Risks and predictors of the development of psoriatic arthritis in psoriasis and issues of the early administration of genetically engineered biological products

Круглова, Л. С.; Lvov, A. N.; Pushkina, A.V.

doi:10.17116/klinderma202019031289

Cited by 3 publications

(1 citation statement)

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“…До настоящего времени этиология ПА остается неизвестной, недостаточно освещены многие аспекты патогенеза этого заболевания, вызывают затруднение ранняя диагностика и лечение. Выделение раннего ПА обусловлено необходимостью своевременного назначения патогенетических препаратов с целью предупреждения развития деструктивных изменений в костно-суставной системе и профилактики тяжелых осложнений [5,9,21]. Изучение патогенеза, разработка методов ранней диагностики и высокотехнологического лечения ПА является приоритетным направлением в дерматологии.…”

Section:  введениеunclassified

Secukinumab in the Therapy of Psoriatic Arthritis

Рахматов¹,

Расулова²

2022

Дерматовенерология Косметология

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Проведение клинико-лабораторных исследований позволило у 64 из 158 (40,5%) пациентов с псориазом установить наличие суставного синдрома с определенной клинической симптоматикой, интенсивность которой была оценена по индексу CASPAR. Особенности клинических проявлений псориатического артрита и данные по экспрессии провоспалительных цитокинов (TNF-α и IL-17) явились основанием для применения генно-инженерных биологических препаратов, в частности секукинумаба, являющегося блокатором IL-17. На курс лечения псориатического артрита понадобилось провести в среднем 10–12 инъекций секукинумаба (доза инъекции препарата составляла 300 мг). Отмечена целесообразность и эффективность применения секукинумаба именно при раннем псориатическом артрите, предупреждающего развитие в дальнейшем инвалидизирующих форм заболевания. Clinical and laboratory investigation made it possible to establish the of joint syndrome with special clinical symptomatology in 64 of 158 (40.5%) patients with psoriasis, the intensity of which was estimated according to CASPAR index. The features of clinical manifestations of psoriatic arthritis and data on the expression of proinflammatory cytokines (TNF-α and IL-17) were the grounds for using genetically engineered biological drugs, in particular secukinumab, which is an IL-17-blocker. An average of 10–12 injections of secukinumab (an injection dose of the drug was 300 mg) were needed for a course of treatment of psoriatic arthritis. The appropriateness and effectiveness of secukinumab use in early psoriatic arthritis was noted, preventing the development of further disabling forms of the disease.

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Section:  введениеunclassified

Secukinumab in the Therapy of Psoriatic Arthritis

Рахматов¹,

Расулова²

2022

Дерматовенерология Косметология

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Efficacy and safety of early treatment of patients with skin psoriasis and axial arthritis with IL-17 inhibitors

Pereverzina

Круглова

Коротаева³

2023

Russian Journal of Skin and Venereal Diseases

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BACKGROUND: On average, within 7 years from the debut of skin psoriasis, patients may develop psoriatic arthritis, characterized by a chronic, relapsing progressive course. Early manifestations of psoriatic arthritis may be axial lesions presenting with inflammatory back pain. Currently, many experts are raising the topic of early prescription of genetically engineered biological drugs for axial lesions in order to prevent disability. Members of the GRAPPA expert group (Group for Research and Assessment of Psoriasis and Psoriatic Arthritis) currently do not provide specific recommendations for the treatment of axial lesions in psoriatic arthritis. The most commonly used regimens are those for axial spondyloarthritis and ankylosing spondylitis. There are also no treatment regimens for early manifestations of axial lesions in patients with smooth skin psoriasis without an established diagnosis of psoriatic arthritis. All regimens consider axial lesions in patients who have already been diagnosed with psoriatic arthritis. Thus, it is necessary to form interdisciplinary standardized protocols for the management of such patients. AIM: to investigate the efficacy and safety of IL-17 inhibitors in axial lesions in patients with skin psoriasis. MATERIALS AND METHODS: A prospective non-interventional comparative multicenter study was conducted in parallel groups of patients with smooth skin psoriasis (n=87). To study the effectiveness of the developed method of therapy, the formation of comparison groups is provided. 3 variants of therapy were analyzed: IL-17A inhibitors (n=21; group 1, main); methotrexate (n=35; group 2, comparison); standard desensitizing therapy was used in group 3 (n=31; control). The distribution into groups was carried out taking into account the severity, prevalence of the skin process (according to PASI, BSA), the quality of life of the patient (according to DLQI), the patient's wishes and the patient's ability to purchase genetically engineered biological drugs. RESULTS: According to our results, the use of IL-17A inhibitors shows high efficiency: by week 52, 100% of patients reached the level of PASI 75, 90.5% ― PASI 90 and 85.7% ― PASI 100, NAPSI 100 (Nail Psoriasis Severity Index) was observed in 71.4% patients. All patients reported a reduction of pain at 12, 24 and 52 weeks with a mean BASDAI of 5.9 (SD=2.3), 4.1 (SD=1.3), and 2.7 (SD=0.9), respectively. It was found that 90.5% of patients achieved ACR 20 by the end of the study at week 52. The majority of patients (85.7%) achieved remission or low DAPSA disease activity after 24 weeks of therapy. The mean ASDAS at 12, 24, 52 weeks was 3.07 (0.9), 2.2 (1.0), and 2.3 (0.9), respectively. CONCLUSIONS: Thus, in patients with skin psoriasis and axial lesions, it is recommended to make the earlier prescription of biologic treatment from the group of IL-17 inhibitors in order to prevent the development of severe forms of psoriatic arthritis and human disability.

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Choice of frst drug of genetically engineered therapy: Benefts of guselcumab

Круглова

Шатохина

Polonskaya

et al. 2022

Medicinskij alfavit

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When choosing the frst drug for genetically engineered biological therapy (GEBT), the following are taken into account: the psoriasis phenotype, diagnosed PsA or predictors of its development, the presence of comorbid pathology, contraindications, dosing regimen, the rate of onset of the effect, and the ‘survival rate’. With the advent of new classes of GEBT-drugs, the concept of ‘treat to target’ has been formed, in accordance with which the importance of achieving clear or almost clear skin as a goal of psoriasis therapy has been noted, since studies have shown that achieving clear or almost clear skin (PASI 90, 100) correlates with higher indicators of health-related quality of life. The concept is reduced to the long-term prescription of highly effective and safe therapies (methods) with a high level of evidence in medicine (A, B). The evolution of GIBT has led to the emergence of a new class of anti-IL-23 drugs. The article presents data from clinical studies on the effcacy and safety of the use of the interleukin-23 blocker guselcumab. Own clinical cases are presented with a discussion of the choice made in favor of guselcumab as the frst genetically engineered drug.Conclusions. Data from clinical trials on the high effcacy, ‘survival rate’ and safety of guselcumab in patients with psoriasis and psoriatic arthritis allows, including those with comorbid pathology, to consider it as a starting therapy using genetically engineered drugs. The data of our own results of observation allow us to conclude that guselkumab is highly effective in psoriasis of smooth skin, as well as in lesions of the scalp, anogenital area, with involvement of the nail plates in the process, which justifes its appointment as the frst GIBT drug.

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Risks and predictors of the development of psoriatic arthritis in psoriasis and issues of the early administration of genetically engineered biological products

Cited by 3 publications

References 50 publications

Secukinumab in the Therapy of Psoriatic Arthritis

Secukinumab in the Therapy of Psoriatic Arthritis

Efficacy and safety of early treatment of patients with skin psoriasis and axial arthritis with IL-17 inhibitors

Choice of frst drug of genetically engineered therapy: Benefts of guselcumab

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