.T.); (H.N.); (J.-L.V.); (J.C.); (F.S.T.)
| | - Marco Menozzi
- Department of Intensive Care, Erasme Hospital, Université Libre de Bruxelles, Route de Lennik, 808 1070 Brussels, Belgium; (N.N.D.); (P.R.); (A.I.); (A.G.); (M.M.); (D.D.); (L.P.); (C.P.); (M.T.); (H.N.); (J.-L.V.); (J.C.); (F.S.T.)
| | - Daniela Diaferia
- Department of Intensive Care, Erasme Hospital, Université Libre de Bruxelles, Route de Lennik, 808 1070 Brussels, Belgium; (N.N.D.); (P.R.); (A.I.); (A.G.); (M.M.); (D.D.); (L.P.); (C.P.); (M.T.); (H.N.); (J.-L.V.); (J.C.); (F.S.T.)
| | - Lorenzo Peluso
- Department of Intensive Care, Erasme Hospital, Université Libre de Bruxelles, Route de Lennik, 808 1070 Brussels, Belgium; (N.N.D.); (P.R.); (A.I.); (A.G.); (M.M.); (D.D.); (L.P.); (C.P.); (M.T.); (H.N.); (J.-L.V.); (J.C.); (F.S.T.)
| | - Chiara Prezioso
- Department of Intensive Care, Erasme Hospital, Université Libre de Bruxelles, Route de Lennik, 808 1070 Brussels, Belgium; (N.N.D.); (P.R.); (A.I.); (A.G.); (M.M.); (D.D.); (L.P.); (C.P.); (M.T.); (H.N.); (J.-L.V.); (J.C.); (F.S.T.)
| | - Marta Talamonti
- Department of Intensive Care, Erasme Hospital, Université Libre de Bruxelles, Route de Lennik, 808 1070 Brussels, Belgium; (N.N.D.); (P.R.); (A.I.); (A.G.); (M.M.); (D.D.); (L.P.); (C.P.); (M.T.); (H.N.); (J.-L.V.); (J.C.); (F.S.T.)
| | - Hassane Njimi
- Department of Intensive Care, Erasme Hospital, Université Libre de Bruxelles, Route de Lennik, 808 1070 Brussels, Belgium; (N.N.D.); (P.R.); (A.I.); (A.G.); (M.M.); (D.D.); (L.P.); (C.P.); (M.T.); (H.N.); (J.-L.V.); (J.C.); (F.S.T.)
| | - Sophie Schuind
- Department of Neurosurgery, Erasme Hospital, Université Libre de Bruxelles, Route de Lennik, 808 1070 Brussels, Belgium;
| | - Jean-Louis Vincent
- Department of Intensive Care, Erasme Hospital, Université Libre de Bruxelles, Route de Lennik, 808 1070 Brussels, Belgium; (N.N.D.); (P.R.); (A.I.); (A.G.); (M.M.); (D.D.); (L.P.); (C.P.); (M.T.); (H.N.); (J.-L.V.); (J.C.); (F.S.T.)
| | - Jacques Creteur
- Department of Intensive Care, Erasme Hospital, Université Libre de Bruxelles, Route de Lennik, 808 1070 Brussels, Belgium; (N.N.D.); (P.R.); (A.I.); (A.G.); (M.M.); (D.D.); (L.P.); (C.P.); (M.T.); (H.N.); (J.-L.V.); (J.C.); (F.S.T.)
| | - Fabio Silvio Taccone
- Department of Intensive Care, Erasme Hospital, Université Libre de Bruxelles, Route de Lennik, 808 1070 Brussels, Belgium; (N.N.D.); (P.R.); (A.I.); (A.G.); (M.M.); (D.D.); (L.P.); (C.P.); (M.T.); (H.N.); (J.-L.V.); (J.C.); (F.S.T.)
| | - Elisa Gouvea Bogossian
- Department of Intensive Care, Erasme Hospital, Université Libre de Bruxelles, Route de Lennik, 808 1070 Brussels, Belgium; (N.N.D.); (P.R.); (A.I.); (A.G.); (M.M.); (D.D.); (L.P.); (C.P.); (M.T.); (H.N.); (J.-L.V.); (J.C.); (F.S.T.)
- Correspondence:
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Ndieugnou Djangang N, Peluso L, Talamonti M, Izzi A, Gevenois PA, Garufi A, Goffard JC, Henrard S, Severgnini P, Vincent JL, Creteur J, Taccone FS. Eosinopenia in COVID-19 Patients: A Retrospective Analysis. Microorganisms 2020; 8:microorganisms8121929. [PMID: 33291791 PMCID: PMC7762070 DOI: 10.3390/microorganisms8121929] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 11/15/2020] [Accepted: 12/03/2020] [Indexed: 12/24/2022] Open
Abstract
Objectives: The aim of this study was to assess the diagnostic role of eosinophils count in COVID-19 patients. Methods: Retrospective analysis of patients admitted to our hospital with suspicion of COVID-19. Demographic, clinical and laboratory data were collected on admission. Eosinopenia was defined as eosinophils < 100 cells/mm3. The outcomes of this study were the association between eosinophils count on admission and positive real-time reverse transcription polymerase chain reaction (rRT-PCR) test and with suggestive chest computerized tomography (CT) of COVID-19 pneumonia. Results: A total of 174 patients was studied. Of those, 54% had positive rRT-PCR for SARS-CoV-2. A chest CT-scan was performed in 145 patients; 71% showed suggestive findings of COVID-19. Eosinophils on admission had a high predictive accuracy for positive rRT-PCR and suggestive chest CT-scan (area under the receiver operating characteristic-ROC curve, 0.84 (95% CIs 0.78-0.90) and 0.84 (95% CIs 0.77-0.91), respectively). Eosinopenia and high LDH were independent predictors of positive rRT-PCR, whereas eosinopenia, high body mass index and hypertension were predictors for suggestive CT-scan findings. Conclusions: Eosinopenia on admission could predict positive rRT-PCR test or suggestive chest CT-scan for COVID-19. This laboratory finding could help to identify patients at high-risk of COVID-19 in the setting where gold standard diagnostic methods are not available.
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Affiliation(s)
- Narcisse Ndieugnou Djangang
- Department of Intensive Care, Clinique Universitaire de Bruxelles Hôpital Erasme, 1070 Brussels, Belgium; (N.N.D.); (M.T.); (A.I.); (A.G.); (J.-L.V.); (J.C.); (F.S.T.)
| | - Lorenzo Peluso
- Department of Intensive Care, Clinique Universitaire de Bruxelles Hôpital Erasme, 1070 Brussels, Belgium; (N.N.D.); (M.T.); (A.I.); (A.G.); (J.-L.V.); (J.C.); (F.S.T.)
- Correspondence: ; Tel.: +32-25553416
| | - Marta Talamonti
- Department of Intensive Care, Clinique Universitaire de Bruxelles Hôpital Erasme, 1070 Brussels, Belgium; (N.N.D.); (M.T.); (A.I.); (A.G.); (J.-L.V.); (J.C.); (F.S.T.)
| | - Antonio Izzi
- Department of Intensive Care, Clinique Universitaire de Bruxelles Hôpital Erasme, 1070 Brussels, Belgium; (N.N.D.); (M.T.); (A.I.); (A.G.); (J.-L.V.); (J.C.); (F.S.T.)
| | - Pierre Alain Gevenois
- Department of Radiology, Clinique Universitaire de Bruxelles Hôpital Erasme, 1070 Brussels, Belgium;
| | - Alessandra Garufi
- Department of Intensive Care, Clinique Universitaire de Bruxelles Hôpital Erasme, 1070 Brussels, Belgium; (N.N.D.); (M.T.); (A.I.); (A.G.); (J.-L.V.); (J.C.); (F.S.T.)
| | - Jean-Christophe Goffard
- Department of Internal Medicine, Clinique Universitaire de Bruxelles Hôpital Erasme, 1070 Brussels, Belgium; (J.-C.G.); (S.H.)
| | - Sophie Henrard
- Department of Internal Medicine, Clinique Universitaire de Bruxelles Hôpital Erasme, 1070 Brussels, Belgium; (J.-C.G.); (S.H.)
| | - Paolo Severgnini
- Dipartimento Biotecnologie e Scienze della Vita, Università degli studi dell’ Insubria, U.O. Anestesia e Rianimazione Cardiologica ASST Sette Laghi, 21100 Varese, Italy;
| | - Jean-Louis Vincent
- Department of Intensive Care, Clinique Universitaire de Bruxelles Hôpital Erasme, 1070 Brussels, Belgium; (N.N.D.); (M.T.); (A.I.); (A.G.); (J.-L.V.); (J.C.); (F.S.T.)
| | - Jacques Creteur
- Department of Intensive Care, Clinique Universitaire de Bruxelles Hôpital Erasme, 1070 Brussels, Belgium; (N.N.D.); (M.T.); (A.I.); (A.G.); (J.-L.V.); (J.C.); (F.S.T.)
| | - Fabio Silvio Taccone
- Department of Intensive Care, Clinique Universitaire de Bruxelles Hôpital Erasme, 1070 Brussels, Belgium; (N.N.D.); (M.T.); (A.I.); (A.G.); (J.-L.V.); (J.C.); (F.S.T.)
