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Aitken P, Stanescu I, Boddington L, Mahon C, Fogarasi A, Liao YH, Ivars M, Moreno-Artero E, Trauner D, DeRoos ST, Jancic J, Nikolic M, Balážová P, Price HN, Hadzsiev K, Riney K, Stapleton S, Tollefson MM, Bauer D, Pinková B, Atkinson H. A novel rapamycin cream formulation improves facial angiofibromas associated with tuberous sclerosis complex: a double-blind randomized placebo-controlled trial. Br J Dermatol 2023; 189:520-530. [PMID: 37463422 DOI: 10.1093/bjd/ljad243] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Revised: 07/03/2023] [Accepted: 07/13/2023] [Indexed: 07/20/2023]
Abstract
BACKGROUND Facial angiofibromas (FAs) are a major feature of tuberous sclerosis complex (TSC). Topical rapamycin can successfully treat FAs. A new stabilized cream formulation that protects rapamycin from oxidation has been developed in 0.5% and 1% concentrations. OBJECTIVES To assess the efficacy and safety of a novel, stabilized topical rapamycin cream formulation. METHODS This multicentre double-blind randomized placebo-controlled dose-response phase II/III study with a parallel design included participants aged 6-65 years with FAs of mild or moderate severity according to the Investigator's Global Assessment (IGA) scale. Participants were randomized to one of three treatment arms: topical rapamycin 0.5%, topical rapamycin 1% or placebo. Treatment was applied once daily for 26 weeks. Safety and efficacy measures were assessed at days 14, 56, 98, 140 and 182. The primary endpoint was the percentage of participants achieving IGA scores of 'clear' or 'almost clear' after 26 weeks of treatment. Secondary measures included Facial Angiofibroma Severity Index (FASI) and participant- and clinician-reported percentage-based improvement. Safety measures included the incidence of treatment-emergent adverse events and blood rapamycin concentration changes over time. RESULTS Participants (n = 107) were randomized to receive either rapamycin 1% (n = 33), rapamycin 0.5% (n = 36) or placebo (n = 38). All treated participants were included in the final analysis. The percentage of participants with a two-grade IGA improvement was greater in the rapamycin 0.5% treatment group (11%) and rapamycin 1% group (9%) than in the placebo group (5%). However, this was not statistically significant [rapamycin 0.5%: odds ratio (OR) 1.71, 95% confidence interval (CI) 0.36-8.18 (P = 0.50); rapamycin 1%: OR 1.68, 95% CI 0.33-8.40 (P = 0.53)]. There was a statistically significant difference in the proportion of participants treated with rapamycin cream that achieved at least a one-grade improvement in IGA [rapamycin 0.5%: 56% (OR 4.73, 95% CI 1.59-14.10; P = 0.005); rapamycin 1%: 61% (OR 5.14, 95% CI 1.70-15.57; P = 0.004); placebo: 24%]. Skin adverse reactions were more common in patients following rapamycin application (64%) vs. placebo (29%). CONCLUSIONS Both rapamycin cream formulations (0.5% and 1%) were well tolerated, and either strength could lead to clinical benefit in the treatment of FA.
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Affiliation(s)
| | | | | | - Caroline Mahon
- Dermatology Department, Christchurch Hospital, Christchurch, New Zealand
| | | | - Yi-Hua Liao
- Department of Dermatology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Marta Ivars
- Dermatology Department, Clínica Universidad de Navarra, Madrid, Spain
| | | | - Doris Trauner
- University of California San Diego Health Sciences, Department of Neurosciences, San Diego, CA, USA
| | | | - Jasna Jancic
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
- Clinic of Neurology and Psychiatry for Children and Youth, Belgrade, Serbia
| | - Milos Nikolic
- University of Belgrade School of Medicine, Department of Dermatovenereology, University Clinical Center of Serbia, Belgrade, Serbia
| | - Patrícia Balážová
- Department of Pediatric Neurology, Faculty of Medicine, Comenius University, National Institute of Children's Diseases, Bratislava, Slovakia
| | - Harper N Price
- Division of Dermatology, Phoenix Children's Hospital, Phoenix, AZ, USA
| | - Kinga Hadzsiev
- Department of Medical Genetics, Medical School, University of Pécs, Pécs, Hungary
| | - Kate Riney
- Neurosciences Unit, Queensland Children's Hospital, South Brisbane, QLD, Australia
- Faculty of Medicine, University of Queensland, St Lucia, QLD, Australia
