1,194 research outputs found
Profile of certolizumab and its potential in the treatment of psoriatic arthritis
No full textMaria Sole Chimenti,1 Rosita Saraceno,2 Andrea Chiricozzi,2,3 Alessandro Giunta,2 Sergio Chimenti,2 Roberto Perricone11Unit of Rheumatology, Allergology, and Clinical Immunology, 2Unit of Dermatology, University of Rome Tor Vergata, Rome, Italy; 3Laboratory for Investigative Dermatology, Rockefeller University, New York, NY, USAAbstract: Psoriatic arthritis (PsA) is a chronic inflammatory arthropathy associated with psoriasis (PsO). PsA could be considered an enthesal disease because of the link between mechanical stress (entheses) and immunologically active tissue (synovium). Evidence of efficacy of anti-tumor necrosis factor alpha (TNF-α) is supported by reduction of histological vascularity and immune cell infiltrates in synovial tissue after treatment. Certolizumab pegol (CZP) is a polyethylene glycolylated (PEGylated) Fab′ fragment of a humanized monoclonal antibody that binds and neutralizes human TNF-α. The PEG moiety of the Fab fragment, markedly increases the half-life of CZP and confers to the drug a unique structure that differs from the other anti-TNF-α agents tested for the treatment of Crohn’s disease, rheumatoid arthritis, ankylosing spondylitis, axial spondyloarthritis, nonradiographic spondyloarthritis, PsO, and PsA. In contrast to other anti-TNF-α agents, CZP did not mediate increased levels of apoptosis, suggesting that these mechanisms are not essential for the anti-TNF-α efficacy in Crohn’s disease. As CZP, infliximab, and adalimumab, but not etanercept, almost completely inhibited lipopolysaccharide-induced interleukin-1 beta release from monocytes, this cytokine-production inhibition may be relevant for drug efficacy. Due to these characteristics, it has been demonstrated in clinical studies that CZP effectively improves signs and symptoms of arthritis and physical function and skin manifestations of PsO, with a safety profile similar to rheumatoid arthritis. This drug can be considered as a valid treatment in patients affected by PsA. The efficacy and tolerability profiles suggest CZP as a suitable antipsoriatic drug in the treatment of PsA.Keywords: psoriatic arthritis, certolizumab pegol, biological therapies, anti-TN
Profile of certolizumab and its potential in the treatment of psoriatic arthritis
No full textPsoriatic arthritis (PsA) is a chronic inflammatory arthropathy associated with psoriasis (PsO). PsA could be considered an enthesal disease because of the link between mechanical stress (entheses) and immunologically active tissue (synovium). Evidence of efficacy of anti-tumor necrosis factor alpha (TNF-α) is supported by reduction of histological vascularity and immune cell infiltrates in synovial tissue after treatment. Certolizumab pegol (CZP) is a polyethylene glycolylated (PEGylated) Fab′ fragment of a humanized monoclonal antibody that binds and neutralizes human TNF-α. The PEG moiety of the Fab fragment, markedly increases the half-life of CZP and confers to the drug a unique structure that differs from the other anti-TNF-α agents tested for the treatment of Crohn's disease, rheumatoid arthritis, ankylosing spondylitis, axial spondyloarthritis, nonradiographic spondyloarthritis, PsO, and PsA. In contrast to other anti-TNF-α agents, CZP did not mediate increased levels of apoptosis, suggesting that these mechanisms are not essential for the anti-TNF-α efficacy in Crohn's disease. As CZP, infliximab, and adalimumab, but not etanercept, almost completely inhibited lipopolysaccharide-induced interleukin-1 beta release from monocytes, this cytokine-production inhibition may be relevant for drug efficacy. Due to these characteristics, it has been demonstrated in clinical studies that CZP effectively improves signs and symptoms of arthritis and physical function and skin manifestations of PsO, with a safety profile similar to rheumatoid arthritis. This drug can be considered as a valid treatment in patients affected by PsA. The efficacy and tolerability profiles suggest CZP as a suitable antipsoriatic drug in the treatment of PsA. © 2013 Chimenti et al, publisher and licensee Dove Medical Press Ltd