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Talamonti M, Galluzzo M, Chiricozzi A, Quaglino P, Fabbrocini G, Gisondi P, Marzano AV, Potenza C, Conti A, Parodi A, Belloni Fortina A, Bardazzi F, Argenziano G, Rongioletti F, Stingeni L, Micali G, Loconsole F, Venturini M, Bongiorno MR, Feliciani C, Rubegni P, Amerio P, Fargnoli MC, Pigatto P, Savoia P, Nisticò SP, Giustini S, Carugno A, Cannavò SP, Rech G, Prignano F, Offidani A, Lombardo M, Zalaudek I, Bianchi L, Peris K. Management of biological therapies for chronic plaque psoriasis during COVID-19 emergency in Italy. J Eur Acad Dermatol Venereol 2020; 34:e770-e772. [PMID: 32735716 PMCID: PMC7436412 DOI: 10.1111/jdv.16841] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Revised: 07/15/2020] [Accepted: 07/21/2020] [Indexed: 01/07/2023]
Affiliation(s)
- M Talamonti
- Dermatology Department, University of Rome 'Tor Vergata', Rome, Italy
| | - M Galluzzo
- Dermatology Department, University of Rome 'Tor Vergata', Rome, Italy
| | - A Chiricozzi
- Dermatologia, Dipartimento Scienze Mediche e Chirurgiche, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.,Dermatologia, Università Cattolica del Sacro Cuore, Rome, Italy
| | - P Quaglino
- Medical Sciences Department, Dermatologic Clinic, University of Turin, Turin, Italy
| | - G Fabbrocini
- Section of Dermatology - Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - P Gisondi
- Section of Dermatology and Venereology, Department of Medicine, University of Verona, Verona, Italy
| | - A V Marzano
- Dermatology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.,Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy
| | - C Potenza
- Department of Medico-Surgical Sciences and Biotechnologies, Dermatology Unit 'Daniele Innocenzi' Sapienza University of Rome - Polo Pontino, Rome, Italy
| | - A Conti
- Dermatologic Unit, Department of Specialized Medicine, AOU Policlinico di Modena, Modena, Italy
| | - A Parodi
- Ospedale-Policlinico San Martino IRCCS Genova, Clinica Dermatologica DiSSal Università di Genova, Genova, Italy
| | - A Belloni Fortina
- Dermatology Unit - Department of Medicine DIMED, University of Padova, Padova, Italy
| | - F Bardazzi
- Dermatology Division, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Italy
| | - G Argenziano
- Dermatology Unit, University of Campania Luigi Vanvitelli, Naples, Italy
| | - F Rongioletti
- Section of Dermatology, Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - L Stingeni
- Dermatology Section, Department of Medicine, University of Perugia, Perugia, Italy
| | - G Micali
- Dermatology Clinic, University of Catania, Catania, Italy
| | - F Loconsole
- Department of Biomedical Science and Human Oncology, Unit of Dermatology, University of Bari, Bari, Italy
| | - M Venturini
- Department of Dermatology, ASST Spedali Civili of Brescia, University of Brescia, Brescia, Italy
| | - M R Bongiorno
- Section of Dermatology, Department of Health Promotion, Maternal-Infant, Internal Medicine and Specialization, University of Palermo, Palermo, Italy
| | - C Feliciani
- Department of Medicine and Surgery, Section of Dermatology, University of Parma, Parma, Italy
| | - P Rubegni
- Dermatology Unit, Department of Medical, Surgical and Neurosciences, University of Siena, Italy
| | - P Amerio
- Department of Medicine and Aging Science, Dermatologic Clinic, G. D'Annunzio University, Chieti, Italy
| | - M C Fargnoli
- Dermatology, Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - P Pigatto
- Department of Biomedical, Surgical and Dental Sciences, Clinical Dermatology, IRCCS Galeazzi Orthopaedic Institute, University of Milan, Milan, Italy
| | - P Savoia
- Department of Health Science, Dermatologic Clinic, University of Eastern Piedmont, Novara, Italy
| | - S P Nisticò
- Dermatology Unit, Department of Health Sciences, Università Magna Graecia, Catanzaro, Italy
| | - S Giustini
- Department of Dermatology, Sapienza' University of Rome, Rome, Italy
| | - A Carugno
- Dermatology Unit, ASST Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - S P Cannavò
- Dermatology, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - G Rech
- Division of Dermatology, Santa Chiara Hospital, Trento, Italy
| | - F Prignano
- Dermatology Clinic, Department of Health Sciences, University of Florence, Florence, Italy
| | - A Offidani
- Dermatological Clinic, Department of Clinical and Molecular Sciences, Polytechnic University of the Marche Region, Ancona, Italy
| | - M Lombardo
- Unit of Dermatological Diseases, ASST Sette Laghi, Ospedale di Circolo, Varese, Italy
| | - I Zalaudek
- Department of Dermatology, University of Trieste, Trieste, Italy
| | - L Bianchi
- Dermatology Department, University of Rome 'Tor Vergata', Rome, Italy
| | - K Peris
- Dermatologia, Dipartimento Scienze Mediche e Chirurgiche, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.,Dermatologia, Università Cattolica del Sacro Cuore, Rome, Italy
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14
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Talamonti M, Tofani L, Bianchi L, Galluzzo M. Optimizing care for psoriatic patients requiring systemic therapies: how will COVID-19 disease transform risk perceptions? Arch Dermatol Res 2020; 313:127-128. [PMID: 32647977 PMCID: PMC7344026 DOI: 10.1007/s00403-020-02103-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Revised: 06/05/2020] [Accepted: 06/30/2020] [Indexed: 01/15/2023]
Affiliation(s)
- M Talamonti
- Dermatology Unit, Fondazione Policlinico Tor Vergata, Rome, Italy.
- Department of Systems Medicine, University of Rome "Tor Vergata", Rome, Italy.
| | - L Tofani
- Dermatology Unit, Fondazione Policlinico Tor Vergata, Rome, Italy
- Department of Systems Medicine, University of Rome "Tor Vergata", Rome, Italy
| | - L Bianchi
- Dermatology Unit, Fondazione Policlinico Tor Vergata, Rome, Italy
- Department of Systems Medicine, University of Rome "Tor Vergata", Rome, Italy
| | - M Galluzzo
- Dermatology Unit, Fondazione Policlinico Tor Vergata, Rome, Italy
- Department of Experimental Medicine, University of Rome "Tor Vergata", Rome, Italy
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15
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D'Adamio S, Massaro A, Biocca S, Bianchi L, Talamonti M, Galluzzo M. A life with atopic dermatitis: the patient's point of view after a new hope with dupilumab. Clin Exp Dermatol 2020; 45:809-810. [PMID: 32472943 DOI: 10.1111/ced.14276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/15/2020] [Indexed: 11/30/2022]
Affiliation(s)
- S D'Adamio
- Dermatology Unit, University of Rome Tor Vergata, Rome, Italy
| | - A Massaro
- Dermatology Unit, University of Rome Tor Vergata, Rome, Italy
| | - S Biocca
- Dermatology Unit, University of Rome Tor Vergata, Rome, Italy.,Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - L Bianchi
- Dermatology Unit, University of Rome Tor Vergata, Rome, Italy
| | - M Talamonti
- Dermatology Unit, University of Rome Tor Vergata, Rome, Italy
| | - M Galluzzo
- Dermatology Unit, University of Rome Tor Vergata, Rome, Italy
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16
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Caldarola G, Pirro F, Di Stefani A, Talamonti M, Galluzzo M, D'Adamio S, Magnano M, Bernardini N, Malagoli P, Bardazzi F, Potenza C, Bianchi L, Peris K, De Simone C. Clinical and histopathological characterization of eczematous eruptions occurring in course of anti IL-17 treatment: a case series and review of the literature. Expert Opin Biol Ther 2020; 20:665-672. [PMID: 32045273 DOI: 10.1080/14712598.2020.1727439] [Citation(s) in RCA: 45] [Impact Index Per Article: 11.3] [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: 02/07/2023]
Abstract
Background: Real-life data often highlight the side effects of certain drugs not previously reported in randomized controlled trials (RCTs).Objective: To describe cutaneous inflammatory eruptions in psoriatic patients treated with an anti IL-17A agent (secukinumab or ixekizumab).Methods: Retrospective analysis of a cohort of patients with chronic plaque psoriasis who started an anti IL-17A agent between September 2016-February 2019 and who developed cutaneous inflammatory eruptions during treatment. A systematic review of similar events reported in the literature was performed.Results: Data of 468 patients were reviewed and 27 cutaneous inflammatory eruptions of 27 (5.8%) patients were collected. The eruptions appeared after a mean of 16.9 ± 17.0 weeks of therapy showing a classical acute eczema in 11 patients (40.7%), an atopic dermatitis-like rash in 11 patients (40.7%) and a psoriasiform eruption in 5 patients (18.5%). Histopathology of 12/27 cases showed epidermal spongiosis in all these variants.Conclusion: We described the clinic-pathologic features of some eczematous eruptions occurring in psoriatic patients, 3-4 months after treatment initiation with an anti IL-17A agent. Further investigations are needed to explain this phenomenon, that might be defined a paradoxical adverse event, based upon the role of IL17 in eczema pathogenesis.
