TNF-Alpha Inhibitors and Ustekinumab for the Treatment of Psoriasis: Therapeutic Utility in the Era of IL-17 and IL-23 Inhibitors

2022 ◽  
pp. 247553032110474
Author(s):  
Julie J. Hong ◽  
Edward K. Hadeler ◽  
Megan L. Mosca ◽  
Nicholas D. Brownstone ◽  
Tina Bhutani ◽  
...  
Keyword(s):  
Treatment Resistance ◽  
Risk Patient ◽  
Tnf Alpha ◽  
Inflammatory Condition ◽  
Biologic Therapies ◽  
Malignancy Risk ◽  
Patient Demographics ◽  
The Past ◽  
Chronic Inflammatory Condition ◽  
Patient Subgroups

Psoriasis is a chronic inflammatory condition for which eleven FDA-approved biologic therapies are approved. Over the past decade, studies have documented the higher efficacy of IL-17 and IL-23 inhibitors for the treatment of psoriasis compared to the TNF-alpha inhibitors and ustekinumab, an IL-12/23 inhibitor. Despite this, there remains an important role for the use of TNF-alpha inhibitors and ustekinumab in the treatment of psoriasis. Here, we review how considerations of infection and malignancy risk, patient demographics, treatment resistance, and comorbidities may make certain TNF-alpha inhibitors or ustekinumab an excellent choice for therapy in particular patient subgroups.

scholarly journals Clinician-Reported Patient Awareness of Symptoms and Severity of Tardive Dyskinesia in Patients Prescribed VMAT2 Inhibitors

CNS Spectrums ◽  
2021 ◽  
Vol 26 (2) ◽  
pp. 151-151
Author(s):  
Jonathan M. Meyer ◽  
Ericha Franey ◽  
Leslie Lundt ◽  
Betsy Benning ◽  
Edward Goldberg ◽  
...  
Keyword(s):  
Tardive Dyskinesia ◽  
Symptom Severity ◽  
Primary Care Physicians ◽  
Additional Data ◽  
Treatment Strategies ◽  
Vesicular Monoamine Transporter ◽  
Patient Awareness ◽  
Patient Demographics ◽  
The Past ◽  
Body Regions

AbstractObjectiveVesicular monoamine transporter 2 (VMAT2) inhibitors including valbenazine are first-line therapies for tardive dyskinesia (TD), a persistent movement disorder associated with antipsychotic exposure. This real-world study was performed to assess the association between patient awareness of TD symptoms and clinician-assessed symptom severity.MethodsClinicians who treated antipsychotic-induced TD with a VMAT2 inhibitor within the past 24 months were asked to extract demographic/clinical data from patients charts and complete a survey for additional data, including patient awareness of TD (yes/no) and TD symptom severity (mild/moderate/severe).ResultsData for 601 patients were provided by 163 clinicians (113 psychiatrists; 46 neurologists; 4 primary care physicians). Patient demographics: 50% male; mean age 50.6 years; 55% schizophrenia/schizoaffective disorder; 29% bipolar disorder; 16% other psychiatric diagnoses. Positive relationships were seen between patient awareness and clinician-assessed symptom severity. Awareness was highest in patients with severe symptoms in specific body regions: face (88% vs 78%/69% [awareness by severe vs moderate/mild symptoms]); jaw (90% vs 80%/67%); wrists (90% vs 69%/63%). In other regions, awareness was similar in patients with severe or moderate symptoms: lips (85%/86% vs 68% [severe/moderate vs mild]); tongue (81%/80% vs 73%); neck (80%/78% vs 68%); arms (67%/66% vs 62%); knees (67%/67% vs 53%).ConclusionsIn patients prescribed a VMAT2 inhibitor for TD, patient awareness was generally higher in those determined to have moderate-to-severe symptom severity as assessed by the clinician. More research is needed to understand how awareness and severity contribute to TD burden, and whether different treatment strategies are needed based on these factors.FundingNeurocrine Biosciences, Inc.

scholarly journals Observed Differences in Diagnostic Test Accuracy between Patient Subgroups: Is It Real or Due to Reference Standard Misclassification?

