Erica B. Lee

Drug survival of secukinumab for psoriasis in a real-world setting.

Secukinumab, an IL-17 inhibitor, is effective for psoriasis and psoriatic arthritis but may have lower drug survival than other biologics in clinical practice (1,2). We retrospectively examined drug survival in 48 patients treated with secukinumab for psoriasis at Kaiser Permanente Los Angeles Medical Center dermatology clinic from January 21, 2015 to January 19, 2018 (Table 1), 12 of whom also had psoriatic arthritis (PsA). Secukinumab failure was defined as adding an oral medication or phototherapy or switching to a different oral or biologic agent. Failure date was set as the date at which the therapy was changed. Kaplan-Meier methodology was used to calculate drug survival probability in the cohort (persistence groups were censored) and provide a comprehensive survival duration. Twenty of 48 (41.7%) of patients persisted on secukinumab therapy throughout the study period (range 74 to 1004, Table 1), eighteen of whom were biologic-experienced. The remaining patients failed therapy after an average of 291 days and median of 198 days of treatment; all but one were biologic-experienced. Of patients with concurrent PsA, 10 of the 12 failed therapy after an average of 316 days. Mean and median drug survival durations (Figure 1) were 512 days (95% confidence interval 216–436 days) and 198 days, respectively.

Rates of latent tuberculosis infection in patients treated with TNF inhibitors for psoriasis: a retrospective chart review

Abstract Background: Although tuberculosis screening guidelines for psoriasis patients on TNF inhibitors exist, few studies have reported the prevalence of latent tuberculosis infection (LTBI) and conversion rates in this population. Objective: To determine the incidence of LTBI and active tuberculosis in patients with psoriasis receiving TNF inhibitor therapy. Methods: A total of 138 patients were included in our retrospective study of patients treated from September 2004 to September 2017. Tuberculin skin test was considered positive with an induration of greater than 5u2009mm. History of Bacillus Calmette-Guérin vaccination, follow-up tests and prophylaxis were recorded. Results: Among 99 biologic-naïve patients, 14 had LTBI before starting biologic therapy and five developed LTBI during TNF inhibitor therapy. One biologic-naïve patient developed LTBI, then active tuberculosis. Among 39 non-biologic-naïve patients, three had LTBI before starting any biologic therapy, and one developed LTBI during treatment. Limitations: Limitations include small sample size and limited information documented in the medical chart. Conclusions: LTBI appears to be prevalent among psoriasis patients. Screening for LTBI in patients on biologics may reduce risk of active tuberculosis; however, current methods may not be fully effective. Clinicians may need to use other tools including risk factor assessment to fully evaluate risk.

Dosage adjustments in patients with psoriasis on adalimumab – a retrospective chart review

with breast or prostate cancer), but the patterns of the alopecia were not described and no scalp biopsies were performed to assess the alopecia. Frontal fibrosing alopecia development after an antiandrogen therapy seems to be a rare event. Androgens may have a role in the lichen planopilaris progression and treatment with antiandrogens, such as finasteride or dutasteride has been proposed to be useful for FFA. On the other hand, many patients show good responses to these drugs, frequently in combination with also topical treatments such as minoxidil. However, MacDonald et al. state that androgen excess cannot be the only reason to explain the FFA pathogenesis as non-androgen-dependent hair is also involved in the process. Different triggering factors could predispose to the development of FFA and increase its incidence. In conclusion, we report the first case of a FFA in a male patient after starting a hormonal therapy with antiandrogens for a prostate cancer. Low serum androgen levels secondary to blockage by bicalutamide and goserelin might play a role in the induction of FFA. Testosterone serum levels might be determined for future studies to assess the possible influence of hormonal therapies in the development of FFA. A. Lobato-Berezo,* A. March-Rodr ıguez, G. Deza, M. Bertol ın-Colilla, R.M. Pujol Department of Dermatology, Hospital del Mar-Parc de Salut Mar, Passeig Mar ıtim, 25-29, 08003, Barcelona, Spain, Department of Dermatology, Hospital Universitari General de Catalunya, Carrer Pedro i Pons 1, 08190, Sant Cugat del V alles, Barcelona, Spain *Correspondence: A. Lobato Berezo. E-mail: allobe@hotmail.es

Adverse events associated with apremilast use and withdrawal for psoriasis in a real-world setting

Apremilast, a phosphodiesterase-4 inhibitor, is an oral therapy for treatment of psoriasis. Its safety profile is favorable, with side effects including diarrhea, nausea, vomiting, depression, and weight decrease, primarily based on clinical trial data. However, limited research exists on the side effect frequency and subsequent adverse events (AEs) in real-world practice. This retrospective chart review included patients who presented to the dermatology clinic at Kaiser Permanente Los Angeles Medical Center and were treated with apremilast at any time between January 1, 2015 and January 11, 2018. Patients were not included if they did not have at least one follow-up by clinic visit, telephone, or email correspondence after being prescribed apremilast. A total of 77 patients were included. AEs and withdrawal due to AEs were assessed throughout the treatment period from each patients respective medical record. This article is protected by copyright. All rights reserved.