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Affiliation(s)
- G Caldarola
- Institute of Dermatology, Università Cattolica del Sacro Cuore, Rome, Italy.,Department of Dermatology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - F Pirro
- Institute of Dermatology, Università Cattolica del Sacro Cuore, Rome, Italy.,Department of Dermatology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - A Di Stefani
- Institute of Dermatology, Università Cattolica del Sacro Cuore, Rome, Italy.,Department of Dermatology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - M Talamonti
- Dermatology Unit, University of Rome "Tor Vergata", Rome, Italy
| | - M Galluzzo
- Dermatology Unit, University of Rome "Tor Vergata", Rome, Italy
| | - S D'Adamio
- Dermatology Unit, University of Rome "Tor Vergata", Rome, Italy
| | - M Magnano
- Division of Dermatology, Department of Specialized, Clinical and Experimental Medicine, University of Bologna, Bologna, Italy
| | - N Bernardini
- Dermatology Unit, Sapienza University of Rome, Polo Pontino, Terracina, Italy
| | - P Malagoli
- Dermatology Unit, Azienda Ospedaliera San Donato Milanese, Milan, Italy
| | - F Bardazzi
- Division of Dermatology, Department of Specialized, Clinical and Experimental Medicine, University of Bologna, Bologna, Italy
| | - C Potenza
- Dermatology Unit, Sapienza University of Rome, Polo Pontino, Terracina, Italy
| | - L Bianchi
- Dermatology Unit, University of Rome "Tor Vergata", Rome, Italy
| | - K Peris
- Institute of Dermatology, Università Cattolica del Sacro Cuore, Rome, Italy.,Department of Dermatology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - C De Simone
- Institute of Dermatology, Università Cattolica del Sacro Cuore, Rome, Italy.,Department of Dermatology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
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17
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van Vugt L, van den Reek J, Meulewaeter E, Hakobjan M, Heddes N, Traks T, Kingo K, Galluzzo M, Talamonti M, Lambert J, Coenen M, de Jong E. Response to IL-17A inhibitors secukinumab and ixekizumab cannot be explained by genetic variation in the protein-coding and untranslated regions of the IL-17A gene: results from a multicentre study of four European psoriasis cohorts. J Eur Acad Dermatol Venereol 2020; 34:112-118. [PMID: 31287604 PMCID: PMC7004147 DOI: 10.1111/jdv.15787] [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] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Accepted: 06/27/2019] [Indexed: 12/12/2022]
Abstract
BACKGROUND Genetic predictors for treatment response could optimize allocation of biological treatment in patients with psoriasis. There is minimal knowledge about pharmacogenetics of anti-IL-17 agents. OBJECTIVES To assess whether genetic variants in the protein-coding region or untranslated regions of the IL-17A gene are associated with response to IL-17A inhibitors in patients with psoriasis. METHODS This was a multicenter European cohort study investigating pharmacogenetics of IL-17A inhibitors in patients with psoriasis. Patients with plaque psoriasis treated with secukinumab or ixekizumab in daily practice were included. For all participants, the protein-coding region and untranslated regions of the IL-17A gene were analysed using Sanger sequencing. Identified genetic variants were tested for association with response to secukinumab/ixekizumab, measured as ∆PASI, after 12 weeks (primary outcome) and after 24 weeks (secondary outcome). Association was tested using a linear regression model with correction for baseline PASI as a fixed covariate and for biological naivety and body mass index as additional covariates. RESULTS In total, 134 patients treated with secukinumab or ixekizumab were included. Genotyping of the cohort identified genetic variants present in untranslated regions and intronic DNA, but not in the protein-coding region of the IL-17A gene. Five genetic variants in non-coding DNA with a known or suspected functional effect on IL-17A expression were selected for association analyses: rs2275913, rs8193037, rs3819025, rs7747909 and rs3748067. After 12 weeks, 62% of patients achieved PASI75 and 39% achieved PASI90. At week 24, PASI75 and PASI90 response rates were 72% and 62%, respectively. No associations were found between the five genetic variants and ∆PASI, PASI75 or PASI90 after 12 and 24 weeks of anti-IL-17A treatment. CONCLUSIONS Response to IL-17A inhibitors secukinumab and ixekizumab cannot be explained by genetic variation in the protein-coding and untranslated regions of the IL-17A gene. Pharmacogenetics of IL-17A inhibitors in the treatment of psoriasis requires further exploration.
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Affiliation(s)
- L.J. van Vugt
- Department of DermatologyRadboud University Medical Centre (Radboudumc)NijmegenThe Netherlands
- Radboud Institute for Health Sciences (RIHS)Radboud University Medical Centre (Radboudumc)NijmegenThe Netherlands
| | - J.M.P.A. van den Reek
- Department of DermatologyRadboud University Medical Centre (Radboudumc)NijmegenThe Netherlands
- Radboud Institute for Health Sciences (RIHS)Radboud University Medical Centre (Radboudumc)NijmegenThe Netherlands
| | - E. Meulewaeter
- Department of DermatologyGhent University HospitalGhentBelgium
| | - M. Hakobjan
- Department of Human GeneticsRadboud University Medical Centre (Radboudumc)NijmegenThe Netherlands
| | - N. Heddes
- Department of DermatologyRadboud University Medical Centre (Radboudumc)NijmegenThe Netherlands
| | - T. Traks
- Department of DermatologyUniversity of TartuTartuEstonia
- Department of DermatologyTartu University HospitalTartuEstonia
| | - K. Kingo
- Department of DermatologyUniversity of TartuTartuEstonia
- Department of DermatologyTartu University HospitalTartuEstonia
| | - M. Galluzzo
- Department of DermatologyUniversity of Rome Tor VergataRomeItaly
| | - M. Talamonti
- Department of DermatologyUniversity of Rome Tor VergataRomeItaly
| | - J. Lambert
- Department of DermatologyGhent University HospitalGhentBelgium
| | - M.J.H. Coenen
- Radboud Institute for Health Sciences (RIHS)Radboud University Medical Centre (Radboudumc)NijmegenThe Netherlands
- Department of Human GeneticsRadboud University Medical Centre (Radboudumc)NijmegenThe Netherlands
| | - E.M.G.J. de Jong
- Department of DermatologyRadboud University Medical Centre (Radboudumc)NijmegenThe Netherlands
- Radboud Institute for Health Sciences (RIHS)Radboud University Medical Centre (Radboudumc)NijmegenThe Netherlands
- Radboud UniversityNijmegenThe Netherlands
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18
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Galluzzo M, D’Adamio S, Silvaggio D, Lombardo P, Massaro A, Egan CG, Bianchi L, Talamonti M. Ustekinumab treatment for moderate-to-severe plaque psoriasis: eight-year real-life experience. Expert Opin Biol Ther 2019; 20:95-104. [DOI: 10.1080/14712598.2020.1684472] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- M. Galluzzo
- Department of Dermatology, University of Rome “Tor Vergata”, Rome, Italy
| | - S. D’Adamio
- Department of Dermatology, University of Rome “Tor Vergata”, Rome, Italy
| | - D. Silvaggio
- Department of Dermatology, University of Rome “Tor Vergata”, Rome, Italy
| | - P. Lombardo
- Department of Dermatology, University of Rome “Tor Vergata”, Rome, Italy
| | - A. Massaro
- Department of Dermatology, University of Rome “Tor Vergata”, Rome, Italy
| | | | - L. Bianchi
- Department of Dermatology, University of Rome “Tor Vergata”, Rome, Italy
| | - M. Talamonti
- Department of Dermatology, University of Rome “Tor Vergata”, Rome, Italy
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19
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D’Adamio S, Silvaggio D, Lombardo P, Bianchi L, Talamonti M, Galluzzo M. The safety of anti-interleukins monoclonal antibodies for the treatment of psoriasis. Expert Opin Drug Saf 2019; 18:1031-1041. [DOI: 10.1080/14740338.2019.1663168] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- S. D’Adamio
- Dermatology Unit, University of Rome “Tor Vergata”, Rome, Italy
| | - D. Silvaggio
- Dermatology Unit, University of Rome “Tor Vergata”, Rome, Italy
| | - P. Lombardo
- Dermatology Unit, University of Rome “Tor Vergata”, Rome, Italy
| | - L. Bianchi
- Dermatology Unit, University of Rome “Tor Vergata”, Rome, Italy
| | - M. Talamonti
- Dermatology Unit, University of Rome “Tor Vergata”, Rome, Italy
| | - M. Galluzzo
- Dermatology Unit, University of Rome “Tor Vergata”, Rome, Italy
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20
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Signa S, Campione E, Rusmini M, Chiesa S, Grossi A, Omenetti A, Caorsi R, Viglizzo GM, Galluzzo M, Bianchi L, Talamonti M, Orlandi A, Martini A, Ceccherini I, Gattorno M. Whole exome sequencing approach to childhood onset familial erythrodermic psoriasis unravels a novel mutation of CARD14 requiring unusual high doses of ustekinumab. Pediatr Rheumatol Online J 2019; 17:38. [PMID: 31286971 PMCID: PMC6615224 DOI: 10.1186/s12969-019-0336-3] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [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: 03/12/2019] [Accepted: 06/05/2019] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Autosomal dominant gain of function mutations in caspase recruitment domain family member 14 (CARD14) is a rare condition associated with plaque-type psoriasis, generalized pustular psoriasis, palmoplantar pustular psoriasis and pityriasis rubra pilaris. Recently, a new CARD14 -associated phenotype defined as CAPE (CARD14-associated papulosquamous eruption) with clinical features of both psoriasis and pityriasis rubra pilaris was reported. We describe a family carrying a novel heterozygous mutation in CARD14 gene, with childhood-onset erythrodermic psoriasis requiring an unusual extremely high dose (up to 2 mg/kg every 8 weeks) of ustekinumab to achieve disease remission. CASE PRESENTATION We describe a large family with three pairs of twins presenting a clinical phenotype characterized by childhood-onset erythrodermic psoriasis; in some family members is also reported psoriatic arthritis. The two probands presented poor clinical response to topic and systemic therapy with antihistamine, steroid, retinoids, cyclosporine and etanercept. After exclusion of the most common genes associated to autoinflammatory diseases (IL36RN, IL1RN, MVK, TNFRSF1A, NLRP3, NLRP12, MEFV, NOD2, PSMB8, PSTPIP1, LPIN2) we approached a new gene search by subjecting to Whole Exome Sequencing (WES) analysis five members of the family. A novel heterozygous mutation (c.446 T > G, leading to the missense amino acid substitution p.L149R) in the exon 4 of the CARD14 gene was identified in all affected members. Increasing dosages (up to 2 mg/kg every 8 weeks) of ustekinumab, a human monoclonal antibody targeting interleukin-12 (IL-12) and interleukin-23 (IL-23), allowed the complete control of the clinical manifestations, with an evident reduction of circulating Th17 and Th22 CD4+ T cell subsets. CONCLUSIONS We describe the association of mutations of the CARD14 gene with an erythrodermic psoriasis pedigree, underlying the necessity to investigate CARD14 mutations in childhood-onset psoriasis cases and confirming the presence of CARD14 causative mutations also in erythrodermic psoriasis form, as recently reported. Also in pediatric age, ustekinumab represents a powerful therapeutic option for this rare condition, that is usually refractory to other treatments. In young children, high and frequent dosages allowed a complete control of the clinical manifestations without any severe side effects, with a long-term follow-up.
