scholarly journals Psoriasis, Vitiligo, and Biologic Therapy: Case Report and Narrative Review

2021 ◽  
pp. 372-378
Author(s):  
Martina Burlando ◽  
Andrea Muracchioli ◽  
Emanuele Cozzani ◽  
Aurora Parodi
Keyword(s):  
Case Report ◽  
Biological Therapy ◽  
Biologic Therapy ◽  
Narrative Review ◽  
Tnf Alpha ◽  
Biological Drugs ◽  
Immune Mediated ◽  
New Onset

Psoriasis and vitiligo are 2 multifactorial immune-mediated diseases, partially sharing pathogenetic underpinnings. Their coexistence in the same patient, although uncommon, is documented in the literature. Further, several cases of vitiligo induced by biological drugs in psoriatic patients are reported. However, improvements in psoriasis and pre-existing vitiligo after the introduction of biological therapy are also described. To date, anti-TNF-alpha is the most cited group of biological drugs that induce new-onset vitiligo or progression of pre-existence vitiligo in psoriatic patients. Even anti-IL-12/23 class would seem to induce vitiligo (as in our case) or even worse it. Anti-IL-17 drugs induce a progression of pre-existing vitiligo while, to date, no cases are reported in literature considering anti-IL-23 class.

scholarly journals Neurological Complications of Biological Treatment of Psoriasis

Life ◽  
2022 ◽  
Vol 12 (1) ◽  
pp. 118
Author(s):  
Mateusz Kamil Ożóg ◽  
Beniamin Oskar Grabarek ◽  
Magdalena Wierzbik-Strońska ◽  
Magdalena Świder
Keyword(s):  
Nervous System ◽  
Side Effects ◽  
Biological Treatment ◽  
Biological Therapy ◽  
Neurological Complications ◽  
Tnf Alpha ◽  
Biological Drugs ◽  
Discontinuation Of Treatment ◽  
The Relationship ◽  
Alpha Therapy

In the available literature, little attention has been paid to the assessment of psoriasis and the biological therapy used for it and the nervous system. The purpose of this article is to discuss the relationship between psoriasis and the nervous system as well as to analyze the mechanisms that lead to neurological complications during anticytokine therapies in psoriasis. However, this connection requires further analysis. The use of biological drugs in psoriasis, although it yields positive therapeutic results, is not without numerous side effects. Serious neurological side effects of the therapy are most often visible with the use of anti-TNF-alpha, which is why patients should be monitored for their potential occurrence. Early detection of complications and rapid discontinuation of treatment with the drug may potentially increase the patient’s chances of a full recovery or improvement of his/her neurological condition. It also seems reasonable that, in the case of complications occurring during anti-TNF-alpha therapy, some of the drugs from other groups should be included in the therapy.

AN UNUSUAL CASE OF NEW ONSET NEPHROPATHY IN A PATIENT OF PSORIASIS: CASE REPORT AND REVIEW OF LITERATURE

2021 ◽  
pp. 13-14
Author(s):  
VPS Punia ◽  
Apoorva Shetty ◽  
Prashant Prashant ◽  
Akash Bharti ◽  
Praveen Raman Mishra ◽  
...  
Keyword(s):  
Nephrotic Syndrome ◽  
Case Report ◽  
Male Patient ◽  
Renal Damage ◽  
Unusual Case ◽  
Review Of Literature ◽  
Immune Mediated ◽  
Different Types ◽  
Glomerular Lesions ◽  
New Onset

Psoriasis is known to cause chronic inammatory disorder of the skin through an immune mediated mechanism, it may be complicated by different types of glomerular lesions. Three different mechanisms have been implicated by which psoriasis can cause renal damage: immune-mediated renal damage, drug-related renal damage and chronic renal damage. This report presents a case of 35 years old male patient with extensive psoriasis, who presented to our hospital with nephrotic syndrome

scholarly journals Pharmacogenetics Update on Biologic Therapy in Psoriasis

Medicina ◽  
2020 ◽  
Vol 56 (12) ◽  
pp. 719
Author(s):  
Ester Muñoz-Aceituno ◽  
Luisa Martos-Cabrera ◽  
María Carmen Ovejero-Benito ◽  
Alejandra Reolid ◽  
Francisco Abad-Santos ◽  
...  
Keyword(s):  
Dna Sequences ◽  
Drug Response ◽  
Genome Wide Association Study ◽  
Response Rate ◽  
Biologic Therapy ◽  
Biological Drugs ◽  
Genome Wide ◽  
Immune Mediated ◽  
Therapeutic Decisions ◽  
A Genome

