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Bagit A, Maliyar K, Mansour M, Georgakopoulos JR, Rankin B, Lytvyn Y, Zaaroura H, Park YJ, Wang E, Mufti A, Torres T, Le AM, Vender R, Prajapati VH, Yeung J. Real-World Effectiveness and Safety of Risankizumab in Adult Patients with Plaque Psoriasis: A 1-year International Multicenter Retrospective Cohort Study. J Am Acad Dermatol 2024:S0190-9622(24)00654-6. [PMID: 38677338 DOI: 10.1016/j.jaad.2024.03.048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2024] [Accepted: 03/23/2024] [Indexed: 04/29/2024]
Affiliation(s)
- A Bagit
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - K Maliyar
- Division of Dermatology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - M Mansour
- Division of Dermatology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - J R Georgakopoulos
- Division of Dermatology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - B Rankin
- Division of Dermatology, Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Y Lytvyn
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; Division of Dermatology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - H Zaaroura
- Division of Dermatology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Y J Park
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - E Wang
- Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - A Mufti
- Division of Dermatology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada; Division of Dermatology, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - T Torres
- Department of Dermatology, Centro Hospitalar de Santo António, 4099-001 Porto, Portugal; Instituto de Ciências Biomédicas Abel Salazar, University of Porto, 4050-313 Porto, Portugal
| | - A M Le
- Department of Dermatology, Centro Hospitalar de Santo António, 4099-001 Porto, Portugal
| | - R Vender
- Dermatrials Research Inc. and Venderm Consulting, Hamilton, Ontario, Canada
| | - V H Prajapati
- Division of Dermatology, Department of Medicine, University of Calgary, Calgary, Alberta, Canada; Dermatology Research Institute, Calgary, Alberta, Canada; Probity Medical Research, Calgary, Alberta, Canada; Skin Health & Wellness Centre, Calgary, Alberta, Canada; Section of Community Pediatrics, University of Calgary, Calgary, Alberta, Canada; Section of Pediatric Rheumatology, Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada
| | - J Yeung
- Division of Dermatology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada; Division of Dermatology, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Division of Dermatology, Women's College Hospital, Toronto, Ontario, Canada; Probity Medical Research, Toronto, Ontario, Canada.
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Nabieva K, Vender R. Quality of Life and Body Region Affected by Psoriasis: A Systematic Review. Actas Dermosifiliogr 2023; 114:33-38. [PMID: 36030828 DOI: 10.1016/j.ad.2022.07.021] [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: 07/06/2021] [Revised: 03/20/2022] [Accepted: 07/28/2022] [Indexed: 01/11/2023] Open
Abstract
PURPOSE Psoriasis is a chronic skin condition that affects approximately 1-3% of the world's population and is known to decrease patients' quality of life. However, it is yet to be ascertained whether the specific location of psoriatic lesions on the body influences one's quality of life. METHODS A systematic review was conducted with a search of MEDLINE, EMBASE, and Web of Science databases. Only non-case report and non-review studies with explicitly stated body regions affected by psoriasis were included in the review. FINDINGS Psoriatic patches and plaques in different areas of the body were not found to influence patients' quality of life to differing extents. CONCLUSIONS While the body of evidence is limited and presents unstandardized results, the results of this review point to the fact that all psoriatic patches and plaques decrease patients' quality of life, with neither one region doing so to a significantly greater extent than another.
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Affiliation(s)
- K Nabieva
- University of Ottawa Faculty of Medicine, Ottawa, Ontario, Canada
| | - R Vender
- Dermatrials Research Inc., Hamilton, Canada.
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3
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Florey A, McLeod J, Parson N, Vender R, Howrylak J, Kumiega L. 304: Finding out what patients want to know: Reproductive health in cystic Fibrosis. J Cyst Fibros 2021. [DOI: 10.1016/s1569-1993(21)01729-x] [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: 10/20/2022]
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4
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Lytvyn Y, Georgakopoulos JR, Mufti A, Devani AR, Gooderham MJ, Jain V, Lansang P, Vender R, Prajapati VH, Yeung J. Incidence and prognosis of COVID-19 in patients with psoriasis on apremilast: a multicentre retrospective cohort study. J Eur Acad Dermatol Venereol 2021; 36:e94-e95. [PMID: 34657332 PMCID: PMC8656447 DOI: 10.1111/jdv.17749] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Accepted: 10/14/2021] [Indexed: 01/02/2023]
Affiliation(s)
- Y Lytvyn
- Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - J R Georgakopoulos
- Division of Dermatology, Department of Medicine, University of Toronto, ON, Canada
| | - A Mufti
- Division of Dermatology, Department of Medicine, University of Toronto, ON, Canada
| | - A R Devani
- Dermatology Research Institute, Calgary, AB, Canada.,Skin Health & Wellness Centre, Calgary, AB, Canada.,Probity Medical Research, Calgary, AB, Canada
| | - M J Gooderham
- Queen's University, Kingston, ON, Canada.,SKiN Centre for Dermatology, Peterborough, ON, Canada.,Probity Medical Research, Peterborough, ON, Canada
| | - V Jain
- Clinal Immunology and Allergy, McMaster University, Hamilton, ON, Canada.,Probity Medical Research, Hamilton, ON, Canada
| | - P Lansang
- Division of Dermatology, Department of Medicine, University of Toronto, ON, Canada.,Division of Dermatology, Department of Medicine, Sunnybrook Health Sciences Centre, Toronto, ON, Canada.,Section␣of Paediatric Dermatology, Department of Paediatric Medicine, The Hospital for Sick Children, Toronto, ON, Canada
| | - R Vender
- Department of Dermatology, McMaster University, Hamilton, ON, Canada.,Dermatrials Research Inc. & Venderm Innovations in Psoriasis, Hamilton, ON, Canada
| | - V H Prajapati
- Skin Health & Wellness Centre, Calgary, AB, Canada.,Probity Medical Research, Calgary, AB, Canada.,Division of Dermatology, Department of Medicine, University of Calgary, Calgary, AB, Canada.,Section␣of Community Pediatrics, Department of Pediatrics, University of Calgary, Calgary, AB, Canada.,Section␣of Pediatric Rheumatology, Department of Pediatrics, University of Calgary, Calgary, AB, Canada
| | - J Yeung
- Division of Dermatology, Department of Medicine, University of Toronto, ON, Canada.,Department of Dermatology, McMaster University, Hamilton, ON, Canada.,Department of Dermatology, Women's College Hospital, Toronto, ON, Canada.,Probity Medical Research Inc, Waterloo, ON, Canada