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Affiliation(s)
- S. Signa
- Centro Malattie Autoinfiammatorie e Immunodeficienze- Clinica Pediatrica e Reumatologia, IRCCS Giannina Gaslini, Via Gaslini 5, 16147 Genova, Italy ,0000 0001 2151 3065grid.5606.5Dipartimento di Neuroscienze, Riabilitazione, Oftalmologia, Genetica e Scienze Materno-Infantili (DINOGMI), Università di Genova, Genoa, Italy
| | - E. Campione
- 0000 0001 2300 0941grid.6530.0Dermatology, Department of “Medicina dei Sistemi”, University of Rome Tor Vergata, Rome, Italy
| | - M. Rusmini
- 0000 0004 1760 0109grid.419504.dUO Genetica Medica, IRCCS G. Gaslini, Genoa, Italy
| | - S. Chiesa
- Centro Malattie Autoinfiammatorie e Immunodeficienze- Clinica Pediatrica e Reumatologia, IRCCS Giannina Gaslini, Via Gaslini 5, 16147 Genova, Italy
| | - A. Grossi
- 0000 0004 1760 0109grid.419504.dUO Genetica Medica, IRCCS G. Gaslini, Genoa, Italy
| | - A. Omenetti
- Centro Malattie Autoinfiammatorie e Immunodeficienze- Clinica Pediatrica e Reumatologia, IRCCS Giannina Gaslini, Via Gaslini 5, 16147 Genova, Italy
| | - R. Caorsi
- Centro Malattie Autoinfiammatorie e Immunodeficienze- Clinica Pediatrica e Reumatologia, IRCCS Giannina Gaslini, Via Gaslini 5, 16147 Genova, Italy
| | - G. M. Viglizzo
- 0000 0004 1760 0109grid.419504.dUO Dermatologia , IRCCS G. Gaslini, Genoa, Italy
| | - M. Galluzzo
- 0000 0001 2300 0941grid.6530.0Dermatology, Department of “Medicina dei Sistemi”, University of Rome Tor Vergata, Rome, Italy
| | - L. Bianchi
- 0000 0001 2300 0941grid.6530.0Dermatology, Department of “Medicina dei Sistemi”, University of Rome Tor Vergata, Rome, Italy
| | - M. Talamonti
- 0000 0001 2300 0941grid.6530.0Dermatology, Department of “Medicina dei Sistemi”, University of Rome Tor Vergata, Rome, Italy
| | - A. Orlandi
- 0000 0001 2300 0941grid.6530.0Cattedra di Anatomia Patologica, Policlinico Universitario di Roma “Tor Vergata”, Rome, Italy
| | - A. Martini
- 0000 0004 1760 0109grid.419504.dDirezione Scientifica, IRCCS G. Gaslini, Genoa, Italy
| | - I. Ceccherini
- 0000 0004 1760 0109grid.419504.dUO Genetica Medica, IRCCS G. Gaslini, Genoa, Italy
| | - M. Gattorno
- Centro Malattie Autoinfiammatorie e Immunodeficienze- Clinica Pediatrica e Reumatologia, IRCCS Giannina Gaslini, Via Gaslini 5, 16147 Genova, Italy
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21
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D’Adamio S, Silvaggio D, Massaro A, Lombardo P, Bianchi L, Talamonti M, Galluzzo M. Pharmacotherapeutic management of psoriasis in adolescents and children. Expert Opin Pharmacother 2019; 20:1777-1785. [DOI: 10.1080/14656566.2019.1636032] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- S. D’Adamio
- Dermatology Unit, University of Rome “Tor Vergata“, Rome, Italy
| | - D. Silvaggio
- Dermatology Unit, University of Rome “Tor Vergata“, Rome, Italy
| | - A. Massaro
- Dermatology Unit, University of Rome “Tor Vergata“, Rome, Italy
| | - P. Lombardo
- Dermatology Unit, University of Rome “Tor Vergata“, Rome, Italy
| | - L. Bianchi
- Dermatology Unit, University of Rome “Tor Vergata“, Rome, Italy
| | - M. Talamonti
- Dermatology Unit, University of Rome “Tor Vergata“, Rome, Italy
| | - M. Galluzzo
- Dermatology Unit, University of Rome “Tor Vergata“, Rome, Italy
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22
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Talamonti M, D'Adamio S, Galluccio T, Andreani M, Pastorino R, Egan C, Bianchi L, Galluzzo M. High‐resolution
HLA
typing identifies a new ‘super responder’ subgroup of
HLA
‐C*06:02‐positive psoriatic patients:
HLA
‐C*06:02/
HLA
‐C*04, in response to ustekinumab. J Eur Acad Dermatol Venereol 2019; 33:e364-e367. [DOI: 10.1111/jdv.15659] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Affiliation(s)
- M. Talamonti
- Dermatology Unit Department of ‘Medicina dei Sistemi’ University of Rome ‘Tor Vergata’ Viale Oxford 81 00133 Rome Italy
| | - S. D'Adamio
- Dermatology Unit Department of ‘Medicina dei Sistemi’ University of Rome ‘Tor Vergata’ Viale Oxford 81 00133 Rome Italy
| | - T. Galluccio
- Laboratorio d'Immunogenetica dei Trapianti, Polo di Ricerca di San PaoloDipartimento di Oncoematologia e Terapia Cellulare e Genica, IRCCS Ospedale Pediatrico Bambino Gesù Viale Ferdinando Baldelli 40 00146Rome Italy
| | - M. Andreani
- Laboratorio d'Immunogenetica dei Trapianti, Polo di Ricerca di San PaoloDipartimento di Oncoematologia e Terapia Cellulare e Genica, IRCCS Ospedale Pediatrico Bambino Gesù Viale Ferdinando Baldelli 40 00146Rome Italy
| | - R. Pastorino
- Section of Hygiene Institute of Public Health Catholic University of the Sacred Heart Largo Agostino Gemelli 8 00168 Rome Italy
| | - C.G. Egan
- CE Medical Writing Via Toscoromagnola 2228, San Lorenzo alle Corti, 56023 Cascina Pisa Italy
| | - L. Bianchi
- Dermatology Unit Department of ‘Medicina dei Sistemi’ University of Rome ‘Tor Vergata’ Viale Oxford 81 00133 Rome Italy
| | - M. Galluzzo
- Dermatology Unit Department of ‘Medicina dei Sistemi’ University of Rome ‘Tor Vergata’ Viale Oxford 81 00133 Rome Italy
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Galluzzo M, D'Adamio S, Massaro A, Piccolo A, Bianchi L, Talamonti M. Spotlight on brodalumab in the treatment of plaque psoriasis: the evidence to date. Clin Cosmet Investig Dermatol 2019; 12:311-321. [PMID: 31118733 PMCID: PMC6503649 DOI: 10.2147/ccid.s165605] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [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: 10/23/2018] [Accepted: 02/15/2019] [Indexed: 12/21/2022]
Abstract
The IL-17/IL-23 axis is now understood to influence psoriasis, and the development of novel IL-17 inhibitor medications marks a sea change in the treatment of psoriasis. Brodalumab is a recombinant, fully human immunoglobulin IgG2 monoclonal antibody specifically targeted against IL-17RA. This article discusses the mechanism of action and the efficacy and safety profile of brodalumab presented in the literature. Brodalumab, the latest approved anti-IL-17-class medication, is the only one that exerts its effects on IL-17C as well as on IL-17A and IL-17F, blocking the shared IL-17 receptor A. In this sense, considering the recent evidence, brodalumab could have beneficial effects not only on psoriasis, but also on atopic dermatitis. It could also serve as a therapeutic alternative in patients who develop paradoxical eczematous reactions or atopic-like dermatitis during treatment with other anti-IL-17A (secukinumab, ixekizumab). ![]()
Point your SmartPhone at the code above. If you have a QR code reader the video abstract will appear. Or use: https://youtu.be/XdU4cyB54FY
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Affiliation(s)
- M Galluzzo
- Dermatology, Department of "Medicina dei Sistemi", University of Rome Tor Vergata, Rome, Italy
| | - S D'Adamio
- Dermatology, Department of "Medicina dei Sistemi", University of Rome Tor Vergata, Rome, Italy
| | - A Massaro
- Dermatology, Department of "Medicina dei Sistemi", University of Rome Tor Vergata, Rome, Italy
| | - A Piccolo
- Dermatology, Department of "Medicina dei Sistemi", University of Rome Tor Vergata, Rome, Italy
| | - L Bianchi
- Dermatology, Department of "Medicina dei Sistemi", University of Rome Tor Vergata, Rome, Italy
| | - M Talamonti
- Dermatology, Department of "Medicina dei Sistemi", University of Rome Tor Vergata, Rome, Italy
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Pitroda S, Khodarev N, Huang L, Uppal A, Wightman S, Ganai S, Joseph N, Xue L, Weber C, Segal J, Stack M, Khan S, Paty P, Kaul K, Andrade J, White K, Talamonti M, Posner M, Hellman S, Weichselbaum R. Integrated Molecular Subtyping of Clinical Metastasis: Implications for Defining a Curable Oligometastatic State. Int J Radiat Oncol Biol Phys 2018. [DOI: 10.1016/j.ijrobp.2018.06.122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Galluzzo M, D'Adamio S, Campione E, Mazzilli S, Bianchi L, Talamonti M. A clinical case of severe disease burden: an erythrodermic psoriatic patient treated with secukinumab. J DERMATOL TREAT 2018; 29:1-11. [PMID: 30256706 DOI: 10.1080/09546634.2018.1524818] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [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: 04/24/2018] [Accepted: 09/07/2018] [Indexed: 10/28/2022]
Abstract
Erythrodermic psoriasis is a severe variant of psoriasis characterized by prominent erythema, affecting the entire body surface. Management of erythrodermic psoriasis is difficult, not standardized, and often ineffective. As clinical studies are lacking, reporting of clinical experience with secukinumab may help to gather insight in this field. Here, we describe the case of a 55-year-old man, with a 10-year history of moderate-to-severe plaque psoriasis. He presents a flare of erythroderma involving approximately 90% of his body surface area and a Psoriasis Area and Severity Index score of 42, with an important impact on his quality of life (DLQI score was 20.0; Skindex-29 score was 67.2). The patient presented also alexithymic features. Due to severity of clinical features and poor quality of life, the patient started secukinumab treatment; we observed a striking and rapid response to therapy with an excellent safety profile and a satisfactory compliance. Furthermore, therapy with secukinumab considerably enhanced patient's quality of life. Although further studies are needed to better understand the role of the IL-23/Th17 pathway, secukinumab can be an effective therapeutic option for patients affected by erythrodermic psoriasis.
