Eric J. Yang

Guselkumab for the treatment of moderate-to-severe plaque psoriasis

ABSTRACT Introduction: Guselkumab is a human monoclonal antibody targeting the p19 subunit of IL-23 that has been approved for the treatment of adult patients with moderate-to-severe plaque psoriasis who are candidates for systemic therapy or phototherapy. This medication blocks the IL-23/IL-17 axis, which has been implicated in playing a key role in the pathogenesis of psoriasis. Areas covered: This review outlines the pharmacologic properties, safety, and efficacy of guselkumab for the treatment of plaque psoriasis. Expert commentary: Guselkumab is the first IL-23 specific inhibitor to be approved for the treatment of plaque psoriasis. Phase II and III clinical trial results have demonstrated excellent safety and efficacy of guselkumab. IL-23 inhibitors may offer potential benefits over existing therapies for moderate-to-severe plaque psoriasis in terms of safety, frequency of administration, and efficacy. Long-term safety data will be critical in evaluating the role of guselkumab in the treatment of psoriasis.

Neuromodulation in Inflammatory Skin Disease

Inflammatory skin diseases are difficult to treat because of a lack of available treatment options for severe disease. However, recent advances have shown that vagus nerve stimulation can be used to decrease inflammation and reduce disease severity in rheumatoid arthritis and inflammatory bowel disease. Changes in cytokine profiles observed in these studies are similar to those seen with use of biologics in inflammatory skin disease, suggesting that they act along similar pathways to disrupt chronic inflammation and treat inflammatory disease. This commentary explores the existing evidence demonstrating the efficacy of neuromodulation in inflammatory disease, and outlines reasons why these findings could translate to the dermatology setting to treat inflammatory skin disease.

Secukinumab in the treatment of psoriasis: patient selection and perspectives

Secukinumab is a human monoclonal antibody targeting IL-17A that has been approved for three indications: moderate-to-severe plaque psoriasis, psoriatic arthritis, and ankylosing spondylitis. In Phase III clinical trials for each of these three indications, secukinumab has proven to be both highly efficacious and well-tolerated. However, several biologic medications are currently approved for the treatment of moderate-to-severe plaque psoriasis, and many demonstrate excellent efficacy and safety. Due to this wide selection, it is often unclear how to choose biologics for specific patients. Important considerations in biologic selection include clinical efficacy, safety, cost, convenience, onset of action, and management of comorbid disease. This article aims to outline the key considerations in patient selection for the treatment of plaque psoriasis with secukinumab.

The impact of genital psoriasis on quality of life: a systematic review

Psoriasis is a chronic immune-mediated inflammatory disease with significant medical and psychological comorbidities. In addition to having increased cardiovascular risk and mortality, psoriasis patients are more likely to be depressed, anxious, and endorse suicidal ideation than the general population. These patients often have low self-esteem and feel stigmatized due to their skin disease, which can prevent them from pursuing relationships, dating, and attending social activities. Up to 63% of adult psoriasis patients experience psoriatic lesions on their genital area during their lifetime, but often do not discuss these issues with their physicians due to embarrassment, stigmatization, or shyness about this sensitive location. However, psoriasis in sensitive areas, such as the genitals, may result in quality of life impairment greater than that of patients with psoriasis elsewhere on their body, particularly in respect to romantic relationships, intimacy, and sexual function. This article evaluates the current literature regarding the impact of genital psoriasis on the quality of life of affected patients.

Profile of tildrakizumab-asmn in the treatment of moderate-to-severe plaque psoriasis: evidence to date

Plaque psoriasis is an immune-mediated skin disease that affects roughly 3% of adults in the United States. Advances over the past 20 years in understanding the immune-mediated pathophysiology of psoriasis have led to the development of targeted biologic therapies for this condition. Currently, biologic medications approved for the treatment of plaque psoriasis include tumor necrosis factor α inhibitors, interleukin (IL)-17 or IL-17 receptor inhibitors, IL-12/23 inhibitors, and IL-23 inhibitors. Tildrakizumab-asmn is a monoclonal antibody that targets the p19 subunit of IL-23 and is approved for use in adult patients with moderate-to-severe plaque psoriasis who are candidates for systemic therapy or phototherapy. This article reviews the current pharmacologic, efficacy, and safety data on tildrakizumab-asmn.