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5
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Brunner PM, Conrad C, Vender R, Grond S, Schuster C, Patel H, Xu W, Carrascosa Carrillo JM. Integrated safety analysis of treatment-emergent eczematous reactions in patients with moderate-to-severe psoriasis treated with ixekizumab, etanercept and ustekinumab. Br J Dermatol 2021; 185:865-867. [PMID: 34076896 PMCID: PMC8518506 DOI: 10.1111/bjd.20527] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Revised: 04/06/2021] [Accepted: 05/30/2021] [Indexed: 01/18/2023]
Affiliation(s)
- P M Brunner
- Department of Dermatology, Medical University of Vienna, Vienna, Austria
| | - C Conrad
- Department of Dermatology, Lausanne University Hospital CHUV, Lausanne, Switzerland
| | - R Vender
- Dermatrials Research Inc, Hamilton, ON, Canada
| | - S Grond
- Eli Lilly and Company, Indianapolis, IN, USA
| | - C Schuster
- Department of Dermatology, Medical University of Vienna, Vienna, Austria.,Eli Lilly and Company, Indianapolis, IN, USA
| | - H Patel
- Eli Lilly and Company, Indianapolis, IN, USA
| | - W Xu
- Eli Lilly and Company, Indianapolis, IN, USA
| | - J M Carrascosa Carrillo
- Department of Dermatology, Hospital Universitari Germans Trias I Pujol, Universitat Autònoma de Barcelona, Barcelona, Spain
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Georgakopoulos JR, Mufti A, Vender R, Prajapati VH, Yeung J. Incidence and prognosis of COVID-19 in psoriasis patients on biologic therapy: a multicentre retrospective cohort study. J Eur Acad Dermatol Venereol 2021; 35:e485-e487. [PMID: 33872431 PMCID: PMC8250560 DOI: 10.1111/jdv.17279] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Accepted: 04/13/2021] [Indexed: 10/28/2022]
Affiliation(s)
- J R Georgakopoulos
- Division of Dermatology, Department of Medicine, University of Toronto, ON, Canada
| | - A Mufti
- Division of Dermatology, Department of Medicine, University of Toronto, ON, Canada
| | - R Vender
- Department of Dermatology, McMaster University, Hamilton, ON, Canada.,Dermatrials Research Inc. & Venderm Innovations in Psoriasis, Hamilton, ON, Canada
| | - V H Prajapati
- Division of Dermatology, Department of Medicine, University of Calgary, Calgary, AB, Canada.,Division of Community Pediatrics, Department of Pediatrics, University of Calgary, Calgary, AB, Canada.,Division of Pediatric Rheumatology, Department of Pediatrics, University of Calgary, Calgary, AB, Canada.,Dermatology Research Institute, Calgary, AB, Canada.,Skin Health & Wellness Centre, Calgary, AB, Canada.,Probity Medical Research Inc, Calgary, AB, Canada
| | - J Yeung
- Division of Dermatology, Department of Medicine, University of Toronto, ON, Canada.,Sunnybrook Health Sciences Centre, Toronto, ON, Canada.,Women's College Hospital, Toronto, ON, Canada.,Probity Medical Research Inc, Waterloo, ON, Canada
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Beecker J, Papp K, Dutz J, Vender R, Gniadecki R, Cooper C, Gisondi P, Gooderham M, Hong C, Kirchhof M, Lynde C, Maari C, Poulin Y, Puig L. Position statement for a pragmatic approach to immunotherapeutics in patients with inflammatory skin diseases during the coronavirus disease 2019 pandemic and beyond. J Eur Acad Dermatol Venereol 2021; 35:797-806. [PMID: 33533553 PMCID: PMC8014810 DOI: 10.1111/jdv.17075] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [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: 09/07/2020] [Revised: 10/27/2020] [Accepted: 11/12/2020] [Indexed: 12/14/2022]
Abstract
Coronavirus disease 2019 (COVID-19) is caused by SARS-CoV-2, a novel RNA virus that was declared a global pandemic on 11 March 2020. The efficiency of infection with SARS-CoV-2 is reflected by its rapid global spread. The SARS-CoV-2 pandemic has implications for patients with inflammatory skin diseases on systemic immunotherapy who may be at increased risk of infection or more severe infection. This position paper is a focused examination of current evidence considering the mechanisms of action of immunotherapeutic drugs in relation to immune response to SARS-CoV-2. We aim to provide practical guidance for dermatologists managing patients with inflammatory skin conditions on systemic therapies during the current pandemic and beyond. Considering the limited and rapidly evolving evidence, mechanisms of action of therapies, and current knowledge of SARS-CoV-2 infection, we propose that systemic immunotherapy can be continued, with special considerations for at risk patients or those presenting with symptoms.
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Affiliation(s)
- J. Beecker
- University of OttawaOttawaONCanada
- Division of DermatologyThe Ottawa HospitalOttawaONCanada
- Ottawa Hospital Research InstituteOttawaONCanada
- Probity Medical Research Inc.WaterlooONCanada
| | - K.A. Papp
- Probity Medical Research Inc.WaterlooONCanada
- K Papp Clinical ResearchWaterlooONCanada
| | - J. Dutz
- Skin Care CenterVancouverBCCanada
- Department of Dermatology and Skin ScienceUniversity of British ColumbiaVancouverBCCanada
- Skin ScienceBC Children's Hospital Research InstituteVancouverBCCanada
| | - R.B. Vender
- Dermatrials Research Inc.HamiltonONCanada
- Department of MedicineMcMaster UniversityHamiltonONCanada
| | - R. Gniadecki
- Probity Medical Research Inc.WaterlooONCanada
- Division of DermatologyDepartment of MedicineFaculty of Medicine and DentistryUniversity of AlbertaEdmontonABCanada
| | - C. Cooper
- University of OttawaOttawaONCanada
- Ottawa Hospital Research InstituteOttawaONCanada
- The Ottawa Hospital and Regional Hepatitis ProgramOttawaONCanada
| | - P. Gisondi
- Department of MedicineSection of Dermatology and VenereologyUniversity of VeronaVeronaItaly
| | - M. Gooderham
- Probity Medical Research Inc.WaterlooONCanada
- SKiN Centre for DermatologyPeterboroughONCanada
| | - C.H. Hong
- Probity Medical Research Inc.WaterlooONCanada
- Department of Dermatology and Skin ScienceUniversity of British ColumbiaVancouverBCCanada
- Dr. Chih‐ho Hong Medical Inc.SurreyBCCanada
| | - M.G. Kirchhof
- University of OttawaOttawaONCanada
- Division of DermatologyThe Ottawa HospitalOttawaONCanada
| | - C.W. Lynde
- Probity Medical Research Inc.WaterlooONCanada
- Lynde Institute for DermatologyMarkhamONCanada
| | - C. Maari
- Innovaderm Research IncMontrealQCCanada
| | - Y. Poulin
- Centre de Recherche Dermatologique du Québec MétropolitainQuébecQCCanada
- Department of MedicineUniversité LavalHôpital Hôtel‐Dieu de QuébecQuebécQCCanada
| | - L. Puig
- Department of DermatologyHospital de la Santa Creu i Sant PauBarcelonaSpain
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Gordon K, Foley P, Krueger JG, Pinter A, Reich K, Vender R, Vanvoorden V, Madden C, Peterson L, Blauvelt A. Efficacy and Safety of Bimekizumab in Patients with Moderate to Severe Plaque Psoriasis: Results from BE READY, a 56-Week Phase 3, Randomized, Double-Blinded, Placebo-Controlled Study with Randomized Withdrawal. ACTA ACUST UNITED AC 2020. [DOI: 10.25251/skin.4.supp.83] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
Abstract not available.