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Affiliation(s)
- M Galluzzo
- a Department of Dermatology , University of Rome "Tor Vergata" , Viale Oxford 81 , 00133 Rome , Italy
| | - S D'Adamio
- a Department of Dermatology , University of Rome "Tor Vergata" , Viale Oxford 81 , 00133 Rome , Italy
| | - E Campione
- a Department of Dermatology , University of Rome "Tor Vergata" , Viale Oxford 81 , 00133 Rome , Italy
| | - S Mazzilli
- a Department of Dermatology , University of Rome "Tor Vergata" , Viale Oxford 81 , 00133 Rome , Italy
| | - L Bianchi
- a Department of Dermatology , University of Rome "Tor Vergata" , Viale Oxford 81 , 00133 Rome , Italy
| | - M Talamonti
- a Department of Dermatology , University of Rome "Tor Vergata" , Viale Oxford 81 , 00133 Rome , Italy
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Galluzzo M, D'Adamio S, Campione E, Bianchi L, Talamonti M. A safety evaluation of guselkumab for the treatment of psoriasis. Expert Opin Drug Saf 2018; 17:741-751. [PMID: 29897790 DOI: 10.1080/14740338.2018.1488963] [Citation(s) in RCA: 8] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Accepted: 06/12/2018] [Indexed: 01/25/2023]
Abstract
INTRODUCTION Guselkumab is a fully human monoclonal IgG1λ antibody for the treatment of plaque psoriasis that inhibits interleukin (IL)-23p19 subunit, reducing the proliferation of type 17 helper T (Th-17) cells and thus production of Th-17-derived pro-inflammatory cytokines, especially IL-17 and IL-22. Areas covered: In the following article, the mechanism of action and mainly the efficacy and safety profile of guselkumab available from results of trials will be discussed. We summarized these data after a literature review including PubMed search, relating proceedings and abstracts from relevant international conferences, assessment reports from European and United States regulatory agencies and treatment guidelines up to April 2018. Expert opinion: The central role of IL-23 in psoriasis pathogenesis is supported by genetic links of IL-23 and IL-23R alleles to psoriasis susceptibility; early clinical trials have demonstrated that sufficient inhibition of IL-23p19 results in rapid resolution of the disease. Targeting IL-23, may be responsible for the high efficacy and durable responses of guselkumab, avoiding some adverse effects of IL-17A blockade, like mucocutaneous candida infections or triggering/worsening of inflammatory bowel disease, experienced with agents acting selectively against this molecule and that seem to be class related.
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Affiliation(s)
- M Galluzzo
- a Dermatology, Department of "Medicina dei Sistemi" , University of Rome Tor Vergata , Rome , Italy
| | - S D'Adamio
- a Dermatology, Department of "Medicina dei Sistemi" , University of Rome Tor Vergata , Rome , Italy
| | - E Campione
- a Dermatology, Department of "Medicina dei Sistemi" , University of Rome Tor Vergata , Rome , Italy
| | - L Bianchi
- a Dermatology, Department of "Medicina dei Sistemi" , University of Rome Tor Vergata , Rome , Italy
| | - M Talamonti
- a Dermatology, Department of "Medicina dei Sistemi" , University of Rome Tor Vergata , Rome , Italy
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Talamonti M, Galluzzo M, Bernardini N, Caldarola G, Persechino S, Cantoresi F, Egan C, Potenza C, Peris K, Bianchi L. Psoriasis Area and Severity Index response in moderate-severe psoriatic patients switched to adalimumab: results from the OPPSA study. J Eur Acad Dermatol Venereol 2018; 32:1737-1744. [DOI: 10.1111/jdv.15077] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Accepted: 05/04/2018] [Indexed: 01/13/2023]
Affiliation(s)
- M. Talamonti
- Department of Dermatology; University of Rome ‘Tor Vergata’; Rome Italy
| | - M. Galluzzo
- Department of Dermatology; University of Rome ‘Tor Vergata’; Rome Italy
| | - N. Bernardini
- Department of Medical and Surgical Sciences and Biotechnologies; Division of Dermatology ‘Daniele Innocenzi’; University of Rome ‘La Sapienza’; Polo Pontino Italy
| | - G. Caldarola
- Institute of Dermatology; Catholic University of the Sacred Heart; Rome Italy
| | - S. Persechino
- Department of Dermatology; NESMOS Unit; Sant'Andrea Hospital; Sapienza University of Rome; Rome Italy
| | - F. Cantoresi
- Department of Dermatology; Policlinico Umberto I; ‘Sapienza’ University of Rome; Rome Italy
| | | | - C. Potenza
- Department of Medical and Surgical Sciences and Biotechnologies; Division of Dermatology ‘Daniele Innocenzi’; University of Rome ‘La Sapienza’; Polo Pontino Italy
| | - K. Peris
- Institute of Dermatology; Catholic University of the Sacred Heart; Rome Italy
| | - L. Bianchi
- Department of Dermatology; University of Rome ‘Tor Vergata’; Rome Italy
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Majmudar K, Quintero LD, Fuentes H, Stocker S, Tafur A, Talamonti M. Post-operative venous thromboembolism increased mortality in patients with either adenocarcinoma or non-adenocarcinoma pancreatic cancer. Ann Oncol 2018. [DOI: 10.1093/annonc/mdy150.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Galluzzo M, D’Adamio S, Bianchi L, Talamonti M. Pharmacokinetic drug evaluation of dalbavancin for the treatment of skin infections. Expert Opin Drug Metab Toxicol 2017; 14:197-206. [DOI: 10.1080/17425255.2018.1420162] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Affiliation(s)
- M. Galluzzo
- Department of Dermatology, University of Rome ‘Tor Vergata,’ Rome, Italy
| | - S. D’Adamio
- Department of Dermatology, University of Rome ‘Tor Vergata,’ Rome, Italy
| | - L. Bianchi
- Department of Dermatology, University of Rome ‘Tor Vergata,’ Rome, Italy
| | - M. Talamonti
- Department of Dermatology, University of Rome ‘Tor Vergata,’ Rome, Italy
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Talamonti M, Galluzzo M, van den Reek J, de Jong E, Lambert J, Malagoli P, Bianchi L, Costanzo A. Role of the HLA-C*06
allele in clinical response to ustekinumab: evidence from real life in a large cohort of European patients. Br J Dermatol 2017; 177:489-496. [DOI: 10.1111/bjd.15387] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/13/2017] [Indexed: 12/30/2022]
Affiliation(s)
- M. Talamonti
- Department of Dermatology; University of Rome Tor Vergata; Italy
| | - M. Galluzzo
- Department of Dermatology; University of Rome Tor Vergata; Italy
| | - J.M. van den Reek
- Department of Dermatology; Radboud University Medical Centre; Nijmegen the Netherlands
| | - E.M. de Jong
- Department of Dermatology; Radboud University Medical Centre; Nijmegen the Netherlands
- Radboud University Nijmegen; the Netherlands
| | - J.L.W. Lambert
- Department of Dermatology; Ghent University Hospital; Ghent Belgium
| | - P. Malagoli
- Dermatology Unit; Azienda Ospedaliera San Donato; Milan Italy
| | - L. Bianchi
- Department of Dermatology; University of Rome Tor Vergata; Italy
| | - A. Costanzo
- Dermatology Unit, Department of Biomedical Sciences; Humanitas University; Milan Italy
- Skin Pathology Laboratory; Istituto Clinico Humanitas; Milan Italy
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Galluzzo M, Talamonti M, D’adamio S, Bianchi L. Pharmacokinetic drug evaluation of brodalumab for the treatment of psoriasis. Expert Opin Drug Metab Toxicol 2017; 13:679-691. [DOI: 10.1080/17425255.2017.1325874] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Affiliation(s)
- M. Galluzzo
- Department of Dermatology, University of Rome ‘Tor Vergata’, Rome, Italy
| | - M. Talamonti
- Department of Dermatology, University of Rome ‘Tor Vergata’, Rome, Italy
| | - S. D’adamio
- Department of Dermatology, University of Rome ‘Tor Vergata’, Rome, Italy
| | - L. Bianchi
- Department of Dermatology, University of Rome ‘Tor Vergata’, Rome, Italy
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Abstract
INTRODUCTION The identification of a number of psoriasis-susceptibility genes and a better understanding of the pathogenesis of the intracellular metabolic pathways, have generated new perspectives on psoriasis treatment, in particular new compounds that inhibit certain intracellular proteins involved in the immune response. In contrast to biologic agents, these compounds block intracellular targets such as transcriptional factors or enzymes. AREAS COVERED Tofacitinib is a small molecule that acts as a reversible, competitive inhibitor of ATP in the ATP binding site of JAK proteins, determining their inactivation, thus prevents the downstream activation of the STAT proteins, which are then unable to up-regulate the pro-inflammatory genes implicated in psoriasis. The authors present an overview of Phases I - III clinical trials of tofacitinib for psoriasis based on peer-reviewed literature. EXPERT OPINION In clinical practice, it is important to assess the response of psoriasis to tofacitinib and identify possible clinical, genetic, and immune biomarkers to predict the response. Comorbidities associated with psoriasis, in particular metabolic syndrome and obesity, are also an important aspect of using tofacitinib in clinical practice. There are some evidences that a drug such as tofacitinib could be used to improve not only psoriasis, but also some of its important comorbidities.
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Affiliation(s)
- M Galluzzo
- a Department of Dermatology , University of Rome 'Tor Vergata' , Rome , Italy
| | - S D'Adamio
- a Department of Dermatology , University of Rome 'Tor Vergata' , Rome , Italy
| | - S Servoli
- a Department of Dermatology , University of Rome 'Tor Vergata' , Rome , Italy
| | - L Bianchi
- a Department of Dermatology , University of Rome 'Tor Vergata' , Rome , Italy
| | - S Chimenti
- a Department of Dermatology , University of Rome 'Tor Vergata' , Rome , Italy
| | - M Talamonti
- a Department of Dermatology , University of Rome 'Tor Vergata' , Rome , Italy
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Gisondi P, Altomare G, Ayala F, Bardazzi F, Bianchi L, Chiricozzi A, Costanzo A, Conti A, Dapavo P, De Simone C, Foti C, Naldi L, Offidani A, Parodi A, Piaserico S, Prignano F, Rongioletti F, Stingeni L, Talamonti M, Girolomoni G. Italian guidelines on the systemic treatments of moderate-to-severe plaque psoriasis. J Eur Acad Dermatol Venereol 2017; 31:774-790. [PMID: 28244153 DOI: 10.1111/jdv.14114] [Citation(s) in RCA: 117] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2016] [Accepted: 12/21/2016] [Indexed: 02/06/2023]
Abstract
Psoriasis is a common disease, which has a considerable impact on the healthcare system. Therefore, appropriate use of therapeutic resources is very important. Management of psoriasis in daily clinical practice is highly variable because many issues are still debated and not definitely addressed by the evidence-based medicine. Moreover, the different availability and reimbursability of drugs in each country justifies national guidelines. Expert consensus can provide helpful guidelines for optimizing patient care. A total of 20 dermatologists from different areas of Italy and with large experience in the treatment of psoriasis agreed to participate in the guidelines expert panel who aimed to reach consensus on the factors influencing psoriasis severity, the indications for systemic treatments, the parameters to be considered in the choice of treatment, and the factors to be considered in the choice of biological treatment. The recommendations for the use, screening and monitoring of systemic therapies were based on the 2015 S3 European Dermatology Forum/European Academy of Dermatology and Venereology psoriasis guidelines. Recommendations on the treatment of psoriasis in special patient populations were also agreed. The final document was discussed in a meeting moderated by a facilitator with participation of the entire group and adopting a nominal group technique to reach consensus. A statement was regarded as consented when agreement was achieved by at least 75% of the voting experts according to the Delphi procedure.
