Latest combination therapies in psoriasis: Narrative review of the literature

Diotallevi, Federico; Paolinelli, Matteo; Radi, Giulia; Offidani, Annamaria

doi:10.1111/dth.15759

Cited by 19 publications

(16 citation statements)

References 47 publications

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“…Theoretically, creating an obstacle for in ammation could be a facilitator for other side effects, particularly infections. However, data of nearly a decade with no signi cant severe adverse events (only cutaneous infectious, herpes zoster ares) and the possibility of remission achievement [39,40] for such patients, justi e we should strive for.…”

Section: Discussionmentioning

confidence: 99%

Combination therapy - is it time to start using? - A case-based review

Ferrari

Franco

Saad

et al. 2023

Preprint

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Background This case-based review presents a Reactive arthritis (ReA) refractory to conventional therapies with excellent response to the combination of ustekinumab and tofacitinib. This is the first case report of ReA with combination therapy with a bDMARD and a tsDMARD. Although not a consensus, combination therapy is already used especially in psoriasis, psoriatic arthritis and inflammatory bowel diseases, motivating this choice since in monotherapy the last two drugs achieved the best responses in different domains, justifying the possibility of blocking several pathophysiological mechanisms of immune-mediated arthritis. Case presentation: A man with peripheral and axial arthritis, conjunctivitis, balanoposthitis, keratoderma blenorrhagicum and urethral discharge preceded by diarrhea, treated with antibiotics, then methotrexate and prednisone were introduced for ReA. Along the years he received three different anti-TNF drugs with no response. Same as IL-17a monoclonal antibody with primary failure. Treatment was changed to ustekinumab with resolution of cutaneous involvement, but not articular. Then, tofacitinib was tried and arthritis improved but skin relapsed. Since severity and refractoriness of the case, combination of ustekinumab and tofacitinib was considered, achieving remission in both domains Conclusions ReA has a difficult diagnosis and treatment, anti-TNF, anti-IL 17, anti-IL 12/23, and JAK inhibitors may be used based on limited data and clinical experience, specially adapted from other spondyloarthritis. This case had poor disease control with all such bDMARD used separately, but achieved low disease activity and resolution of skin lesions with combination of JAK inhibitor and anti-IL 12/23 with no severe adverse effects during follow-up.

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Section: Discussionmentioning

confidence: 99%

Combination therapy - is it time to start using? - A case-based review

Ferrari

Franco

Saad

et al. 2023

Preprint

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“…[7][8][9] Psoriasis is a chronic inflammatory multisystemic skin condition, many other conditions could be associated with it, such as psoriatic arthritis, uveitis, depression, and inflammatory bowel diseases. 10,11 Scaly skin patches, plaques, and pustules are common signs of the disease, along with episodes of remission and relapse. Over 50% of cases of psoriasis develop during the first three decades of life, with the prevalence of the disease being approximately 2% worldwide.…”

Section: Introductionmentioning

confidence: 99%

Effects of Metabolic Syndrome on Cardiovascular Outcomes of Psoriatic Patients with Coronary Artery Disease: A Single Center Retrospective Cohort Study

Zhao¹,

Sun²,

Yang³

et al. 2023

DMSO

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Background: Psoriasis is associated with an increased prevalence of cardiovascular risk factors, including metabolic syndrome (MetS). To date, it is unclear whether MetS causes differences in cardiovascular outcomes in psoriatic patients with coronary artery disease. Methods:We conducted a retrospective cohort study to determine the effects of MetS in psoriatic patients with coronary artery disease. Comparisons were made between patients with and without MetS. Cox regression analysis and Kaplan-Meier survival analysis were used to evaluate the association between variables. Results: Of the 307 psoriatic patients with coronary artery disease, 94 met criteria (30.6%) for MetS. Individuals with MetS were more likely to be female (p <0.001). Levels of platelet counts and high-sensitivity C-reactive protein were higher in the MetS group (p = 0.038 and 0.005, respectively). After a mean follow-up of 35.32 months, major adverse cardiovascular events (MACEs) and nonfatal myocardial infarction were more likely in the MetS than the non-MetS group (33.3% vs 20.6%, p = 0.02; 26.4% vs 15.7%, p = 0.032, respectively). Kaplan-Meier estimates showed the same trend. Cox regression analysis showed that MetS (hazard ratio 1.738; 95% confidence interval 1.045-2.891; p = 0.033) and left ventricular ejection fraction (hazard ratio 0.968; 95% confidence interval 0.945-0.991; p = 0.006) were associated with an increased risk of MACEs. Conclusion:In psoriatic patients with coronary artery disease, MetS independently predicted MACEs. In addition, left ventricular ejection fraction was negatively associated with an increased risk of MACEs. To reduce the cardiovascular disease risk, it is necessary to increase awareness of MetS in psoriatic patients with coronary artery disease.

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“…The high variance in treatment response highlights the need for personalized medicine approaches to tailor treatment options to individual patients based on their unique genetic, molecular, and clinical characteristics. Drug switching and combination treatment have been proposed as potential solutions for these patients [9,10].…”

Section: Introductionmentioning

confidence: 99%

A dynamic Boolean model of molecular and cellular interactions represents psoriasis development and predicts drug candidates

Tsirvouli,

Noël,

Flobak

et al. 2023

Preprint

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Psoriasis is a chronic skin disease affecting 2-3% of the global population. Psoriasis arises from complex interactions between keratinocytes and immune cells, leading to uncontrolled inflammation, immune hyperactivation and perturbed keratinocyte life cycle. Although the latest generation of drugs have greatly improved psoriasis management, the disease remains incurable, and the substantial variability in treatment response calls for novel approaches to comprehend the intricate mechanisms underlying disease development and to discover potential drug targets. In this study, we present a multiscale population model that captures the dynamics of cell-specific phenotypes in psoriasis, integrating discrete logical formalism and population dynamics simulations. Through simulations and network metrics, we identify potential pairwise interventions as alternative treatment options. Specifically, The model predictions suggest that targeting neutrophil activation in conjunction with either PGE2 production or STAT3 signaling shows promise comparable to IL-17 inhibition, which is currently the most used treatment option for moderate and severe cases of psoriasis. Our findings underscore the significance of considering complex intercellular interactions and intracellular signaling cascades in psoriasis, and highlight the importance of computational approaches in unraveling complex biological systems for drug target identification.

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Latest combination therapies in psoriasis: Narrative review of the literature

Cited by 19 publications

References 47 publications

Combination therapy - is it time to start using? - A case-based review

Combination therapy - is it time to start using? - A case-based review

Effects of Metabolic Syndrome on Cardiovascular Outcomes of Psoriatic Patients with Coronary Artery Disease: A Single Center Retrospective Cohort Study

A dynamic Boolean model of molecular and cellular interactions represents psoriasis development and predicts drug candidates

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