Efficacy of short-term cyclosporine treatment to control psoriasis-related events during efalizumab therapy
No full textEfalizumab is a recombinant humanized anti-CD11a monoclonal antibody that blocks the activation, adhesion and trafficking of T cells and has been approved for the treatment of moderate-to-severe plaque psoriasis. To document management of the fluctuations in symptom control that patients with psoriasis sometimes experience during treatment, we performed a retrospective analysis of our experience using cyclosporine as an intercurrent treatment to control psoriasis-related adverse events (AEs) in 10 patients who had received continuous efalizumab therapy for 20-200 weeks prior to recurrence of symptoms. Combination therapy with cyclosporine and efalizumab was generally well tolerated and controlled the relapse effectively. There were no reports of severe AEs during combination treatment, and no clinically significant changes were noted in clinical and laboratory values. Although mild, localized psoriasis recurred in most of these patients after cyclosporine termination, no patient experienced rebound or psoriasis flare and all continued with long-term efalizumab treatment. Copyright (C) 2008 S. Karger AG, Base
Adalimumab for the treatment of severe psoriasis and psoriatic arthritis
No full textBackground: Psoriasis is a chronic, genetically determined, immunomediated, inflammatory skin disease affecting similar to 2 - 3% of the Caucasian population. Systemic treatment is required in moderate to severe plaque-type psoriasis forms or psoriatic arthritis. However, cumulative organ toxicity, lack of efficacy overtime and other underlying diseases may limit long-term use of conventional treatments. Objectives: TNF-alpha, serves a key role in potentiating inflammatory responses associated with both psoriasis and psoriatic arthritis. Adalimumab is a fully human anti-TNF-alpha monoclonal antibody; approved for the treatment of psoriatic arthritis and, more recently, for plaque-type psoriasis. Methods: This review reports the latest progresses made in the clinical use of 'biologic' drugs for psoriasis focusing on the clinical management of adalimumab in the treatment of plaque psoriasis and psoriatic arthritis. Results: Adalimumab was shown to be effective in treating both psoriasis and psoriatic arthritis with a rapid onset of action and a good safety profile
Prevalence and management of panic attacks during infliximab infusion in psoriatic patients
No full textBACKGROUND:
Psoriasis is a chronic, inflammatory skin disease associated with anxiety and depression. Infliximab (IFX) is a human/mouse chimeric anti-TNF-α antibody effective in the treatment of psoriasis.
OBJECTIVE:
The aim of this study was to evaluate the prevalence of panic disorders in psoriatic patients during IFX infusions.
METHODS:
A retrospective study was performed on patients affected with psoriasis who were treated with IFX from 2002 to 2011 at a single center. Panic disorders were defined using the clinical criteria of the Diagnostic and Statistical Manual of Mental Disorders, 4th edition. A population of dermatological patients under treatment with IVG, rituximab, apheresis, intravenous corticosteroids and antibiotics was considered as the control group.
RESULTS:
A total of 141 patients were evaluated. Of these, 6 (4.25%) experienced panic attacks during the infusion; 16 (11.3%) had a medical history of panic attack and of those 5/16 (31%) experienced panic attacks during IFX infusion. In the control group panic attacks were not recorded.