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Blauvelt A, Leonardi C, Elewski B, Crowley JJ, Guenther LC, Gooderham M, Langley RG, Vender R, Pinter A, Griffiths CEM, Tada Y, Elmaraghy H, Lima RG, Gallo G, Renda L, Burge R, Park SY, Zhu B, Papp K. A head-to-head comparison of ixekizumab vs. guselkumab in patients with moderate-to-severe plaque psoriasis: 24-week efficacy and safety results from a randomized, double-blinded trial. Br J Dermatol 2020; 184:1047-1058. [PMID: 32880909 PMCID: PMC8246960 DOI: 10.1111/bjd.19509] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [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] [Accepted: 08/27/2020] [Indexed: 12/12/2022]
Abstract
Background Significantly more patients with moderate‐to‐severe plaque psoriasis treated with the interleukin (IL)‐17A inhibitor ixekizumab vs. the IL‐23p19 inhibitor guselkumab in the IXORA‐R head‐to‐head trial achieved 100% improvement in Psoriasis Area and Severity Index (PASI 100) at week 12. Objectives To compare skin and nail clearance and patient‐reported outcomes for ixekizumab vs. guselkumab, up to week 24. Methods IXORA‐R enrolled adults with moderate‐to‐severe plaque psoriasis, defined as static Physician’s Global Assessment ≥ 3, PASI ≥ 12 and involved body surface area ≥ 10%. Statistical comparisons were performed using the Cochran–Mantel–Haenszel test stratified by pooled site. Time‐to‐first‐event comparisons were performed using Kaplan–Meier analysis, and P‐values were generated using adjusted log‐rank tests stratified by treatment group. Cumulative days at clinical and patient‐reported responses were compared by ancova. The trial was registered with ClinicalTrials.gov (NCT03573323). Results Of the 1027 patients randomly assigned, 90% completed the trial (465 of 520 ixekizumab and 459 of 507 guselkumab). As early as week 2 and through week 16, more patients on ixekizumab achieved PASI 100 (P < 0·01). At week 24, ixekizumab was noninferior to guselkumab (50% vs. 52%, difference −2·3%), with no statistically significant difference in PASI 100 (P = 0·41). More patients receiving ixekizumab showed completely clear nails at week 24 (52% vs. 31%, P = 0·007). The median time to first PASI 50/75/90 and PASI 100 were 2 and 7·5 weeks shorter, respectively, for patients on ixekizumab vs. guselkumab (P < 0·001). Patients on ixekizumab also had a greater cumulative benefit, with more days at PASI 90 and 100, with Dermatology Life Quality Index of 0 or 1, and itch free (P < 0·05). The frequency of serious adverse events was 3% for each group, with no new safety signals. Conclusions Ixekizumab was noninferior to guselkumab in complete skin clearance and superior in clearing nails at week 24. Ixekizumab cleared skin more rapidly in patients with moderate‐to‐severe plaque psoriasis, with a greater cumulative benefit, than guselkumab. Overall, the safety findings were consistent with the known safety profile for ixekizumab. What is already known about this topic?Patients with plaque psoriasis desire both high levels of clearance and rapid onset of treatment effects. Ixekizumab is a high‐affinity monoclonal antibody that selectively targets interleukin (IL)‐17A. In the 12‐week report of the IXORA‐R study, ixekizumab demonstrated significantly higher efficacy at early timepoints than the IL‐23p19 inhibitor guselkumab, with more patients achieving 100% improvement in Psoriasis Area and Severity Index (PASI 100) and improved quality of life as early as week 4.
What does this study add?Patients on ixekizumab vs. guselkumab achieved similar levels of skin clearance and superior efficacy in the resolution of nail psoriasis at week 24. Patients on ixekizumab vs. guselkumab had a greater cumulative benefit, with more days at PASI 90 and 100, more days when psoriasis did not impact their quality of life, and more itch‐free days. The safety profiles of both drugs were consistent with those in previous studies.
Linked Comment: Puig. Br J Dermatol 2021; 184:992–993.
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Affiliation(s)
- A Blauvelt
- Oregon Medical Research Center, Portland, OR, USA
| | | | - B Elewski
- Deparment of Dermatology, University of Alabama, Birmingham, AL, USA
| | - J J Crowley
- Bakersfield Dermatology and Skin Cancer Medical Group, Bakersfield, CA, USA
| | | | - M Gooderham
- SKiN Centre for Dermatology, Peterborough, ON, Canada
| | | | - R Vender
- Dermatrials Research Inc, Hamilton, ON, Canada
| | - A Pinter
- Clinic for Dermatology, Venereology and Allergology, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - C E M Griffiths
- Dermatology Centre, Salford Royal Hospital, NIHR Manchester Biomedical Research Centre, University of Manchester, Manchester, UK
| | - Y Tada
- Department of Dermatology, Teikyo University School of Medicine, Tokyo, Japan
| | - H Elmaraghy
- Eli Lilly and Company, Indianapolis, IN, USA
| | - R G Lima
- Eli Lilly and Company, Indianapolis, IN, USA
| | - G Gallo
- Eli Lilly and Company, Indianapolis, IN, USA
| | - L Renda
- Eli Lilly and Company, Indianapolis, IN, USA
| | - R Burge
- Eli Lilly and Company, Indianapolis, IN, USA
| | - S Y Park
- Eli Lilly and Company, Indianapolis, IN, USA
| | - B Zhu
- Eli Lilly and Company, Indianapolis, IN, USA
| | - K Papp
- Probity Medical Research, Inc., Waterloo, ON, Canada
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Reich K, Dutz J, Foley P, Thaçi D, Vender R, Song M, Miller M, You Y, Li S, Shen YK, Armstrong A. AB0759 FOUR-YEAR EFFICACY AND SAFETY OF GUSELKUMAB IN PSORIASIS PATIENTS WITH AND WITHOUT PSORIATIC ARTHRITIS: A POOLED ANALYSIS FROM VOYAGE 1 AND VOYAGE 2. Ann Rheum Dis 2020. [DOI: 10.1136/annrheumdis-2020-eular.1333] [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: 11/03/2022]
Abstract
