Long-Term Efficacy and Safety of Risankizumab for Moderate to Severe Psoriasis: A 2-Year Real-Life Retrospective Study.

Risankizumab is a humanized IgG monoclonal antibody inhibitor of IL23 and has been recently approved by the EMA and the FDA for the treatment of moderate to severe plaque psoriasis in adults who are candidates for systemic therapy. Its efficacy and safety have been reported by clinical trials and real-life studies. However, even if long-term data from trials have already been reported (up to 172 weeks), data on long-term real-life experiences are still limited. The aim of our study was to investigate the long-term (2 years) efficacy and safety of risankizumab for psoriasis management in a real-life setting. A monocentric retrospective study was performed, enrolling 168 patients affected by moderate to severe psoriasis who were undergoing treatment with risankizumab. Psoriasis severity and safety outcomes were evaluated at each follow-up visit (week 16, week 28, week 52, week 88, week 104). A statistically significant reduction of psoriasis severity scores was reported from week 16 and was maintained up to week 104. Moreover, interesting results in terms of safety have been collected, without any serious adverse events registered. Our long-term real-life monocentric retrospective study confirmed the efficacy and safety of risankizumab up to 104 weeks of treatment. However, further studies are required to confirm our results and to increase available data to establish the best evidence-based biologic selection algorithm.

Prognostic Value of TLR7, and Serum level of IL- 17 and IL-23 in COVID-19 Infection

Background: In December 2019, Wuhan, China, had seen an uncommon outbreak of coronavirus disease 2019 (COVID-19), a form of viral infection with pneumonia that is brought on by coronavirus 2 causing severe acute respiratory syndrome (SARS-CoV2) due to Severe acute respiratory CoV-2 level of contagiousness and COVID-19 disease pandemic. Objective: The aim of the present study is to find out the role of of TLR7 gene expression in COVID- 19 patients and disease progression to use them as a prognostic biomarker, also evaluation serum levels of IL-17 and IL-23 in disease course of patients.Materials and Methods: A case control study have been conducted, blood Samples has been collected from hospitals in Dhi-Qar Health Department, COVID-19 isolation centers for those infected with COVID- 19 disease. The patients were sub-divided into three groups: Mild cases group (N: 50), sever cases group (N: 50), and third control group (N: 50). genomic RNA was extracted from blood for molecular assay to study the role of TLR7 and Enzyme linked immunosorbent assay(ELIZA)technique was used to detect serum level of IL-17 and IL-23 in COVID -19 patients. Results: Higher significantly variation on median TLR7 fold change, the median TLR7 fold change in the severe group which was 69.04 (39.81), in the mild group which was 28.38 (38.62) and in the control group which was 1.84 (2.84) which were significant (p< 0.05). There was higher significantly variation on IL-17 and IL-23 level, change severity group was higher comparison in both the control with mild groups (p < 0.05). Conclusion: All these studded parameters show high sensitivity and specificity, thus, we can using them as a combination for prognostic value in COVID-19 patients. © 2022, ResearchTrentz Academy Publishing Education Services. All rights reserved.

Vaccination Recommendations for Psoriasis and Atopic Dermatitis Patients on Biologic Therapy: A Practical Guide

Novel biologic therapies have revolutionized the treatment of psoriasis and atopic dermatitis. Although they are generally safe, they are immunomodulatory and therefore unique considerations apply in regards to infections and vaccine administration. This review aims to provide a clear and practical guide for dermatologists or other healthcare providers to reference when caring for psoriasis or atopic dermatitis patients being treated with biologic therapies using currently available guidelines and clinical data. Vaccinations for approved biologics including TNF alpha, IL-12/23, IL-23, IL-17, and IL-4/13 inhibitors will be discussed, with a special note on current COVID-19 vaccination recommendations.

Risankizumab treatment in psoriasis patients who failed anti-IL17: A 52-week real-life study.