Recent Developments in Atopic Dermatitis

In this article, we review recent updates in the comorbidities, quality of life effects, pathophysiology, management techniques, and therapeutics for AD. Atopic dermatitis (AD) is a bothersome and common skin disease affecting ∼10.7% of children in the United States. This skin condition significantly decreases quality of life in not only patients, but in their families as well. Pediatricians are often the first physicians to diagnose and manage these patients and thus are relied on by families to answer questions about this disease. AD is complex, multifactorial, and has historically had limited therapeutic options, but the landscape of this disease is now rapidly changing. Pathways contributing to the pathogenesis of this disease are continually being discovered, and new therapies for AD are being developed at an unprecedented rate. With this article, we will review the current guidelines regarding the management of AD, outline updates in the current understanding of its pathophysiology, and highlight novel developments available for the treatment of this burdensome disease.

Oral Agents for Psoriasis

A variety of oral agents are part of the therapeutic armamentarium for the treatment of moderate-to-severe psoriasis. Types of oral agents that are used to treat psoriasis include cytotoxic and immunomodulatory drugs such as methotrexate, cyclosporine, and apremilast. Another oral agent, acitretin, is a systemic retinoid that affects epidermal proliferation and differentiation as well as immunomodulation. Oral agents for psoriasis are effective as monotherapy and may also be used in combination with other treatment modalities. Important factors to consider when selecting an oral agent include effectiveness, comorbid conditions, drug side effects, lifestyle considerations, risk factors, drug availability, patient preference, and financial cost of treatment. MTX, cyclosporine, and acitretin have long been used in the treatment of psoriasis for decades and require careful monitoring due to their generally unfavorable side effect profiles, whereas, apremilast, a much newer oral therapy, has far fewer adverse effects. This chapter will review the evidence for use of each of these oral agents in the treatment of psoriasis.

Pharmacy Costs of Specialty Medications for Plaque Psoriasis in the United States

s of this work were previously presented at Maui Derm for Dermatologists in Maui, Hawaii, January 28-February 1, 2018, and the 42nd Hawaii Dermatology Seminar in Kauai, Hawaii, February 4-9, 2018. Reprints not available from the authors. Correspondence to: Eric J. Yang, BS, University of California San Francisco Psoriasis and Skin Treatment Center, 515 Spruce St, San Francisco, CA, 94118 E-mail: ericjyang@outlook.com REFERENCES 1. Lim HW, Collins SAB, Resneck JS Jr, et al. The burden of skin disease in the United States. J Am Acad Dermatol. 2017;76:958-972.e2. 2. Schumock GT, Li EC, Wiest MD, et al. National trends in prescription drug expenditures and projections for 2017. Am J Health Syst Pharm. 2017;74:1158-1173. 3. Keehan SP, Poisal JA, Cuckler GA, et al. National health expenditure projections, 2015-25: economy, prices, and aging expected to shape spending and enrollment. Health Aff (Millwood). 2016;35:1522-1531. 4. 2016 Drug Trend Report: Express Scripts. https://doi.org/10.1016/j.jaad.2018.04.019 Analysis of national skin cancer expenditures in the United States Medicare population, 2013 To the Editor: Approximately 3 million adults in the United States are treated annually for skin cancer, costing nearly

Vagus Nerve Stimulation: A Novel Anti-Inflammatory Treatment Option for Psoriasis and Psoriatic Arthritis?

8.1 billion per year. Nonmelanoma skin cancer and malignant melanoma (MM) are the fifth and ninth most costly dermatologic conditions, respectively. The few studies that have evaluated allocation of resources on skin cancer have underestimated total cost, as they included only payments to dermatologists. The goal of this study was to analyze 2013 Medicare skin cancer spending by diagnosis and procedure. The 2013 Medicare Limited Data Set Standard Analytic File 5% Sample Physician Supplier was queried for all claims filed for International Classification of Diseases, Ninth Revision, Clinical Modification codes for MM, squamous cell carcinoma (SCC), basal cell carcinoma (BCC), other malignant neoplasms of the skin, carcinoma in situ of the skin (CIS), actinic keratosis (AK), and neoplasm of uncertain behavior of the skin. All payments

Pharmacy Costs of Systemic Medications for Hidradenitis Suppurativa in the United States

Treatments for psoriasis and psoriatic arthritis have progressed at a rapid rate over the past 20 years, but treating patients with recalcitrant disease still remains a difficult task. Current therapies for these diseases involve topical agents, phototherapy, and systemic immunosuppression. However, the role of the nervous system in psoriasis and psoriatic arthritis remains largely unexplored. Recent animal studies and clinical trials have demonstrated that vagus nerve stimulation can decrease inflammatory processes in rheumatoid arthritis and inflammatory bowel disease. In this article, we outline the existing knowledge of the nervous system’s role in chronic inflammatory disease and discuss how these findings could be utilized in the future for treatment of psoriasis and psoriatic arthritis.