2007 ◽  
Vol 53 (10) ◽  
pp. 1725-1729 ◽  
Author(s):  
Corné Biesheuvel ◽  
Les Irwig ◽  
Patrick Bossuyt
Keyword(s):  
Clinical Practice ◽  
Diagnostic Test ◽  
Sensitivity And Specificity ◽  
Diagnostic Test Accuracy ◽  
Test Accuracy ◽  
Reference Standard ◽  
Target Condition ◽  
Test Sensitivity ◽  
The Past ◽  
Patient Subgroups

Abstract Before a new test is introduced in clinical practice, its accuracy should be assessed. In the past decade, researchers have put an increased emphasis on exploring differences in test sensitivity and specificity between patient subgroups. If the reference standard is imperfect and the prevalence of the target condition differs among subgroups, apparent differences in test sensitivity and specificity between subgroups may be caused by reference standard misclassification. We provide guidance on how to determine whether observed differences may be explained by reference standard misclassification. Such misclassification may be ascertained by examining how the apparent sensitivity and specificity change with the prevalence of the target condition in the subgroups.

scholarly journals Pilonidal Cyst of the Penis Mimicking Carcinoma

2013 ◽  
Vol 2013 ◽  
pp. 1-2
Author(s):  
Luigi Cormio ◽  
Francesca Sanguedolce ◽  
Paolo Massenio ◽  
Giuseppe Di Fino ◽  
Giuseppe Carrieri
Keyword(s):  
Differential Diagnosis ◽  
Pilonidal Sinus ◽  
Rare Case ◽  
Subcutaneous Tissue ◽  
Sinus Tract ◽  
Penile Carcinoma ◽  
Inflammatory Condition ◽  
Pilonidal Cyst ◽  
Chronic Inflammatory Condition

Pilonidal sinus is a long-standing chronic inflammatory condition consisting of a sinus tract from the skin-lined orifice extending into subcutaneous tissue, with hairs attached to the wall of the tract and projecting outside of the opening. Penile location is rare, and differential diagnosis with severe balanoposthitis, epidermal cysts, and neoplasms can be difficult. We report a rare case of pilonidal cyst located between coronal sulcus and prepuce which, due to its ulcerated aspect and absence of a tract with projecting hairs, simulated a penile carcinoma.

scholarly journals Cardiopulmonary Manifestations of Ankylosing Spondylitis

2011 ◽  
Vol 2011 ◽  
pp. 1-6 ◽  
Author(s):  
Mahnaz Momeni ◽  
Nora Taylor ◽  
Mahsa Tehrani
Keyword(s):  
Ankylosing Spondylitis ◽  
Cardiac Dysfunction ◽  
Spontaneous Pneumothorax ◽  
Pulmonary Complications ◽  
Inflammatory Condition ◽  
Stepwise Approach ◽  
Conduction Disturbances ◽  
Chronic Inflammatory Condition ◽  
Pulmonary Manifestations ◽  
Valve Diseases

Ankylosing spondylitis is a chronic inflammatory condition that usually affects young men. Cardiac dysfunction and pulmonary disease are well-known and commonly reported extra-articular manifestation, associated with ankylosing spondylitis (AS). AS has also been reported to be specifically associated with aortitis, aortic valve diseases, conduction disturbances, cardiomyopathy and ischemic heart disease. The pulmonary manifestations of the disease include fibrosis of the upper lobes, interstitial lung disease, ventilatory impairment due to chest wall restriction, sleep apnea, and spontaneous pneumothorax. They are many reports detailing pathophysiology, hypothesized mechanisms leading to these derangements, and estimated prevalence of such findings in the AS populations. At this time, there are no clear guidelines regarding a stepwise approach to screen these patients for cardiovascular and pulmonary complications.

scholarly journals Cancer Immunology and Immunotherapies: Mechanisms That Affect Antitumor Immune Response and Treatment Resistance

Cancers ◽  
2021 ◽  
Vol 13 (22) ◽  
pp. 5655
Author(s):  
Xianda Zhao ◽  
Subbaya Subramanian
Keyword(s):  
Immune Response ◽  
Cancer Treatment ◽  
Treatment Resistance ◽  
Cancer Immunology ◽  
Antitumor Immune Response ◽  
The Past

The past decade has seen immunotherapy rise to the forefront of cancer treatment [...]

scholarly journals Not all colonic growths are malignant

2019 ◽  
Vol 12 (7) ◽  
pp. e229515
Author(s):  
Geethu Rachel Iype ◽  
Sasank Kalipatnapu ◽  
Dipti Masih ◽  
Gigi Varghese
Keyword(s):  
Inflammatory Condition ◽  
Chronic Inflammatory Condition ◽  
Xanthogranulomatous Inflammation

We present the case of a 34-year-old woman who was diagnosed to have adenocarcinoma of the caecum based on the clinical, radiological, histopathological and intraoperative findings. However, postoperative histopathology showed only features of xanthogranulomatous inflammation without any evidence of malignancy. This benign chronic inflammatory condition could present as a histological surprise. It is important for both surgeons and pathologists alike to be aware of this.

