Annunziata Dattola

Golimumab in Patients Affected by Moderate to Severe Psoriatic Arthritis: An Open-Label Study in Thirty-Two Patients Previously Treated with Other Biologics

Background: Clinical trials have demonstrated the efficacy of golimumab (GLB) in improving the signs and symptoms of psoriatic arthritis (PsA). Objective: The aim of this study was to evaluate the efficacy of GLB in monotherapy in patients affected by PsA with cutaneous involvement unresponsive to other anti-tumor necrosis factor-α (TNF-α) agents. Methods: This study included 32 patients treated with GLB as monotherapy, at a dosage of 50 mg, subcutaneously, every 4 weeks. Patients were divided into 3 groups (A, B, and C) according to their number of previous anti-TNF-α treatments (1, 2, or 3). Clinical and laboratory evaluations were performed at weeks 0, 12, and 24. Results: All patients showed significant improvement of their clinical, inflammatory, and quality of life indexes. Conclusion: Data suggest that GLB can be successful and safe in patients affected by PsA with skin involvement previously treated with other anti-TNF-α agents.

Safety evaluation of apremilast for the treatment of psoriasis

ABSTRACT Introduction: Psoriasis (PSo) is a chronic inflammatory skin disease associated with co-morbidities such as hypertension, diabetes, dyslipidemia and metabolic syndrome. It is a typothypical Th1/Th17 disease that affects from 2 to 3% of the world population. Numerous are the drugs that can be used in our clinical practice; the choice of these drugs depends on the characteristics of the patient. Areas covered: Apremilast is the first oral small molecules to receive FDA approval for the treatment of adults with active psoriasis and psoriatic arthritis. It is a small-molecule that specifically inhibits the activity of cyclic AMP phosphodiesterase-4 (PDE4). Several analyses have been performed on data from phase III studies to assess apremilast safety and efficacy on psoriasis and psoriatic arthritis (PsA). Apremilast could also represent a treatment opportunity for those patients unresponsive to both systemic and biological agents or whose treatment was contraindicated. Expert opinion: For its safety profile and easy route of administration, apremilast may offer an oral treatment option for those patients that discontinue treatments because of ineffectiveness, intolerability or ineligibility to the currently available drugs.

Efficacy and safety of infliximab in psoriatic patients over the age of 65

ABSTRACT Background: Clinical data on the long-term safety and efficacy of infliximab on psoriatic patients who are older than 65 years are limited. Objectives: The aim is to report the long-term efficacy, safety and tolerance of infliximab in geriatric patients. Methods: This was a retrospective study conducted at the Department of Dermatology of the University of Rome Tor Vergata. Clinical data were reported at week 12, 52, 104, 208. Results: 151 charts were evaluated. A total of 27 patients were included. Range of the age was between 65 and 85 years; mean age was 73 years ±5.4; female to male ratio was 1:2; mean age of onset of psoriasis was 43 years±17. The average of treatment duration was 39 months ±27 (range 1–100). Fourteen patients suffered from plaque type psoriasis and 13 from psoriatic arthritis. At the baseline the mean PASI score was 15.6 ± 10.2. At week 12, 52, 104, and 208 the mean PASI was 2, 2.3, 1.9 and 1.8 respectively. A reduction in the mean PASI was maintained in the long-term treatment in 12 patients (p < 0.001). Conclusion: Our data suggest that long-term treatment with infliximab is effective and safe in patients over 65 years old and that IV therapy is also associated with a high compliance.

Increased levels of IL-17 in tear fluid of moderate-to-severe psoriatic patients is reduced by adalimumab therapy.

Editor Psoriasis is a chronic inflammatory skin disorder whose pathogenic mechanism is driven by multiple cytokines such as TNF-a, IL-22, IFNc, and, particularly, by the IL-23/IL-17 signalling pathway. Some of these soluble mediators represent the selective target for successful antipsoriatic therapies, such as the anti-TNF-a agents, namely infliximab, adalimumab and etanercept. Psoriasis is nowadays considered a systemic disorder, particularly the moderate-to-severe form, as it is associated with a plethora of comorbidities. The pathogenic mechanism linking psoriasis to its comorbidities is thought to be represented by elevated levels of circulating proinflammatory mediators that create a systemic inflammatory state, altering the homeostasis of distant organs or tissues, and thus, favouring the development or exacerbation of comorbid conditions. Since ocular comorbid conditions associated to psoriasis are poorly investigated, the aim of the study was to evaluate ocular manifestations in psoriatic patients, tear production as compared to healthy controls, and IL-17A tear levels before and after adalimumab therapy. Evaluating ocular condition in 53 moderate-to-severe psoriasis patients who were assigned to start adalimumab monotherapy, we observed 17% of patients (9/53) suffering from dry eye disease, and 3.8% (2/53) affected by conjunctivitis. Schirmer tests, that were included in the eye examination test panel, revealed a significantly higher tear production in healthy controls as compared to psoriatic patients (Schirmer II test 14.15 vs. 9.51, P = 0.0487; Fig. 1a). Similarly, Schirmer I test showed a higher tear production in healthy donors, though statistically not significant (14.52 vs. 11.77, P = 0.2188; Fig. 1b). We randomly selected Schirmer I test paper strips from 20 patients obtained at the baseline, and from all 10 healthy subjects enrolled, in order to assess IL-17 tear levels by ELISA. We detected significantly higher IL-17 tear concentration in untreated patients (mean value: 0.17 ng/mL) compared to healthy subjects (mean value: 0.027 ng/mL, P < 0.0085, Fig. 2a). Notably, IL-17 tear levels were higher in plaque-type psoriasis compared to psoriatic arthritis (Fig. 2b). This evidence could reflect the differential expression of IL-17 signalling in lesional skin vs. synovial fluid in psoriatic arthritis patients. Eye examination, including Schirmer test I and II, was repeated after 4 months of adalimumab therapy. Compared to baseline, IL-17 in tear liquid levels dropped down after 4 months of therapy (T0: 0.17 ng/mL vs. T4: 0.05 ng/mL, P < 0.004) as shown in Fig. 2c. Specifically, IL-17 tear levels were more markedly reduced in psoriatic arthritis compared to plaque psoriasis. (Fig. 2d, e). Similarly, mean PASI score significantly decreased to 5.26 (mean baseline PASI: 11.6; P = 0.0046). Thereby, the enhanced IL-17 tear liquid expression detected in psoriatic patients and its reduction during adalimumab therapy that is associated with