Background:Guselkumab (GUS), a fully human monoclonal antibody, selectively binds and blocks interleukin-23. VOYAGE 1 and VOYAGE 2 are two ongoing Phase 3, randomized, double-blind, placebo (PBO)/active comparator-controlled clinical trials of GUS in patients (pts) with moderate-to-severe psoriasis (PsO).Objectives:This post-hoc analysis reports pooled results through 4 years among a subgroup of moderate-to-severe PsO pts with self-reported psoriatic arthritis (PsA) at baseline.Methods:1829 pts were randomized to GUS 100 mg at Weeks (Wks) 0, 4, and 12, then every 8 wks (q8wk); PBO at Wks 0, 4, and 12, GUS at Wks 16 and 20 then q8wk; or adalimumab (ADA) 80 mg at Wk 0, 40 mg at Wk 1, then 40 mg q2wk until Wk 47 (VOYAGE 1) or Wk 23 (VOYAGE 2). In VOYAGE 1, all pts received open-label GUS 100 mg q8wk during Wks 52-204. VOYAGE 2 incorporated a randomized withdrawal study design, followed by open-label GUS during Wks 76-204. Pooled subgroup analyses using the combined GUS group were conducted based on self-reported PsA status at baseline. Efficacy based on Investigator Global Assessment (IGA) score and Psoriasis Area and Severity Index (PASI) response was assessed using prespecified treatment failure rules (nonresponder status for all time points after discontinuing due to lack of efficacy, worsening of PsO, or use of a prohibited treatment).Results:For pooled VOYAGE 1 and VOYAGE 2 pts (N=1721), combined GUS and ADA to GUS response rates at Wks 100, 156, and 204 were: PASI 90 80.6%, 80.0%, and 80.4%; PASI 100 50.1%, 49.9%, and 52.2%; IGA 0/1 83.6%, 83.3%, and 81.7%; and IGA 0 54.3%, 52.9%, and 53.9, respectively. In the pooled subgroup analysis of pts with and without PsA, response rates were similar across the Wk 100, Wk 156, and Wk 204 evaluations (Table). Rates of adverse events through Wk 204 were comparable for pts with PsA vs those without PsA at baseline.Conclusion:Among GUS-treated pts with moderate-to-severe PsO with and without self-reported PsA at baseline, stable, durable, and high levels of skin responses, as well as comparable safety outcomes, through 4 years were observed.Table.Pooled GUS Response RatesWithout PsA at BaselineWith PsA at BaselineWk 100Wk 156Wk 204Wk 100Wk 156Wk 204N=1301N=1239N=1191N=289N=276N=264PASI 901049(80.6%)1001(80.8%)964(80.9%)233(80.6%)211 (76.4%)206(78.0%)PASI 100648(49.8%)631(50.9%)635(53.3%)149(51.6%)125 (45.3%)125 (47.3%)N=1300N=1235N=1189N=288N=276N=264IGA 0/11086(83.5%)1042(84.4%)979(82.3%)241(83.7%)217 (78.6%)208(78.8%)IGA 0702(54.0%)664(53.8%)649(54.6%)160(55.6%)135 (48.9%)134(50.8%)Acknowledgments:NoneDisclosure of Interests:Kristian Reich Grant/research support from: Janssen Research & Development, LLC, Jan Dutz Grant/research support from: Janssen Research & Development, LLC, Peter Foley Grant/research support from: Janssen Research & Development, LLC, Diamant Thaçi Grant/research support from: Janssen Research & Development, LLC, Ronald Vender Grant/research support from: Janssen Research & Development, LLC, Michael Song Employee of: Janssen Research & Development, LLC, Megan Miller Employee of: Janssen Research & Development, LLC, Yin You Employee of: Janssen Research & Development, LLC, Shu Li Employee of: Janssen Research & Development, LLC, Yaung-Kaung Shen Employee of: Janssen Research & Development, LLC, April Armstrong Grant/research support from: Janssen Research & Development, LLC
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Konstantinou M, Blauvelt A, Vender R, Spelman L, Paul C, Eyerich K, Flavin S, Randazzo B, Li S, Langley R. Efficacité du guselkumab par rapport au sécukinumab chez les patients atteints de psoriasis en plaques modéré à sévère selon les traitements antérieurs du psoriasis : résultats de l’étude ECLIPSE. Ann Dermatol Venereol 2019. [DOI: 10.1016/j.annder.2019.09.572] [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: 11/24/2022]
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Papp K, Gooderham M, Jenkins R, Vender R, Szepietowski J, Wagner T, Hunt B, Souberbielle B. Anti‐GM‐CSF therapy in psoriasis. Br J Dermatol 2019. [DOI: 10.1111/bjd.17946] [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: 11/30/2022]
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Papp K, Gooderham M, Jenkins R, Vender R, Szepietowski J, Wagner T, Hunt B, Souberbielle B. 银屑病抗‐GM‐CSF 治疗. Br J Dermatol 2019. [DOI: 10.1111/bjd.17963] [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: 11/30/2022]
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Papp KA, Gooderham M, Jenkins R, Vender R, Szepietowski JC, Wagner T, Hunt B, Souberbielle B. Granulocyte-macrophage colony-stimulating factor (GM-CSF) as a therapeutic target in psoriasis: randomized, controlled investigation using namilumab, a specific human anti-GM-CSF monoclonal antibody. Br J Dermatol 2018; 180:1352-1360. [PMID: 30207587 PMCID: PMC7379964 DOI: 10.1111/bjd.17195] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [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] [Accepted: 09/06/2018] [Indexed: 12/16/2022]
Abstract
BACKGROUND The relevance of granulocyte-macrophage colony-stimulating factor (GM-CSF) in the management of psoriasis has not been studied previously. GM-CSF is important in the initiation and maintenance of chronic inflammatory processes. OBJECTIVES To investigate the clinical use of GM-CSF neutralization by evaluating the efficacy and safety of namilumab (AMG203), a monoclonal antibody GM-CSF inhibitor, in patients with moderate-to-severe plaque psoriasis. METHODS A phase II, multicentre, randomized, double-blind, placebo-controlled, parallel-group, dose-finding, proof-of-concept study (NEPTUNE) was conducted. Four doses of namilumab (20, 50, 80 and 150 mg, via subcutaneous injection) were compared with placebo. Assessment of the primary end point - the proportion of patients achieving ≥ 75% reduction in Psoriasis Area and Severity Index (PASI 75 treatment response) - was performed at week 12. Exploratory investigation at the tissue level was conducted in a subset of the overall study population. The trial was registered with the number NCT02129777. RESULTS In total, 122 patients were enrolled and 106 (86·9%) completed the double-blind treatment; 16 (13·1%) prematurely discontinued study medication. Serum concentration-time profiles were as expected for subcutaneous delivery of an IgG1 monoclonal antibody, and exposure increased proportionally with dose elevation. The number of patients showing PASI 75 treatment response at week 12 was low in all groups; no significant difference was recorded in this end point between placebo and any namilumab group. Similar outcomes were recorded for other clinical study end points. Moreover, no significant treatment-related changes from baseline were observed in laboratory investigations of cell types or subpopulations, or cytokines relevant to inflammatory pathways in psoriasis. CONCLUSIONS GM-CSF blockade is not critical for suppression of key inflammatory pathways underlying psoriasis.