Background and objectives: Psoriasis is a chronic immune-mediated skin disease caused by several complex factors, both environmental and genetic, many of which are still not fully understood. Nowadays, several groups of biological drugs are being used for psoriasis treatment. Although these therapies are very effective, they show significant variability in efficacy among individuals. Therefore, there is a need for biomarkers to predict treatment outcomes in order to guide personalized therapeutic decisions. Pharmacogenetics is the study of variations in DNA sequences related to drug response. Materials and Methods: In this article, we review pharmacogenetics studies on the treatment of moderate-to-severe psoriasis focusing on anti-interleukin (IL) 12/23 (ustekinumab) and anti-IL17 drugs (secukinumab and ixekizumab), as well as recent studies concerning anti-TNF drugs. Results: Several polymorphisms have been studied over the years in reference to anti-TNF drugs; some of the most recent studies included the performance of a genome-wide association study (GWAS) and pharmacogenetics studies focused on the optimization of a treatment regimen. Various polymorphisms in different genes have been related to ustekinumab response; among them, the most commonly studied is the HLA-C*06:02 allele. Conclusions: Although not confirmed in some studies, most studies have shown that patients carrying this allele present a significantly higher response rate to ustekinumab. Some polymorphisms have been studied in patients treated with anti-IL17 drugs, mostly related to secukinumab; however, up to now, no association has been found between any of these polymorphisms and response. Nevertheless, further studies involving larger cohorts are needed in order to confirm these results before the implementation of this biomarker in clinical practice.

scholarly journals Evolution of biological therapy for psoriasis: realities and prospects

2020 ◽  
Vol 23 (6) ◽  
pp. 395-401
Author(s):  
E. V. Fayzullina ◽  
A. R. Marsina ◽  
Irina Khismatulina ◽  
G. M. Zinatulina
Keyword(s):  
Biological Therapy ◽  
The United States ◽  
Immune Defense ◽  
The Body ◽  
Biological Drugs ◽  
Systematic Assessment ◽  
Leading Role ◽  
Immune Mediated ◽  
The Russian Federation ◽  
Pro Inflammatory Cytokines

INTRODUCTION: Psoriasis is a common multifactorial chronic dermatosis. Despite numerous studies, its pathogenesis is still not fully understood. Currently, great importance is given to disorders in the regulation of the immune system. Knowledge of the key links of pathogenesis, the main cytokines allow us to purposefully act on them, leading to a stop in the cascade of immune-mediated inflammation reactions. It is for the treatment of psoriasis in dermatology that biological drugs were first used. AIM: is to assess the development of theoretical and practical approaches to the use of biological drugs for the treatment of psoriasis. The analysis of literature data is carried out. We studied the sources of Russian and foreign literature on the biological therapy of psoriasis, published from 2004 to 2019. RESULTS: Based on a systematic assessment of the experience of clinical use of biological therapy of psoriasis, the historical aspects of improving the points of application of drugs are studied. The first drugs were targeted by T cells, which were assigned a leading role in the development of psoriasis, then by pro-inflammatory cytokines: TNFa, later -- IL-12 and IL-23. However, uncontrolled inhibition of the basic components of the immune defense could lead to side effects in the form of reactivation of infectious processes in the body, a decrease in antitumor activity. Modern drugs have become highly selective, their point of application is inhibition of the A-17 receptor. An assessment of the evolution of medicines registered in the Russian Federation and in the United States was carried out. CONCLUSION: A comparative assessment of the therapeutic response to biological therapy according to the PASI index showed that the netakimab as well as secucinumab and icsecizumab demonstrates low immunogenicity and high therapeutic effect in patients with severe forms of psoriasis.

Biological therapy in idiopathic inflammatory myopathies

2014 ◽  
Vol 155 (1) ◽  
pp. 3-10
Author(s):  
Levente Bodoki ◽  
Melinda Nagy-Vincze ◽  
Zoltán Griger ◽  
Andrea Péter ◽  
Csilla András ◽  
...  
Keyword(s):  
T Cells ◽  
Muscle Weakness ◽  
Biological Therapy ◽  
Therapeutic Options ◽  
Idiopathic Inflammatory Myopathies ◽  
Inflammatory Myopathies ◽  
Progressive Muscle Weakness ◽  
Immune Mediated ◽  
Novel Therapeutic

Idiopathic inflammatory myopathies are systemic, immune-mediated diseases characterized by proximal, symmetrical, progressive muscle weakness. The aim of this work is to give an overview of the biological therapy used in the treatment of idiopathic inflammatory myopathies. The authors also focus on novel results in the therapy directed against the B- and T-cells. They emphasize the importance of new trials in these diseases which may lead to the introduction of novel therapeutic options in these disorders. Orv. Hetil., 2014, 155(1), 3–10.

scholarly journals Effect of first-line biologic initiation on glucocorticoid exposure in children hospitalized with new-onset systemic juvenile idiopathic arthritis: emulation of a pragmatic trial using observational data