| | | | - Megha M Tollefson
- Departments of Dermatology and Pediatrics, Mayo Clinic and Mayo Clinic Children's Center, MN, USA
| | - Derek Bauer
- University of Virginia, Charlottesville, VA, USA
| | - Blanka Pinková
- Department of Paediatric Dermatology, Faculty Hospital, Brno, Czech Republic
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Rybárová N, Pinková B, Došková H, Vlková E. Sight-threatening Complication of Cicatricial Ectropion in a Patient with Lamellar Ichthyosis - Case Report. Acta Dermatovenerol Croat 2020; 28:29-33. [PMID: 32650848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
We report a case of lamellar ichthyosis and sight-threatening complications of cicatricial ectropion in an adult male patient which was surgically managed with tectonic penetrating keratoplasty. We present a case of autosomal-recessive lamellar ichthyosis in a 47-year-old man who was referred to our outpatient eye clinic for treatment of primary keratouveitis of the right eye with keratolysis and exudation in the anterior chamber. A diagnosis of cicatricial ectropion with serious lagophthalmos was established on examination. The patient underwent tectonic penetrating keratoplasty, cataract extraction, and intra-ocular lens placement with no perioperative complications. The patient was subsequently treated with oral fluconazole 200 mg once daily for 12 days due to a positive fungal culture for Candida albicans and systemic oral acyclovir 250 mg 3 times per day for 12 days as prophylaxis for a labial herpetic infection. Post-operative complications included corneal rejection and nonhealing neurotropic epithelial defect of the graft. Long-term treatment with topical cyclosporine (Ikervis®) and dexamethasone led to resolution of the corneal rejection. Lubrication with artificial tears containing hyaluronic acid, perfluorohexyl octane (Evotears®), and vitamin A ointment led to symptomatic relief of dry eye disease. The patient was referred to a dermatologist and was started on systemic retinoid acitretin at a dose of 0.5 mg/kg per day. Ten months after surgery, the patient's visual acuity was 0.1 based on the Snellen chart and the corneal graft was stable. Infection in the cornea can rapidly progress to corneal melting in patients with severe cicatricial ectropion. A good patient outcome depends on the interdisciplinary approach to patient management by the ophthalmologist, dermatologist, and plastic surgeon.
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Affiliation(s)
- Natália Rybárová
- Natália Rybárová, MD, Oční klinika FN Brno, Jihlavská 20, 625 00 Brno, Czech Republic;
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Borská R, Pinková B, Réblová K, Bučková H, Kopečková L, Němečková J, Puchmajerová A, Malíková M, Hermanová M, Fajkusová L. Inherited ichthyoses: molecular causes of the disease in Czech patients. Orphanet J Rare Dis 2019; 14:92. [PMID: 31046801 PMCID: PMC6498588 DOI: 10.1186/s13023-019-1076-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2018] [Accepted: 04/18/2019] [Indexed: 11/13/2022] Open
Abstract
Inherited ichthyoses belong to a large and heterogeneous group of mendelian disorders of cornification, and can be distinguished by the quality and distribution of scaling and hyperkeratosis, by other dermatologic and extracutaneous involvement, and by inheritance. We present the genetic analysis results of probands with X-linked ichthyosis, autosomal recessive congenital ichthyosis, keratinopathic ichthyosis, and a patient with Netherton syndrome. Genetic diagnostics was complemented by in silico missense variant analysis based on 3D protein structures and commonly used prediction programs to compare the yields of these two approaches to each other. This analysis revealed various structural defects in proteins coded by mutated genes while no defects were associated with known polymorphisms. Two patients with pathogenic variants in the ABCA12 gene have a premature termination codon mutation on one allele and a silent variant on the second. The silent variants c.69G > A and c.4977G > A are localised in the last nucleotide of exon 1 and exon 32, respectively, and probably affect mRNA splicing. The phenotype of both patients is very severe, including a picture harlequin foetus after birth; later (at 3 and 6 years of age, respectively) ectropin, eclabion, generalised large polygonal scaling and erythema.