How to choose between IL-17 inhibitors and IL-23 inhibitors for psoriasis

Sir,With the advent of novel biologic agents for psoriasis, such as IL-17 inhibitors and IL-23 inhibitors, the treatment options available for psoriasis have increased considerably. Dermatologists ...

Treatment changes in patients with psoriasis on etanercept or adalimumab: a retrospective chart review

PURPOSEnTo determine the frequency of and reasons for treatment changes in patients with psoriasis.nnnMATERIALS AND METHODSnA retrospective chart review of 140 patients with psoriasis treated with adalimumab or etanercept seen at Kaiser Permanente Los Angeles Medical Center between September 20, 2004 and September 8, 2017 was conducted. The first treatment change and reason for that change was documented.nnnRESULTSnOf 140 patients, 103 patients had treatment changes, most commonly due to inefficacy, however complicating events and changes due to patient preference were also seen.nnnCONCLUSIONnAlthough biologics are considered the gold standard for psoriasis, clinicians should still take individual variations in response and preferences into account.

Systematic review of anti-drug antibodies of IL-17 inhibitors for psoriasis

Abstract Three main biologics target the IL-17 pathway; these include secukinumab, ixekizumab, brodalumab, all of which are approved for treatment of moderate-to-severe plaque psoriasis. We performed a systematic review of the literature to determine if IL-17 inhibitors are prone to develop anti-drug antibodies (ADA) and how efficacy of treatment is influenced. A total of 14 papers were reviewed. Only one secukinumab trial detected treatment-emergent ADA in 4 out of 996 (0.41%) patients during the 52-week treatment period. Two of these patients (1 on 150-mg retreatment as needed and 1 on 150-mg fixed interval) were found to have neutralizing antibodies; however, they were not associated with decreased efficacy. One paper reported ADAs against ixekizumab. One out of 1150 (9%) developed titers to ixekizumab after receiving 160-mg-loading dose followed by 80u2009mg every 2 weeks. Nineteen out of 1150 (1.7%) developed high titer (>1:1280) which impacted clinical outcomes. Three studies did detect ADA against brodalumab; however, none were neutralizing. It is difficult to draw a conclusion from our findings given the variability in ADA development. Most trials did not develop ADA, and if they did, the majority of the time they were not neutralizing. Only ixekizumab showed decreased efficacy, but no increased adverse events in cases with neutralizing ADA.

Comparison of guidelines for the use of TNF inhibitors for psoriasis in the United States, Canada, Europe and the United Kingdom: a critical appraisal and comprehensive review

Abstract Purpose: To compare and contrast evidence-based CPGs from leading dermatological organizations for the use of tumor necrosis factor inhibitors (TNFi) in psoriasis. Materials and methods: Guidelines from the British National Institute for Health and Care Excellence (NICE), the British Association of Dermatologists (BAD), the American Academy of Dermatology (AAD), the National Psoriasis Foundation (NPF), and the Canadian Dermatology Association (CDA) were reviewed and compared. Results: Various guidelines are similar regarding treatment initiation but have significant differences regarding topics such as continuous versus intermittent therapy, use in erythrodermic and pustular palmoplantar psoriasis and special patient populations. Conclusion: TNF inhibitors remain valuable tools in psoriasis therapy, and guidelines for their use may help clinicians use them effectively.

Psoriasis-Associated Cutaneous Pain: Etiology, Assessment, Impact, and Management

Abstract Cutaneous pain, a very broad, subjective, and complex symptom, is prevalent in patients with psoriasis. It is prompted by neurogenic inflammation and augmented by physical and psychosocial stress. Many psoriasis patients are troubled by aching, burning, stinging, tenderness, cramping, and tingling in their skin. However, there lacks a thorough and verified metric that allows patients to adequately report their unique skin pain experiences. Limited literature exists that aims to understand cutaneous pain in psoriasis patients; most studies focus on joint pain and generalized pain, and many do not specify the location of pain. This review explores and analyzes current literature on the etiology, assessment, burden, and management of skin pain in psoriasis patients. It emphasizes the significance of appropriately quantifying the skin pain experience in psoriasis and developing therapeutics that target the underlying processes that contribute to noxious skin sensations.

Treatment of psoriasis with crisaborole

Abstract Crisaborole, a topical phosphodiesterase-4 (PDE4) inhibitor, is effective in patients with atopic dermatitis. As systemic PDE4 inhibition has also been used with success in psoriasis, clinical trials are underway to determine the utility of topical PDE4 inhibitors in these patients. However, there is no current literature documenting use of crisaborole for psoriasis. Here, we present two cases in which patients with psoriasis were treated successfully with crisaborole.