Profiling of histone 3 lysine 27 acetylation reveals its role in a chronic DSS-induced colitis mouse model

2019 ◽  
Vol 15 (4) ◽  
pp. 296-307
Author(s):  
Meng Chen ◽  
Qinglan Li ◽  
Nan Cao ◽  
Yanan Deng ◽  
Lianyun Li ◽  
...  
Keyword(s):  
Inflammatory Bowel Disease ◽  
Gastrointestinal Tract ◽  
Mouse Model ◽  
Bowel Disease ◽  
Inflammatory Condition ◽  
Histone 3 ◽  
Chronic Inflammatory Condition ◽  
Inflammatory Bowel

Inflammatory bowel disease (IBD) is a chronic inflammatory condition of the gastrointestinal tract.

Type and Quantity of Pharmacologic Therapy for Crohn's Disease before Eventual Surgical Treatment

2016 ◽  
Vol 82 (10) ◽  
pp. 989-991 ◽  
Author(s):  
Jan P. KamiŃSki ◽  
Emily Miraflor ◽  
Karen Zaghiyan ◽  
Phillip Fleshner
Keyword(s):  
Crohn’S Disease ◽  
Crohn's Disease ◽  
Biologic Therapy ◽  
Pharmacologic Therapy ◽  
Aminosalicylic Acid ◽  
Biologic Therapies ◽  
Pharmaceutical Treatment ◽  
Prospective Data ◽  
Therapeutic Modalities ◽  
Patient Demographics

Treatment of Crohn's disease (CD) relies on medical therapy with surgery reserved for medically refractory cases. This study measured pharmaceutical therapies that CD patients receive before surgery. Prospective data were collected on 558 patients undergoing surgery for medically refractory CD from November 1999 through June 2014. Patient demographics and preoperative medical therapies were tabulated, including types and number of doses of aminosalicylic acid, corticosteroids, immunomodulators, and biologic therapies. Most patients had been treated with preoperative aminosalicylic acid (72%), steroids (77%), or immunomodulators (69%). Forty-two per cent of patients were treated with a biologic before surgery with a mean number of 20 doses (range, 1–130). In 29 per cent of patients, all therapeutic modalities were used before surgery. Biologic therapy was more common in the last seven years of the study compared with the first eight years (64% vs 35%; P < 0.01). More patients had been treated with all therapeutic modalities before surgery in the second half of the study period (37% vs 19%; P < 0.01). CD patients undergoing surgery have had extensive pharmaceutical treatment. In the current era, more patients have been placed on biologic therapies and more than one third of them failed all available classes of medications before surgical intervention.

scholarly journals Periodontal Disease Is an Independent Predictor of Intracardiac Calcification

2013 ◽  
Vol 2013 ◽  
pp. 1-6 ◽  
Author(s):  
Gregg S. Pressman ◽  
Atif Qasim ◽  
Nitin Verma ◽  
Masami Miyamae ◽  
Kumiko Arishiro ◽  
...  
Keyword(s):  
Risk Factors ◽  
Periodontal Disease ◽  
Subclinical Atherosclerosis ◽  
Scoring Systems ◽  
Cross Sectional Study ◽  
Inflammatory Condition ◽  
Cross Sectional ◽  
Calcification Score ◽  
Chronic Inflammatory Condition ◽  
Traditional Risk Factors

Background. Periodontitis is the most common chronic inflammatory condition worldwide and is associated with incident coronary disease.Hypothesis. We hypothesized that periodontal disease would also be associated with cardiac calcification, a condition which shares many risk factors with atherosclerosis and is considered a marker of subclinical atherosclerosis.Methods. Cross-sectional study at two sites (USA and Japan) involving subjects with both clinical echocardiograms and detailed dental examinations. Semiquantitative scoring systems were used to assess severity of periodontal disease and echocardiographic calcification.Results. Fifty-six of 73 subjects (77%) had cardiac calcifications, and 51% had moderate to severe periodontal disease (score > 2). In unadjusted analysis, a significant relationship between periodontal score and cardiac calcification (Spearman rho = 0.4,P=0.001) was noted, with increases in mean calcification score seen across increasing levels of periodontal disease. On multivariate logistic regression, adjusted for age, gender, race, glomerular filtration rate, and traditional risk factors, this association remained significant (P=0.024). There was no significant interaction by study site, race, or gender.Conclusions. In a multiracial population, we found a significant association between the degree of periodontal disease, a chronic inflammatory condition, and cardiac calcification. Further, higher periodontal scores were associated with greater degrees of calcification.

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