2021 ◽  
Vol 19 (1) ◽  
Author(s):  
Rosemary G. Peterson ◽  
Rui Xiao ◽  
Hannah Katcoff ◽  
Brian T. Fisher ◽  
Pamela F. Weiss
Keyword(s):  
Juvenile Idiopathic Arthritis ◽  
Biologic Therapy ◽  
Tertiary Care ◽  
Pragmatic Trial ◽  
Systemic Juvenile Idiopathic Arthritis ◽  
Source Population ◽  
First Line ◽  
Eligibility Criteria ◽  
Over Time ◽  
New Onset

Abstract Background Glucocorticoid exposure is a significant driver of morbidity in children with systemic juvenile idiopathic arthritis (sJIA). We determined the effect of early initiation of biologic therapy (IL-1 or IL-6 inhibition) on glucocorticoid exposure in hospitalized patients with new-onset sJIA. Methods We emulated a pragmatic sequence of trials (“pseudo-trials”) of biologic initiation in children (≤ 18 years) hospitalized with new-onset sJIA utilizing retrospective data from an administrative database from 52 tertiary care children’s hospitals from 2008 to 2019. Eligibility window, treatment assignment and start of follow-up between biologic and non-biologic study arms were aligned for each pseudo-trial. Patients in the source population could meet eligibility criteria at several timepoints. Mixed-effects logistic regression was used to determine the effect of biologic initiation on in-hospital glucocorticoid exposure. Results Four hundred sixty-eight children met eligibility criteria, of which 19% received biologic therapy without preceding or concomitant initiation of immunomodulatory medications. This proportion significantly increased over time during the study period (p <  0.01). 1451 trial subjects were included across 4 pseudo-trials with 71 assigned to the biologic arm and 1380 assigned to the non-biologic arm. After adjustment, there was a trend toward decreased odds of glucocorticoid initiation in the biologic arm compared to the non-biologic arm (OR 0.39, 95% CI [0.13, 1.15]). Conclusion Biologic initiation in children hospitalized with new-onset sJIA significantly increased over time and may be associated with reduced glucocorticoid exposure. The increasing use of first-line biologic therapy may lead to clinically relevant reductions in treatment-related adverse effects of glucocorticoid-reliant therapeutic approaches.

scholarly journals AB0634 BUDGET IMPACT ANALYSIS OF BIOLOGICAL THERAPY COMPARED TO CONVENTIONAL SPONDYLOARTHRITIS TREATMENT, IN A FOURTH LEVEL HOSPITAL IN BOGOTA COLOMBIA

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 1612.2-1613
Author(s):  
J. M. Bello-Gualtero ◽  
O. J. Calixto ◽  
G. Salguedo ◽  
Y. M. Chamorro-Melo ◽  
C. A. Camargo Rodríguez ◽  
...  
Keyword(s):  
Ankylosing Spondylitis ◽  
Annual Cost ◽  
Impact Analysis ◽  
Budget Impact ◽  
Biological Therapy ◽  
Biologic Therapy ◽  
Disease Diagnosis ◽  
Budget Impact Analysis ◽  
Military Hospital ◽  
Number Of Patients

Background:Spondyloarthritis refers to a family of diseases, of which ankylosing spondylitis and non-radiographic axial spondyloarthritis are responsible for axial impairment. Previously, the only treatment available were NSAIDs, which control activity and stop radiological progression, but at the expense of increased adverse effects, such as cardiovascular risk, dyspepsia and chronic renal failure. For the past 2 decades, biological therapy has been available, which means an increase in care costs.Objectives:The objective of this study is to perform a budget impact analysis of biologic therapy.Methods:To do a budget impact analysis from the perspective of the payer, comparing biological therapy with coventional therapy for the treatment of spondyloarthritis. Demographic characterization of the population attended at the Central Military Hospital. Time horizon from 2012 to 2018, taking the activity count according to the hospital’s billing and the prices of the activities of the state body SISMED. Exchange rates at the end of 2018.Results:The patients attended were 117, mostly men (63, 25%), average age 46, 4 years (SD 13), with disease diagnosis time of 9, 8 years (SD 9, 6). In the budget impact analysis, it is observed that 25% of patients were on DMARDs therapy, 22% with NSAIDs and 96% with biologic therapy. The average year/patient cost with NSAIDs alone would be EUR 381, with DMARDs only EUR 9,318 and, if only biological therapy was used, EUR 423. Within the total number of patients, the average annual cost, including the possibility of combining these drugs, amounted to EUR 5,403Conclusion:Including biological therapy in the care of patients with spondyloarthritis can increase up to 24 times the annual cost per patient. This increase is not only due to higher market value, it also relates to the need for more medical procedures and diagnostic follow-up tests.References:[1]Strömbeck, et al. Cost of Illness from the Public Payers’ Perspective in Patients with Ankylosing Spondylitis in Rheumatological Care. J Rheumatol 2010;37;2348-2355.Disclosure of Interests:None declared