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Affiliation(s)
- P Gisondi
- Department of Medicine, Section of Dermatology and Venereology, University of Verona, Verona, Italy
| | - G Altomare
- Department of Dermatology and Venereology, I.R.C.C.S. Istituto Ortopedico Galeazzi, University of Milan, Milano, Italy
| | - F Ayala
- Department of Dermatology, University of Naples Federico II, Napoli, Italy
| | - F Bardazzi
- Division of Dermatology, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy
| | - L Bianchi
- Department of Dermatology, University of Rome Tor Vergata, Rome, Italy
| | - A Chiricozzi
- Department of Dermatology, University of Pisa, Pisa, Italy
| | - A Costanzo
- Department of Dermatology, Humanitas Research Hospital, Rozzano, Italy
| | - A Conti
- Department of Dermatology, University of Modena and Reggio Emilia, Modena, Italy
| | - P Dapavo
- Department of Biomedical Science and Human Oncology, Second Dermatologic Clinic, University of Turin, Turin, Italy
| | - C De Simone
- Department of Dermatology, Catholic University of the Sacred Heart, Rome, Italy
| | - C Foti
- Department of Biomedical Science and Human Oncology, Section of Dermatology, University of Bari, Bari, Italy
| | - L Naldi
- Department of Dermatology, Azienda Ospedaliera Papa Giovanni XXIII, Bergamo, Italy
| | - A Offidani
- Department of Clinical and Molecular Sciences, Dermatology Unit, Polytechnic Marche University, Ancona, Italy
| | - A Parodi
- Department of Dermatology, University of Genoa, Genova, Italy
| | - S Piaserico
- Department of Dermatology, University of Padua, Padova, Italy
| | - F Prignano
- Department of Dermatology, University of Florence, Firenze, Italy
| | - F Rongioletti
- Department of Medical Sciences and Public Health, Section of Dermatology, University of Cagliari, Cagliari, Italy
| | - L Stingeni
- Department of Medicine, Section of Clinical, Allergological and Venereological Dermatology, University of Perugia, Perugia, Italy
| | - M Talamonti
- Department of Dermatology, University of Rome Tor Vergata, Rome, Italy
| | - G Girolomoni
- Department of Medicine, Section of Dermatology and Venereology, University of Verona, Verona, Italy
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Galluzzo M, Talamonti M, Perino F, Servoli S, Giordano D, Chimenti S, De Simone C, Peris K. Bioelectrical impedance analysis to define an excess of body fat: evaluation in patients with psoriasis. J DERMATOL TREAT 2016; 28:299-303. [DOI: 10.1080/09546634.2016.1254326] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- M. Galluzzo
- Department of Dermatology, University of Rome “Tor Vergata”, Rome, Italy
| | - M. Talamonti
- Department of Dermatology, University of Rome “Tor Vergata”, Rome, Italy
| | - F. Perino
- Institute of Dermatology, Catholic University of the Sacred Heart, Rome, Italy
| | - S. Servoli
- Department of Dermatology, University of Rome “Tor Vergata”, Rome, Italy
| | - D. Giordano
- Institute of Dermatology, Catholic University of the Sacred Heart, Rome, Italy
| | - S. Chimenti
- Department of Dermatology, University of Rome “Tor Vergata”, Rome, Italy
| | - C. De Simone
- Institute of Dermatology, Catholic University of the Sacred Heart, Rome, Italy
| | - K. Peris
- Institute of Dermatology, Catholic University of the Sacred Heart, Rome, Italy
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Chimenti M, Triggianese P, Ortolan A, Tonelli M, Talamonti M, Costa L, Caso F, Teoli M, Galluzzo M, Ramonda R, Scarpa R, Punzi L, Perricone R. FRI0464 Long-Term Efficacy of Ustekinumab Treatment in Patients Affected by Psoriatic Arthritis Previously Treated with TNF Inhibitors. Ann Rheum Dis 2016. [DOI: 10.1136/annrheumdis-2016-eular.5432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Galluzzo M, Andreani M, Testi M, Chimenti S, Talamonti M. HLA-C*18:01: A Rare Allele in the European Caucasian Population Coinciding with Difficult-to-Treat Plaque Psoriasis. Mol Diagn Ther 2016; 20:227-30. [DOI: 10.1007/s40291-016-0199-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Nardi B, Lucarelli C, Talamonti M, Arimatea E, Fiori V, Moltedo-Perfetti A. NEETs versus EETs: an observational study in Italy on the framework of the HEALTH25 European project. ACTA ACUST UNITED AC 2015. [DOI: 10.1080/13596748.2015.1081749] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Talamonti M, Botti E, Galluzzo M, Teoli M, Spallone G, Bavetta M, Chimenti S, Costanzo A. Pharmacogenetics of psoriasis: HLA-Cw6 but not LCE3B/3C deletion nor TNFAIP3 polymorphism predisposes to clinical response to interleukin 12/23 blocker ustekinumab. Br J Dermatol 2014; 169:458-63. [PMID: 23521149 DOI: 10.1111/bjd.12331] [Citation(s) in RCA: 114] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/17/2013] [Indexed: 12/31/2022]
Abstract
BACKGROUND Our understanding of the genetic basis of predisposition to psoriasis is increasing exponentially due to the progress of genetic studies. However, so far little is known about genetic predisposition in relation to the response to psoriasis treatments. Recent data identified genetic predictors for the clinical outcome of conventional treatments such as methotrexate, acitretin and vitamin D derivatives, but few studies are available on genetic predictors of response to biologics. We hypothesized that genetic variations associated with increased risk of developing psoriasis may also act as predictors for the outcome of biologic therapy. OBJECTIVES The aim of our study was to analyse the presence of three different psoriasis susceptibility genetic variations (HLA-Cw6; TNFAIP3 rs610604 polymorphism; LCE3B/3C gene deletions) in a cohort of patients affected by moderate to severe psoriasis under ustekinumab treatment. Our primary endpoint was to evaluate the association between Psoriasis Area and Severity Index (PASI) 75 response at week 12 and HLA-Cw6 status. METHODS Fifty-one patients were genotyped by standard methods and psoriasis severity (PASI score) was evaluated at day 0 and after 4, 12, 24 and 40 weeks of treatment. RESULTS We observed increased response to ustekinumab in Cw6-positive (Cw6POS) patients [PASI 75 at week 12: 96·4% in Cw6POS vs. 65·2% in Cw6-negative (Cw6NEG) patients; P = 0·008]. In addition, we show that HLA-Cw6POS patients responded faster to ustekinumab, 89·3% of them reaching PASI 50 at week 4, after a single injection (vs. 60·9% of HLA-Cw6NEG patients). The superior response of HLA-Cw6POS patients was maintained throughout the study period, reaching the highest statistical significance for PASI 75 at week 28 (96·35% Cw6POS vs. 72·7% Cw6NEG; odds ratio 9·8). Analysis of TNFAIP3 rs610604 polymorphism and LCE3B/3C gene deletions did not show any significant association with response to ustekinumab. CONCLUSIONS Our observations underline the role of HLA-Cw6 not only as a psoriasis susceptibility gene, but also as a pharmacogenetic marker of response to ustekinumab in psoriasis.
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Affiliation(s)
- M Talamonti
- Department of Dermatology, University of Rome Tor Vergata, Rome, Italy
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Hussong J, Talamonti M, Rao M. p53 protein overexpression in infiltrating ductal carcinoma of female breast and its association with lymph node metastasis. Oncol Rep 2012; 4:917-20. [PMID: 21590166 DOI: 10.3892/or.4.5.917] [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] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Traditionally, prognosis in carcinoma of the breast is evaluated based on size and differentiation of the tumor and status of lymph node metastasis. In addition to these established markers, in this molecular age other parameters such as overexpression of p53, c-erbB-2 and c-myc proteins are increasingly used to assess the prognosis. At present, the prognostic value of the molecular markers, at best, is controversial and conflicting. In this study, we examined 67 infiltrating ductal. carcinomas of female breast with and without lymph node metastasis for p53 protein overexpression by immunohistochemistry on formalin-fixed, paraffin-embedded tissue sections to ascertain if p53 positive tumors have greater metastatic potential than p53 negative tumors. In addition, p53 overexpression was also correlated with tumor size, grade, expression of estrogen and progesterone receptors, and age of the patient to clarify the issue of relevance of p53 overexpression in prognostication, p53 overexpression was observed in 39% of tumors and showed strong correlation only with the histological grade of the tumor. The incidence of p53 overexpression in grade 1, grade 2 and grade 3 tumors was 0%, 33% and 58% respectively. Lymph node metastasis was less frequent in tumors that overexpressed p53 protein. Twenty-seven percent of primary tumors with lymph node metastasis showed p53 protein overexpression, in contrast to 44% of tumors without metastasis. No correlation was observed between p53 overexpression and all the other parameters evaluated except progesterone receptor negative status. These results suggest that p53 overexpression is not an independent prognostic indicator and should not be used to predict lymph node metastasis or aggressive behavior of the tumor.