The efficacy and tolerability of 5-aminolevulinic acid 5% thermosetting gel photodynamic therapy (PDT) in the treatment of mild-to-moderate acne vulgaris. A two-center, prospective assessor-blinded, proof-of-concept study

Acne vulgaris is a chronic inflammatory skin disease, commonly treated with topical or systemic drugs, according to the severity of the condition. Retinoids and antibiotic compounds are considered cornerstone approaches in this condition. However, low adherence to the therapy and the issue of bacterial resistance undermine the efficacy in the long term. Photodynamic therapy (PDT) with 20% aminolevulinic acid (ALA) has shown to be effective in the treatment of inflammatory acne. Skin tolerability, however, could be a limiting factor for a widespread use of this approach. A new formulation of 5% ALA in thermosetting gel has been recently available. This formulation allows a more convenient application procedure without occlusion and better and more efficient release of the active compound in comparison with traditional ALA formulations like creams or ointments.

Update of calcineurin inhibitors to treat inverse psoriasis: A systematic review

Inverse psoriasis commonly involves skin fold areas including the axillae, perianal skin, intergluteal cleft, inframammary, genital/inguinal, abdominal, and retroauricular folds. Topical calcineurin inhibitors are indicated for the treatment of atopic dermatitis but have also been studied in the treatment of psoriasis. The object of the present study is to define the efficacy of topical calcineurin inhibitors in the treatment of psoriasis. We checked for English‐vernacular articles conveyed since 1990 in PubMed, Ovid/Cochrane, and Embase using “tacrolimus,” “pimecrolimus,” or “topical calcineurin inhibitors,” and “psoriasis” as keywords. Eight double‐blind studies and seven open studies displayed the ampleness of topical tacrolimus in psoriasis. Included studies demonstrated a considerable efficacy of topical administration of tacrolimus and pimecrolimus in the treatment of psoriasis, especially for facial, genital, and intertriginous areas. The role of topical tacrolimus and pimecrolimus in the treatment of psoriasis seems to be promising as shown by the results of double‐blind and open studies. Because these agents do not cause cutaneous atrophy, they have a special role in facial, genital, and intertriginous psoriatic lesions. Both agents await additional investigation to determine their roles.

CO2 laser and photodynamic therapy: Study of efficacy in periocular BCC

Basal cell carcinoma (BCC), the most common type of skin cancer in the world, usually arises in sun‐exposed areas of the skin. The therapeutic approach to periocular BCC has changed in the last few years. Currently the treatment, considering the delicate localization of the disease, must not only ensure complete recovery from the neoplastic disease, but must also satisfy functional and aesthetic criteria. In this study we tried to evaluate the efficacy of CO2 laser and photodynamic therapy in periocular BCC.

Contents Vol. 227, 2013

G. Argenziano, Reggio Emilia M. Augustin, Hamburg W.H. Boehncke, Geneve L. Borradori, Bern R.P. Braun, Zürich R. Cerio, London L. Cerroni, Graz O. Chosidow, Créteil A. Dupuy, Rennes J.W. Fluhr, Berlin L. French, Zürich F. Furukawa, Wakayama M. Gilliet, Lausanne A.K. Gupta, London, Ont. R. Happle, Freiburg R.J. Hay, London P. Itin, Basel G. Kaya, Geneva R.G.B. Langley, Halifax, N.S. J.M. Mascaro, Jr., Barcelona K. Matsunaga, Nagoya Y. Miyachi, Kyoto L. Naldi, Bergamo F. Nestle, London C. Paul, Toulouse T. Shiohara, Tokyo Th. Simonart, Brussels H.P. Soyer, Brisbane L. Thomas, Lyon R.M. Trueb, Zürich T.J. Yoon, Jinju Ch.C. Zouboulis, Dessau International Advisory Board