CONCLUSION:
We describe 6 cases of patients in whom panic attacks were triggered by IFX infusion. Premedication with oral benzodiazepine and a slow rate of infusion is recommended
The significance of the development of antinuclear antibodies during infliximab treatment
No full textEvaluation of Clinical and Ultrasonographic Parameters in Psoriatic Arthritis Patients Treated with Adalimumab: A Retrospective Study
No full textObjectives. The aim of this study was to evaluate clinical and US-PD parameters in PsA during adalimumab treatment. Methods. A retrospective study has been conducted in forty patients affected by moderate-to-severe peripheral PsA. Clinical, laboratory, and US-PD evaluations were performed at baseline, after 4, 12, and 24 weeks of treatment. They included erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), visual analogue scale (VAS), Health Assessment Questionnaire (HAQ) modified for Spondyloarthritis, Psoriasis Area Severity Index (PASI) score, the 28-joint Disease Activity Score (DAS 28), and US-PD assessment. US-PD findings were scored according to a semiquantitative scale (ranging 0–3) for synovial proliferation (SP), joint effusion (SE), bone erosions (BE), and PD. Results. Data obtained for clinical, laboratory findings and US-PD evaluation showed statistical significant improvement in all the measures performed except for BE. A significant parallel decrease in SE, SP, and PD values were demonstrated. Conclusion. This study demonstrated that US-PD is a valid technique in monitoring the response to adalimumab in moderate-to-severe PsA
Emerging treatments in the management of psoriasis: biological targeting with ustekinumab
No full textMarina Papoutsaki, Antonio Costanzo, Sergio ChimentiDepartment of Dermatology, University of Rome, “Tor vergata”, Rome, ItalyAbstract: Psoriasis is a chronic, genetically determined, immune-mediated, inflammatory skin disease affecting approximately 2% to 3% of Caucasian population. Given the well-established role of the immuno-mediated inflammation in the pathogenesis of psoriasis, in the past few years several key steps in the pathogenesis of this disease have been elucidated and the increased knowledge led to the development of specific drugs, commonly defined as “biologics” targeting one or more of these steps. At present an anti-CD11a antibody (efalizumab), an anti-LFA3/CD2 receptor (alefacept) and 3 antitumor necrosis factor alpha agents (adalimumab, etanercept, infliximab) are now commercially available for the treatment of both psoriasis and psoriatic arthritis. Recent studies have demonstrated that interleukins (IL) 12 and 23 play an important role in the pathophysiology of psoriasis. In fact members of the IL-12 family of cytokines have the potential to act as the next major cytokine(s) in pathogenesis and the treatment of psoriasis. Ustekinumab (CNTO 1275, Centocor Inc, Malvern, PA, USA) is a human monoclonal antibody that binds to the shared p40 protein subunit of human interleukins 12 and 23 with high affinity and specificity, thereby preventing interaction with their surface IL-12Rβ1 receptor. Different clinical studies have been conducted to date. In particular a phase II study and two phase III studies, PHOENIX 1 together with PHOENIX 2, show very encouraging results. This review reports on the latest progress made in the clinical use of biologic drugs for psoriasis focusing on the new human IL-12/23 monoclonal antibody, ustekinumab, for psoriasis.Keywords: psoriasis, ustekinumab, interleukin-12/23 monoclonal antibod
Combination therapy with etanercept in psoriasis: Retrospective analysis of efficacy and safety outcomes from real-life practice
No full textobjective to investigate the efficacy and safety outcomes of combination therapy used to optimize etanercept treatment in patients with psoriasis treated in real-life clinical practice.methods data from patients presenting with psoriasis, treated initially with etanercept monotherapy, were analysed retrospectively. patients subsequently treated with combination therapy were further analysed. the psoriasis area and severity Index (PASI) score was recorded for all patients receiving comedication; a subjective pain score was recorded in those with psoriatic arthritis receiving comedication after 12, 24 and 48weeks' treatment and thereafter at 6-month intervals.results from the database of 400 patients treated with etanercept, 37 patients (18 male; 19 female; mean age 59.43years) underwent combination therapy due to lack of efficacy. patients received mostly short-term (range 4-34weeks) comedication with corticosteroids, cyclosporine, methotrexate, nonsteroidal anti-inflammatory drugs, acitretin or sulphasalazine. there were significant reductions in the mean PASI score from baseline at all timepoints. there were also significant reductions in the mean pain VAS score from baseline at all timepoints in patients with psoriatic arthritis. the drug survival rate was 59.6% over a mean duration of 323weeks of etanercept treatment. the safety profile of combination therapy was satisfactory.conclusions short-term comedication in combination with etanercept may optimize treatment options and improve long-term drug survival in patients with psoriasis
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