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Affiliation(s)
- J Hussong
- NORTHWESTERN UNIV,DEPT PATHOL,SCH MED,CHICAGO,IL 60611. NORTHWESTERN UNIV,DEPT SURG,SCH MED,CHICAGO,IL 60611
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Talamonti M, Teoli M, Botti E, Spallone G, Chimenti S, Costanzo A. Patients with moderate to severe plaque psoriasis: one year after the European Medicines Agency recommendation of efalizumab suspension. Dermatology 2011; 222:250-5. [PMID: 21494026 DOI: 10.1159/000326111] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2010] [Accepted: 02/14/2011] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND In February 19, 2009, the European Medicines Agency (EMA) had recommended the suspension of the marketing authorization for efalizumab after the occurrence of cases of progressive multifocal leukoencephalopathy. OBJECTIVE To explore the efficacy of alternative therapies for psoriasis and the health status of patients who discontinued efalizumab. METHODS An observational study was performed on 101 patients. After the EMA communication, efalizumab was discontinued in the following 2-3 months. In agreement with the patients, we decided to either prescribe other treatments or none at all. RESULTS After 1 year, 11 patients are still not treated, 63 patients are treated with biologics, and 9 patients are treated with systemic conventional therapies. CONCLUSION In order to prevent rebound or relapse, various approaches are available, including cyclosporine, methotrexate and biologic therapies. Interestingly, in 11 out of 31 patients who did not receive any systemic drug, psoriasis is still under control, suggesting a long-term effect of efalizumab.
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Affiliation(s)
- M Talamonti
- Department of Dermatology, University of Rome Tor Vergata, Rome, Italy.
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Hardacre JM, Mulcahy MF, Small W, Talamonti M, Obel JC, Rocha Lima CS, Safran H, Lenz H, Chiorean EG, Link CJ. Effect of the addition of algenpantucel-L immunotherapy to standard adjuvant therapy on survival in patients with resected pancreas cancer. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.4_suppl.236] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
236 Background: Pancreatic cancer portends a poor prognosis with ∼4% long-term survival. Among the estimated 20% of patients who have resectable disease, the 1-/3-/5-year survival rates approximate only 70%/30%/18%, even with adjuvant therapy. Better treatment options are needed and addition of algenpantucel-L (HyperAcute-Pancreas) to standard adjuvant therapy is proposed to improve prospects for survival. Algenpantucel-L is composed of irradiated, live, allogeneic human pancreatic cancer cells expressing the enzyme α-1,3 galactosyl transferase (α-GT), which is the major barrier to xenotransplantation from lower mammals to humans (e.g., hyperacute rejection). Up to 2% of circulating human antibodies are directed against the α-GT epitope of algenpantucel-L and are the proposed mechanism of initiating the anti-tumor immune response. Methods: Open-label, single arm, multi-institutional phase II study (NLG0205) to evaluate algenpantucel-L + standard adjuvant therapy (RTOG-9704, JAMA, 2008: gemcitabine + 5-FU-XRT) for pancreatic cancer patients undergoing R0/R1 resection. Disease-free (DFS) and overall survival (OS) are the primary and secondary endpoints, respectively. Results: 73 patients (70 evaluable, 15 month median follow up) received gemcitabine + 5-FU-XRT + algenpantucel-L (mean 12 doses, range 1-14). Demographics and prognostic factors: median age 62 years, 47% female, 81.4% lymph node positive, median tumor size 3.2 cm (range 2-15 cm; 26% > 4cm) and 24% post-operative CA 19-9 > 90. Kaplan-Meier estimated survival rates at 12 and 24 months are 91% and 54%, respectively, comparing favorably to 63% and 32% expected based on the nomogram described by Brennan et al (Ann Surg, 2004). Likewise, the current median DFS of 16 months compares favorably to the 11 months observed in RTOG 9704. OS data continues to mature, with 74% still censored. Algenpantucel-L was well tolerated with no likely/directly attributable grade 3 SAEs. The most common adverse events were injection site pain and induration. Conclusions: Addition of algenpantucel-L to standard adjuvant therapy for resected pancreatic cancer may improve survival. A phase III study began patient enrollment in May 2010. [Table: see text]
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Affiliation(s)
- J. M. Hardacre
- University Hospitals Case Medical Center, Cleveland, OH; Northwestern University Feinberg School of Medicine, Chicago, IL; The Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, IL; NorthShore, Evanston, IL; Evanston Northwestern Healthcare, Evanston, IL; University of Miami Sylvester Comprehensive Cancer Center, Miami, FL; Brown University Oncology Group, Providence, RI; University of Southern California Norris Comprehensive Cancer Center, Los Angeles, CA; Indiana
| | - M. F. Mulcahy
- University Hospitals Case Medical Center, Cleveland, OH; Northwestern University Feinberg School of Medicine, Chicago, IL; The Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, IL; NorthShore, Evanston, IL; Evanston Northwestern Healthcare, Evanston, IL; University of Miami Sylvester Comprehensive Cancer Center, Miami, FL; Brown University Oncology Group, Providence, RI; University of Southern California Norris Comprehensive Cancer Center, Los Angeles, CA; Indiana
| | - W. Small
- University Hospitals Case Medical Center, Cleveland, OH; Northwestern University Feinberg School of Medicine, Chicago, IL; The Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, IL; NorthShore, Evanston, IL; Evanston Northwestern Healthcare, Evanston, IL; University of Miami Sylvester Comprehensive Cancer Center, Miami, FL; Brown University Oncology Group, Providence, RI; University of Southern California Norris Comprehensive Cancer Center, Los Angeles, CA; Indiana
| | - M. Talamonti
- University Hospitals Case Medical Center, Cleveland, OH; Northwestern University Feinberg School of Medicine, Chicago, IL; The Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, IL; NorthShore, Evanston, IL; Evanston Northwestern Healthcare, Evanston, IL; University of Miami Sylvester Comprehensive Cancer Center, Miami, FL; Brown University Oncology Group, Providence, RI; University of Southern California Norris Comprehensive Cancer Center, Los Angeles, CA; Indiana
| | - J. C. Obel
- University Hospitals Case Medical Center, Cleveland, OH; Northwestern University Feinberg School of Medicine, Chicago, IL; The Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, IL; NorthShore, Evanston, IL; Evanston Northwestern Healthcare, Evanston, IL; University of Miami Sylvester Comprehensive Cancer Center, Miami, FL; Brown University Oncology Group, Providence, RI; University of Southern California Norris Comprehensive Cancer Center, Los Angeles, CA; Indiana
| | - C. S. Rocha Lima
- University Hospitals Case Medical Center, Cleveland, OH; Northwestern University Feinberg School of Medicine, Chicago, IL; The Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, IL; NorthShore, Evanston, IL; Evanston Northwestern Healthcare, Evanston, IL; University of Miami Sylvester Comprehensive Cancer Center, Miami, FL; Brown University Oncology Group, Providence, RI; University of Southern California Norris Comprehensive Cancer Center, Los Angeles, CA; Indiana
| | - H. Safran
- University Hospitals Case Medical Center, Cleveland, OH; Northwestern University Feinberg School of Medicine, Chicago, IL; The Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, IL; NorthShore, Evanston, IL; Evanston Northwestern Healthcare, Evanston, IL; University of Miami Sylvester Comprehensive Cancer Center, Miami, FL; Brown University Oncology Group, Providence, RI; University of Southern California Norris Comprehensive Cancer Center, Los Angeles, CA; Indiana
| | - H. Lenz
- University Hospitals Case Medical Center, Cleveland, OH; Northwestern University Feinberg School of Medicine, Chicago, IL; The Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, IL; NorthShore, Evanston, IL; Evanston Northwestern Healthcare, Evanston, IL; University of Miami Sylvester Comprehensive Cancer Center, Miami, FL; Brown University Oncology Group, Providence, RI; University of Southern California Norris Comprehensive Cancer Center, Los Angeles, CA; Indiana
| | - E. G. Chiorean
- University Hospitals Case Medical Center, Cleveland, OH; Northwestern University Feinberg School of Medicine, Chicago, IL; The Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, IL; NorthShore, Evanston, IL; Evanston Northwestern Healthcare, Evanston, IL; University of Miami Sylvester Comprehensive Cancer Center, Miami, FL; Brown University Oncology Group, Providence, RI; University of Southern California Norris Comprehensive Cancer Center, Los Angeles, CA; Indiana
| | - C. J. Link
- University Hospitals Case Medical Center, Cleveland, OH; Northwestern University Feinberg School of Medicine, Chicago, IL; The Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, IL; NorthShore, Evanston, IL; Evanston Northwestern Healthcare, Evanston, IL; University of Miami Sylvester Comprehensive Cancer Center, Miami, FL; Brown University Oncology Group, Providence, RI; University of Southern California Norris Comprehensive Cancer Center, Los Angeles, CA; Indiana
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Hardacre JM, Mulcahy MF, Talamonti M, Obel JC, Rocha Lima CS, Safran H, Rossi GR, Tennant L, Vahanian NN, Link CJ. Effect of hyperacute immunotherapy in addition to standard adjuvant therapy for resected pancreatic cancer on disease-free and overall survival: Preliminary analysis of phase II data. J Clin Oncol 2010. [DOI: 10.1200/jco.2010.28.15_suppl.4059] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Esposito M, Giunta A, Mazzotta A, Babino G, Talamonti M, Chimenti M, Chimenti S. Continuous Treatment of Plaque-Type Psoriasis with Etanercept: An Observational Long-Term Experience. Int J Immunopathol Pharmacol 2010; 23:503-9. [DOI: 10.1177/039463201002300212] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
To assess the long-term efficacy and safety profile and the patient-reported outcomes (PRO) in patients with moderate-to-severe plaque-type psoriasis receiving continuous etanercept treatment. An open-label study was conducted to evaluate etanercept as long-term treatment for moderate-to-severe plaque psoriasis. Continuous therapy was administered at a dose of 50 mg subcutaneously twice weekly for 12 weeks followed by a continuous treatment with 50 mg subcutaneously once weekly or 25 mg twice weekly throughout a 96-week study. The primary measure of efficacy was the proportion of patients with PASI 75 at week 24, 48 and 96. Patient-reported outcomes (PRO) were also assessed during the study, at week 24, 48 and 96, including the Dermatology Life Quality Index (DLQI) and the Psoriasis Disability Index (PDI). At baseline, mean PASI score, DLQI and PDI for patients eligible to initiate treatment with etanercept showed significant disease severity, quality-of-life impairment and psoriasis-related disability. At week 96, patients showed statistically significant and meaningful improvements. The continuous etanercept regimen provided a consistent improvement in both clinical disease parameters and PRO measures.