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Affiliation(s)
- Romana Borská
- Centre of Molecular Biology and Gene Therapy, University Hospital Brno and Masaryk University, Jihlavská 20, 625 00, Brno, Czech Republic
| | - Blanka Pinková
- Department of Pediatric Dermatology, Pediatric Clinic, University Hospital Brno and Masaryk University, Jihlavská 20, 625 00, Brno, Czech Republic
| | - Kamila Réblová
- Central European Institute of Technology, Masaryk University, Kamenice 753/5, 625 00, Brno, Czech Republic
| | - Hana Bučková
- Department of Pediatric Dermatology, Pediatric Clinic, University Hospital Brno and Masaryk University, Jihlavská 20, 625 00, Brno, Czech Republic
| | - Lenka Kopečková
- Centre of Molecular Biology and Gene Therapy, University Hospital Brno and Masaryk University, Jihlavská 20, 625 00, Brno, Czech Republic
| | - Jitka Němečková
- Department of Medical Genetics, University Hospital Brno, Jihlavská 20, 625 00, Brno, Czech Republic.,Department of Public Health, Faculty of Medicine, Masaryk University, Kamenice 5, 625 00, Brno, Czech Republic
| | - Alena Puchmajerová
- Institute of Biology and Medical Genetics, University Hospital Motol, V Úvalu 84, 150 06, Prague, Czech Republic.,GENNET, Kostelní 9/292, 170 00, Prague, Czech Republic
| | - Marcela Malíková
- Institute of Biology and Medical Genetics, University Hospital Motol, V Úvalu 84, 150 06, Prague, Czech Republic
| | - Markéta Hermanová
- First Department of Pathological Anatomy, Faculty of Medicine, Masaryk University and St. Anne's University Hospital, Pekařská 664/53, 656 91, Brno, Czech Republic
| | - Lenka Fajkusová
- Centre of Molecular Biology and Gene Therapy, University Hospital Brno and Masaryk University, Jihlavská 20, 625 00, Brno, Czech Republic. .,Central European Institute of Technology, Masaryk University, Kamenice 753/5, 625 00, Brno, Czech Republic. .,Laboratory of Functional Genomics and Proteomics, NCBR, Faculty of Science, Kotlářská 267/2, 611 37, Brno, Czech Republic.
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Bučková H, Nosková H, Borská R, Réblová K, Pinková B, Zapletalová E, Kopečková L, Horký O, Němečková J, Gaillyová R, Nagy Z, Veselý K, Hermanová M, Stehlíková K, Fajkusová L. Autosomal recessive congenital ichthyoses in the Czech Republic. Br J Dermatol 2015; 174:405-7. [DOI: 10.1111/bjd.13918] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- H. Bučková
- Pediatric Clinic; University Hospital Brno; Brno Czech Republic
| | - H. Nosková
- Centre of Molecular Biology and Gene Therapy; University Hospital Brno and Masaryk University; Jihlavská 20 CZ-62500 Brno Czech Republic
- Central European Institute of Technology; Masaryk University; Brno Czech Republic
| | - R. Borská
- Centre of Molecular Biology and Gene Therapy; University Hospital Brno and Masaryk University; Jihlavská 20 CZ-62500 Brno Czech Republic
| | - K. Réblová
- Central European Institute of Technology; Masaryk University; Brno Czech Republic
| | - B. Pinková
- Pediatric Clinic; University Hospital Brno; Brno Czech Republic
| | - E. Zapletalová
- Centre of Molecular Biology and Gene Therapy; University Hospital Brno and Masaryk University; Jihlavská 20 CZ-62500 Brno Czech Republic
| | - L. Kopečková
- Centre of Molecular Biology and Gene Therapy; University Hospital Brno and Masaryk University; Jihlavská 20 CZ-62500 Brno Czech Republic
| | - O. Horký
- Centre of Molecular Biology and Gene Therapy; University Hospital Brno and Masaryk University; Jihlavská 20 CZ-62500 Brno Czech Republic
| | - J. Němečková
- Department of Medical Genetics; University Hospital Brno; Brno Czech Republic
| | - R. Gaillyová
- Department of Medical Genetics; University Hospital Brno; Brno Czech Republic
| | - Z. Nagy
- Pediatric Clinic; University Hospital Brno; Brno Czech Republic
| | - K. Veselý
- First Department of Pathological Anatomy; Faculty of Medicine; Masaryk University and St Anne's University Hospital; Brno Czech Republic
| | - M. Hermanová
- First Department of Pathological Anatomy; Faculty of Medicine; Masaryk University and St Anne's University Hospital; Brno Czech Republic
| | - K. Stehlíková
- Centre of Molecular Biology and Gene Therapy; University Hospital Brno and Masaryk University; Jihlavská 20 CZ-62500 Brno Czech Republic
| | - L. Fajkusová
- Centre of Molecular Biology and Gene Therapy; University Hospital Brno and Masaryk University; Jihlavská 20 CZ-62500 Brno Czech Republic
- Central European Institute of Technology; Masaryk University; Brno Czech Republic
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