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Affiliation(s)
- K A Papp
- K Papp Clinical Research and Probity Medical Research, 135 Union St E, Waterloo, ON, N2J1C4, Canada
| | - M Gooderham
- SKiN Centre for Dermatology, Queen's University and Probity Medical Research, Peterborough, ON, Canada
| | - R Jenkins
- Clinical Science, Takeda International - U.K. Branch, London, U.K
| | - R Vender
- Dermatrials Research Inc, Hamilton, ON, Canada
| | - J C Szepietowski
- Department of Dermatology, Venereology and Allergology, Wroclaw Medical University, Wroclaw, Poland
| | - T Wagner
- Modelling and Simulation, Takeda Pharmaceuticals International, Zurich, Switzerland
| | - B Hunt
- Statistics, Takeda International, Deerfield, IL, U.S.A
| | - B Souberbielle
- Clinical Science, Takeda International - U.K. Branch, London, U.K
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Vender R, Gooderham MJ, Guenther LC, Kyritsis D, Rao J, Kowalczyk A, Ashkenas J. Psoriasis patients' preference for an aerosol foam topical formulation. J Eur Acad Dermatol Venereol 2018; 32:e400-e401. [PMID: 29633366 DOI: 10.1111/jdv.14993] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- R Vender
- Dermatrials Research, Hamilton, ON, Canada.,McMaster University, Hamilton, ON, Canada
| | - M J Gooderham
- SKiN Centre for Dermatology, Peterborough, ON, Canada.,Queens University, Kingston, ON, Canada
| | - L C Guenther
- Guenther Dermatology Research Centre, London, ON, Canada.,University of Western Ontario, London, ON, Canada
| | - D Kyritsis
- Clinique de Dermatologie Protoderma, Montreal, QC, Canada
| | - J Rao
- Division of Dermatology, University of Alberta Medical School, Edmonton, AB, Canada
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16
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Affiliation(s)
- R Vender
- Dermatrials Research Inc & Venderm Innovations in Psoriasis, McMaster University, Hamilton, ON, Canada
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17
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Cohen AD, Wu JJ, Puig L, Chimenti S, Vender R, Rajagopalan M, Romiti R, de la Cruz C, Skov L, Zachariae C, Young HS, Foley P, van der Walt JM, Naldi L, Prens EP, Blauvelt A. Biosimilars for psoriasis: worldwide overview of regulatory guidelines, uptake and implications for dermatology clinical practice. Br J Dermatol 2017. [PMID: 28646580 DOI: 10.1111/bjd.15756] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
The introduction of biological drugs for the treatment of patients with psoriasis has revolutionized treatment paradigms and enabled numerous patients to achieve disease control with an acceptable safety profile. However, the high cost of biologics limits access to these medications for the majority of patients worldwide. In recent years, the introduction of biosimilars for inflammatory diseases has become a fast evolving field. The future use of biosimilars offers the potential for decreased cost and increased access to biologics for patients with psoriasis. For approval of biosimilars, different regulatory agencies use highly variable methods for definition, production, approval, marketing and postmarketing surveillance. Due to potential interchangeability between biologics and biosimilars, traceability and pharmacovigilance are required to collect accurate data about adverse events in patients with psoriasis; spontaneous reporting, registries and use of 'big data' should facilitate this process on a global basis. The current article describes biosimilar regulatory guidelines and examples of biosimilar uptake in clinical practice in several countries around the world. As it is apparent that biological therapy treatment decisions may become more physician independent, the International Psoriasis Council recommends that dermatologists should take an active role in the development of biosimilar prescribing policies with their respective healthcare settings and government agencies.
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Affiliation(s)
- A D Cohen
- Siaal Research Center for Family Medicine and Primary Care, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel.,Department of Quality Measurements and Research, Chief Physician's Office, Clalit Health Services, Tel Aviv, Israel
| | - J J Wu
- Department of Dermatology, Kaiser Permanente Los Angeles Medical Center, Los Angeles, CA, U.S.A
| | - L Puig
- Department of Dermatology, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - S Chimenti
- University of Rome Tor Vergata, Rome, Italy
| | - R Vender
- Dermatrials Research Inc. & Venderm Innovations in Psoriasis, Hamilton, ON, Canada
| | - M Rajagopalan
- Department of Dermatology, Apollo Hospitals, Chennai, India
| | - R Romiti
- Department of Dermatology, University of São Paulo, São Paulo, Brazil
| | | | - L Skov
- Department of Dermatology and Allergy, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
| | - C Zachariae
- Department of Dermatology and Allergy, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
| | - H S Young
- The University of Manchester, Manchester Academic Health Science Centre, Manchester, U.K.,Department of Dermatology, Salford Royal NHS Foundation Trust, Manchester, U.K
| | - P Foley
- Skin & Cancer Foundation Inc., Carlton, Vic., Australia.,Department of Dermatology, The University of Melbourne, Melbourne, Vic., Australia.,St Vincent's Hospital, Melbourne, Vic., Australia
| | | | - L Naldi
- Department of Dermatology, Azienda Ospedaliera Papa Giovanni XXIII, Bergamo, Italy
| | - E P Prens
- Deptartment of Dermatology, Erasmus MC, P.O. Box 5201, 3008, AE Rotterdam, the Netherlands
| | - A Blauvelt
- Oregon Medical Research Center, Portland, OR, U.S.A
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Blauvelt A, Puig L, Chimenti S, Vender R, Rajagopalan M, Romiti R, Skov L, Zachariae C, Young H, Prens E, Cohen A, van der Walt J, Wu JJ. Biosimilars for psoriasis: clinical studies to determine similarity. Br J Dermatol 2017; 177:23-33. [PMID: 27639072 DOI: 10.1111/bjd.15067] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/16/2016] [Indexed: 11/29/2022]
Abstract
Biosimilars are drugs that are similar, but not identical, to originator biologics. Preclinical analytical studies are required to show similarity on a molecular and structural level, but efficacy and safety studies in humans are essential to determining biosimilarity. In this review, written by members of the International Psoriasis Council, we discuss how biosimilars are evaluated in a clinical setting, with emphasis on extrapolation of indication, interchangeability and optimal clinical trial design.
