Enhanced Effectiveness of Adalimumab Compared to Topical/Traditional Systemic Agents in the Treatment of Moderate to Severe Plaque Psoriasis: Results from a Canadian Observational Epidemiologic Study (COMPLETE-PS).

INTRODUCTION: Real-world evidence is important for post-marketing evaluation. Data comparing adalimumab's effectiveness and safety with traditional therapies in clinical settings are currently lacking. The aim of this study was to compare real-world effectiveness of adalimumab versus topical/traditional systemic agents for management of moderate to severe plaque psoriasis METHODS: Patients requiring change in treatment were enrolled between 2011 and 2016 and followed per routine care for up to 24 months. Achievement of Physician Global Assessment (PGA) ≤ 1.0 at 6 months was assessed with logistic regression; time to achievement was assessed using Cox regression. Additional outcomes were assessed using repeated measures mixed models. RESULTS: Patients receiving adalimumab (n = 293) versus topical/traditional systemic agents (n = 302) were more likely to achieve PGA ≤ 1.0 at 6 months (odds ratio 2.37, 95% confidence interval [CI] 1.31-4.30) in a shorter time (hazard ratio 2.14, 95% CI 1.53-3.00), reporting both lower body surface area and improved quality of life and work productivity. CONCLUSION: In this real-world study, adalimumab was more effective than topical/traditional systemic agents at reducing disease activity and improving quality of life outcomes among Canadians with moderate to severe plaque psoriasis. (NCT00799877).

Real-world, long-term treatment patterns of commonly used biologics in Canadian patients with moderate-to-severe chronic plaque psoriasis.

Real-world and long-term data on biologic treatment changes - including switching, discontinuation, dose escalation, and interval change (both increasing and decreasing) - are required to understand treatment patterns for psoriasis (PsO) in Canada. The study objectives were to evaluate the time to first biologic treatment change and to document these changes in Canadian patients with moderate-to-severe chronic plaque PsO. Charts from 13 Canadian sites were queried retrospectively (2005-2019); a period covering all biologic classes commonly used for PsO in Canada. Included were patients diagnosed with, and currently using biologics for, moderate-to-severe chronic plaque PsO. Time to first treatment change, nature of treatment change, number of lines of treatment, proportion of patients on each drug, and drug survival were collected. Based on 1149 medical charts, adalimumab had the longest time to first treatment change (49.3 months; 95% confidence interval, 37.4-67.4). Approximately half of the patients had a treatment change, and nearly 75% of these changes were either an interval change or a biologic switch. Lack of efficacy was the most prevalent primary reason for biologic switch (67.3%), whereas 6.7% of patients switched due to adverse events. Drug survival for etanercept and infliximab was approximately twice as long for patients who had dose optimization (i.e., dose escalation or interval change) than patients without dose optimization. The survival curve of adalimumab was similar to the one of ustekinumab after 48 months of treatment, showing approximately 60% of patients remaining on treatment after 132 months, with or without dose optimization. Assessing treatment patterns of all commonly used biologics for moderate-to-severe chronic plaque PsO in Canada between 2005 and 2019 showed that approximately half of the patients required a treatment change (mainly interval change or biologic switch) while the other half remained on treatment.

Extolling the benefits of molecular therapeutic lipidation.

The conjugation of drug or molecular recognition motif to a hydrophobic fatty entity, for purpose of drug-membrane localization, has been a molecular strategy utilized for targeted inhibition of pathways involved in diseased cells. In general, membrane-anchored inhibitor structures have been composed of either a lipid or sterol group coupled via a broad range of inert linkers to either a peptide or small molecule protein recognition agent. Whilst not adhering to the molecular paradigms of modern medicinal chemistry, this approach has afforded peptidic-based therapeutics with improved cellular and in vivo efficacy, leading to more selective targeting of membrane associated protein targets and the effective immobilization of cytosolic signaling proteins through membrane anchorage. The evidence suggests that membrane-anchored peptidic inhibitors are more selective, potent, structurally rigid, and possess enhanced cell permeability profiles as compared to their non-lipidated precursors. This perspectives article will review the application of lipid or sterol conjugation to peptide inhibitors (lipo-molecules) to circumvent the poor cell permeability and metabolic labilities associated with peptidic therapeutics. In addition, the concept of protein-membrane anchorage as a novel drug modality for inhibiting cytosolic signaling protein motility in cells will be reviewed and its merits as an approach to inhibiting protein complexation, protein nuclear translocation and their potential for more effective targeting of membrane associated targets.

Inhibiting aberrant Stat3 function with molecular therapeutics: a progress report.

Aberrantly activated signal transducer and activator of transcription 3 (Stat3) protein plays a master regulatory role in the progression and survival of human cancers through the upregulation of target protooncogenes. Numerous human cancers, including breast, ovarian, prostate, leukemia, lymphoma, multiple myeloma, and brain cancers have been shown to harbor constitutively active Stat3 protein resulting in the expression of protooncogenes. The transcriptionally active Stat3-Stat3 protein homodimer has been extensively targeted as a means to suppress the aberrant Stat3 function in human cancer. This review will outline the recent progress made toward identifying drug-like compounds capable of effectively inhibiting aberrant Stat3 signaling through the disruption of Stat3 protein-protein interactions.

A photostable, pH-invariant fluorescein derivative for single-molecule microscopy.

We herein report the comprehensive characterization of the spectral and single-photon fluorescence properties of a recently synthesized fluorescein derivative and its biotinylated analog. The fluorophore displays significant increases in photostability compared to the known fluorescein label fluorescein isothiocyanate (FITC), as well as superb pH independence. This fluorescein variant has two readily accessible functional groups (aniline NH2 and phenol OH) that can be activated or blocked independently and can serve, for instance, as a fluorescent bridge between two different recognition motifs. Excellent single-photon counting fluorescence data demonstrates that it is also a particularly appropriate probe for single-molecule studies of biological interactions.