365 Secukinumab normalizes skin transcriptomes to a never-lesional state in new-onset psoriasis patients more rapidly than in chronic patients
Lars IversenC. ConradJ. KärnerA. CostanzoM. CardnerK. BierF. LohmannF. KolbingerP. JagielloE. Ferrero
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SUMMARY There is a wide range of morphological variation of psoriasis which is due to structural and functional regional differences of the skin surface; to the frequent combination of psoriasis with other dermatoses; to the action of various triggering factors and to the changes produced by treatment of the dermatosis. For the understanding and management of the resulting complex psoriasiform dermatoses, an appreciation of the existence of these factors is essential. The patch of psoriasis offers resistance to impetiginization and to super‐infection by dermatophytes. The coexistence of eczema and psoriasis in the same lesion is common and may pass unsuspected. The combination of atopic dermatitis and psoriasis in the same individual is rarely seen. There is good reason to believe that patients affected by keratotic (Norwegian) scabies are psoriatics. Pityriasis rubra pilairs is not rarely a complex dermatosis in a psoriatic patient. Some forms of palmo‐plantar and linear keratoses are of hidden psoriatic nature. Due to modern methods of therapy (corticosteroids and antimetabolites) the number of the complex, atypical forms of psoriasis is on the increase.
Pityriasis rubra pilaris
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Background: Spondyloarthropathies are a heterogeneous group of similar diseases, with interrelated clinical manifestations, such as Psoriasis Arthritis (APs) and Ankylosing Spondylitis (EA). There are different treatments for this group of pathologies. Objectives: It is very important to differentiate between those that present predominantly axial (spine and/or sacroiliac) or peripheral involvement, since the response to treatment is very different. In some clinical trials, secukinumab significantly improved versus placebo, the symptoms and signs, physical function and quality of life, however, at present, we do not have enough data from secukinumab in real clinical practice. This is the real reason of this study: the use of secukinumab in clinical practice. Methods: Multicentric longitudinal observational study of 5 Hospitals in Madrid. Patients are over 18 years old and meet the following inclusion criteria: New York criteria for AS, ASAS for EA, CASPAR for APs, and all of them are with secukinumab or have received it. We will evaluate the effectiveness rate as well as its confidence interval at 95%. In addition, the effectiveness of secukinumab will be compared in the different pathologies by using χ 2 . Results: 72 patients were collected, 41 of them were women (57,75%). 12 patients (16,90%) had not received FAME before secukinumab and 22 patients (33,99%) were naive to biological treatment. In 4 patients, the reason for starting secukinumab was the patient’s comorbidities, in 2 the adverse effects of previous treatment and in the rest, was the lack of efficacy of the previous treatment. The patients were divided into 4 categories according to the level of DAS-28 or BASDAI, at the beginning of the treatment and the last recorded value, in: Absence of activity, mild, moderate and severe activity. Of the patients with data, they managed to improve the DAS-28 score (change category) by 30,95%, while only 4,76% worsened their score. With respect to BASDAI, of the total number of patients, only 3,03% worsened, while his score improved 27,27%. According to baseline diagnosis, a greater improvement of the disease activity in peripheral APs(66,67%) and mixed APs(61,54%) is achieved. Conclusion: In real clinical practice, treatment with secukinumab was effective in patients with spondyloarthritis, achieving improvement in previous activity rates. In this study, the most significant improvement was obtained in peripheral and mixed APs. Disclosure of Interests: None declared
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Clinical efficacy
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The article shows the key role of IL-17 in the psoriasis pathogenesis and the opportunities of its management via monoclonal antibodies product secukinumab. The review of international randomized trials on clinical efficacy and safety of genetically engineered biologic drug secukinumab in children and adolescents with psoriasis is presented. During treatment periods of 12 to 52 weeks, secukinumab has shown high therapeutic efficacy for psoriasis severity and skin lesion areas and has improved quality of life of children and adolescents according to dynamic assessments of PASI, IGA 0/1 mod 2011 indices, CDLQI questionnaire. The safety profile of secukinumab in children is estimated as favorable and comparable to using it in adults.
Ixekizumab
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Secukinumab (also known as AIN-457) is a human monoclonal antibody targeting IL-17A, which has been recently FDA-approved for the treatment of moderate to severe psoriasis and psoriatic arthritis with coexistent moderate to severe plaque psoriasis based on clinical trials demonstrating excellent efficacy. This review will address the rationale for targeting the IL-23/Th17/IL-17 axis, the role of IL-17 and Th17 cells in psoriasis and other chronic inflammatory diseases, and will examine pre-clinical studies, pharmacologic properties, clinical efficacy, and the safety profile of secukinumab.
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Irritant and allergic contact dermatitis occuring in a patient with psoriasis may clinically appear as a dermatitis, psoriasis (eg, pustular psoriasis) or as an ill-defined subgroup sometimes designated eczematous psoriasis. This subgroup of psoriasis has a clinically heterogenic picture, but retains the chronicity of classical psoriasis. Coexistence of psoriasis and contact dermatitis has prognostic and therapeutic implications for the patient. Allergic contact dermatitis in psoriatics may present itself clinically as psoriasis, and the diagnosis can therefore be missed unless appropriate patch testing is performed. The present study examines the clinical presentation of patients with recognized eczematous psoriasis. It is concluded that the definition of this entity primarily rests on the patient history and response to treatment. The morphology and distribution of the skin lesions are of lesser importance. A missed contact allergy in a psoriasis patient may be one of several reasons why the psoriasis spreads or resists adequate treatment.
Concomitant
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Psoriasis is a systemic immunologic disorder associated with decreased quality of life and numerous co-morbidities, including psoriatic arthritis and cardiovascular disease. Secukinumab, a fully human IgG1 monoclonal antibody, selectively binds IL-17A and is approved by the US FDA and European Medicines Agency for moderate-to-severe plaque psoriasis and psoriatic arthritis. This review examines the efficacy and safety of secukinumab for the treatment of psoriasis using the literature retrieved from the PubMed database. In clinical trials, treatment with secukinumab led to rapid and sustained improvement in Psoriasis Area and Severity Index (PASI) scores, with PASI 90 response rates up to 68.5% at 5 years. Long-term clinical trial and real-world data have established secukinumab as a safe and effective treatment for psoriasis.
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