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Affiliation(s)
- A Blauvelt
- Oregon Medical Research Center, Portland, OR, U.S.A
| | - L Puig
- Department of Dermatology, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - S Chimenti
- University of Rome Tor Vergate, Rome, Italy
| | - R Vender
- Dermatrials Research Inc., Hamilton, ON, Canada.,Venderm Innovations in Psoriasis, Hamilton, ON, Canada
| | | | - R Romiti
- Department of Dermatology, University of São Paulo, São Paulo, Brazil
| | - L Skov
- Herllev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
| | - C Zachariae
- Herllev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
| | - H Young
- Manchester Academic Health Science Centre, Department of Dermatology, University of Manchester, Salford Royal Hospital, Manchester, U.K
| | - E Prens
- Department of Dermatology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - A Cohen
- Siaal Research Center for Family Medicine and Primary Care, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel.,Department of Quality Measurements and Research, Chief Physician's Office, Clalit Health Services, Tel Aviv, Israel
| | | | - J J Wu
- Department of Dermatology, Kaiser Permanente Los Angeles Medical Center, Los Angeles, CA, U.S.A
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Lacour JP, Ruer-Mulard M, Khemis A, Beylot-Barry M, Célérier P, Blauvelt A, Reich K, Tsai TF, Tyring S, Kingo K, Ziv M, Pinter A, Vender R, Hugot S, You R, Milutinovic M, Blanc AS, Martin L, Thaçi D. Supériorité du sécukinumab sur l’ustékinumab dans le psoriasis en plaques modéré à sévère de l’adulte : résultats de l’étude CLEAR à 1 an. Ann Dermatol Venereol 2016. [DOI: 10.1016/j.annder.2016.09.231] [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: 10/20/2022]
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20
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Griffiths CEM, Vender R, Sofen H, Kircik L, Tan H, Rottinghaus ST, Bachinsky M, Mallbris L, Mamolo C. Effect of tofacitinib withdrawal and re-treatment on patient-reported outcomes: results from a Phase 3 study in patients with moderate to severe chronic plaque psoriasis. J Eur Acad Dermatol Venereol 2016; 31:323-332. [PMID: 27600367 PMCID: PMC5297866 DOI: 10.1111/jdv.13808] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [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: 01/08/2016] [Accepted: 04/14/2016] [Indexed: 12/25/2022]
Abstract
BACKGROUND Tofacitinib is an oral Janus kinase inhibitor being investigated for psoriasis. A Phase 3 withdrawal/re-treatment study (NCT01186744; OPT Retreatment) showed tofacitinib re-treatment was effective in patients with chronic plaque psoriasis. OBJECTIVES To describe the effects of tofacitinib withdrawal/re-treatment on health-related quality of life (HRQoL) and disease symptoms measured by patient-reported outcomes (PROs). METHODS The study was divided into initial treatment, treatment withdrawal, and re-treatment periods. Initial treatment: patients were randomized to receive tofacitinib 5 (n = 331) or 10 mg (n = 335) BID for 24 weeks. Treatment withdrawal: patients who achieved both ≥ 75% reduction in Psoriasis Area and Severity Index (PASI) score from baseline and Physician's Global Assessment of 'clear'/'almost clear' at Week (W)24 received placebo (withdrawal) or the previous dose (continuous treatment). Re-treatment: at relapse (> 50% loss of W24 PASI response) or at W40, patients received their initial tofacitinib dose. PROs included: Dermatology Life Quality Index (DLQI), Itch Severity Item (ISI), Short Form-36 (SF-36) and Patient's Global Assessment (PtGA). RESULTS After initial treatment with tofacitinib 5 and 10 mg BID, substantial and significant improvements were reported for mean DLQI (baseline: 12.6 and 12.6; W24: 5.1 and 2.6) and ISI (baseline: 6.7 and 6.9; W24: 2.9 and 1.6). Patients continuously treated with tofacitinib 5 and 10 mg BID maintained those improvements through Week 56 (DLQI: 3.0 and 2.1; ISI: 2.3 and 1.4). By W40, patients withdrawn from tofacitinib 5 and 10 mg BID showed worsening in DLQI (5.0 and 6.2) and ISI (3.7 and 4.0) scores; improvements were regained upon re-treatment (W56, DLQI: 3.4 and 2.4; ISI: 2.2 and 1.6). Similar results were reported for PtGA and SF-36. CONCLUSION Continuous tofacitinib treatment provided sustained improvement in HRQoL and disease symptoms. Patients randomized to treatment withdrawal lost initial improvements. Upon re-treatment, improvements were recaptured to levels comparable to those seen with continuous treatment.
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Affiliation(s)
- C E M Griffiths
- The Dermatology Centre, Salford Royal Hospital, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - R Vender
- Dermatrials Research Inc, Hamilton, ON, Canada
| | - H Sofen
- UCLA School of Medicine, Los Angeles, CA, USA
| | - L Kircik
- Icahn School of Medicine at Mount Sinai, New York, NY, USA.,Indiana School of Medicine, Indianapolis, IN, USA.,DermResearch PLLC, Louisville, KY, USA
| | - H Tan
- Pfizer Inc, Global Innovative Pharmaceuticals, Groton, CT, USA
| | - S T Rottinghaus
- Pfizer Inc, Global Innovative Pharmaceuticals, Groton, CT, USA
| | - M Bachinsky
- Pfizer Inc, Global Innovative Pharmaceuticals, Groton, CT, USA
| | | | - C Mamolo
- Pfizer Inc, Global Innovative Pharmaceuticals, Groton, CT, USA
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21
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Blauvelt A, Cohen A, Puig L, Vender R, van der Walt J, Wu J. Biosimilars for psoriasis: preclinical analytical assessment to determine similarity. Br J Dermatol 2015; 174:282-6. [DOI: 10.1111/bjd.14267] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/26/2015] [Indexed: 11/30/2022]
Affiliation(s)
- A. Blauvelt
- Oregon Medical Research Center; Portland OR U.S.A
| | - A.D. Cohen
- Siaal Research Center for Family Medicine and Primary Care; Faculty of Health Sciences; Ben-Gurion University of the Negev; Beer-Sheva Israel
- Department of Quality Measurements and Research; Chief Physician's Office; Clalit Health Services; Tel Aviv Israel
| | - L. Puig
- Department of Dermatology; Hospital de la Santa Creu i Sant Pau; Universitat Autònoma de Barcelona; Barcelona Spain
| | - R. Vender
- Dermatrials Research Inc.; 132 Young Street Hamilton ON Canada L8N 1V6
| | | | - J.J. Wu
- Department of Dermatology; Kaiser Permanente Los Angeles Medical Center; 1515 North Vermont Avenue, 5th Floor Los Angeles CA 90027 U.S.A
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22
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Bissonnette R, Maari C, Barber K, Lynde C, Vender R. Etanercept for patients with psoriasis who did not respond or who lost their response to adalimumab or infliximab. J Eur Acad Dermatol Venereol 2015; 29:1576-81. [DOI: 10.1111/jdv.12943] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2014] [Accepted: 11/28/2014] [Indexed: 01/09/2023]
Affiliation(s)
| | - C. Maari
