The Journal of dermatological treatment最新文献

Purpose of the study: Head, neck (HN), and face involvement in atopic dermatitis (AD) poses a major psychological burden and can be challenging to effectively treat. New appearance of HN dermatitis has been reported with biologics used to treat AD. Lebrikizumab (LEBRI), a monoclonal targeting IL-13, is approved for AD treatment in the US, Europe and Asia. We evaluated HN dermatitis improvement using the HN Eczema Area and Severity Index (EASI) and a facial dermatitis questionnaire, along with safety evaluations focusing on HN and facial erythema.

Materials and methods: Efficacy analyses were performed on placebo (PBO) controlled modified intention-to-treat (mITT) populations from the 16-week induction periods of ADvocate1 and ADvocate2 (pooled) and ADhere studies. Treatment-emergent adverse events (TEAEs) of HN and facial erythema were summarized from eight Phase 2 and 3 clinical trials.

Results: LEBRI resulted in significantly greater improvements than PBO in EASI HN subscore as early as Week 2 (ADvocate 1&2), with 68.1% improvement at Week 16.

Conclusions: LEBRI improved EASI HN subscore and HN EASI clinical signs of erythema and facial dermatitis at Week 16. During the PBO-controlled period, an increased reporting of HN and facial erythema as TEAE was not observed in the LEBRI group and HN and facial TEAEs reporting did not increase with longer exposure.

Background: The number of monotherapies for hidradenitis suppurativa (HS) has expanded. However, the efficacy of active comparators has not been determined in head-to-head trials.

Aims: We conducted an NMA to determine the relative efficacy and safety of monotherapies for HS.

Methods: The literature was systematically reviewed to obtain data from trials that (1) were published in English, (2) investigated a systemically administered monotherapy with an immunomodulatory agent (3) randomized, and (4) quantified efficacy, at 16 weeks, insofar as the Hidradenitis Suppurativa Clinical Response 50 (HiSCR-50), Dermatology Life Quality Index (DLQI) and Numeric Rating Scale 30 (NRS30). For safety, we analyzed the occurrence of treatment-emergent adverse events (TEAEs). For sensitivity analyses, we conducted network meta-regressions adjusted for age and sex.

Results: We determined the efficacy of numerous regimens including those approved by the United States FDA; for instance, the FDA-approved 'bimekizumab 320 mg every 2 weeks' was more efficacious than 'IFX-1 800 mg every 2 weeks' (odd ratio = 1.99, 95% credible interval: 1.09,3.87, p < 0.05) in terms of HiSCR-50. Sensitivity analyses showed that the main analyses were robust. Overall, risk of bias across studies was low.

Conclusions: The current NMA provides comparative evidence on systematic immunomodulatory HS monotherapies from the most up-to-date trial evidence.

Aim: To evaluate the therapeutic efficacy and safety of the Janus kinase (JAK) inhibitor tofacitinib in the management of refractory perianal pyoderma gangrenosum (PG) under conditions of baseline immunosuppression and bone marrow suppression.

Methods: We present a 62-year-old male with a 4-month history of painful, progressive symmetrical perianal ulcerations diagnosed as PG, coexisting with condyloma acuminatum. The patient had a background of pure red cell aplasia and myasthenia gravis, and was undergoing chronic immunosuppressive therapy with prednisolone and tacrolimus. Previous interventions including topical agents, antibiotics, phototherapy, and surgical debridement were ineffective. Oral tofacitinib (5 mg/day) was introduced following multidisciplinary evaluation.

Results: Marked pain reduction was achieved by day two of tofacitinib therapy, with near-complete ulcer healing observed within two weeks. Hematologic parameters remained stable throughout the 4-month treatment course, which was well tolerated with no adverse effects. The patient remained relapse-free during a 1-year follow-up.

Conclusions: Tofacitinib may offer a rapid, effective, and well-tolerated treatment alternative in cases of refractory PG, even when layered onto preexisting immunosuppressive regimens. This case highlights the potential of JAK inhibitors as targeted therapy in complex PG presentations and supports their further clinical evaluation.

Objectives: Baricitinib showed efficacy for alopecia areata (AA) in clinical trials, with real-world data supporting its short-term effectiveness. However, long-term data are limited. We assessed the effectiveness and safety of baricitinib in AA patients over one year and explored predictive factors.

