FDA Approved Biologics: Can Etanercept and Ustekinumab be Considered a First-Line Systemic Therapy for Pediatric/Adolescents in Moderate to Severe Psoriasis? A Systematic Review

Aslam, Nida; Saleem, Hajra; Murtazaliev, Salikh; Quazi, Sohail; Khan, Safeera

doi:10.7759/cureus.9812

Cited by 8 publications

(6 citation statements)

References 32 publications

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“…These therapeutics have gained popularity in the treatment of psoriasis and are a mainstay of treatment. Currently, there are 11 FDA-approved biologics to treat psoriasis targeting the important TNF-α/IL-23/IL-17 inflammatory axis [ 52 ]. The four main classes are TNF-α inhibitors, IL-12/IL-23 inhibitors, IL-17 inhibitors, and IL-23/IL-39 inhibitors ( Figure 1 ) [ 2 ].…”

Section: Resultsmentioning

confidence: 99%

The Cytokine Mediated Molecular Pathophysiology of Psoriasis and Its Clinical Implications

Singh

Koppu

Perche

et al. 2021

IJMS

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Psoriasis is the result of uncontrolled keratinocyte proliferation, and its pathogenesis involves the dysregulation of the immune system. The interplay among cytokines released by dendritic, Th1, Th2, and Th17 cells leads to the phenotypical manifestations seen in psoriasis. Biological therapies target the cytokine-mediated pathogenesis of psoriasis and have improved patient quality of life. This review will describe the underlying molecular pathophysiology and biologics used to treat psoriasis. A review of the literature was conducted using the PubMed and Google Scholar repositories to investigate the molecular pathogenesis, clinical presentation, and current therapeutics in psoriasis. Plaque psoriasis’, the most prevalent subtype of psoriasis, pathogenesis primarily involves cytokines TNF-α, IL-17, and IL-23. Pustular psoriasis’, an uncommon variant, pathogenesis involves a mutation in IL-36RN. Currently, biological therapeutics targeted at TNF-α, IL-12/IL-23, IL-17, and IL-23/IL-39 are approved for the treatment of moderate to severe psoriasis. More studies need to be performed to elucidate the precise molecular pathology and assess efficacy between biological therapies for psoriasis. Psoriasis is a heterogenous, chronic, systemic inflammatory disease that presents in the skin with multiple types. Recognizing and understanding the underlying molecular pathways and biological therapeutics to treat psoriasis is important in treating this common disease.

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Section: Resultsmentioning

confidence: 99%

The Cytokine Mediated Molecular Pathophysiology of Psoriasis and Its Clinical Implications

Singh

Koppu

Perche

et al. 2021

IJMS

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“…Of note, dermatologists in support of using systemic treatments in paediatric PsO tended to be younger, work in hospitals and consult frequently with severe patients ( 29 ). Biologic therapies have been used to treat paediatric PsO for over a decade; data on the use of biologic therapy is quickly expanding and numerous studies have reported the safety of systemic therapy in this patient population ( 6 , 30 , 31 ). Nevertheless, the most common reasons for patients not receiving a biologic were patient/guardian decision and concerns regarding the safety/side-effect profile of biologic therapy, suggesting the need for better education surrounding the use of biologics for paediatric PsO patients and their parents/guardians.…”

Section: Discussionmentioning

confidence: 99%

Physician-reported Clinical Unmet Needs, Burden and Treatment Patterns of Paediatric Psoriasis Patients: A US and EU Real-world Evidence Study

Seyger

Augustin²,

Sticherling³

et al. 2022

Acta Derm Venereol

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This study is a retrospective analysis using data collected from the Adelphi Paediatric Psoriasis Disease-Specific Programme cross-sectional survey. Despite being treated for their psoriasis, a substantial proportion of paediatric patients presented with moderate (18.3%) or severe (1.3%) disease at sampling; 42.9% and 92.0% had a body surface area (BSA) of >10%, and 38.8% and 100.0% had a Psoriasis Area Severity Index (PASI) score >10, respectively. Overall, 69.9% of patients had only ever been treated with a topical therapy for their psoriasis. For patients with moderate or severe disease at sampling, 16.3% and 14.4% were currently receiving conventional systemics or biologic therapy, respectively. There is a clinical unmet need in this paediatric population; a considerable percentage of patients still experienced moderate or severe disease and persistent psoriasis symptoms, with numerous body areas affected. A significant proportion of patients were undertreated, which may explain the high burden of disease observed.

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“…The inhibitors of TNFα such as infliximab, etanercept, adalimumab are now second line to methotrexate in Rheumatoid arthritis, 13 while etanercept is first line treatment for psoriatic in children. 14 Other first line treatments include; the inhibitors of the vascular endothelial growth factor A (VEGF-A) such as bevacizumab, cetuximab, and panitumumab for metastatic colorectal cancer, 15 the inhibitors of the HER-2 such as trastuzumab for hormone sensitive metastatic breast cancer, 16 and the granulocyte colony stimulating factors such as filgrastim for chemotherapy induced neutropenia. 17 This is driven by clinical observations that, for most of these chronic disorders, particularly rheumatoid arthritis, early start of aggressive therapy with effective drugs and continuation of such therapy led to improved patient functionality and quality of life, and reduced comorbidities and increased survival.…”

Section: Discussionmentioning

confidence: 99%

A framework for the use of biological medicines in the free state province, South Africa

Mocke-Richter

Walubo

Rooyen

2021

Pharmacoepidemiology and Drug

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Purpose: The use of biological medicines (BM) has increased worldwide owing to their effectiveness in the treatment of many chronic diseases. However, in South Africa, access to BM remains limited, hence, there is a need to develop strategies that will enable timely access to BM by all patients who need them.Objective: To develop a framework for the use of BM in South Africa.Methods: Using a Delphi questionnaire that was developed by integration of the opinions of newly qualified doctors (<2 years practice), prescribing specialists, and patients using BM, a Delphi method was used to guide an experts' panel into consensus on the different opinions in the questionnaire, and from this, a framework for the use of BM was constructed.Results: From the surveys, 76.2% of the newly qualified doctors and 91.7% of the prescribing specialists indicated that they had limited knowledge on the pharmacology of BM, and, respectively, 64.5% and 77.8% admitted that their knowledge on BM was not adequate for prescribing and taking care of patients on BM. Also, 58.3% and 75% of the prescribers indicated that the high cost and the tedious procurement process, respectively, were barriers of access to BM. The Delphi panel reached consensus after two rounds, and the resultant framework recommends that, appropriate use of BM requires establishing guidelines for the use of BM, increasing BM content in the medical training programs and information resources used by healthcare professionals, enacting drug regulations and drug policies that will increase availability of BM, offering appropriate patient information and public engagement. Conclusion:The lack of knowledge on BM by health professionals, together with the high cost and a complex procurement processes are the major impediment to access to BM. A framework for the use of BM in South Africa was successfully developed to address these and other challenges.

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FDA Approved Biologics: Can Etanercept and Ustekinumab be Considered a First-Line Systemic Therapy for Pediatric/Adolescents in Moderate to Severe Psoriasis? A Systematic Review

Cited by 8 publications

References 32 publications

The Cytokine Mediated Molecular Pathophysiology of Psoriasis and Its Clinical Implications

The Cytokine Mediated Molecular Pathophysiology of Psoriasis and Its Clinical Implications

Physician-reported Clinical Unmet Needs, Burden and Treatment Patterns of Paediatric Psoriasis Patients: A US and EU Real-world Evidence Study

A framework for the use of biological medicines in the free state province, South Africa

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