- Innovaderm Research; Montreal QC Canada
| | - K. Barber
- Kirk Barber Research; Calgary AB Canada
| | | | - R. Vender
- Dermatrials Research; Hamilton ON Canada
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23
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Tan J, Humphrey S, Vender R, Barankin B, Gooderham M, Kerrouche N, Audibert F, Lynde C. A treatment for severe nodular acne: a randomized investigator-blinded, controlled, noninferiority trial comparing fixed-dose adapalene/benzoyl peroxide plus doxycycline vs. oral isotretinoin. Br J Dermatol 2014; 171:1508-16. [DOI: 10.1111/bjd.13191] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/08/2014] [Indexed: 10/25/2022]
Affiliation(s)
- J. Tan
- University of Western Ontario and Windsor Clinical Research Inc.; 2224 Walker Rd. Suite 300 Windsor ON Canada
| | - S. Humphrey
- Department of Dermatology and Skin Science; The University of British Columbia; Vancouver BC Canada
| | - R. Vender
- Dermatrials Research Inc.; Hamilton ON Canada
| | | | - M. Gooderham
- SKiN Centre for Dermatology; Peterborough ON Canada
| | | | | | - C. Lynde
- Lynderm Clinical Research; Markham ON Canada
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24
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Conrad C, Lymp J, Thompson V, Dunn C, Davies Z, Chatfield B, Nichols D, Clancy J, Vender R, Egan ME, Quittell L, Michelson P, Antony V, Spahr J, Rubenstein RC, Moss RB, Herzenberg LA, Goss CH, Tirouvanziam R. Long-term treatment with oral N-acetylcysteine: affects lung function but not sputum inflammation in cystic fibrosis subjects. A phase II randomized placebo-controlled trial. J Cyst Fibros 2014; 14:219-27. [PMID: 25228446 DOI: 10.1016/j.jcf.2014.08.008] [Citation(s) in RCA: 71] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2014] [Revised: 08/12/2014] [Accepted: 08/24/2014] [Indexed: 11/17/2022]
Abstract
PURPOSE To evaluate the effects of oral N-acetylcysteine (NAC), which replenishes systemic glutathione, on decreasing inflammation and improving lung function in CF airways. METHODS A multicenter, randomized, double-blind proof of concept study in which 70 CF subjects received NAC or placebo orally thrice daily for 24 weeks. ENDPOINTS primary, change in sputum human neutrophil elastase (HNE) activity; secondary, FEV(1) and other clinical lung function measures; and safety, the safety and tolerability of NAC and the potential of NAC to promote pulmonary hypertension in subjects with CF. RESULTS Lung function (FEV(1) and FEF(25-75%)) remained stable or increased slightly in the NAC group but decreased in the placebo group (p=0.02 and 0.02). Log(10) HNE activity remained equal between cohorts (difference 0.21, 95% CI -0.07 to 0.48, p=0.14). CONCLUSIONS NAC recipients maintained their lung function while placebo recipients declined (24 week FEV1 treatment effect=150 mL, p<0.02). However no effect on HNE activity and other selected biomarkers of neutrophilic inflammation were detected. Further studies on mechanism and clinical outcomes are warranted.
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Affiliation(s)
- C Conrad
- Lucile Packard Children's Hospital, Center of Excellence in Pulmonary Biology, 770 Welch Rd., #350, Stanford University, Palo Alto, CA 94304, United States
| | - J Lymp
- CFFT Therapeutics Development Network Coordinating Center, Seattle, WA. 2001 8th Avenue, Seattle, WA 98121, United States
| | - V Thompson
- CFFT Therapeutics Development Network Coordinating Center, Seattle, WA. 2001 8th Avenue, Seattle, WA 98121, United States
| | - C Dunn
- Lucile Packard Children's Hospital, Center of Excellence in Pulmonary Biology, 770 Welch Rd., #350, Stanford University, Palo Alto, CA 94304, United States
| | - Z Davies
- Lucile Packard Children's Hospital, Center of Excellence in Pulmonary Biology, 770 Welch Rd., #350, Stanford University, Palo Alto, CA 94304, United States
| | - B Chatfield
- University of Utah Pediatric Pulmonology, 100N. Mario Capecchi Dr., Salt Lake City, UT 84113, United States
| | - D Nichols
- National Jewish Health, 1400 Jackson St., Adult CF Center, Denver, CO 80206, United States
| | - J Clancy
- Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave., Pulmonary Medicine, OSB 5, Cincinnati, OH 45229, United States
| | - R Vender
- Pennsylvania State University/Milton S. Hershey Medical Center, PO Box 850, Hershey, PA 17033, United States
| | - M E Egan
- Yale University School of Medicine, Yale University School of Medicine, 333 Cedar St., Rm. FMP 526, New Haven, CT 06520, United States
| | - L Quittell
- Morgan Stanley Children's Hospital of New York, Division of Pediatric Pulmonology, Columbia University Medical Center, 3959 Broadway CHC 7-701, New York, NY 10032, United States
| | - P Michelson
- St. Louis Children's Hospital, 660 Euclid Ave., CF Center, 10th Floor NW Tower, St. Louis, MO 63110, United States
| | - V Antony
- University of Alabama at Birmingham, 422 Tinsley Harrison Tower, 1900 University Blvd, Birmingham, AL 35294-0006, United States
| | - J Spahr
- Children's Hospital of Pittsburgh of UPMC, 4221 Penn Avenue, AOB Suite 3300, Pittsburgh, PA 15224, United States
| | - R C Rubenstein
- The Children's Hospital of Philadelphia, 34th St and Civic Center Blvd, Abramson Research Center, Room 410A, Philadelphia, PA 19104, United States
| | - R B Moss
- Lucile Packard Children's Hospital, Center of Excellence in Pulmonary Biology, 770 Welch Rd., #350, Stanford University, Palo Alto, CA 94304, United States
| | - L A Herzenberg
- Department of Genetics, Stanford University School of Medicine, Stanford, CA 94305-5318, United States
| | - C H Goss
- CFFT Therapeutics Development Network Coordinating Center, Seattle, WA. 2001 8th Avenue, Seattle, WA 98121, United States
| | - R Tirouvanziam
- Emory+Children's Center for CF and Airways Disease Research, 2015 Uppergate Dr., Rm. 344, Emory University School of Medicine, Atlanta, GA 30322, United States
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25
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Horwitz A, Graff G, Vender R, Sachs L, Craig T. Sinus and Mastoid Involvement in Cystic Fibrosis and the Efficacy of Surgical Intervention. J Allergy Clin Immunol 2006. [DOI: 10.1016/j.jaci.2005.12.1038] [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: 10/24/2022]
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Abstract