Methods: We analyzed data from 27 AA patients treated with baricitinib at our hospital.

Results: The majority (81%) had alopecia universalis, with a mean baseline SALT score of 93.9. Disease duration was positively correlated with the current AA episode's duration and negatively with serum TARC levels. At 3, 6, 9, and 12 months, 3.8%, 19.2%, 37%, and 58% of patients achieved a SALT score ≤20, respectively. The duration of the current AA episode at initiating baricitinib was correlated positively with absolute SALT score at 6 and 9 months, and negatively with the reduction rate of SALT score at 6 and 9 months. A shorter duration of the current episode (<4 years) was associated with better improvement in SALT scores at 6, 9, and 12 months compared to longer durations (≥4 years).

Conclusions: Baricitinib proved effective and safe for severe AA patients. The duration of the current AA episode is a key predictor of treatment success, highlighting the importance of early intervention.

Background: Vunakizumab (anti-interleukin-17A antibody) has shown favorable efficacy and safety in treating moderate-to-severe plaque psoriasis. The morbidity and severity of psoriasis vary in different regions of China.

Objective: This post-hoc exploratory analysis aims to investigate the efficacy and safety of vunakizumab in patients with moderate-to-severe plaque psoriasis across different regions of China.

Methods: This post-hoc exploratory analysis used data from a phase III trial (NCT04839016), with 461 patients receiving vunakizumab categorized into North (n = 118), Central (n = 252), and South (n = 91) China groups.

Results: Psoriasis area and severity index (PASI)75/90/100 and static physician's global assessment (sPGA) 0/1 response rates were similar among the three groups at week 12 (W12). Additionally, W12-W52 sustained PASI 75/90/100 and sPGA 0/1 response rates were also similar among groups. Similar improvements in patient-reported outcomes, including dermatology life quality index, itch-numerical rating scale, EuroQol-5D, and short form-36, were observed in the three groups. The incidence of adverse events was 80.5%, 90.1%, and 90.1% in the North, Central, and South China groups, respectively.

Conclusion: The efficacy and safety of vunakizumab are not affected by different regions of China in patients with moderate-to-severe plaque psoriasis.

Purpose: Twenty-nail dystrophy (TND) is a chronic nail disorder affecting all or some nails and posing a significant therapeutic challenge for dermatologists. Janus kinase (JAK) inhibitors have recently emerged as a promising treatment modality for refractory nail diseases.

Results: We report a case of a patient with idiopathic TND for 12 years duration, and successfully treated with oral tofacitinib, which offered a potential new therapeutic choice for this challenging entity. Some successful cases of treating inflammatory nail diseases with Janus kinase (JAK) inhibitors were reviewed.

Conclusion: Janus kinase (JAK) inhibitors may be a promising therapeutic option for patients with twenty-nail dystrophy.

Background: Psoriasis is a chronic inflammatory disease affecting about 2% of the global population, with moderate-to-severe forms requiring systemic treatment for successful disease management. By targeting the interleukin (IL)-23p19 subunit of IL-23, the master cytokine of psoriasis pathogenesis, guselkumab, tildrakizumab, and risankizumab offer improved risk-benefit profiles.

Objective: While randomized clinical trials (RCTs) provide controlled data, real-world evidence (RWE) offers insights into the performance of these therapies in diverse patient populations, including those with comorbidities or difficult-to-treat areas affected. With RWE on these inhibitors constantly emerging, a comprehensive overview and expert interpretation are essential for providing key insights into psoriasis management in clinical practice.

Methods: This review, therefore, examined RWE on the effectiveness and safety of IL-23p19 inhibitors compared to their pivotal RCTs.

Results: Despite some gaps between RCT and RWE outcomes, particularly in underrepresented subpopulations, IL-23p19 inhibitors show strong effectiveness and favorable safety across both settings in the short- and especially in the long term, accompanied by an improvement in health-related quality of life and reduction of the main symptoms.

Conclusion: Altogether, these factors make these medicines ideal treatment options. Future research should focus on improving patient-reported outcomes, specifically addressing psychological and quality-of-life aspects, to further optimize psoriasis management.