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Affiliation(s)
| | | | | | | | | | - M.S. Chimenti
- Department of Rheumatology, University of Rome “Tor Vergata”
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Papoutsaki M, Talamonti M, Giunta A, Costanzo A, Ruzzetti M, Teoli M, Chimenti S. The Impact of Methodological Approaches for Presenting Long-Term Clinical Data on Estimates of Efficacy in Psoriasis Illustrated by Three-Year Treatment Data on Infliximab. Dermatology 2010; 221 Suppl 1:43-7. [DOI: 10.1159/000316184] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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Costanzo A, Talamonti M, Botti E, Spallone G, Papoutsaki M, Chimenti S. Efficacy of Efalizumab in Psoriasis Patients Previously Treated with Tumour Necrosis Factor Blockers. Dermatology 2009; 219:48-53. [DOI: 10.1159/000213758] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2008] [Accepted: 02/16/2009] [Indexed: 11/19/2022] Open
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Small W, Mulcahy M, Rademaker A, Benson A, Bentrem D, Talamonti M. A Phase II Trial of Weekly Gemcitabine and Bevacizumab in Combination with Abdominal Radiation Therapy in Patients with Localized Pancreatic Cancer. Int J Radiat Oncol Biol Phys 2008. [DOI: 10.1016/j.ijrobp.2008.06.781] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Small W, Mulcahy M, Benson A, Gold S, Bredesen R, Rademaker F, Talamonti M. A phase II trial of weekly gemcitabine and bevacizumab in combination with abdominal radiation therapy in patients with localized pancreatic cancer. J Clin Oncol 2007. [DOI: 10.1200/jco.2007.25.18_suppl.15043] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
15043 Purpose: To evaluate the response rate, survival and toxicity of non-metastatic pancreatic cancer patients treated with a combination of, Gemcitabine, Bevacizumab and Radiotherapy. Materials and Methods: Eligibility included patients with non- metastatic pancreatic cancer, standard organ function and ECOG performance status of 0 or 1. The patients received three cycles of therapy. Cycle one was 21 days and consisted of Gemcitabine days 1 and 8 and Bevacizumab days 1 and 15. Cycle 2 was 28 days and consisted of Gemcitabine days 1, 8, and 15, Bevacizumab days 8 and 22 and Radiotherapy days 1–5, 8–12, and 15–19. Cycle three was 21 days and delivered Gemcitabine days 1 and 8, and Bevacizumab day 8. The Gemcitabine dose was 1,000 mg/m2, Bevacizumab at 10 mg/kg and Radiotherapy was delivered to the gross tumor volume only for a total dose of 36 Gy at 2.4 Gy/fraction. Response was determined on week ten with cross sectional imaging and CA 19–9. Toxicities were scored utilizing CTC version 3.0. Resectable patients were to undergo surgery 8 (currently amended to 6) weeks after the last dose of Bevacizumab. Results: Ninteen patients have been enrolled on study from 10/10/05 - 1/4/07. Twelve patients are evaluable for toxicity and response. Ten (83%) had a grade 3 toxicity. The grade 3 toxicities included cytopenias (9), DVT (2), Dehydration (2), hypotension (1), mucositis (1), increased LFT’s (2), Anorexia (1), nausea (1) and fatigue (1).There were no Grade 4 or 5 toxicities. All but one patient completed all three cycles. Radiographic response at 10 weeks was noted to be stable in 10 (83%) patients. Two patients progressed distantly (liver and abdomen). The mean CA 19–9 pre and post treatment CA 19–9 was 1519.56 and 356.09 respectively. One patient underwent surgical resection. The mean follow up is 4.83 months. At last follow up nine patients were alive. Conclusions: The combination of full dose Gemcitabine, Bevacizumab and Radiotherapy was generally well tolerated with no Grade 4 toxicities and the majority of Grade 3 toxicities hematologic. All but one patient completed all three cycles. Responses were limited to a reduction in CA 19–9. Nine patients remain alive. Accrual to the trial continues. No significant financial relationships to disclose.
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Affiliation(s)
- W. Small
- Northwestern University, Chicago, IL
| | | | - A. Benson
- Northwestern University, Chicago, IL
| | - S. Gold
- Northwestern University, Chicago, IL
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Oyama Y, Talamonti M, Mulcahy M, Gonda E, Burt RK, Vahanian NN, Bell R, Tennant L, Ramsey WJ, Adrian T, Link C. A phase I/II study of an antitumor vaccination using α (1,3) galactosyltransferase expressing allogeneic tumor cells in pancreatic cancer. J Clin Oncol 2007. [DOI: 10.1200/jco.2007.25.18_suppl.13512] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
13512 Background: Prognosis of pancreatic cancer remains poor despite surgical resection. In a phase I trial, we examined the safety and feasibility of antitumor vaccination in Pts with surgically resected pancreatic cancer with two irradiated genetically altered human pancreatic cancer cell lines engineered to express xenotransplantation antigens by retroviral transfer of the murine a(1,3) galactosyltrasferase gene {HyperAcute Pancreatic Cancer Vaccine (HAPa)}. Methods: Pts had undergone complete surgical resection for stage IA to IIB pancreatic adenocarcinoma, ECOG PS≤2, no immunosuppressive drug use and an adequate organ function were eligible. Various adjuvant treatments were allowed prior to the start of HAPa according to the institutional preferences (5FU/radiation, cisplatin/gemicitabine followed by 5FU/radiation, 5FU/radiation followed by gemicitabine or gemicitabine/capecitabine/bevasizumab/radiation). Six Pts were scheduled to receive 12 every two week-intradermal injections (initial priming dose followed by 11 boost doses). The first cohort (Pts 1–3) was to receive at lower doses (2 × 108 cells priming and 1 x 108 cells boost). The second cohort (Pts 4–6) was to receive at higher doses (5 x 10^8 cells priming and 3 x 10^8 cells boost). Toxicity was assessed using the CTC v3.0. Results: To date, 6 Pts, 3 males, 3 females, median age 59 (range 50–66) were treated. Two Pts completed all 12 injections. Others received 9, 6, 6 and 4 injections, respectively. To date no serious adverse events can be attributed to the vaccine. Adverse events (≤CTC grade 2) attributable to the vaccine include injection site pain/discomfort and local skin reaction in all Pts. Other adverse events (≤grade 2) include hyperkalemia, fever and increased LDH levels in one Pt. One Pt with non-malignant hepatic lesions at the time of initial surgery was removed from the study after confirmation of metastatic disease in the liver. At this point the median 6.5 (range 9–4) months in the study all remaining (5/6) patients have no evidence of recurrent disease. Conclusions: Preliminary data indicate that antitumor vaccination with genetically altered allogeneic human pancreatic cancer cells expressing a(1, 3) galactosyltrasferase is safe and feasible [Table: see text]
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Affiliation(s)
- Y. Oyama
- Kameda Medical Center, Chiba, Japan; Northwestern University, Chicago, IL; NewLink Genetics, Ames, IA
| | - M. Talamonti
- Kameda Medical Center, Chiba, Japan; Northwestern University, Chicago, IL; NewLink Genetics, Ames, IA
| | - M. Mulcahy
- Kameda Medical Center, Chiba, Japan; Northwestern University, Chicago, IL; NewLink Genetics, Ames, IA
| | - E. Gonda
- Kameda Medical Center, Chiba, Japan; Northwestern University, Chicago, IL; NewLink Genetics, Ames, IA
| | - R. K. Burt
- Kameda Medical Center, Chiba, Japan; Northwestern University, Chicago, IL; NewLink Genetics, Ames, IA
| | - N. N. Vahanian
- Kameda Medical Center, Chiba, Japan; Northwestern University, Chicago, IL; NewLink Genetics, Ames, IA
| | - R. Bell
- Kameda Medical Center, Chiba, Japan; Northwestern University, Chicago, IL; NewLink Genetics, Ames, IA
| | - L. Tennant
- Kameda Medical Center, Chiba, Japan; Northwestern University, Chicago, IL; NewLink Genetics, Ames, IA
| | - W. J. Ramsey
- Kameda Medical Center, Chiba, Japan; Northwestern University, Chicago, IL; NewLink Genetics, Ames, IA
| | - T. Adrian
- Kameda Medical Center, Chiba, Japan; Northwestern University, Chicago, IL; NewLink Genetics, Ames, IA
| | - C. Link
- Kameda Medical Center, Chiba, Japan; Northwestern University, Chicago, IL; NewLink Genetics, Ames, IA
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Costanzo A, Peris K, Talamonti M, Di Cesare A, Fargnoli MC, Botti E, Chimenti S. Long-term treatment of plaque psoriasis with efalizumab: an Italian experience. Br J Dermatol 2007; 156 Suppl 2:17-23. [PMID: 17371319 DOI: 10.1111/j.1365-2133.2007.07765.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [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: 11/27/2022]
Abstract
Biologic agents are an important new class of drugs, offering targeted treatment for chronic skin diseases such as psoriasis. The biologic therapy efalizumab is an anti-CD11a monoclonal antibody, which was approved by the European regulatory agency in 2004 for the treatment of moderate-to-severe plaque psoriasis. Here we describe our 2-year experience in treating over 100 patients with moderate-to-severe psoriasis with efalizumab at two dermatology centres in Italy. Overall, we found efalizumab is efficacious for a large subset of patients, regardless of previous therapies received, and has an easily manageable safety profile. We believe one important quality of efalizumab is the stability and maintenance of clinical response over time. We found that most patients who respond to treatment experience a long-term clearing of psoriasis with only mild recurrence events. Our experience with individual cases provides specific insights into efalizumab re-treatment, the use of efalizumab in patients with a history of heart failure, and the management of patients who become pregnant or conceive while receiving efalizumab therapy. In summary, our off-trial experience in over 100 patients confirms the efficacy and safety of efalizumab in the treatment of moderate-to-severe plaque psoriasis.
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Affiliation(s)
- A Costanzo
- Department of Dermatology, University of Rome Tor Vergata, Rome, Italy.
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