Recent knowledge on the key role of interleukin (IL) 23/17 axis in psoriasis pathogenesis, led to development of new biologic drugs. Risankizumab is a humanized immunoglobulin G1 monoclonal antibody specifically targeting IL23. Its efficacy and safety were showed by both clinical trials and real-life experiences. However, real-life data on effectiveness and safety of risankizumab in patients who previously failed anti-IL17 are scant. To assess the efficacy and safety of risankizumab in patients who previously failed anti-IL17. A 52-week real-life retrospective study was performed to assess the long-term efficacy and safety of risankizumab in patients who previously failed anti-IL17. A total of 39 patients (26 male, 66.7%; mean age 50.5 ± 13.7 years) were enrolled. A statistically significant reduction of psoriasis area severity index (PASI) and body surface area (BSA) was assessed at each follow-up (PASI at baseline vs. week 52: 13.7 ± 5.8 vs. 0.9 ± 0.8, p < 0.0001; BSA 21.9 ± 14.6 vs. 1.9 ± 1.7, p < 0.0001). Nail psoriasis severity index improved as well, being statistically significative only at week 16 and thereafter [9.3 ± 4.7 at baseline, 4.1 ± 2.4 (p < 0.01) at week 16, 1.4 ± 0.8 (p < 0.0001) at week 52]. Treatment was discontinued for primary and secondary inefficacy in 1(2.6%) and 3(7.7%) patients, respectively. No cases of serious adverse events were assessed. Our real-life study confirmed the efficacy and safety of risankizumab, suggesting it as a valuable therapeutic weapon among the armamentarium of biologics, also in psoriasis patients who previously failed anti-IL17 treatments.

Gender affects IL-23 serum levels in the hospitalized COVID-19 infected patients.

Cytokine storm is a main complication in the hospitalized patients, who are infected with the novel coronavirus (COVID-19). The pro-inflammatory cytokines are the main causes of the cytokine storm, however, the roles played by IL-17A, IL-23 and CCL3 are yet to be clarified completely. This prospective study was aimed to explore serum levels of these cytokines in the hospitalized patients infected by COVID-19. Serum levels of IL-17A, IL-23 and CCL3 were measured in 30 COVID-19 infected patients in parallel with 30 healthy controls using ELISA technique. Although serum levels of IL-17A, IL-23 and CCL3 did not alter in the patients in comparison to healthy controls, male patients had higher serum levels of IL-23 than women. Hypertension, type 2 diabetes, lung involvement and age did not affect serum levels of IL-17A, IL-23 and CCL3 in the patients. It appears that IL-17A, IL-23 and CCL3 do not participate in the pro-inflammatory responses in Iranian hospitalized COVID-19 infected patients. However, the gender can be considered as a risk factor for production of more IL-23, which needs to be explored further.

A real-life experience as a proof of Guselkumab effectiveness and safety in patients with moderate to severe psoriasis.

Psoriasis is a skin disorder characterized by chronic inflammation driven by different immunologic pathways, among which the IL-23/Th17 axis plays a pivotal role. For this reason, the use of IL23p19 inhibitors in psoriasis treatment has been evaluated over the years. Guselkumab, a totally human IgG1 lambda monoclonal antibody, that selectively blocks the p 19 subunit of IL- 23 has demonstrated high efficacy and safety throughout several, randomized, double-blind phase III trials (VOYAGE 1 and 2, NAVIGATE and ECLIPSE). We designed a single-center retrospective cohort study in a population consisting of 46 patients followed from December 2018 to April 2021. After a diagnosis of moderate to severe psoriasis, all the patients were considered suitable to receive treatment with Guselkumab. In our population, among those who achieved clinical improvement in terms of Psoriasis Area Severity Index (PASI), PASI 75, 90, and 100 were achieved on average on weeks 14, 19, 21 respectively. We then analyzed a subgroup of our population, consisting of 35 patients, who had an identical follow-up time of 28 weeks, thus observing the trend in mean PASI at subsequent assessments and the number of patients who had reached PASI 75, PASI 90, and PASI 100 at week 4 (10; 3; 1), week 12 (12; 13; 11), week 20 (7; 6; 2), and week 28 (1; 4; 6), respectively. The results obtained are in line with those obtained from previous studies, thus confirming that Guselkumab is an excellent choice in terms of security, long-term efficacy, and overall tolerance.

Biologics for Psoriasis During the COVID-19 Pandemic.

Coronavirus disease 2019 (COVID-19), a new form of acute infectious respiratory syndrome first reported in 2019, has rapidly spread worldwide and has been recognized as a pandemic by the WHO. It raised widespread concern about the treatment of psoriasis in this COVID-19 pandemic era, especially on the biologics use for patients with psoriasis. This review will summarize key information that is currently known about the relationship between psoriasis, biological treatments, and COVID-19, and vaccination-related issues. We also provide references for dermatologists and patients when they need to make clinical decisions. Currently, there is no consensus on whether biological agents increase the risk of coronavirus infection; however, current research shows that biological agents have no adverse effects on the prognosis of patients with COVID-19 with psoriasis. In short, it is not recommended to stop biological treatment in patients with psoriasis to prevent the infection risk, and for those patients who tested positive for SARS-CoV-2, the decision to pause biologic therapy should be considered on a case-by-case basis, and individual risk and benefit should be taken into account. Vaccine immunization against SARS-CoV-2 is strictly recommendable in patients with psoriasis without discontinuation of their biologics but evaluating the risk-benefit ratio of maintaining biologics before vaccination is mandatory at the moment.