Who Will Be Responsible for the Dialysis Bill? A Case Report and Narrative Review of Insulin Affordability 100 Years After the Discovery of Insulin

2021 ◽  
Author(s):  
Alheli Arce Gastelum ◽  
Sima Maraqa ◽  
Walter Ariel Marquez Lavenant ◽  
Ammara Khan ◽  
Robert S. McMahon ◽  
...  
Keyword(s):  
Case Report ◽  
Narrative Review

scholarly journals Immune-Mediated Disease Flares or New-Onset Disease in 27 Subjects Following mRNA/DNA SARS-CoV-2 Vaccination

Vaccines ◽  
2021 ◽  
Vol 9 (5) ◽  
pp. 435
Author(s):  
Abdulla Watad ◽  
Gabriele De Marco ◽  
Hussein Mahajna ◽  
Amit Druyan ◽  
Mailam Eltity ◽  
...  
Keyword(s):  
Disease Onset ◽  
Underlying Disease ◽  
Organ System ◽  
Population Exposure ◽  
Disease Phenotype ◽  
Autoimmune Rheumatic Disease ◽  
Adverse Event Following Immunization ◽  
Immune Mediated ◽  
The Mean ◽  
New Onset

Background: Infectious diseases and vaccines can occasionally cause new-onset or flare of immune-mediated diseases (IMDs). The adjuvanticity of the available SARS-CoV-2 vaccines is based on either TLR-7/8 or TLR-9 agonism, which is distinct from previous vaccines and is a common pathogenic mechanism in IMDs. Methods: We evaluated IMD flares or new disease onset within 28-days of SARS-CoV-2 vaccination at five large tertiary centres in countries with early vaccination adoption, three in Israel, one in UK, and one in USA. We assessed the pattern of disease expression in terms of autoimmune, autoinflammatory, or mixed disease phenotype and organ system affected. We also evaluated outcomes. Findings: 27 cases included 17 flares and 10 new onset IMDs. 23/27 received the BNT - 162b2 vaccine, 2/27 the mRNA-1273 and 2/27 the ChAdOx1 vaccines. The mean age was 54.4 ± 19.2 years and 55% of cases were female. Among the 27 cases, 21 (78%) had at least one underlying autoimmune/rheumatic disease prior the vaccination. Among those patients with a flare or activation, four episodes occurred after receiving the second-dose and in one patient they occurred both after the first and the second-dose. In those patients with a new onset disease, two occurred after the second-dose and in one patient occurred both after the first (new onset) and second-dose (flare). For either dose, IMDs occurred on average 4 days later. Of the cases, 20/27 (75%) were mild to moderate in severity. Over 80% of cases had excellent resolution of inflammatory features, mostly with the use of corticosteroid therapy. Other immune-mediated conditions included idiopathic pericarditis (n = 2), neurosarcoidosis with small fiber neuropathy (n = 1), demyelination (n = 1), and myasthenia gravis (n = 2). In 22 cases (81.5%), the insurgence of Adverse event following immunization (AEFI)/IMD could not be explained based on the drug received by the patient. In 23 cases (85.2%), AEFI development could not be explained based on the underlying disease/co-morbidities. Only in one case (3.7%), the timing window of the insurgence of the side effect was considered not compatible with the time from vaccine to flare. Interpretation: Despite the high population exposure in the regions served by these centers, IMDs flares or onset temporally-associated with SARS-CoV-2 vaccination appear rare. Most are moderate in severity and responsive to therapy although some severe flares occurred. Funding: none.

scholarly journals Nonepileptic Myoclonus in COVID-19: Case Report

2021 ◽  
pp. 194187442110043
Author(s):  
Henly Hewan ◽  
Annie Yang ◽  
Aparna Vaddiparti ◽  
Benison Keung
Keyword(s):  
Case Report ◽  
Critically Ill ◽  
Recovery Phase ◽  
Critically Ill Patient ◽  
High Dose ◽  
The Novel ◽  
Neurological Manifestations ◽  
Immune Mediated ◽  
Novel Coronavirus ◽  
Post Infectious

In late 2019, the novel coronavirus, SARS-CoV-2, and the disease it causes, COVID-19, was identified. Since then many different neurological manifestations of COVID-19 have been well reported. Movement abnormalities have been rarely described. We report here a critically ill patient with COVID-19 who developed generalized myoclonus during the recovery phase of the infection. Myoclonus was associated with cyclical fevers and decreased alertness. Movements were refractory to conventional anti-epileptic therapies. There was concern that myoclonus could be part of a post-infectious immune-mediated syndrome. The patient improved fully with a 4-day course of high-dose steroids. Our experience highlights a rare, generalized myoclonus syndrome associated with COVID-19 that may be immune-mediated and is responsive to treatment.

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