We determined the diseases associated with extremely high levels of alkaline phosphatase in hospitalized patients. Computerized laboratory records of the Hospital of Saint Raphael identified all inpatients who had elevations of alkaline phosphatase above 1,000 U/l from April 1994 to September 1995. Thirty-seven inpatients with alkaline phosphatase levels above 1,000 U/l were identified. Six had bone involvement from malignancy or Paget's disease and were eliminated from further analysis, and 31 patients were included in the study. Levels of alkaline phosphatase ranged from 1,014 to 3,360 U/l. Ten patients had sepsis as the cause of the elevated alkaline phosphatase. These included gram-negative organisms, gram-positive organisms, and two patients with fungal sepsis. Seven of 10 patients with sepsis had an extremely high alkaline phosphatase level and a normal bilirubin, 3 of 10 patients with sepsis also had acquired immunodeficiency syndrome (AIDS). Eight patients had biliary obstruction, 7 with malignant obstruction and 1 with a common bile duct stone. Nine patients had AIDS. The cause of the elevated alkaline phosphatase in these included three with sepsis, three with mycobacterium avium intracellulare (MAI) infection, two with cytomegalovirus infection, and one with Dilantin toxicity. Three patients had diffuse liver metastases. Finally, four patients had benign intrahepatic disease, including one patient with liver hemangiomas, one patient with sarcoid hepatitis, one patient with lead toxicity, and one patient with drug-induced cholestasis. Extremely high elevations of alkaline phosphatase are most frequently seen in patients with sepsis, malignant obstruction, and AIDS. Patients with sepsis can have an extremely high alkaline phosphatase level and a normal bilirubin. A variety of other causes were also noted.
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Affiliation(s)
- O Maldonado
- Department of Gastroenterology, Hospital of Saint Raphael, Yale University School of Medicine, New Haven, Connecticut, USA
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Abstract
BACKGROUND ERCP is a frequently performed procedure, but its necessity for diagnosis and ability to change management plans are unclear in many cases. METHODS We prospectively evaluated diagnosis, certainty of diagnosis, and management recommendations, both before and after ERCP, as well as therapeutic maneuvers performed during ERCP, in unselected patients undergoing this procedure. RESULTS ERCP procedures (1341) were studied at a university hospital, an ERCP referral center, and two community hospitals. Among patients undergoing first-time ERCP, the preceding clinical diagnosis was correct for 64% of those predicted to have bile duct stones, 86% to 89% of those given other biliary diagnoses, and 88% predicted to be normal. In 35% of cases, diagnostic confidence improved substantially after ERCP. Endoscopic therapy was successfully completed in 51%. After ERCP, plans for other invasive procedures changed in 82%: percutaneous biliary studies and open surgical procedures were recommended less often and laparoscopic cholecystectomy more often. Endoscopic therapy and overall clinical utility were most common in patients with cholangitis, jaundice, or bile leaks. CONCLUSIONS ERCP is particularly helpful for diagnosis of bile duct stones but is less likely to change other diagnoses. The endoscopic therapy commonly carried out during ERCP often changes the treatment plan, leading to fewer surgical and percutaneous interventions in general, but more laparoscopic cholecystectomies.
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Affiliation(s)
- M Topazian
- Yale University School of Medicine, New Haven, Connecticut 06520-8019, USA
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28
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Affiliation(s)
- R Vender
- Hospital of St. Raphael, Dept. of Gastroenterology, New Haven, CT 06511, USA
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29
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Affiliation(s)
- J Larson
- Hospital of Saint Raphael, Yale University School of Medicine, New Haven, Connecticut, USA
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30
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Larson J, Vender R, Camuto P. Cholestatic jaundice due to ackee fruit poisoning. Am J Gastroenterol 1994; 89:1577-8. [PMID: 8079944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
A 27-yr-old Jamaican male presented with a 2-month history of jaundice, pruritus, intermittent diarrhea, and right upper quadrant abdominal pain. Over the next month, his abdominal pain and diarrhea improved, but his jaundice and pruritus worsened. He was afebrile and profoundly jaundice, with a benign abdominal examination. Medical workup included a normal abdominal ultrasound, iron studies, ceruloplasm, and serum electrophoresis. Negative viral (Epstein-Barr virus, cytomegalovirus, mononucleosis, hepatitis A, B, C) studies, ANA, AMA, ASMA, RPR were noted. He denied any alcohol, drug, or toxin exposure. Liver tests revealed total bilirubin of 25.6 mg/dl, direct bilirubin of 13.9 mg/dl, alkaline phosphatase 278 IU/L, AST 45 IU/L, and ALT 71 IU/L. Liver biopsy demonstrated centrilobular zonal necrosis and cholestasis most consistent with a toxic reaction. The patient was again interviewed regarding potential toxins, and he admitted to the ingestion of ackee fruit, a native Jamaican fruit that is illegal in the United States. Shortly after he had ceased intake of the fruit, his symptoms resolved and his liver function tests returned to normal. We present a case of chronic ackee fruit ingestion that led to cholestatic jaundice, vomiting, and abdominal pain.
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Affiliation(s)
- J Larson
- Hospital of Saint Raphael, Yale University School of Medicine, New Haven, Connecticut
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Abstract
An association between fecal carriage of Streptococcus bovis and colorectal carcinoma has been reported. A relationship between S. bovis and colorectal adenomas has also been suggested. In the present study, the relationship between S. bovis and adenomas was investigated. Two of 18 current adenoma patients (11%) were found to have S. bovis in their stool compared with 12 of 84 controls (14%). Six of 38 patients who had ever had a diagnosis of adenoma (16%) had S. bovis compared with 8 of 64 controls (13%). These results rule out a strong association between fecal carriage of S. bovis and adenomas; however, because of the relatively small sample size, a weak to moderate association cannot be excluded.
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Affiliation(s)
- R Dubrow
- Department of Epidemiology, Yale University School of Medicine, New Haven, Connecticut
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33
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Abstract
A 21-year-old man developed acute pancreatitis on two separate occasions after a short-term course (less than 10 days) of tetracycline in the presence of normal liver and renal function. Although tetracycline is frequently listed as a cause of pancreatitis, this is only the second documented case of tetracycline-induced pancreatitis in an otherwise healthy person. We review the pertinent literature.
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Affiliation(s)
- J Torosis
- Yale University, School of Medicine, New Haven, Connecticut
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