Evaluating the Role of the Interleukin-23/17 Axis in Critically Ill COVID-19 Patients.

Studies have hypothesized a potential role of the interleukin (IL)-23/17 axis in coronavirus disease 2019 (COVID-19). However, to date, levels of IL-23 and 17 have not been compared between critically ill COVID-19 patients and critically ill non-COVID-19 patients. IL-23 and 17 were measured on admission to the intensive care unit (ICU) in critically ill COVID-19 (N = 38) and critically ill non-COVID-19 (N = 34) patients with an equal critical illness severity. Critically ill non-COVID-19 patients did not have sepsis or septic shock on ICU admission. None of the enrolled patients had previously received corticosteroids. In our study, circulating IL-17 levels were higher in the COVID-19 patients. More specifically, critically ill COVID-19 patients had levels of 0.78 (0.05-1.8) pg/mL compared to 0.11 (0.05-0.9) pg/mL in the critically ill non-COVID-19 patients (p = 0.04). In contrast, IL-23 levels were comparable between groups. A group of patients hospitalized in the specialized COVID-19 clinic (N = 16) was also used to evaluate IL-17 and IL-23 levels with respect to COVID-19 severity. Non-critically ill COVID-19 patients had undetectable levels of both cytokines. Our results support the notion of inhibiting IL-17 in critical COVID-19 infection.

Pathophysiology of moderate to severe plaque psoriasis: anti-IL-17 towards disease modification.

Psoriasis is a chronic inflammatory disease that can be triggered by injury, trauma, infection and medications. Genetic and immunologic studies have highlighted the importance of the interleukin (IL)-23/T-helper 17 (Th17) pathway in systemic psoriasis pathogenesis. Main IL-23 is an upstream regulatory cytokine with direct effects on epidermal keratinocytes and other resident skin cells while IL-17, a downstream molecule, can activate inflammatory responses in different cells across a diversity of organs. Disease modification could be achieved with drugs that can slow down the biological processes that cause the persistent inflammation in moderate to severe psoriasis. Early intervention with anti-IL-17 and anti-IL-23 agents in new-onset moderate to severe plaque psoriasis might modify the natural course of the disease. Perhaps we are not simply seeing a pharmacologic and mechanistic effect of new-generation biologics but eventually a disease modification process. In this short report we underline the main available data which supports an important role for IL-17 blockade and address whether these new drugs targeting the IL-23/IL-17 axis could be disease-modifying agents in plaque psoriasis. This type of data gains more relevance in the current pandemic era, where chronic patients undergoing earlier treatment may have better outcomes and consequently avoid constant hospital visits.

Severe Acute Respiratory Syndrome Coronavirus 2 and the Use of Biologics in Patients With Psoriasis [Formula: see text].

Coronavirus disease (COVID-19), a respiratory disease caused by a novel coronavirus designated severe acute respiratory syndrome coronavirus 2, has rapidly spread worldwide and has been recognized as a pandemic by the World Health Organization. Patients with altered immunologic function are at higher risk of acquiring COVID-19. In patients with psoriasis, inhibition of select pro-inflammatory cytokines through the use of biologic agents has been shown to be an effective treatment option. Pro-inflammatory cytokines have key immunomodulatory effects and are known to be involved in the hosts' immune response to a variety of viral infections. Though little is currently known about the role of inflammatory cytokines in COVID-19, early reports have shown patients with severe disease to have elevated serum levels of select inflammatory cytokines such as tumor necrosis factor alpha. This review will summarize key information that is currently known about COVID-19, the role of select cytokines in viral defense, and important considerations for patients with psoriasis using biologic agents during this pandemic. Currently, there is insufficient evidence to discontinue biologic therapy in patients with psoriasis who have not tested positive for COVID-19. The decision to pause biologic therapy should be considered on a case-by-case basis in patients in higher risk populations, and should take into account individual risk and benefit. Until more is known about the impact of biologic therapy on COVID-19 outcomes, we recommend patients with psoriasis who test positive for COVID-19 be instructed to discontinue or postpone biologic treatment until they have recovered from infection.